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The Return Of The Little Black Bag In Healthcare

August 17, 2011 Leave a comment

Right around the same time some private physicians are refusing to accept new Medicare patients in fear of lower government reimbursements, another physician based concept is taking hold. The Academy of Home Care Physicians has a mission statement that promotes the art, science and practice of medicine in the home. Established in 1988, the Academy “envisions a healthcare system in which any patient who needs it can receive comprehensive primary care in their home.” Research shows that for every elderly person in a nursing home, there are three more patients equally as sick and fragile who are living at home. In a recently article published in The New England Journal of Medicine on “Why Health Care is Going Home,” Dr. Steven H. Landers stated that, “Our financing system, malpractice laws, and consumer culture all encourage utilization of costly services and have contributed to unsustainable increases in the cost of care. In home care is often less costly, and since it is highly desirable for patients, it offers a potential win–win solution.”

He added that, “The transformation of patients’ homes into central venues for health care may take years or decades, depending on how the national and institutional politics play out. New payment models are needed to cover services that haven’t previously been offered at home and to realign physicians’ incentives. Yet, ultimately, health care organizations that do not adapt to the home care imperative risk becoming irrelevant.” In today’s generation of physicians, few have been educated in medical school or continuing education to provide the kind and level of care that could be made available. Few have been educated to provide home health agencies with professional support as medical directors; fewer still have learned the advanced team techniques that allow them to work with other health professionals, nurse practitioners, physician assistants, pharmacists and others by providing continuity of care across the care continuum. Concerns over reimbursement also have been a barrier.

The American Academy of Home Care Physicians serves the needs of thousands of physicians and related professionals and agencies interested in improving care of patients in the home. Members and volunteers work to reduce barriers and enhance practice education. Notable successes include fostering increased reimbursement, sponsoring multiple educational and scientific seminars and providing the practice community with a variety of helpful publications. Academy members include home care physicians who make house calls, care for homebound patients, act as home health agency medical directors or refer patients to home care agencies. Specialties include internal medicine, family practice, pediatrics, geriatrics, psychiatry, emergency medicine and more.
Other members are directors of agencies actively planning for future home care organizations, medical directors of managed care plans, nurse practitioners who make house calls, physician assistants, and administrators of medical groups interested in home care. The services provided by home care agencies and physicians are billed under a set of codes designated by the Centers for Medicare and Medicaid. Physicians, nurse practitioners, clinical nurse specialists and physician assistants are required to oversee or directly provide progressively more sophisticated and more frequent home visits.

Beyond the licensure and certification processes, no similar evaluation mechanism exists for skills obtained through continuing education and practice experience. The Home Care Credentialing Examination fills this gap and enables home care medical providers to demonstrate their proficiency. Patients also benefit from proficiency testing and the Academy’s recognition of those who receive the credential since the exam assesses the knowledge and skills identified by respected experts as necessary to provide safe and effective medical care in the home. Upon the completion of this educational activity, the participant should be better able to:
Discuss and apply knowledge of clinical problems, effective approaches to end of life/palliative care, functionality, social services and legal/ethical concerns related to home care. Attest to his or her added competency in home care medicine by demonstrating knowledge, skills and proficiency in managing common problems faced in home care. As a public service, The American Academy of Home Care Physician’s website provides a list of its members and medical groups that provide home care.

800Seniors.com is a leading referral system in the Elderly Healthcare industry. We are located on 5400 Atlantis Court, Moorpark, California 93021. 800Seniors.com provides the perfect match between seniors searching for health care provisions such as Home Care Chicago, Home Health, Skilled Nursing, Hospice Care, Medical Supplies, as well as a variety of Assisted Living Facilities and Care Homes nationwide. Take the confusion and hassle out of the search. For more information call 1-800-768-8221, visit http://800seniors.com or fax us your details at (805)517-1623.

About The Author: Gloria Ha’o Schneider is an expert in senior citizen and baby boomer issues. Her topics revolve around Senior Living and Healthcare to provide the latest information to this demographic as well as their families and loved ones.

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Tube Feeding Depends On The Attitude Of The Facility

July 6, 2011 Leave a comment

By the year 2030, the number of people in the United States over 65 will soar to 71.5 million. The healthcare industry is keeping pace by providing communities with the housing and care resources needed to accommodate the nation’s aging population. Independent, assisted living and memory care facilities are oftentimes located on the same property and are known as Continuing Care Retirement Communities.  At a CCRC, residents can move within the tiers as their conditions may change over the years. Many assisted living facilities are also stand alone homes that frequently have wings for providing memory care to those residents with loss of cognitive skills such as those with Alzheimer’s disease or other forms of dementia.

Tube feeding is a procedure used in acute care hospitals for patients recovering from certain surgeries, those with neurological problems, some going through intense chemotherapy or for any reason, are unable to receive proper nutrition by swallowing. Feeding tubes, or the medical term, Percutaneous Endoscopic Gastrostomy, (PEG), are frequently utilized to provide nutrition for the elderly. Many of these elderly patients reside in assisted living facilities and skilled nursing facilities. Though the procedure is fairly routine medically, there are many complex issues surrounding PEG use, particularly for patients near the end of life, where the decision to use or not to use a PEG is frequently made without the participation of the patient.

The ethical picture is further clouded by several studies that question the medical benefit of PEGs in elderly demented patients, a group that receives a high percentage of the PEG procedures currently done. Other studies have found a surprisingly high death rate for those patients within one month of a PEG insertion. Tube feeding has been shown to have no demonstrable benefit in assisted living or skilled nursing patients with advanced cognitive impairment, yet its use within this population reveals a striking and unexplained variation within the United States.

Half complete memory by *Jangmai on deviantART

The Journal of the American Medical Association has published a report on a study of patients with advanced cognitive impairment and found that 70% of feeding tube insertions were done in the acute care hospital prior to the patient being moved to an assisted living facility. The study suggests that higher insertion rates are associated with the following acute hospital factors:

For profit ownership vs. government owned
Larger size vs. smaller size (more than 310 beds vs. less than 101 beds)
A more aggressive approach to end of life care, meaning greater use of the intensive care unit in the last 6 months of life as opposed to a memory care facility or hospice.

A field study was also done in two South Carolina assisted living facilities. Field studies are based on the idea that humans are best understood to the fullest possible context if it includes the place where they live, the improvements they’ve made to that place, how they are making a living and providing food, housing, energy and water for themselves or others, what language(s) they speak and so on. The study revealed a startling variation in the culture of the organizations and its influence on attitudes toward tube feeding. Key features in assisted living facilities with low use of feeding tubes:

A more home like environment in which food, mealtimes, and family are central.
Administrative support in solving feeding problems.
Emphasis on the value of, and sufficient staff for hand feeding.
Family inclusion in decision making.

In contrast, the high use feeding tube facility had an impersonal, institutional atmosphere with strictly scheduled and poorly staffed mealtimes.  Staff attitudes favored tube feeding, and though the decision making process was not clear, it emphatically did NOT include family. If you are considering a Continuing Care Retirement Community or a standalone assisted living facility that most often includes a memory care wing for the cognitively impaired, it is essential to ask about their policy on tube feeding. Using an experienced, qualified referral service to assist you in the process, can help you determine the attitudes and policies of the organization where you or your loved one will reside.

800Seniors.com is a leading referral system in the Elderly Healthcare industry. We are located on 5400 Atlantis Court, Moorpark, California 93021. 800Seniors.com provides the perfect match between seniors searching for health care provisions such as Home Care, Home Health, Skilled Nursing, Hospice Care, Medical Supplies, as well as a variety of Assisted Living Philadelphia and Care Homes nationwide. Take the confusion and hassle out of the search. For more information call 1-800-768-8221, visit http://800seniors.com or fax us your details at (805)517-1623.

About The Author: Gloria Ha’o Schneider is an expert in senior citizen and baby boomer issues. Her topics revolve around Senior Living and Healthcare to provide the latest information to this demographic as well as their families and loved ones.

Understanding Cultural Differences – What Role Do They Play In Healthcare

June 28, 2011 Leave a comment

Ramon Jimenez, chairperson of the diversity advisory board of the American Academy of Orthopaedic Surgeons could not have said it better, “Cultural competency will have to be on everybody’s radar screen for generations to come. When the day comes that the melting pot is truly a melting pot, then we won’t need this, but that day isn’t here yet.” Patients differ in many ways. Some of these differences are due to patient illness, personality, socioeconomic class, or education, but the most profound differences may be cultural. Many health professionals think that if they just treat each patient with respect, they will avert most cultural problems. That is not always the case. Some knowledge of cultural customs can help avoid misunderstandings and enable practitioners to provide better care.

Cultural generalizations will not fit every patient whom physicians see, but knowledge of broad patterns of behavior and belief can give physicians and other health professionals a starting point from which to provide a variety of ethnic and cultural different patients with the most appropriate care. Cultural Sensitivity & Competence for health care professionals is achieved through formal coursework, informal interaction, networking, and experience.

A few examples of why understanding differences is important :

A person of Chinese ethnicity was hospitalized and put in room number 4. In Chinese (and Japanese), the character for the number 4 is pronounced the same way as the character for the word “death.” Just as many American patients might not be comfortable in room 13—a number that is considered bad luck—many Chinese and Japanese patients would prefer not to be in a room called “death.” Even the most sensitive health care provider could not be expected to know the significance of the number 4 without some knowledge of these cultures or their languages.

Culture by *AagaardDS on deviantART

Lack of eye contact in American culture may indicate many things, most of which are negative. A physician may interpret a patient’s refusal to make eye contact as a lack of interest, embarrassment, or even depression. However, a Chinese patient may be showing the physician respect by avoiding eye contact. If the patient is female and from a Muslim country, and her physician is male, she may be trying to avoid sexual impropriety by not making eye contact. A Navajo patient may be trying to avoid soul theft or loss. Knowing the meaning of eye contact, or lack thereof, may help avoid misinterpreting a patient’s behavior.

Nurses are generally taught the importance of touch. Yet, if they are caring for a patient of the opposite sex and that patient is an Orthodox Jew, for example, it is important to know that, for that religion, contact outside of hands-on care is prohibited. A custom in many cultures, including Mexican, Filipino, Chinese, and Iranian, is for a patient’s family to be the first to hear about a poor prognosis, after which the family decides whether and how much to tell the patient. Members of such cultural groups may believe that it would be insensitive for a patient to be told bad news and that it could affect their prognosis for recovery.

Some groups share the belief that only God knows when someone will die naturally, so (according to the Hmong, for example) the only way a physician could know when someone will die is if that physician planned to kill the patient. Not all members of a group share these beliefs, so physicians should not automatically assume that every patient who is a member of one of these groups would want to be shielded from information. Nevertheless, a physician who is aware of such cultural differences could arrange to discuss with the patient, in advance, just who should be given information regarding the patient’s condition.

800Seniors.com is a leading referral system in the Elderly Healthcare industry. We are located on 5400 Atlantis Court, Moorpark, California 93021. 800Seniors.com provides the perfect match between seniors searching for health care provisions such as Home Care, Home Health, Skilled Nursing, Hospice Care, Medical Supplies, as well as a variety of Assisted Living Philadelphia and Care Homes nationwide. Take the confusion and hassle out of the search. For more information call 1-800-768-8221, visit http://800seniors.com or fax us your details at (805)517-1623.

About The Author: Gloria Ha’o Schneider is an expert in senior citizen and baby boomer issues. Her topics revolve around Senior Living and Healthcare to provide the latest information to this demographic as well as their families and loved ones.

The Medical Home Concept: A Solution For The Healthcare Conundrum?

November 12, 2010 Leave a comment

The current monetary number for healthcare spending in the US is 2 trillion dollars, a topic that has created a lot of frustration in our country. At times it seems all we have to show for it is patient confusion over navigating the system, employer and patient agitation over rising costs, and government resistance and aggravation trying to provide affordable access to all. In the last few years, there has been a growing interest in the concept of a Patient Centered Medical Home as a way to combat the ills of the U.S. healthcare system. Proponents of this approach believe the way out of our healthcare conundrum is to make the primary care physician the hub of a patient’s disease prevention and care coordination.

In a medical home model, the primary care doctors and clinicians serve as advocates for patients, helping to avert unnecessary tests and procedures, hospital admissions and avoidable complications. Instead of a payment system that rewards procedures and volume, it would shift to one based on patient satisfaction and clinical outcomes. While few argue with the goals of a patient centered approach to the delivery of healthcare, most agree that transforming the current system would not be easy. Nor is the financial viability of this concept so readily clear.

History of The Medical Home Concept

The origin of the medical home concept goes all the way back to 1967, when The American Academy of Pediatrics used the term to describe a central location for archiving a child’s medical records. In the following decades, medical homes focused primarily on families with children of special needs, helping to coordinate care and information across multiple specialists and services. By the 1990’s, as the delivery of healthcare was becoming more complex, the role of the medical home expanded to include the provision of comprehensive primary care for adults. Associations such as the American College of Physicians and the American Academy of Family Physicians also embraced the medical home concept and issued a joint statement of principles with the AAP in 2007.


Healthcare by ~sciophobik on deviantART

Today, the term “medical home” has become somewhat misleading, as it refers not to a location but to a model based on integrated care across all elements of the healthcare system including hospitals, Nursing Homes, subspecialty care, Home Healthcare agencies, public and private community services and family members. Interest in implementing a Patient Centered Medical Home has been gaining interest among hospitals and physician groups over the last few years based on the summary of several factors. In 2008, Harris Interactive conducted a survey of over 1,000 adults that revealed the current healthcare delivery system does not serve the public well. 8 of 10 respondents said it needs to be fundamentally changed or completely rebuilt.

Specifically, common frustrations voiced by participants in the survey included:

  • Nearly 73% of those surveyed had difficulty making timely doctors’ appointments, getting phone advice or receiving afterhours care without having to visit an emergency room.
  • Approximately 30% reported difficulties getting same or next day appointments with their doctor when they are sick. An even larger share, 41% said they had difficulties getting advice from their doctor by phone during regular office hours.
  • 6 out of 10 said it was difficult to get care on nights, weekends, or holidays without going to the emergency room.
  • Nearly half of all adults reported at least 1 failure of coordination of care. More than half, 56% of those seeing 3 or more doctors experienced poorly coordinated care.
  • 32% of adults and 40% of those in fair or poor health thought they received either duplicate tests or unnecessary care.

In 2002, the American Association of Pediatrics expanded its definition of a Medical Home Model to include its operational characteristics. “The medical home offers accessible, continuous, comprehensive, family centered, coordinated, compassionate, and culturally effective care.” Since then, the American Academy of Family Physicians and the American College of Physicians have developed models referred to as “advanced medical homes” and the “medical home.”  Both entities build upon the AAP model by integrating care coordination features with pay for coordination and performance as outlined in Wagner’s Chronic Care Model described below.

This model identifies the essential components of high quality chronic disease care: the community, the health system, self management support, delivery system design, decision support and clinical information. The goal is healthier patients and more satisfied providers which results in medical cost savings. Enactment of health care reform legislation will accelerate the adoption of the patient centered medical home in the public and private sectors by making key investments in the nation’s primary care infrastructure. The legislation will give the Centers for Medicare & Medicaid Services greater latitude in launching and sustaining innovative models, which may then be implemented by the private sector.

800Seniors.com is a leading referral system in the Elderly Healthcare industry. We are located on 5400 Atlantis Court, Moorpark, California 93021. 800Seniors.com provides the perfect match between seniors searching for health care provisions such as Home Care, Home Health, Skilled Nursing, Hospice Care, Medical Supplies, as well as a variety of Assisted Living Philadelphia and Care Homes nationwide. Take the confusion and hassle out of the search. For more information call 1-800-768-8221, visit http://800seniors.com or fax us your details at (805)517-1623.

About The Author: Gloria Ha’o Schneider is an expert in senior citizen and baby boomer issues. Her topics revolve around Senior Living and Healthcare to provide the latest information to this demographic as well as their families and loved ones.

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