Category: Caregiving

Guest Post: Flu Activity

By: Donna Lazorik, RN, MS
Deputy Program Manager for Program Development, Immunization Program
Massachusetts Dept. Public Health

National Flu Activity

Flu activity continues to increase in the U.S., according to CDC’s latest FluView report.  “Reports of influenza-like-illness (ILI) are nearing what have been peak levels during moderately severe seasons,” according to Dr. Joe Bresee, Chief of the Epidemiology and Prevention Branch in CDC’s Influenza Division.  “Anyone who has not already been vaccinated should do so now,”

While the timing of flu seasons is impossible to predict, based on past experience it’s likely that flu activity will continue for some time.  During the past 10 seasons, ILI remained at or above baseline for an average of 12 consecutive weeks.  One factor that may indicate increased severity this season is that the predominant circulating type of influenza virus is influenza A (H3N2) viruses, which account for about 76% of the viruses reported.  Bresee explains “typically ‘H3N2 seasons’ have been more severe, with higher numbers of hospitalizations and deaths, but we will have to see how the season plays out.” Continue reading “Guest Post: Flu Activity”

Guest Post: Think Like a Home Care Professional

By: Patricia O’Brien, MBA, MS, RN, Executive Director of Hebrew Senior Life.

Re-posted with permission from Hebrew SeniorLife Blog.

The Five Minute Assessment Families Can Do

Elder At Home A loose railing. A dusty table. Expired milk in the refrigerator. These can all seem like simple problems, but may actually be signs of bigger issues for seniors. That loose railing can mean difficulty making it up stairs. Ignored dust can hint at eye sight trouble or that house work has become too strenuous. Expired food can mean a senior is not getting the right nutrition or simply needs help getting to the store more often.

It’s these small things that affect a senior’s quality of life in a big way. I’m proud that our staff at HSL is trained to immediately notice issues, big and small, and offer advice to improve a myriad of situations relating to senior home health care. Within five minutes of visiting a senior, home care professionals have completed an environmental assessment that includes potential safety risks or signs of potential problems.

Continue reading “Guest Post: Think Like a Home Care Professional”

Introducing the Caregiver Video Resource Center

Working with families is an integral part of home care agencies do. Unlike most other forms of healthcare, their work is done in their clients’ residences and often alongside the 65,000,000 family members, friends, and neighbors who help care for an elderly or disabled person at home.

To help care providers understand what an agency can do for their loved one, the Alliance has produced a series of short, instructional videos with ElderCareSKILLS.org. The videos feature a variety of home health professionals including nurses, therapists, owners, and home care aides answering the most common questions families ask.

Each Monday, we will feature a new video here on the newsfeed.  In the first, Geoffrey Abraskin, PT, DPT of Amedisys Home Health discusses the basics of choosing a home care agency:

There are currently nine videos available both at www.thinkhomecare.org/videos, and on the Alliance’s YouTube channel, with additional ones planned.  You can also subscribe to  ElderCareSKILLS to access these and hundreds of additional videos designed for family caregivers.

Return to www.thinkhomecare.org.

Guest Post: Utilization of Post-Acute Services by ALF Residents

The following is a guest blog post on the utilization of post-acute services by residents of an assisted living facility written by Elizabeth Hogue, Esq. The author plans future articles on this subject so be sure to check back for updates!

As the number of years in which they have been in business increases, ALF’s are more eager to help their residents to “age in place.”  ALF’s often view availability of services from post-acute providers; including Medicare home care, private duty home care, hospice, and home medical equipment (HME); as essential to allow them to achieve this goal.  While ALF’s want to encourage utilization of these types of services by residents, ALF’s cannot lose sight of the fact that the healthcare industry is highly regulated.  With ever-increasing emphasis on fraud and abuse compliance, ALF’s and post-acute providers cannot afford to violate the law.

How can ALF’s encourage the use of services available from post-acute providers by residents?  What are the potential legal pitfalls that ALF’s and post-acute providers must avoid?  The most effective way to maximize utilization of these services may be to take a multi-pronged approach that includes:

1. Assignment of liaisons/coordinators from post-acute providers to ALF’s

Use of coordinators/liaisons at ALF’s raises issues related to violation of the federal anti-kickback statute.  This statute generally prohibits providers from either offering to give or actually giving anything to referral sources in order to induce referrals.  Consequently, liaisons and coordinators must be scrupulous about avoiding the provision of free services to ALF’s and/or their residents.  Possible violations include “staffing” an office with an RN who responds to requests from residents in their apartments or has “office hours” to address health conditions of residents.

Continue reading “Guest Post: Utilization of Post-Acute Services by ALF Residents”

New Reports on Hospital Readmissions from STAAR and DHCFP

The Massachusetts State Action on Avoidable Readmission (STAAR) project has published a new report on the Patient Care Link website. The report – Reducing Readmissions: Highlights from the Massachusetts STAAR Cross Continuum Teams  – includes improvement stories from 22 of the 50 cross continuum teams working on reducing readmission.

Available on the Preventing Avoidable Readmissions page of the MA Coalition to Prevent Medical Errors website is a digest of customizable tools that eleven of the teams have made available free of charge. The STAAR work and these reports were funded by a grant from the Commonwealth Fund.

Also available from the state’s Division of Healthcare Finance & Policy (DHCFP) is a pair of new health care cost trend reports that conclude preventable hospitalizations have slowed, although preventable emergency department use has slightly risen.

The first report states that preventable hospitalizations are not driving cost growth, but remains a significant percentage of overall health care expenditures. Some of the more notable findings indicate that nearly half of preventable hospital admissions are for people aged 75 and older and 64 percent are for those over 65 years of age.

The report suggests something of no surprise to home care agencies, which is that managing chronic illnesses between non-acute health care settings is the best approach to combating the issue. However, the report further states the fee-for-service pay structure remains a barrier to that method working efficiently. Demographic influences aside from age were also noted as those lower income and some minority groups were more likely to receive costly and inefficient care that led to a higher rate of preventable hospitalizations among those groups.

As for the DHCFP report on hospital emergency department efficiency, the number of preventable ED visits rose 6.3 percent from 2006 to 2010 to a total of more than 1.17 million. Preventable or avoidable visits, the report continues, accounted for more than 45 percent of total ED visit costs.

To see both DHCFP reports, visit their  Cost Trends page.

Return to www.thinkhomecare.org.

Mass. Thanks HCA and Members for Survey Participation

The state’s Executive Office of Health and Human Services thanked the Home Care Alliance and member agencies who participated in the recently completed Direct Service Workers (DSW) Survey.

A comprehensive report of the survey results is underway and those results will be available Fall 2012. Results will be shared with all providers who received the survey. Below is part of the ‘thank you’ statement:

Thanks in large part to outreach assistance provided by Home Care Alliance of Massachusetts, we received a survey response rate of 36%.  We’re happy to announce that the federal contractor, The Lewin Group, who has provided assistance through the survey process, is preparing a report which will include an analysis of the Massachusetts survey results. The Lewin Group anticipates this report will be ready for distribution by the end of September and we plan to share the report, along with additional survey results and analysis, with all providers who received the DSW Employer Survey.  We will distribute the report by email and will send a postcard to all providers asking them to submit an email address for this purpose.

The Direct Service Worker Employer Survey is a collaborative effort with the Home Care Alliance of Massachusetts and Massachusetts Council for Home Care Aide Services, Inc. to collect state-specific data on the home and community-based direct service workforce including volume, stability, wages and compensation.

According to EOHHS, information from this survey will be used to develop ways to attract more workers and keep workers longer.  The information from this survey can also assist organizations in understanding how they compare to other organizations in Massachusetts, and how organizations in Massachusetts compare to those in other states. Survey results will be used to better understand the current state of the direct service workforce in Massachusetts and areas for policy improvement.

Return to www.thinkhomecare.org.

Skilled Teaching for Dementia Patients

NHIC, Corp. has just released a medical policy article that addresses a specific category of skilled nursing care currently available to Medicare home health beneficiaries who have dementia with behavioral disturbances; A51856 Home Health Skilled Nursing Care: Teaching and Training for Dementia Patients with Behavioral Disturbances.  The category of skilled nursing is called “teaching and training activities”, defined in the CMS Manual System. The Medicare beneficiaries with dementia and behavioral disturbances could receive a patient-centered care plan directed at teaching the family or caregiver how to manage the behavioral disturbances.

Refer to Article A51856 for sample case scenarios and details on documentation, coding guidelines, and potential interventions

Return to www.thinkhomecare.org.

Home Care Alliance, National Organizations Make Statements on Supreme Court Decision

In light of the Supreme Court’s decision to uphold the Affordable Care Act, the Home Care Alliance of Massachusetts and other organizations representing health care providers and consumers had this to say:

“Today’s decision of the US Supreme Court has established the Affordable Care Act as the law. With their ruling, the Supreme Court has removed enormous uncertainty – particularly in states other than Massachusetts and for those involved in ACA funded demonstrations – as to whether to move forward. They now can, and we think they must.  While some parts of the law will impact Massachusetts far less directly than other states, there is evidence that our state has already benefited by some provisions. Most notably, 62,000 seniors and people with disabilities in Massachusetts have seen significant savings on their prescription drugs because the law was upheld.

All providers, including home health care, were subject to Medicare rate reductions in the ACA in order to expand coverage and pay for reform demonstrations.  These cuts have not been easy to absorb. With this ruling, we must now get to work to deliver on the promise in our state not just of universal access to insurance, but to a better coordinated, and ultimately more cost effective delivery system.”

-Patricia Kelleher, HCA Executive Director

Statement from the National Association for Home Care & Hospice (NAHC):

“NAHC has long supported reforms that increase access to health care for all in the United States and supports health delivery reforms and the expansion of Medicaid eligibility. The ACA rightly shifts the focus of care from inpatient services and institutional care to the community setting, which home health agencies and hospices have effectively served for decades.

NAHC believes that the Affordable Care Act can and should be improved. Accordingly, NAHC will continue to work with both Democrats and Republicans to improve the legislation. NAHC will ask that its implementation date be delayed for two years so that states have the time to prepare for implementation, including the creation of exchanges. This delay will also save approximately $200 billion, which can be applied to deficit reduction, extending the SGR “doc fix” and avoiding the need for any further cuts to Medicare. NAHC will continue to argue that home health care has been cut disproportionately and will oppose the imposition of copayments or additional cuts. NAHC believes that a good case can be made for expanding the scope of Medicare home health services to reduce hospitalization costs and improve services for the 5 percent of Americans who are responsible for 50 percent of total U.S. health care costs.”

-Val Halamandaris, NAHC President

Here are other statements from the following organizations:

And statements from political leaders:

Return to www.thinkhomecare.org.

State Budget Advocacy Needed on Telehealth

The FY13 state budget conference committee that will meld the House and Senate budget proposals are in negotiations and HCA needs your help in advocating so that we can achieve MassHealth reimbursement of telehealth services and adequate funding in the state home care programs.  (According to Mass Home Care, there were 935 elders on the Enhanced Community Options program waiting list as of May, 2012.)

Members and advocates can do their part by calling or emailing the members of the conference committee and asking them to:

  1. Support Senate budget amendment #692 which would direct Masshealth to reimburse for telehealth services
  2. Support the House funding proposal over the Senate’s for Enhanced Community Options Program (ECOP), line-item 9110-1500.  The House budget proposal gives the ECOP program $1.327 million more than the Senate.
  3. Support House funding proposal over the Senate’s for Elder Home Care Purchased Services, line-item 9110-1630.  The House budget gives almost $500,000 more dollars to this account which funds the Basic Elder Home Care program.

Here are the names, email addresses and phone numbers of the conference committee:

The telehealth amendment language, data, and talking points are all available on a fact sheet prepared by the Alliance.  Please contact these legislators today, even if they do not represent your area.  Please urge your legislators to do all he/she can to support this funding. In addition, when you speak to your Senator’s office, be sure to thank the Senate for adding this critical funding to their FY13 budget proposal.

If you or the legislators you speak with have any questions, contact James Fuccione at HCA.

Return to www.thinkhomecare.org.

Guest Blog Post: National Health Care Decisions Day is Apr. 16

The Home Care Alliance thanks John Albert, President and CEO of Home Health VNA and Merrimack Valley Hospice for his guest blog post.

On Monday, April 16, National Health Care Decisions Day, I urge you to take some time to have a thoughtful conversation with family members and loved ones about your end-of-life healthcare decisions, and to complete an advanced directive. By having these conversations and documenting your wishes in an advanced directive, your health care decisions will be respected by health care professionals and your personal wishes will be honored.

Discussing end-of-life decisions before they are needed can help you and your family prepare for any emergency.  By completing an advanced directive, you can provide useful guidance to loved ones, and health care providers so that your wishes will be honored in the event you cannot speak for yourself.  You can fill out an advanced directive without hiring a lawyer.  It is easy to do and it is free.

Massachusetts recognizes two main forms of advanced directives:

  • A “Massachusetts Health Care Proxy” is a simple, legal document that allows you to appoint someone you know and trust to make decisions on your behalf if you cannot speak for yourself
  • Five Wishes is a “living will” a legal document that instructs your family and your health care providers about your personal, emotional and spiritual needs and your medical wishes at the end of life

It is important to ask yourself: Who will speak for me and respect my health care choices if I am unable to do so?  You can find more information on advanced directives at www.nationalhealthcaredecisionsday.org.


Return to www.thinkhomecare.org.