Eli's Rehab Report

Rehab therapists working in LTC facilities have a new duty to report a crime against a patient. A recent CMS survey & cert memo says "covered individuals" in such facilities have to let the survey agency and local law enforcement know any time they develop a "reasonable suspicion of crimes committed against a resident of that facility."

A "covered individual" is "an owner, operator, employee, manager, agent, or contractor" of a federally funded longterm care facility, according to the memo.

"The term 'contractor' in the survey & cert memo and law could apply to therapists," says Roshunda Drummond- Dye, associate director of payment policy and advocacy for the American Physical Therapy Association. "We have a lot of members who contract to provide therapy in long-term care facilities. We are awaiting for more specifics from CMS on how this term is defined."

The memo doesn't define a "reasonable suspicion of a crime." It does, however, direct facilities to "coordinate the facility's State and local law enforcement entities to determine what actions are considered crimes in their political subdivision."

Keep in mind: The "EJA places the onus on the nursing facility to make sure individuals understand their reporting requirements," says attorney Fred Miles in Denver, Colo.

Editor's note: Download the memo, which includes a recently added Q&A, at www.cms.gov/Surveycertificationgeninfo/downloads/SCLetter11_30.pdf. Check out a new study on cranberry juice and UTI.

The study by Terri Camesano, PhD, professor of chemical engineering at Worcester Polytech Institute, and colleagues found that cranberry juice cocktail can "inhibit the formation of biofilm by uropathogenic Escherichia coli," according to a study abstract (http://www.ncbi.nlm.nih.gov/pubmed/21480803).

"What's really interesting about cranberry is that it doesn't kill bacteria," Camesano told Eli in an interview. Instead, the cranberry juice prevents bacteria from "latching onto the bladder or kidney cells." And the bacteria can't become resistant to the cranberry juice as it does to antibiotics, she adds.

"The effect of cranberry juice in preventing UTI is fairly well accepted at least for UTIs caused by E. coli," says geriatrician David Dosa, MD, at Brown University. "Should we put everyone at risk of UTI on cranberry juice? I don't think there are any guidelines that suggest that," Dosa tells Eli.

Charles Crecelius, MD, PhD, in St. Louis, Mo., says cranberry juice can be used for recurrent UTI, although he usually prescribes cranberry extract for that purpose. "Forcing people to drink cranberry juice when they have an inflamed bladder can be painful," he says.

Warning: Patients taking warfarin should "avoid cranberry supplements and limit intake of cranberry juice as this can inhibit warfarin metabolism and increase the risk of bleeding," advises Albert Barber, PharmD, in Stow, Ohio.