Approximately 26 million Americans have diabetes today. More people are diagnosed with this disease every year, and approximately one in three Americans is expected to have diabetes by the year 2050. Of those with diabetes today, only 19 million actually know they have the diagnosis. Seven million unknowingly have the disease. What does this mean for diabetes management, for the healthcare industry today, and in the coming years?
Prevention, better diagnosis, prompt treatment
In part thanks to the Affordable Care Act, patients who have not had access to diagnosis and treatment are now able to get it. Skilled nursing facilities can play a major role in assisting with diabetes management and with the health problems that result from diabetic complications, such as coronary artery disease, stroke, chronic kidney disease, high blood pressure, eye problems, and circulatory problems leading to injury and amputation.
Skilled nursing facilities' important role in diabetes management
- For long-term and older residents
About 25% of residents in skilled nursing facilities have diabetes, and that percentage is expected to go up as the population ages. Residents with diabetes have special concerns that need to be addressed in terms of physical activity, medical interventions, hydration, and nutrition, all with a focus on controlling blood sugar and preventing injury.
Special challenges for older diabetic patients
All diabetics must pay careful attention to blood sugar levels and control, but older residents present unique challenges. They are at risk for polypharmacy, may be more likely to fall when cognitive or physical symptoms of hypo- or hypoglycemia occur, and are at greater risk of dehydration.
Close monitoring of A1C and blood glucose is necessary, balanced with the need to prevent hypoglycemic difficulties such as orthostatic hypotension, bradycardia, or hyperglycemia, which could increase risk of falling.
Other diabetic complications, such as chronic kidney disease, may also need ongoing care through medication and/or dialysis. Skilled nursing facilities are uniquely qualified to meet older diabetic patients' needs in a safe, medically supervised environment that nonetheless encourages independence as much as is possible.
- In postacute care
Skilled nursing facilities can also play an important role in patient recovery after diabetic complications have been managed in a hospital setting. Examples of postacute care after hospitalization include:
- Managing chronic kidney disease
Diabetes can cause a permanent loss of kidney function; currently, 11% of the population has chronic kidney disease, with 20 million at risk. Patients in the nursing home may be able to get dialysis treatment as "home" patients, rather than as outpatients.
- Rehabilitation after amputation
If amputation is necessary because of diabetic complications, postacute nursing facilities can provide rehabilitation services meant to help the patient recover function as fully as possible.
Rehabilitation after amputation must be multifaceted. Patients who need inpatient postacute treatment after their amputations will work with a team of specialists who will help them manage aftereffects of the amputation, including psychological ramifications like depression after the surgery. Physically, there is the need to rebuild strength, coordination, and endurance, and patients may need to be fitted with and then taught to walk with prosthetics, as well. Skilled nursing facilities have the ability to provide these services in a patient-centered setting.
