TOPEKA, Kan. (AP) — Kansas now has only three shelters that use gas chambers to euthanize animals after a fourth shut its chamber down earlier this month.
The Topeka Capital-Journal reports Eureka unplugged its chamber a few days after the newspaper published a story about the ongoing practice in the state. The city’s administrator says switching to a different way to euthanize animals had been a goal for quite a while.
Nationwide only about 50 shelters and pounds still use gas chambers. Of the three Kansas communities that still operate gas chambers, one hasn’t used its chamber since last year, one didn’t respond to interview requests and the other is looking into alternatives only because it anticipates state law changes that would make it impractical to continue using its chamber.
WASHINGTON (AP) — President Barack Obama will be addressing the American Legion National Convention three months after a veterans’ health care scandal rocked his administration.
The president’s speech to the legionnaires today in Charlotte, North Carolina, aims to draw attention to administration initiatives to care for veterans once they come home.
TOPEKA, Kan. (AP) — A report by a Kansas school board association finds the increase in children receiving free or reduced-price meals is tied to poverty rates and isn’t a ploy to boost school funding.
Over the past 15 years, the number of students eligible for the meals had swelled from 33 to 50 percent.
The number of students who qualify for free meals factors into the state’s school finance formula.
School districts receive more money for students from low-income households. It’s based on the idea that schools in impoverished areas have a higher need.
The Topeka Capital-Journal reports state lawmakers have raised questions about why there’s an increase in students eligible for the meals and whether the growth in applications is linked to schools misusing the formula to get more funding.
U.S. Congressman Sam Graves continues his listening tour with another in a series of town hall meetings today in Maryville.
Graves will be discussing his recent efforts to protect family farmers and small businesses by reining in the EPA and burdensome rules that the agency has announced. Topics like immigration, government spending and the economy will also be discussed during the August listening tour. As representative of the people of Missouri’s 6th District, Graves knows the importance of hearing directly from them on the important issues facing north Missourians.
Today’s meeting begins at 5:30 p.m. at Northwest Missouri State’s Center for Innovation and Entrepreneurship (CIE), 1402 N. College Drive, Maryville, MO
Jodi Buckmeier, a licensed practical nurse, checks medication information for residents at Brewster Place in Topeka. Brewster Place ranks among Kansas nursing homes with the lowest rates of use of antipsychotic medication for its residents – at 7.8 percent for the last quarter of 2013 or the first quarter of 2014 – although the state’s overall rate ranks 47th worst-Photo by Susie Fagan
By Mike Shields
KHI News Service
TOPEKA — Experts say powerful antipsychotic drugs — sometimes given in combination — are used too much and often inappropriately as “chemical restraints” or sedatives to control the behavior of Kansas nursing home residents suffering from Alzheimer’s or other dementias, and that efforts to curb the practice so far are showing weak results compared with other states.
“Kansas is pretty far outside the norm, clearly, of what is happening in the rest of the nation,” said Mitzi McFatrich, executive director of Kansas Advocates for Better Care, a Lawrence-based group that champions improved conditions in nursing homes.
Kansas was 47th worst among the states and the District of Columbia in a recent rankings report published by the Centers for Medicare and Medicaid Services, which in 2012 launched a national initiative to reduce the use of antipsychotics for dementia in nursing home residents. The effort came after a 2011 report by the U.S. Department of Health and Human Services Office of Inspector General raised concerns about too frequent “off-label” prescription of the drugs, which can have harmful, sometimes fatal, side effects.
‘Black box warning’
“The black box warning for antipsychotic medication warns of increased risk of death for elders and, in fact, the latest statistics show that up to one in 12 elders taking antipsychotics for dementia will die from the drug,” said Linda Farrar, a nurse and nursing home consultant who is the facilitator for the Kansas Partnership to Improve Dementia Care in Nursing Homes, a statewide coalition formed in response to the problem. “The death certificate would probably actually say heart attack or stroke or infection, usually pneumonia, but the side effects of giving an elder with dementia an antipsychotic are very serious. About 35 percent of elders with dementia getting antipsychotics will become more incontinent.”
Joe Ewert, who heads the nursing home inspection unit at the Kansas Department for Aging and Disability Services, said about 18,000 Kansans reside in nursing homes and that an estimated 38 percent of them “would be considered to have moderate to severe dementia.”
Kansas has more than 300 nursing homes, and the CMS report noted the percentage of residents in each who had received antipsychotic drugs in the last quarter of 2013 or the first quarter of 2014. In a few, the number of “long-stay residents” given the drugs exceeded 90 percent. The percentage exceeded 30 percent in more than 50 facilities, including the Kansas Soldiers Home, a state-run institution in Fort Dodge where 41.1 percent of residents were given the medications.
Obstacles to improvement
Farrar and others working to minimize the prescribing say a number of factors have impeded greater progress. But they are optimistic that programs launched by the coalition and now under way will make a difference in the near future. “I think it’s going to bear fruit. I believe that we will not be ranked 47th forever,” Farrar said.
The coalition includes representatives from the nursing home and pharmacy industries, Kansas and Kansas State universities, state agencies and other organizations.
The group is focusing on better training of nursing home staff and cooperation with the doctors or medical directors employed by the facilities. The Kansas Medical Directors Association is part of the coalition.
Farrar said she believes the chief obstacle to reducing the drug use in Kansas facilities is “limited resources … and that’s all kinds of resources — financial, staffing and training. Staff training is huge. The direct care partners, the people working directly with those elders need to be trained.”
There is no FDA-approved medication that reverses or controls dementia. The antipsychotics are used instead to control aggressive or disruptive behavior of addled residents whose disruptive actions may be prompted by a variety of problems they are experiencing — pain, thirst, fear, soiled clothing — but are unable to constructively communicate because of their diminished mental capacity.
Preferred alternative
The preferred alternative to doping the patients is close attention from caregivers, but that requires ample staffing and workers who know the resident well enough to respond promptly to sometimes subtle cues in ways that leave the resident soothed.
“It requires consistent staffing, the same people taking care of the same elders every day, and what you end up with becomes a sort of family,” Farrar said.
Direct care workers generally receive minimal training and are paid relatively low wages. Turnover in the industry is high, in part because the jobs are physically and emotionally demanding.
There are other obstacles to decreasing the rates of antipsychotic use and improving the state’s ranking, Farrar and others said.
Typically, doctors hired as medical directors for the nursing facilities write the prescriptions for the antipsychotics. Not all of them want outsiders telling them what orders to write.
“The other barrier we’ve run into is physician resistance, especially in rural Kansas,” Farrar said. “Some physicians get right on board and say, ‘Yes, this is the wrong thing to do,’ and other physicians don’t like direction from any regulator or nurse.”
Doctors’ role
Ewert at KDADS agreed that doctors have a key role in dealing with the problem.
“We really need a lot of participation with the physicians, the prescribers, to get a handle on this,” he said.
But he, Farrar and others said a number of factors affect the doctors’ decisions to prescribe the drugs. Usually, the doctor writes an order after being contacted by a nurse at a facility who describes problems with a resident.
Farrar said the doctors generally assume that the nurse already has tried all reasonable alternatives to sedation, though that isn’t always the case, and sometimes the nurse is calling merely to report a problem or behavior, not necessarily expecting a prescription
Ewert said some residents come to the facility with a history of using the antipsychotics and family members become concerned with their behaviors after the drugs are stopped. They then will urge caregivers and doctors to resume the medications.
Staff quality
Ewert said KDADS inspectors try to keep tabs on use of the drugs and can penalize facilities that use them inappropriately. The regulatory efforts are having some positive benefits, Farrar said.
“We’ve done a lot of training on that,” Ewert said. “We’ve spent a considerable amount of time training our staff to work the process (of determining whether the drugs were used appropriately) but also to become experts.”
He said the “quality” rather than the “number” of staff at a facility seems to be a greater factor in reducing reliance on the medications.
He and Farrar said Kansas has a number of nursing homes that have been “pioneers” in the so-called “culture-change movement” within the industry and that they have shown success in minimizing use of the drugs.
“They got it by making smaller units and dedicating staff to those units so that staff are working with the same people (residents) every day, and by virtue of that arrangement they know the residents better and are much better equipped and able to intervene to keep some of these issues from ever becoming a problem,” he said.
KDADS supports the work of the coalition, Ewert said, noting that agency regulators — due to the nature of their role in the system — must rely “mostly on sticks” rather than “carrots” to shape practices and conditions at nursing homes.
St. Joseph, Mo. -The incoming freshman class starting their college careers at Missouri Western State University today is the largest class in several years. The total incoming freshman class is up about 5.5 percent to 1,068, according to preliminary enrollment figures. The number of freshmen entering directly from high school is up 8.9 percent.
“Demographically, the size of high school graduating classes in Missouri is decreasing, so we’re especially excited about the increase we’ve seen in freshmen entering directly from high school,” said Dr. Jeanne Daffron, provost and vice president for academic affairs. “We’re also pleased that our initiatives to increase student retention are paying off with more of last year’s freshman class returning for their sophomore year this fall.”
The freshman-to-sophomore retention rate increased 4 percent between last year and this year. Dr. Daffron said numbers also indicate this year’s freshman class continues the recent trend of being better prepared academically, as reflected by indicators like ACT scores.
Preliminary enrollment figures also indicate continuing progress in the internationalization of campus, which has been a priority of Dr. Robert Vartabedian’s since he became Missouri Western’s president in 2008. When Dr. Vartabedian arrived, there were eight international students enrolled. This fall, there are 128, an increase of about 58 percent from a year ago.
“The enrollment of international students helps our students learn to think globally and consider issues from international perspectives,” Dr. Daffron said. “A number of departments have worked very hard to increase our outreach to other countries, and we’re seeing the fruits of those efforts.”
Enrollment numbers will be finalized after the official census date in September.
Missouri Western State University is a comprehensive regional university providing a blend of traditional liberal arts and professional degree programs. The university offers student-centered, high quality instruction that focuses on experience-based learning, community service, and state-of-the-art technology. Missouri Western is located in St. Joseph, Mo., and is committed to the educational, economic, cultural and social development of the region it serves. Visit www.missouriwestern.edu.
ST. JOSEPH, Mo. (AP) — A St. Joseph company that supplies ingredients to pet food companies is planning a new plant.
Protein LLC is investing $11.6 million in the project on 9.5 acres in an industrial area.
The St. Joseph Chamber of Commerce said in a news release Monday that site preparation work has begun for the project.
The Kansas City Star reports the land was provided to the company by the St. Joseph Regional Port Authority and Buchanan County.
Protein LLC also will receive at least a 50 percent real property tax abatement on improvements it makes and additional incentives are possible.
Protein LLC currently employs 50 people and plans to add 20 full-time jobs when the plant opens.
ENON, Mo. (AP) — A body found by a hunter in central Missouri has been identified as that of a Jefferson City man, but authorities don’t know how or when he died.
The Jefferson City News Tribune reports dental records confirmed the remains as those of 32-year-old Cody Odean Thirlwall. A hunter discovered them Aug. 9 in rural Moniteau County near Enon (EE’-nuhn), about 20 miles south of Jefferson City.
Missouri Highway Patrol Sgt. Kevin Hunter said Monday an anthropologist will try to determine the cause of death.
Thirlwall was charged in February with second-degree burglary for breaking into a Jefferson City home. A Cole County judge issued an arrest warrant for him in late June, after he failed to appear for a hearing on the charge.
HAMILTON- A Missouri woman was injured in an accident on Monday morning in Caldwell County.
The Missouri State Highway Patrol Reported a 2004 Dodge truck driven by Zachery B. Watts, 21, Sumner, was following a 2001 Mercury Grand Marquis driven by Christine B. Foxworthy, 89, Cameron west bound on U.S. 36 two miles west of Hamilton.
The Mercury slowed to turn north on Caldwell road and was rear-ended by the truck.
Foxworthy was transported to Cameron Regional Medical Center. Watts refused treatment.
The MSHP reported both drivers were properly restrained at the time of the accident.
WICHITA, Kan. (AP) — The latest government agricultural snapshot notes that Kansas farmers have been busy preparing wheat fields for fall seeding.
The National Agricultural Statistics Service reported Monday that while northern tier counties got the most rain last week, spotty rains in the southern half have left some farms dry. Pastures and crops missed by recent rains are stressed amid warmer-than-normal temperatures across the state.
About 13 percent of the corn crops in Kansas have now matured.
The agency rates corn conditions as 16 percent poor to very poor, 30 percent fair, 42 percent good and 12 percent excellent.
Thirteen percent of both the sorghum and soybean crops in Kansas are rated in poor to very poor condition.
Twenty-five percent of pastures and ranges are also in poor to very poor shape.
