Developing and maintaining a care plan will help you balance both your life and that of the person to whom you are providing care!

Are you a caregiver for an older adult with dementia or another chronic health condition? If so, do they have a care plan? Having a care plan can help you as a caregiver, especially if there are multiple caregivers, to aid with transitions and to have all important information in one place.

What is a care plan?

A care plan is a form [1.48 MB] where you can summarize a person’s health conditions, specific care needs, and current treatments. The care plan should outline what needs to be done to manage the care needs. It can help organize and prioritize caregiving activities. A care plan can give you a sense of control and confidence when managing caregiving tasks and help assure you that the care recipient’s needs are being met.

Care plans can especially be helpful if you care for more than one person.  Forty-two million Americans are caring for someone aged 50 or older; 24% are providing care for at least two people.

What should I include in the care plan?

The plan should include information about:

• Personal Information (name, date of birth, contact information)
• Health conditions
• Medicines, dosages, and when/how given
• Health care providers with contact information
• Health insurance information
• Emergency Contacts

How do I develop a care plan?

• Begin a care planning conversation with the person you care for. Use Complete Care Plan [PDF – 1 MB] to help start and guide the discussions.
• If the care recipient is unable to provide all the information needed, talk to others who regularly interact with them (a family member or home nurse aide) and invite them to join the discussions and help complete the form.
• Ask about suitable care options for the person you care for. Medicare covers appointments to manage chronic conditions and discuss advanced care plans, including planning appointments for people with Alzheimer’s, other dementias, memory problems, or suspected cognitive impairment.
• Try to update the care plan every year, or more often if the person you care for has a change in health or medicines. Remember to respect the care recipient’s privacy after reviewing their personal information and discussing their health conditions.

What are the benefits of a care plan?

• Care plans can reduce emergency room visits and hospitalizations and improve overall medical management for people with a chronic health condition, like Alzheimer’s disease.
• Care plans can support you, the caregiver, so you can stay healthy.
• Care plans can help retain quality of life and independence for the care recipient.

What about my own health?

If you’re a caregiver, taking care of yourself is crucial. Make sure to discuss any concerns you have as a caregiver with your health care provider. Caregivers can experience emotional, psychological, and physical strain. In addition, caregivers often neglect their own health. This neglect can increase their risk of having multiple chronic conditions. Nearly 2 in 5 caregivers have at least two chronic health conditions. Caregivers of people with dementia or Alzheimer’s are at greater risk for anxiety, depression, and lower quality of life than caregivers of people with other chronic conditions.

To learn more, please visit https://www.cdc.gov/aging/publications/features/caregivers-month.html.

What is Alzheimer’s Disease?

• Alzheimer’s disease is the most common type of dementia.
• It is a progressive disease beginning with mild memory loss and possibly leading to loss of the ability to carry on a conversation and respond to the environment.
• Alzheimer’s disease involves parts of the brain that control thought, memory, and language.
• It can seriously affect a person’s ability to carry out daily activities.

Who has Alzheimer’s Disease?

Alzheimer’s Disease and Racial and Ethnic Disparities infographic

All Alzheimer-related infographics

• In 2020, as many as 5.8 million Americans were living with Alzheimer’s disease.¹
• Younger people may get Alzheimer’s disease, but it is less common.
• The number of people living with the disease doubles every 5 years beyond age 65.
• This number is projected to nearly triple to 14 million people by 2060.¹
• Symptoms of the disease can first appear after age 60, and the risk increases with age.

What is known about Alzheimer’s Disease?

Scientists do not yet fully understand what causes Alzheimer’s disease. There likely is not a single cause but rather several factors that can affect each person differently.

• Age is the best known risk factor for Alzheimer’s disease.
• Family history—researchers believe that genetics may play a role in developing Alzheimer’s disease. However, genes do not equal destiny. A healthy lifestyle may help reduce your risk of developing Alzheimer’s disease. Two large, long term studies indicate that adequate physical activity, a nutritious diet, limited alcohol consumption, and not smoking may help people. To learn more about the study, you can listen to a short podcast.
• Changes in the brain can begin years before the first symptoms appear.
• Researchers are studying whether education, diet, and environment play a role in developing Alzheimer’s disease.
• There is growing scientific evidence that healthy behaviors, which have been shown to prevent cancer, diabetes, and heart disease, may also reduce risk for subjective cognitive decline. Here’s 8 ways.

What are the warning signs of Alzheimer’s disease?

Alzheimer’s disease is not a normal part of aging. Memory problems are typically one of the first warning signs of Alzheimer’s disease and related dementias.

In addition to memory problems, someone with symptoms of Alzheimer’s disease may experience one or more of the following:

• Memory loss that disrupts daily life, such as getting lost in a familiar place or repeating questions.
• Trouble handling money and paying bills.
• Difficulty completing familiar tasks at home, at work or at leisure.
• Decreased or poor judgment.
• Misplacing things and being unable to retrace steps to find them.
• Changes in mood, personality, or behavior.

Even if you or someone you know has several or even most of these signs, it doesn’t mean it’s Alzheimer’s disease. Know the 10 warning signs (also available in Spanish).

What to do if you suspect Alzheimer’s disease

Getting checked by your healthcare provider can help determine if the symptoms you are experiencing are related to Alzheimer’s disease, or a more treatable conditions such as a vitamin deficiency or a side effect from medication. Early and accurate diagnosis also provides opportunities for you and your family to consider financial planning, develop advance directives, enroll in clinical trials, and anticipate care needs.

How is Alzheimer’s disease treated?

Medical management can improve quality of life for individuals living with Alzheimer’s disease and for their caregivers. There is currently no known cure for Alzheimer’s disease. Treatment addresses several areas:

• Helping people maintain brain health.
• Managing behavioral symptoms.
• Slowing or delaying symptoms of the disease.

Support for family and friends

Currently, many people living with Alzheimer’s disease are cared for at home by family members. Caregiving can have positive aspects for the caregiver as well as the person being cared for. It may bring personal fulfillment to the caregiver, such as satisfaction from helping a family member or friend, and lead to the development of new skills and improved family relationships.

Although most people willingly provide care to their loved ones and friends, caring for a person with Alzheimer’s disease at home can be a difficult task and may become overwhelming at times. Each day brings new challenges as the caregiver copes with changing levels of ability and new patterns of behavior. As the disease gets worse, people living with Alzheimer’s disease often need more intensive care.

You can find more information about caring for yourself and access a helpful care planning form.

What is the burden of Alzheimer’s disease in the United States?

• Alzheimer’s disease is one of the top 10 leading causes of death in the United States.²
• The 6th leading cause of death among US adults.
• The 5th leading cause of death among adults aged 65 years or older.³

In 2020, an estimated 5.8 million Americans aged 65 years or older had Alzheimer’s disease.¹ This number is projected to nearly triple to 14 million people by 2060.¹

In 2010, the costs of treating Alzheimer’s disease were projected to fall between $159 and $215 billion.⁴ By 2040, these costs are projected to jump to between $379 and more than $500 billion annually.⁴

Death rates for Alzheimer’s disease are increasing, unlike heart disease and cancer death rates that are on the decline.⁵ Dementia, including Alzheimer’s disease, has been shown to be under-reported in death certificates and therefore the proportion of older people who die from Alzheimer’s may be considerably higher.⁶

What is known about reducing your risk of Alzheimer’s Disease?

The science on risk reduction is quickly evolving, and major breakthroughs are within reach. For example, there is growing evidence that people who adopt healthy lifestyle habits — like regular exercise and blood pressure management — can lower their risk of dementia. There is growing scientific evidence that healthy behaviors, which have been shown to prevent cancer, diabetes, and heart disease, may also reduce risk for subjective cognitive decline. To learn more about the current state of evidence on dementia risk factors and the implications for public health, please read the following summaries on Cardiovascular Health, Exercise, Diabetes and Obesity, Traumatic Brain Injury (TBI), Tobacco and Alcohol, Diet and Nutrition,  Sleep, Sensory Impairment, and Social Engagement or the Compiled Report (includes all reports in this list).

To learn more, please visit https://www.cdc.gov/aging/aginginfo/alzheimers.htm.

Follow these easy steps to make sure you’re protected.

Natural disasters, such as hurricanes, tornadoes, and blizzards, may force you to evacuate your home or shelter-in-place at short notice. It is important to know what to do in case of an emergency well before disaster strikes.

If you are an older adult living in the community, you may face some challenges during an emergency. For example, you may have mobility problems, or chronic health conditions, or you may not have any family or friends nearby to support you. Support services that are usually available, such as help from caregivers or in-home health care and meal delivery services, may be unavailable for a period of time. In addition, older adults may experience challenges that come with advanced age, such as hearing or vision problems or cognitive impairment, which may make it difficult to access, understand, and respond to emergency instructions.

You or the person you care for can be prepared for emergency situations by creating a plan, reviewing or practicing it regularly, and keeping an emergency supply kit.

Creating A Plan

The first step in preparing for an emergency is creating a plan. Work with your friends, family, and neighbors to develop a plan that will fit your needs.

• Choose a contact person who will check on you during a disaster, and decide how you will communicate with each other (for instance, by telephone, knocking on doors). Consider speaking with your neighbors about developing a check-in system together.
• Create a list of contact information for family members and friends. Leave a copy by your phone(s) and include one in your Emergency Supply Kit.
• Plan how you will leave and where you will go during an evacuation. If you are living in a retirement or assisted living community, learn what procedures are in place in case of emergencies. Keep a copy of exit routes and meeting places in an easy-to-reach place.
• Create a care plan and keep a copy in your Emergency Supply Kit. Try out CDC’s easy-to-use care plan template pdf icon[ PDF – 1 MB ]. Español (Spanish) pdf icon[PDF – 1 MB]
• If you have medical, transportation, or other access needs during an emergency, consider signing up for SMART911, Code Red, or your local county registry, depending upon which service your area uses to helps first responders identify people who may need assistance right away.

Creating an Emergency Supply Kit

After an emergency, you may not have access to clean water or electricity. Make sure you are prepared with your own supply of food, water, and other items to last for at least 72 hours.

• Visit Ready.govexternal iconexternal icon for a list of basic items to gather for your Disaster Supply Kit.
• Medical-Related Items:
  • A 3-day supply of medicine, at a minimum. If medications need to be kept cold, have a cooler and ice packs available.
  • ID band (full name, contact number for family member/caregiver, and allergies)
  • Hearing aids and extra batteries
  • Glasses and/or contacts and contact solution
  • Medical supplies like syringes or extra batteries
  • Information about medical devices such as wheelchairs, walkers, and oxygen including model numbers and vender.
• Documents (Keep physical copies in a waterproof bag and take photos of each document for backup):
  • Your Care Plan pdf icon[PDF – 1 MB]        Español (Spanish) pdf icon[PDF – 1 MB]
  • Contact information for family members, doctors, pharmacies and/or caregivers
  • List of all medications, including the exact name of the medicine and the dosage, and contact information for pharmacy and doctor who prescribed medicine
  • List of allergies to food or medicines
  • Copies of medical insurance cards
  • Copies of a photo ID
  • Durable power of attorney and/or medical power of attorney documents, as appropriate.

To learn more, please visit https://www.cdc.gov/aging/emergency-preparedness/index.html

During National Nurses Week, take time to celebrate the founder of modern nursing, Florence Nightingale! Her endeavors to improve the aspect of healthcare has greatly shaped the quality of care by nurses in the 19th and 20th centuries. 

Currently, there are nurses all around the world putting their lives on the line. It’s clear that Florence Nightingale’s impact on healthcare also helped pave the way for modern-day nurses and healthcare professionals to follow suit.

“With nurses around the world on the front lines of a global pandemic, it’s a poignant time to reflect on how Nightingale’s legacy laid the groundwork for their heroic work in hospitals today.” Says Greta Westwood, CEO of the Florence Nightingale Foundation. “She never took no for an answer – anything was possible.”

Also known as “The Lady with the Lamp”, Florence Nightingale started her nursing career in London, and later became appointed as the head nurse of the 1854 Crimean War. Nightingale’s passion and determination set her apart from others and got her the famous nickname “Lady with the Lamp” for checking on her patients via lamplight during the war. Not only did she care for her patients’ health, but she also often wrote letters to soldiers’ loved ones on their behalf.

The “Angel of the Crimea” made it her goal to lower death rates by improving hygiene practices in hospitals. She created numerous patient services that improved each patient’s quality of care while admitted in the hospital. She oversaw “invalid’s kitchen” where she set out food plans for patients that had dietary requirements. She also secured a laundry area so patients could have clean bed sheets and towels.

After the Crimean War, Nightingale wrote a book called Matters Affecting the Health, Efficiency and Hospital Administration of the British Army to share her observations and experiences while tending wounded soldiers. In 1857, the War Office’s administrative department was completely reconstruction due to Nightingale’s book and her experiences during the Crimean War, reforming several military hospitals that were under very poor conditions. (History.com Editors 2009)

In August of 1910, Nightingale became ill and was battling with heart failure. She died a week later at her home in London, bringing her life to an end at 90 years old. (History.com Editors 2009) Two years after her death, the Florence Nightingale Medal was created by the International Committee of the Red Cross, dedicated to be given to exceptional nurses every 2 years. In 1965, International Nurses Day was also created, residing on Nightingale’s birthday to continue celebrating her accomplishments. (Alexander 2018)

Despite her unexpected death, her legacy continues to live on at the Florence Nightingale Museum, which is located at the exact same spot of the original Nightingale Training School for Nurses. The museum holds over 2,000 artifacts to memorialize the mother of modern nursing. (History.com Editors 2009)

Florence Nightingale’s legacy is important to note during significant time for nurses courageously fighting on the frontlines during the pandemic. Notes Westwood, “Florence would be so proud of what nurses have managed to achieve during the pandemic.” (Haynes 2020)

References:

https://time.com/5835150/florence-nightingale-legacy-nurses/

http://history.com/topics/womens-history/florence-nightingale-1

https://www.womenshistory.org/education-resources/biographies/florence-nightingale

You are a caregiver if you care for someone who needs help. Caregiving can be hard on you despite the great sense of reward you may feel. To continue being a good caregiver, you need to take care of yourself. One way you can do that is to make sure you have consistent breaks from your caregiving responsibilities. This is called respite. Short breaks can be a key part of maintaining your own health.

What is Respite Care?

You are a caregiver if you are caring for someone who needs help. Taking short breaks can be the key to maintaining your own health.

Respite care allows the caregiver some time off from their caregiving responsibilities. It can take the form of different types of services in the home, adult day care, or even short-term nursing home care so caregivers can have a break or even go on vacation. Research shows that even a few hours of respite a week can improve a caregiver’s well-being.¹ Respite care may be provided by family, friends, a nonprofit group, or government agency. Some of these services may be free or low-cost.

Family and Friends

Make Your Needs Known

Here are some suggestions for getting help from people you know.

1. Identify a caregiving task or a block of time that you would like help with. Perhaps there’s a book club meeting you’d like to go to that you’ve been missing because of your caregiving responsibilities. Be ready when someone says, “What can I do to help?” with a specific time or task, such as, “It would be really helpful for me if you could stay with Mom Tuesday night so I can go to my book club for 2 hours.”
2. Be understanding if you are turned down. The person may not be able to help with that specific request, but they may be able to help another time. Don’t be afraid to ask again.
3. If you have trouble asking for help face to face, try writing an e-mail to your friends and family members about your needs. Set up a shared online calendar or scheduling tool where people can sign up to provide you with regular respite.

Your Doctor or Other Health Care Provider

Does your doctor know you are a caregiver?

• You have special needs as a caregiver that your doctor should be aware of. Be sure to let your doctor know if your caregiving responsibilities are making you feel depressed or anxious. Health care professionals may also know about support groups offered in the community.
• Let your doctor (or your care recipient’s doctor) know that you need help finding respite care. A doctor may be able to write you a “prescription” for respite services via Medicare’s PACE program. PACE services are available to Medicare and Medicaid beneficiaries in some states.

Nonprofit Organizations or Government Agencies

Here’s how to get back some of your “me time”

A great source for respite services is the Area Agencies on Aging. Check the website for the agency in your area. Other resources include:

• Organizations that advocate for people with specific diseases. If you care for someone with Alzheimer’s disease, heart disease, cancer, or lung disease, respite care services may be available from the following organizations.

• Alzheimer’s Association
• American Heart Association
• American Cancer Society
• American Lung Association
• National Respite Locator. This resource can help you find adult day care and other respite services.
• CDC’s free Complete Care Plan [PDF – 1 MB] and other caregiver resources.

The Department of Veterans Affairs offers respite resources for veterans or their spouses.

Still Not Able to Get a Break?

Consider joining an online support group. It’s important for you to have an opportunity to share your experiences with others in similar circumstances and to get support and new resources from them.

• Family Alliance on Caregiving—The Caregiver-online support group is an unmoderated group for families, partners, and other caregivers of adults with disorders such as Alzheimer’s, stroke, brain injury, and other chronic debilitating health conditions. The group offers a safe place to discuss the stresses, challenges, and rewards of providing care for another.
• Caring.com Resource Center—Offers key resources to help you better navigate caregiving and access to online support groups, such as the Alzheimer’s Caregiver Support Group.

Remember—To be an effective caregiver, you must take care of yourself. Your care recipient is counting on you.

To learn more, please visit https://www.cdc.gov/aging/publications/features/caring-for-yourself.html.

Boyd Nursing and Rehabilitation would like to recognize the remarkable recovery of our resident, Bonnie Fletcher!

Bonnie was admitted in January following an extensive and complicated hospitalization involving a cardiac event and a stroke that caused significant functional deficits, weakness, balance, and mobility deficits, compounded by cognitive impairment. When Bonnie began her rehab journey at Boyd Nursing, she was at totally dependent level for assistance. Fortunately, she had a strong will to recover despite all her obstacles. Over the next three months, she received physical and occupational therapy to regain her mobility and independence with self-care activities. She has continued to receive therapy services to improve her executive cognitive skills for money management, medication management, meal prep, and home safety. We are so excited to report that Bonnie recently completed a successful home visit, and we are assisting her with planning her discharge home and to community living. Best wishes for continued success, Bonnie!

We are preparing for an amazing celebration of National Nurses Week this year! Many companies are showing their gratitude for nurses and healthcare workers by offering awesome deals and freebies during Nurses Week and throughout the year. Whether you are a healthcare worker looking for a good deal or you’re shopping for a healthcare hero in your life, check out these great deals valid for the entire month of May for Nurses Week 2023!

Food & Grocery

• Cinnabon – Free classic Cinnamon Roll, Minibon, or 4-count Bonbites
• Outback Steakhouse – 10% off entire check
• Hello Fresh – 55% off your first box
• KIND – 15% off and free shipping
• Thrive Market – Free membership

Electronics

• Bose – Special discount on orders over $199
• Samsung – 30% off
• HP – Savings up to 40% off & free shipping
• McAfee – Special discount on 10-Device McAfee Total Protection for Nurses
• Therabody – 20% off regularly-priced Theragun or TheraOne CBD for Nurses
• Sennheiser – Up to 20% off & free shipping for Nurses
• Netgear – 15% off
• Leatherman – 30% off multi-tools
• Ember – 20% off
• Sonos – 15% off
• Lenovo – 5% off

Apparel, Shoes, & Accessories

• Calvin Klein – 20% off
• Backcountry – 20% off
• Citizen – 15% off select models
• Clarks – 10% off
• Dagne Dover – 20% off
• Hunter Boots – 20% off
• Jockey – 10%
• Klogs – 15% off
• L.L. Bean – 10% off
• Motherhood – 10% off
• Vera Bradley – 15% off
• Tortuga Backpack – 20% off
• The Sak – 20% off
• RVCA – 30% off
• Bodybuilding.com – 10% off
• Everyman Jack – 25% off
• HEYDUDE – 20% off
• Merrell – 20% off
• Moosejaw – 20%off
• Southern Tide – 20% off
• Tuckernuck – 15% off
• O’Neil – 20% off
• Ashley Stewart – 20% off
• Orthofeet – 10% off orders over $70 for Nurses
• Keds – 20% off
• U.S. Polo Assn. – 20% off
• Unique Vintage – 10% off
• Champion – 10% off
• Sunglasses Hut – 15%
• Sperry – 30% off
• Dockers – 25% off
• Lululemon – 15% off
• Nike – 10% off at Nike.com and Nike app
• Puma – 20% off entire order
• Ray-Ban – 20% off entire order
• Under Armour – 20% off
• Pandora – 10% off
• Adidas – 10% off
• Asics – 40% off
• Vera Bradley – 15% off
• Carhartt – 25% off
• Levis – 15% off
• Reebok – 50% off
• Rothy’s – 20% off

Entertainment & Services

• TireBuyer – 10% off
• Verizon – Welcome unlimited for $20/line per month for 4 lines
• AT&T – 25% off unlimited plans
• Verizon Fios – Fios Internet for as low as $34.99.mo
• Cheap Caribbean – $150 off your next vacation
• Babbel – Save 60% off on 6 months of Babbel lessons
• Redrock Casino, Resort, & Spa – Up to 35% off
• Planet Hollywood – Up to 30% off the lowest hotel rate
• Getaway – 15% off every getaway
• Walt Disney World Resort – Save up to $100 off gate prices
• Budget – Up to 25% off
• Hilton All-Inclusive – 15% off the lowest rates (all dining & drinks included)
• Indiana Wesleyan University – 15% off tuition

Cosmetics, Skincare, & Nutrition

• TULA Skincare – 20% off
• Grown Alchemist – 20% off
• Chantecaille – 15% off & free shipping
• Spongelle – 20% off
• Stacked Skincare – 20% off
• Grande Cosmetics – 15% off
• SiO Beauty – 15% off
• Natura – 20% off
• Colorscience – 15% off
• e.l.f. – 25% off a minimum order of $30
• ContactsDirect.com – 15% off any order % free shipping
• GNC – 10% off
• Hairstory – 15% off
• Discount Contact Lenses – 20% off
• Joy Organics – 50% off
• Ritual – Get 20% off your first 3 months
• Glasses.com – 50% off lenses & free shipping

Outdoors, Sports, & Fitness

• Huffy Bikes – 25% off
• Competitive Cyclist – 20%
• Rad Power Bikes – $50 off a RadRover 6 Plus
• VKTRY Gear – 25% off
• Beyond Yoga – 20% off
• TRX Training – 20% off
• Sole Bicycles – Extra 15% off
• Jillian Michaels | The Fitness App – 40% off
• Spalding – 20% off
• Saucony – 20% off
• No Bull – 20% off
• TaylorMade Golf – 15% off
• Arctic Zone – 15% off
• Burton – 20% off of select gear
• Fanatics – 15% off
• GCI Outdoor – 15% off
• Stanley – 20% off
• Yeti – 20% off
• Peloton – $200 off accessories or accessory packages with purchase of a Peloton Bike, Bike+, or Tread

In addition to this month’s discounts and freebies, we are proud to partner with Panda Perks to give our Care Team members 24/7 access to discounts and perks on the brands you love!

Jody Littlejohn, OTR/L, DOR

“I am the Director of Rehabilitation and Occupational Therapist at Boyd Nursing and Rehabilitation.  I have been a practicing OT for 21 years.  I was inspired at a young age to become an OT after observing my grandmother complete rehabilitation following a hip fracture.  What I enjoy most about my career is the opportunity to develop a relationship with my patients, not only for the purpose of rehab but to learn about their history and hear to their stories.  I truly cherish those experiences and the opportunity to be a part of their life journey. I have had the opportunity to enjoy the practice in multiple realms of OT but my niche and specialty is with geriatric care.

Background

Residents in nursing homes are at increased risk of becoming colonized and developing infection with MDROs [2]. As described further in Consideration for the Use of Enhanced Barrier Precautions in Skilled Nursing Facilities [PDF – 9 pages], more than 50% of nursing home residents may be colonized with an MDRO, nursing homes have been the setting for MDRO outbreaks, and when these MDROs result in resident infections, limited treatment options are available [1-9]. Implementation of Contact Precautions, as described in the CDC Guideline for Isolation Precautions, is perceived to create challenges for nursing homes trying to balance the use of PPE and room restriction to prevent MDRO transmission with residents’ quality of life. Thus, many nursing homes only implement Contact Precautions when residents are infected with an MDRO and on treatment.

Focusing only on residents with active infection fails to address the continued risk of transmission from residents with MDRO colonization, who by definition have no symptoms of illness. MDRO colonization may persist for long periods of time (e.g., months) [10] which contributes to the silent spread of MDROs.

With the need for an effective response to the detection of serious antibiotic resistance threats, there is growing evidence that the traditional implementation of Contact Precautions in nursing homes is not implementable for most residents for prevention of MDRO transmission.

This document is intended to provide guidance for PPE use and room restriction in nursing homes for preventing transmission of MDROs, including as part of a public health response. For the purposes of this guidance, the MDROs for which the use of EBP applies are based on local epidemiology. At a minimum, they should include resistant organisms targeted by CDC but can also include other epidemiologically important MDROs [9, 10].

Examples of MDROs Targeted by CDC include:

• Pan-resistant organisms,
• Carbapenemase-producing carbapenem-resistant Enterobacterales,
• Carbapenemase-producing carbapenem-resistant Pseudomonas spp.,
• Carbapenemase-producing carbapenem-resistant  Acinetobacter baumannii, and
• Candida auris

Additional epidemiologically important MDROs may include, but are not limited to:

• Methicillin-resistant Staphylococcus aureus (MRSA),
• ESBL-producing Enterobacterales,
• Vancomycin-resistant Enterococci (VRE),
• Multidrug-resistant Pseudomonas aeruginosa,
• Drug-resistant Streptococcus pneumoniae

This document is not intended for use in acute care or long-term acute care hospitals and does not replace existing guidance regarding use of Contact Precautions for other pathogens (e.g., Clostridioides difficile, norovirus) in nursing homes.

Description of Precautions

Standard Precautions are a group of infection prevention practices that apply to the care of all residents, regardless of suspected or confirmed infection or colonization status. They are based on the principle that all blood, body fluids, secretions, and excretions (except sweat) may contain transmissible infectious agents. Proper selection and use of PPE, such as gowns and gloves, is one component of Standard Precautions, along with hand hygiene, safe injection practices, respiratory hygiene and cough etiquette, environmental cleaning and disinfection, and reprocessing of reusable medical equipment. Use of PPE is based on the staff interaction with residents and the potential for exposure to blood, body fluids, or pathogens (e.g., gloves are worn when contact with blood, body fluids, mucous membranes, non-intact skin, or potentially contaminated surfaces or equipment are anticipated). More detail about Standard Precautions is available as part of the Core Infection Prevention and Control Practices for Safe Healthcare Delivery in all Settings.

Contact Precautions are one type of Transmission-Based Precaution that are used when pathogen transmission is not completely interrupted by Standard Precautions alone. Contact Precautions are intended to prevent transmission of infectious agents, like MDROs, that are spread by direct or indirect contact with the resident or the resident’s environment.

Contact Precautions require the use of gown and gloves on every entry into a resident’s room. The resident is given dedicated equipment (e.g., stethoscope and blood pressure cuff) and is placed into a private room. When private rooms are not available, some residents (e.g., residents with the same pathogen) may be cohorted, or grouped together. Residents on Contact Precautions should be restricted to their rooms except for medically necessary care and restricted from participation in group activities.

Because Contact Precautions require room restriction, they are generally intended to be time limited and, when implemented, should include a plan for discontinuation or de-escalation.

More detail about Transmission-Based Precautions, including descriptions of Droplet Precautions and Airborne Precautions are available in the CDC Guideline for Isolation Precautions. In addition, other infections (e.g. norovirus, C. difficile, and scabies) and conditions for which Contact Precautions are indicated are summarized in Appendix A – Type and Duration of Precautions Recommended for Selected Infections and Conditions of the guideline.

Enhanced Barrier Precautions expand the use of PPE and refer to the use of gown and gloves during high-contact resident care activities that provide opportunities for transfer of MDROs to staff hands and clothing [11-15]. MDROs may be indirectly transferred from resident-to-resident during these high-contact care activities. Nursing home residents with wounds and indwelling medical devices are at especially high risk of both acquisition of and colonization with MDROs [3,5,6]. The use of gown and gloves for high-contact resident care activities is indicated, when Contact Precautions do not otherwise apply, for nursing home residents with wounds and/or indwelling medical devices regardless of MDRO colonization as well as for residents with MDRO infection or colonization.

Examples of high-contact resident care activities requiring gown and glove use for Enhanced Barrier Precautions include:

• Dressing
• Bathing/showering
• Transferring
• Providing hygiene
• Changing linens
• Changing briefs or assisting with toileting
• Device care or use: central line, urinary catheter, feeding tube, tracheostomy/ventilator
• Wound care: any skin opening requiring a dressing

In general, gown and gloves would not be required for resident care activities other than those listed above, unless otherwise necessary for adherence to Standard Precautions. Residents are not restricted to their rooms or limited from participation in group activities. Because Enhanced Barrier Precautions do not impose the same activity and room placement restrictions as Contact Precautions, they are intended to be in place for the duration of a resident’s stay in the facility or until resolution of the wound or discontinuation of the indwelling medical device that placed them at higher risk.

Implementation

When implementing Contact Precautions or Enhanced Barrier Precautions, it is critical to ensure that staff have awareness of the facility’s expectations about hand hygiene and gown/glove use, initial and refresher training, and access to appropriate supplies. To accomplish this:

• Post clear signage on the door or wall outside of the resident room indicating the type of Precautions and required PPE (e.g., gown and gloves)
  • For Enhanced Barrier Precautions, signage should also clearly indicate the high-contact resident care activities that require the use of gown and gloves
• Make PPE, including gowns and gloves, available immediately outside of the resident room
• Ensure access to alcohol-based hand rub in every resident room (ideally both inside and outside of the room)
• Position a trash can inside the resident room and near the exit for discarding PPE after removal, prior to exit of the room or before providing care for another resident in the same room
• Incorporate periodic monitoring and assessment of adherence to determine the need for additional training and education
• Provide education to residents and visitors

Note: Prevention of MDRO transmission in nursing homes requires more than just proper use of PPE and room restriction. Guidance on implementing other recommended infection prevention practices (e.g., hand hygiene, environmental cleaning, proper handling of wounds, indwelling medical devices, and resident care equipment) are available in CDC’s free online course — The Nursing Home Infection Preventionist Training. Nursing homes are encouraged to have staff review relevant modules and to use the resources provided in the training (e.g., policy and procedure templates, checklists) to assess and improve practices in their facility.

To learn more, please visit https://www.cdc.gov/hai/containment/PPE-Nursing-Homes.html.

Each year, millions of older people—those 65 and older—fall. In fact, more than one out of four older people falls each year, but less than half tell their doctor. Falling once doubles your chances of falling again.

Falls Are Serious and Costly

• One out of five falls causes a serious injury such as broken bones or a head injury^,4,5
• Each year, 3 million older people are treated in emergency departments for fall injuries.⁶
• Over 800,000 patients a year are hospitalized because of a fall injury, most often because of a head injury or hip fracture.⁶
• Each year at least 300,000 older people are hospitalized for hip fractures.⁷
• More than 95% of hip fractures are caused by falling,⁸ usually by falling sideways.⁹
• Falls are the most common cause of traumatic brain injuries (TBI).¹⁰
• In 2015, the total medical costs for falls totaled more than $50 billion.¹¹ Medicare and Medicaid shouldered 75% of these costs.

What Can Happen After a Fall?

Many falls do not cause injuries. But one out of five falls does cause a serious injury such as a broken bone or a head injury.^4,5 These injuries can make it hard for a person to get around, do everyday activities, or live on their own.

• Falls can cause broken bones, like wrist, arm, ankle, and hip fractures.
• Falls can cause head injuries. These can be very serious, especially if the person is taking certain medicines (like blood thinners). An older person who falls and hits their head should see their doctor right away to make sure they don’t have a brain injury.
• Many people who fall, even if they’re not injured, become afraid of falling. This fear may cause a person to cut down on their everyday activities. When a person is less active, they become weaker and this increases their chances of falling.¹²

What Conditions Make You More Likely to Fall?

Research has identified many conditions that contribute to falling. These are called risk factors. Many risk factors can be changed or modified to help prevent falls. They include:

• Lower body weakness
• Vitamin D deficiency (that is, not enough vitamin D in your system)
• Difficulties with walking and balance
• Use of medicines, such as tranquilizers, sedatives, or antidepressants. Even some over-the-counter medicines can affect balance and how steady you are on your feet.
• Vision problems
• Foot pain or poor footwear
• Home hazards or dangers such as
  • broken or uneven steps, and
  • throw rugs or clutter that can be tripped over.

Most falls are caused by a combination of risk factors. The more risk factors a person has, the greater their chances of falling.

Healthcare providers can help cut down a person’s risk by reducing the fall risk factors listed above. To learn more, please visit https://www.cdc.gov/falls/facts.html.