Ventilator-dependent patients are best served through high-quality home care rather than institutional care. However, improvements are needed to support caregivers and meet patients' specialized needs. The document recommends: 1) Increased wages for trained caregivers to reduce turnover and ensure continuity of care. 2) A paid training program for caregivers in respiratory care. 3) Increased availability of case managers and respiratory therapists to support patients. 4) Allowing increased hours during illness to avoid hospitalization. This would improve outcomes and reduce costs compared to frequent hospitalizations. Evaluation of costs and outcomes is recommended to assess the impact of improved home care programs.
The document discusses direct primary care (DPC), an alternative primary care model that focuses on the patient-provider relationship through a monthly membership fee rather than insurance billing. Key elements of DPC include long appointments, 24/7 access to providers, and a focus on prevention, wellness, and lifestyle choices over treatment of acute issues. DPC aims to improve outcomes, access, costs and experience for both patients and providers by empowering the relationship between an individual and their personal primary care clinician.
Concierge Medicine Brave New World Of Health CareJames Kane
This document summarizes concierge medicine and specialty medical services tailored for individuals. Concierge practices offer enhanced services like same-day appointments in exchange for annual fees, though they remain small. Critics argue they could worsen healthcare access, while proponents say the current system is unsustainable. The document provides tips for what to ask if your doctor transitions to concierge care. It also discusses specialty services that can provide referrals to top specialists for complex illnesses and emergency care while traveling globally through virtual consultations.
This document provides an overview of long-term care options and nursing roles. It describes the long-term care continuum and various settings like nursing facilities, assisted living facilities, adult day care and home health care. Nursing facilities are highly regulated and provide medical care for those dependent in activities of daily living. Assisted living facilities provide personal care and social activities for more independent seniors who need some assistance. Nurses play many roles in long-term care including direct care, care coordination, and advocacy.
This document provides an overview of long-term care options and nursing roles. It describes the long-term care continuum, various long-term care settings like nursing facilities and assisted living facilities, and the principles of rehabilitative nursing. It also compares institutional and community-based long-term care and discusses how nurses can help families choose nursing homes.
This document provides information about Medicare coverage of home health care services. It outlines who is eligible for home health care benefits, what services are covered including skilled nursing care, physical therapy, occupational therapy and more. It also discusses how Medicare pays for home health care through 60-day episodes of care. The document notes some services that are not covered like 24-hour care, delivered meals or personal care services.
The document discusses long-term care, defining it as assistance for those with chronic illnesses or disabilities with activities of daily living rather than medical treatment. It examines the different levels of long-term care including home health, assisted living, nursing homes, skilled nursing facilities and the populations served by each. The challenges facing long-term care are also reviewed such as financing issues and the need for quality staffing.
The Complexities and Challenges of Health and Aged Care System
The three primary goals of healthcare organisations today are:
• improve the experience of care
• improve the health of the population and
• reduce per capita costs of delivery.
This requires healthcare organisations to engage and impact the health of one person at a time. This can only be achieved with the right people, processes and information systems in place.
Home health nursing services allow individuals to receive healthcare in their own homes, providing comfort and dignity. Services may include skilled nursing, physical therapy, occupational therapy, social services, and more. Care is provided through developing a treatment plan with the patient's physician, making regular visits to work towards goals, and documenting progress for quality assessment.
The document discusses direct primary care (DPC), an alternative primary care model that focuses on the patient-provider relationship through a monthly membership fee rather than insurance billing. Key elements of DPC include long appointments, 24/7 access to providers, and a focus on prevention, wellness, and lifestyle choices over treatment of acute issues. DPC aims to improve outcomes, access, costs and experience for both patients and providers by empowering the relationship between an individual and their personal primary care clinician.
Concierge Medicine Brave New World Of Health CareJames Kane
This document summarizes concierge medicine and specialty medical services tailored for individuals. Concierge practices offer enhanced services like same-day appointments in exchange for annual fees, though they remain small. Critics argue they could worsen healthcare access, while proponents say the current system is unsustainable. The document provides tips for what to ask if your doctor transitions to concierge care. It also discusses specialty services that can provide referrals to top specialists for complex illnesses and emergency care while traveling globally through virtual consultations.
This document provides an overview of long-term care options and nursing roles. It describes the long-term care continuum and various settings like nursing facilities, assisted living facilities, adult day care and home health care. Nursing facilities are highly regulated and provide medical care for those dependent in activities of daily living. Assisted living facilities provide personal care and social activities for more independent seniors who need some assistance. Nurses play many roles in long-term care including direct care, care coordination, and advocacy.
This document provides an overview of long-term care options and nursing roles. It describes the long-term care continuum, various long-term care settings like nursing facilities and assisted living facilities, and the principles of rehabilitative nursing. It also compares institutional and community-based long-term care and discusses how nurses can help families choose nursing homes.
This document provides information about Medicare coverage of home health care services. It outlines who is eligible for home health care benefits, what services are covered including skilled nursing care, physical therapy, occupational therapy and more. It also discusses how Medicare pays for home health care through 60-day episodes of care. The document notes some services that are not covered like 24-hour care, delivered meals or personal care services.
The document discusses long-term care, defining it as assistance for those with chronic illnesses or disabilities with activities of daily living rather than medical treatment. It examines the different levels of long-term care including home health, assisted living, nursing homes, skilled nursing facilities and the populations served by each. The challenges facing long-term care are also reviewed such as financing issues and the need for quality staffing.
The Complexities and Challenges of Health and Aged Care System
The three primary goals of healthcare organisations today are:
• improve the experience of care
• improve the health of the population and
• reduce per capita costs of delivery.
This requires healthcare organisations to engage and impact the health of one person at a time. This can only be achieved with the right people, processes and information systems in place.
Home health nursing services allow individuals to receive healthcare in their own homes, providing comfort and dignity. Services may include skilled nursing, physical therapy, occupational therapy, social services, and more. Care is provided through developing a treatment plan with the patient's physician, making regular visits to work towards goals, and documenting progress for quality assessment.
This document discusses long-term care options and settings. It describes the long-term care continuum including nursing facilities, assisted living facilities, adult day care, home health care, and hospice care. It also discusses community-based versus institutional long-term care and compares services provided in nursing homes versus assisted living facilities.
Telehealth offers convenient virtual care that can reduce costs while improving outcomes. It allows patients to access care remotely through video or phone instead of visiting physical offices. This saves money by reducing unnecessary emergency room visits and tests. It also improves productivity and wellness by making care more accessible. Telehealth is highly satisfactory to patients and can help prevent medical issues by facilitating preventative care. Its 24/7 availability makes telehealth a valuable option for employers and insurers to include in health plans.
Saint Peter's University Hospital in New Brunswick, NJ has been recognized as a "top performer" by The Joint Commission for quality. This places it among the top 18% of accredited hospitals nationwide. The honor is based on data from 2011 showing Saint Peter's met or exceeded 95% performance targets on key quality measures for conditions like heart failure, heart attack, pneumonia, and surgery. This recognition follows other awards the hospital has received for programs like its stroke and cancer programs. A support group and education program calendar for November 2012 is also included.
The document discusses the need for more patient-centered chronic care that takes a holistic approach and moves care closer to home. It provides examples of how optimizing care pathways for patients with conditions like diabetes or who experience falls can lead to better outcomes and lower costs. Reducing unwarranted variations in care across regions and implementing evidence-based approaches like NHS RightCare that involve clinicians can help standardize best practices and deliver value. However, fully coordinated care requires alignment between health and social care partners.
A presentation designed to inform health care workers about the components and importance of advance directives, with specific information for Massachusetts residents.
Differences between inpatient rehabilitation & skilled nursing carejulenemcalister
The document discusses the definitions, criteria, services, and payment systems for inpatient rehabilitation facilities (IRFs) and skilled nursing facilities (SNFs) under Medicare. Both programs require skilled rehabilitation services and focus on restoring function, but IRFs provide a more intensive rehabilitation program requiring 3+ hours of therapy daily. Patient placement is determined by each program's technical requirements, covered diagnoses and RUGs payment groups.
Advance Directives & Advance Care Planning | VITAS HealthcareVITAS Healthcare
Learn how healthcare professionals can ensure that their patients’ voices are heard by embracing advance care planning (ACP), defined as honest conversations about how patients want to be cared for at the end of life if they are unable to communicate or make decisions. This webinar explores advance directives, the legal documents that spell out patients’ wishes for family members, caregivers and healthcare teams.
Independence at Home Demonstration Program MemoMegan Gonyo
The memorandum recommends that Integrated Delivery System (IDS) not participate in the Independence at Home Demonstration Program at this time. The program aims to reduce healthcare costs by providing home-based primary care to high-need Medicare beneficiaries, but it requires capabilities IDS does not currently have, such as experience providing home-based care and mobile diagnostic equipment. Participating would require considerable investments in training physicians and nurses and purchasing new technology. Additionally, the program's rules around eligible patients and minimum enrollment numbers make it difficult to predict costs and benefits. Given ongoing uncertainties, participating poses too much financial risk for IDS.
Presentation - The Future of Home HealthC Sam Smith
"Instead of it being described as home healthcare, in a few years the services performed by home health care agencies will simply be known as "modern healthcare".
-Dr. Steve Landers, VNA Health Group, New Jersey
This document discusses various legal and ethical issues nurses may face, including negligence, malpractice, invasion of privacy, and defamation. It defines these concepts and provides examples of situations that could lead to legal liability. The document also discusses how nurses can protect themselves legally, such as through licensure, proper documentation, and following standards of care. Finally, it outlines the role of nurse managers in addressing legal issues and reducing nurses' risk through education, role modeling, and supporting professional organizations.
The document describes North Carolina's program for care coordination of Medicaid recipients which includes assigning recipients to primary care medical homes, providing per member per month payments to support care management activities, and creating regional Community Care of North Carolina networks involving over 600 care managers to improve care delivery and reduce costs. It provides details on the various state agencies and organizations involved in coordinating care as well as the technologies and data used to support their efforts.
In Connecticut, certified nursing assistants (CNAs) can find stable employment due to the state's growing elderly population. To become a CNA, one must complete a state-approved training program of at least 100 hours and pass a certification exam. Programs are offered through various schools and facilities and cover topics like patient care, anatomy, and nursing skills. The exam consists of a written and practical test, and certification must be renewed every two years. With certification, CNAs can work in healthcare facilities and expect an average annual salary of around $30,000.
Healing hands care coordination - final, web-readyskrentz
This document discusses care coordination models for serving people experiencing homelessness. It provides background on the historical segmentation of health care services and the difficulties this poses for those without stable housing. Care coordination aims to increase access to comprehensive care through coordinated treatment plans, minimizing travel between services by providing multiple services in one location. The document outlines some key elements, goals and benefits of care coordination, as well as ongoing challenges, and provides examples of solutions being implemented through various case studies, including increasing access, improving continuity of care, intensive case management, community outreach, and coordination across settings.
How useful are advance directives in directing end of life care and do people really understand or want to know the true status of their health as the end nears?
This document provides information about advanced directives. It defines an advanced directive as a legal document that specifies a person's wishes for medical treatment if they become unable to make decisions. It discusses the importance of advanced directives for patients, families, and physicians. It also describes different types of advanced directives like living wills, medical powers of attorney, and do not resuscitate orders.
National Conference on Health and Domestic Violence. Plenary talk Paul Grundy
explaining how the Patient Centered Medical Home (PCMH) platform for healthcare deliver is more likely to support domestic violence prevention and creat a safer environment than the FFS episode of care system we are in now. The medical Home is a home for the data where the all the data goes and is held accountable this idea was first articulated by Dr. Calvin C.J. Sia, a Honolulu-based pediatrician in 1967.
This concept of the medical home was integrated with Ed Wagners Chronic disease Model and Thomas Bodenheimer Kevin Grumbach advanced/proactive primary care at the request of the Patient Centered Primary care Collaborative into a set of principles Know as the Joint principles of the Patient centered medical home.
The patient-centered medical home (PCMH), is a team based health care delivery set of principles led by a physician that provides comprehensive and continuous medical care to patients with the goal of obtaining maximized health outcomes. It is "an approach to providing comprehensive primary care for children, youth and adults" The provision PCMH medical homes allow better access to health care, increase satisfaction with care, and improve health. Joint principles that define a PCMH have been established through the cohesive efforts of the American Academy of Pediatrics (AAP), American Academy of Family Physicians (AAFP), American College of Physicians (ACP), and American Osteopathic Association (AOA).[10] Care coordination is an essential component of the PCMH. Care coordination requires additional resources such as health information technology, and appropriately trained staff to provide coordinated care through team-based models. Additionally, payment models that compensate PCMHs for their effort devoted to care coordination activities and patient-centered care management that fall outside the face-to-face patient encounter may help encourage coordination.
The document summarizes a presentation by Paul Grundy on extracting value from the patient centered medical home model. It discusses:
1) How the patient centered medical home model creates partnerships across the healthcare system to drive primary care redesign, offer population health management, and move away from an episodic, fee-for-service model.
2) Studies that show improvements in costs, quality, access, and utilization from implementing the patient centered medical home model, including reduced hospital and ER use.
3) How payment models are shifting towards value-based purchasing tied to quality, utilization, and patient satisfaction outcomes rather than volume of services.
The Patient-Centered Medical Home in the Transformation From Healthcare to He...Paul Grundy
Surgeon General of the Navy VADM Matthew L. Nathan, MC USN
Fortunately, we have a way to address this crisis—the
Patient-Centered Medical Home (PCMH) model launched at Naval Hospital Pensacola and Walter Reed National Military Medical Center, Bethesda, Maryland (formerly the National Naval Medical Center) in 2008. It is now being implemented throughout the Military Health System (MHS) and carries great promise. It provides the clinical framework we need to meet our strategic objectives in terms of quality of care, impact on costs, population health, and readiness. One of the most significant benefits of the team-based, collaborative approach is that it allows us to embed within a primary care environment the psychologists, nutritionists, tobacco cessation specialists, mind-body medicine therapists, and health educators our patients need in order to develop and maintain mindful, healthy behaviors—along with the “mental armor,” our active duty military personnel need to increase their operational effectiveness and their resiliency in bouncing back from stressful situations. As we move ahead with this more comprehensive approach to health, we can begin to better address so many of our patients for whom we can find no specific reason for pain and discomfort. The PCMH model also provides a positive impact on our costs. Early data reporting from the PCMH clinics at Bethesda show reduced visits to the emergency room, lowered pharmacy costs, and significant per beneficiary per year savings and improved Healthcare Effectiveness Data and Information Set metrics, access, and patient satisfaction and trust. These positive impacts on the bottom line can be applied directly to improved costs or toward the reallocation of resources from reimbursing those who are sick to the population health-based programs that can make and keep our patients healthy.More significant, however, the PCMH environment allows us to go beyond mere collaboration and to a much more proactive approach to managing our patient populations. It is within the context of the medical home that we can begin to surround our patients with the tools and resources they need to move them from health care to health.
The document provides a map of the United Kingdom with its major cities labeled. It shows Scotland with its capital Edinburgh and largest city Glasgow. Northern Ireland is noted with Belfast as its capital. England, Wales, and Ireland are labeled on the map with their respective capital cities of London, Cardiff, and Dublin.
Alexandria Kelly is seeking a challenging position that allows growth. She has a continuing education certificate in medical billing from Prince George's Community College. Her experience includes over 4 years as a collections coordinator at Educational Systems Federal Credit Union, processing claims and assisting with loans. Previously she was a member service representative at the same credit union for over 3 years, advising members on products and services. She also has sales experience from positions at Protocall Communications, a medical office, and Marshalls department store.
This document discusses long-term care options and settings. It describes the long-term care continuum including nursing facilities, assisted living facilities, adult day care, home health care, and hospice care. It also discusses community-based versus institutional long-term care and compares services provided in nursing homes versus assisted living facilities.
Telehealth offers convenient virtual care that can reduce costs while improving outcomes. It allows patients to access care remotely through video or phone instead of visiting physical offices. This saves money by reducing unnecessary emergency room visits and tests. It also improves productivity and wellness by making care more accessible. Telehealth is highly satisfactory to patients and can help prevent medical issues by facilitating preventative care. Its 24/7 availability makes telehealth a valuable option for employers and insurers to include in health plans.
Saint Peter's University Hospital in New Brunswick, NJ has been recognized as a "top performer" by The Joint Commission for quality. This places it among the top 18% of accredited hospitals nationwide. The honor is based on data from 2011 showing Saint Peter's met or exceeded 95% performance targets on key quality measures for conditions like heart failure, heart attack, pneumonia, and surgery. This recognition follows other awards the hospital has received for programs like its stroke and cancer programs. A support group and education program calendar for November 2012 is also included.
The document discusses the need for more patient-centered chronic care that takes a holistic approach and moves care closer to home. It provides examples of how optimizing care pathways for patients with conditions like diabetes or who experience falls can lead to better outcomes and lower costs. Reducing unwarranted variations in care across regions and implementing evidence-based approaches like NHS RightCare that involve clinicians can help standardize best practices and deliver value. However, fully coordinated care requires alignment between health and social care partners.
A presentation designed to inform health care workers about the components and importance of advance directives, with specific information for Massachusetts residents.
Differences between inpatient rehabilitation & skilled nursing carejulenemcalister
The document discusses the definitions, criteria, services, and payment systems for inpatient rehabilitation facilities (IRFs) and skilled nursing facilities (SNFs) under Medicare. Both programs require skilled rehabilitation services and focus on restoring function, but IRFs provide a more intensive rehabilitation program requiring 3+ hours of therapy daily. Patient placement is determined by each program's technical requirements, covered diagnoses and RUGs payment groups.
Advance Directives & Advance Care Planning | VITAS HealthcareVITAS Healthcare
Learn how healthcare professionals can ensure that their patients’ voices are heard by embracing advance care planning (ACP), defined as honest conversations about how patients want to be cared for at the end of life if they are unable to communicate or make decisions. This webinar explores advance directives, the legal documents that spell out patients’ wishes for family members, caregivers and healthcare teams.
Independence at Home Demonstration Program MemoMegan Gonyo
The memorandum recommends that Integrated Delivery System (IDS) not participate in the Independence at Home Demonstration Program at this time. The program aims to reduce healthcare costs by providing home-based primary care to high-need Medicare beneficiaries, but it requires capabilities IDS does not currently have, such as experience providing home-based care and mobile diagnostic equipment. Participating would require considerable investments in training physicians and nurses and purchasing new technology. Additionally, the program's rules around eligible patients and minimum enrollment numbers make it difficult to predict costs and benefits. Given ongoing uncertainties, participating poses too much financial risk for IDS.
Presentation - The Future of Home HealthC Sam Smith
"Instead of it being described as home healthcare, in a few years the services performed by home health care agencies will simply be known as "modern healthcare".
-Dr. Steve Landers, VNA Health Group, New Jersey
This document discusses various legal and ethical issues nurses may face, including negligence, malpractice, invasion of privacy, and defamation. It defines these concepts and provides examples of situations that could lead to legal liability. The document also discusses how nurses can protect themselves legally, such as through licensure, proper documentation, and following standards of care. Finally, it outlines the role of nurse managers in addressing legal issues and reducing nurses' risk through education, role modeling, and supporting professional organizations.
The document describes North Carolina's program for care coordination of Medicaid recipients which includes assigning recipients to primary care medical homes, providing per member per month payments to support care management activities, and creating regional Community Care of North Carolina networks involving over 600 care managers to improve care delivery and reduce costs. It provides details on the various state agencies and organizations involved in coordinating care as well as the technologies and data used to support their efforts.
In Connecticut, certified nursing assistants (CNAs) can find stable employment due to the state's growing elderly population. To become a CNA, one must complete a state-approved training program of at least 100 hours and pass a certification exam. Programs are offered through various schools and facilities and cover topics like patient care, anatomy, and nursing skills. The exam consists of a written and practical test, and certification must be renewed every two years. With certification, CNAs can work in healthcare facilities and expect an average annual salary of around $30,000.
Healing hands care coordination - final, web-readyskrentz
This document discusses care coordination models for serving people experiencing homelessness. It provides background on the historical segmentation of health care services and the difficulties this poses for those without stable housing. Care coordination aims to increase access to comprehensive care through coordinated treatment plans, minimizing travel between services by providing multiple services in one location. The document outlines some key elements, goals and benefits of care coordination, as well as ongoing challenges, and provides examples of solutions being implemented through various case studies, including increasing access, improving continuity of care, intensive case management, community outreach, and coordination across settings.
How useful are advance directives in directing end of life care and do people really understand or want to know the true status of their health as the end nears?
This document provides information about advanced directives. It defines an advanced directive as a legal document that specifies a person's wishes for medical treatment if they become unable to make decisions. It discusses the importance of advanced directives for patients, families, and physicians. It also describes different types of advanced directives like living wills, medical powers of attorney, and do not resuscitate orders.
National Conference on Health and Domestic Violence. Plenary talk Paul Grundy
explaining how the Patient Centered Medical Home (PCMH) platform for healthcare deliver is more likely to support domestic violence prevention and creat a safer environment than the FFS episode of care system we are in now. The medical Home is a home for the data where the all the data goes and is held accountable this idea was first articulated by Dr. Calvin C.J. Sia, a Honolulu-based pediatrician in 1967.
This concept of the medical home was integrated with Ed Wagners Chronic disease Model and Thomas Bodenheimer Kevin Grumbach advanced/proactive primary care at the request of the Patient Centered Primary care Collaborative into a set of principles Know as the Joint principles of the Patient centered medical home.
The patient-centered medical home (PCMH), is a team based health care delivery set of principles led by a physician that provides comprehensive and continuous medical care to patients with the goal of obtaining maximized health outcomes. It is "an approach to providing comprehensive primary care for children, youth and adults" The provision PCMH medical homes allow better access to health care, increase satisfaction with care, and improve health. Joint principles that define a PCMH have been established through the cohesive efforts of the American Academy of Pediatrics (AAP), American Academy of Family Physicians (AAFP), American College of Physicians (ACP), and American Osteopathic Association (AOA).[10] Care coordination is an essential component of the PCMH. Care coordination requires additional resources such as health information technology, and appropriately trained staff to provide coordinated care through team-based models. Additionally, payment models that compensate PCMHs for their effort devoted to care coordination activities and patient-centered care management that fall outside the face-to-face patient encounter may help encourage coordination.
The document summarizes a presentation by Paul Grundy on extracting value from the patient centered medical home model. It discusses:
1) How the patient centered medical home model creates partnerships across the healthcare system to drive primary care redesign, offer population health management, and move away from an episodic, fee-for-service model.
2) Studies that show improvements in costs, quality, access, and utilization from implementing the patient centered medical home model, including reduced hospital and ER use.
3) How payment models are shifting towards value-based purchasing tied to quality, utilization, and patient satisfaction outcomes rather than volume of services.
The Patient-Centered Medical Home in the Transformation From Healthcare to He...Paul Grundy
Surgeon General of the Navy VADM Matthew L. Nathan, MC USN
Fortunately, we have a way to address this crisis—the
Patient-Centered Medical Home (PCMH) model launched at Naval Hospital Pensacola and Walter Reed National Military Medical Center, Bethesda, Maryland (formerly the National Naval Medical Center) in 2008. It is now being implemented throughout the Military Health System (MHS) and carries great promise. It provides the clinical framework we need to meet our strategic objectives in terms of quality of care, impact on costs, population health, and readiness. One of the most significant benefits of the team-based, collaborative approach is that it allows us to embed within a primary care environment the psychologists, nutritionists, tobacco cessation specialists, mind-body medicine therapists, and health educators our patients need in order to develop and maintain mindful, healthy behaviors—along with the “mental armor,” our active duty military personnel need to increase their operational effectiveness and their resiliency in bouncing back from stressful situations. As we move ahead with this more comprehensive approach to health, we can begin to better address so many of our patients for whom we can find no specific reason for pain and discomfort. The PCMH model also provides a positive impact on our costs. Early data reporting from the PCMH clinics at Bethesda show reduced visits to the emergency room, lowered pharmacy costs, and significant per beneficiary per year savings and improved Healthcare Effectiveness Data and Information Set metrics, access, and patient satisfaction and trust. These positive impacts on the bottom line can be applied directly to improved costs or toward the reallocation of resources from reimbursing those who are sick to the population health-based programs that can make and keep our patients healthy.More significant, however, the PCMH environment allows us to go beyond mere collaboration and to a much more proactive approach to managing our patient populations. It is within the context of the medical home that we can begin to surround our patients with the tools and resources they need to move them from health care to health.
The document provides a map of the United Kingdom with its major cities labeled. It shows Scotland with its capital Edinburgh and largest city Glasgow. Northern Ireland is noted with Belfast as its capital. England, Wales, and Ireland are labeled on the map with their respective capital cities of London, Cardiff, and Dublin.
Alexandria Kelly is seeking a challenging position that allows growth. She has a continuing education certificate in medical billing from Prince George's Community College. Her experience includes over 4 years as a collections coordinator at Educational Systems Federal Credit Union, processing claims and assisting with loans. Previously she was a member service representative at the same credit union for over 3 years, advising members on products and services. She also has sales experience from positions at Protocall Communications, a medical office, and Marshalls department store.
Aardvarks are furry animals that live in Africa and have pig-like faces, big ears, and good eyesight. They use their claws to dig into ant and termite mounds at night, eating the insects inside using their long sticky tongues. Aardvarks live alone in underground dens found in grasslands, woodlands, and scrub across much of Africa, and have a lifespan of around 10 years in captivity.
Alexandria Kelly is seeking a challenging position that allows growth. She has a continuing education certificate in medical billing from Prince George's Community College. Her experience includes over 4 years as a collections coordinator at Educational Systems Federal Credit Union, processing claims and assisting with loans. Previously she was a member service representative at the same credit union for over 3 years, advising members on products and services. She also has sales experience from positions at Protocall Communications, a medical office, and Marshalls department store.
Что такое Ad Block?
Кто блокирует?
Ad Block в цифрах
Мнение сайтов об Ad Block
Что такое Ad Fraud?
Ad Fraud в цифрах
Что такое viewability rate?
Что такое "видимый" показ?
iChemTM Revolution is an automated chemical control system that delivers precise amounts of chemicals based on volume and dosing frequency needs. It allows operators to remotely manage chemical programs and costs. The system features remote monitoring and control, automated calibration, variable dosing frequencies, and alarms to optimize chemical injection programs.
This document discusses combining real-time and batch processing by using a semi-aggregated strategy with snapshots. It presents a simple example of counting events in real-time using Storm and periodically aggregating the counts in Hadoop. This strategy allows for real-time processing with Storm while still being able to run batch jobs on historical data in Hadoop. It also discusses how this approach can be extended to other online algorithms like Bayesian bandits by representing distributions with sampling and updating counts in real-time.
Professional services marketing consists of organized activities and programs by professional services firms that are designed to retain present clients and attract new clients by sensing, serving, and satisfying their needs through delivery of appropriate services on a paid basis in a manner consistent with creditable professional goals and norms.
The document provides an overview of cloud professional services including:
1) Feasibility studies to assess infrastructure readiness and clarify expectations for cloud resources.
2) Cloud inception programs to clarify business objectives and identify critical processes.
3) Cloud architecture design including developing cloud architectures and interfacing points.
4) Cloud implementation services such as provisioning, storage solutions, and migration.
5) Cloud education on topics like public vs private clouds, cloud computing benefits, and building a cloud culture.
6) Cloud expansion and bridging services including reviewing service level agreements, governance, and integration.
In your reponses, identify common themes among your post and you.docxannettsparrow
In your reponses, identify common themes among your post and your peers’ posts. Describe utilization by long-term nursing home residents under an ACO. Are there policy solutions to these themes? Is there a better way to reimburse long-term care organizations? What are gaps in the ACO model of reimbursement?
should be 100 to 150 words, with a minimum of one supporting reference included
Response 1
The fact that I found most surprising regarding the cost of long-term care is that 1 in 10 older adults over the age of 50 that are in need of long-term care will be personally responsible for over $200,000 in costs. Although nearly half of adults 50 years of age and older will require a stay in a nursing home, only 10% of adults 62 years of age and older have private long-term care insurance (Braun et al., 2019). Another surprising factor is that Medicare does not cover the cost of long-term care service, placing financial responsibility on the patient and family (Willink et al., 2019). This is particularly surprising as Medicare is health insurance for older adults, and it is expected that they will need some type of long-term care service as they age. This adds to the financial challenges experienced by older adults as they are retired and may not have a steady stream of income. The older adult is responsible for the cost of housing, insurance, medication copays, health care deductibles, and the general cost of living just to name a few. In the event long-term care is needed, the services are paid for through private insurance, Medicaid if the individual is eligible due to low income, of out of packet by the patient or family. Payment patterns for long-term care in the nursing home include the majority of individuals entering the nursing home as a private payer and leaving as a private payer (Spillman & Kemper, 1995). Other payment patterns include individuals eligible for Medicaid, or individuals spending down assets to become eligible for Medicaid (Spillman & Kemper, 1995).
In the United States in 2017, the cost of nursing home care accounted for $166.3 billion dollars in health care cost, a number that is expected to grow to $270.7 billion dollars by 2027 (Chang et al., 2020). The Accountable Care Organization (ACO) is an alternative payment model that places the responsibility of the cost and quality of care directly on the providers, and the providers that are enrolled in the program are eligible to receive saving bonuses (Chang et al., 2020). The goal of this program is to provide highest quality of coordinated care with the goal of limiting the use of acute care such as unnecessary visits to the emergency room. This is made possible through communication between primary care providers, specialists, hospitals, and nursing homes.
Long-term care is reimbursed for services through Medicaid, private insurance, or through private pay. Low reimbursement rates can impact the quality of care delivered to aging adults in the long-term care.
Hello,
I would like to present my healthcare delivery start-up—At Home Nursing Services (AHNS). The aim of AHNS is to reduce the gridlock in hospital emergency departments (ED) and related life-threatening care delays. Our system will reduce hospital and Medicare expenses, while bolstering the health system infrastructure by improving geriatric use of hospital emergency department.
The problem with elderly visits to the ED is they too often result in hospitalization and many of those visits are avoidable. The estimated price of the average ER visit is around $2,200. Annual ED visits cost $80 B, and $8 B are unnecessary visits.
AHNS’ solution to this predicament is to reimagine the traditionally congested ED with an ED/AHNS linkage to eliminate unnecessary and costly hospitalizations.
For example, after an ED physician determines it’s unnecessary to hospitalize a senior, AHNS will treat the senior in the safety of their home with a new wave of digital products, making it easier to receive care via the benefit of telemedicine, and any equipment, medication or other supplies the ED physician believes is needed.
Instead of consuming an ED physician’s time and a hospital bed, AHNS’ disruptive differentiation is our 24-hour staffing of a caregiver (an HHA at our cost and at no expense to the hospital) who waits in the ED to meet the patient and care for them in their home. AHNS’ 24-hour on-call concierge service will reduce both Medicare and hospital costs while providing convenient home care for a senior.
In addition, we have the advantage of establishing a long-term relationship with a senior in the ED with an ED physician’s discharge that authorizes AHNS to provide additional skilled nursing services (RN, PT, OT) rather than going to another healthcare firm (a huge revenue source). Need substantiation of the concept? Consider the success of Luna PT and Dispatch Health, and realize we’ll be the first firm to care for the home health needs of the senior—not Luna or Dispatch. Please contact any ED physician for their reaction to the idea, and how we’ll be market dominant in the ED homecare field!
I am now actively looking for investor financing for our upcoming $950,000 Seed Round. Following are facts to substantiate my passion about this strong start-up: 1) The two founders of AHNS each have 20-years of experience in healthcare and emergency hospitalists, 2) The massive geriatric home care market is expected by Fortune Business Insights to reach $146.61 billion in 2028, and 3) 140% average annual revenue growth during first 5 years and over a 20X return on investment.
Attached is our Business Plan. If after reading the plan you have unanswered questions, or would like to review our financial projections, you can contact me by phone: (747) 235 9628 or by email: mhfruch@icloud.com.
Cordially,
Martin Fruchtman
Housecall Providers, a Portland-based nonprofit that provides home-based primary care, saved $830 per patient per month in the second year of the Independence at Home Medicare study. This represented savings of 26% over patients not receiving home-based care. For the second year in a row, Housecall Providers achieved the highest savings of the 15 sites in the study. The organization will receive $1.1 million in incentive pay for meeting quality measures such as reducing hospital readmissions. The study shows that home-based primary care can both improve patient care for those with chronic conditions and reduce health care costs.
This document discusses the importance of critical care nurse certification. It notes that today's critically ill patients require highly skilled care from teams including over 400,000 critical care nurses. It argues that certification provides validation of specialized critical care knowledge, skills, and experience for nurses. The document calls for public, employers, and nurses to work together to support certification and ensure an adequate supply of qualified critical care nurses.
The document discusses transitional care and efforts to reduce hospital readmissions. It provides background on the Hospital Readmission Penalty Program established by the Affordable Care Act and initiatives like Bundled Payments for Care Improvement (BPCI) that aim to improve care coordination. Popular tactics to reduce avoidable readmissions include patient education, risk assessment, care coordination between providers, and transitional care models.
Health administrators oversee various healthcare facility types including hospitals, outpatient clinics, long-term care facilities, clinical labs, and hospices. Hospitals provide in-patient care for patients needing extensive treatment while outpatient clinics offer brief care for issues not requiring an overnight stay. Long-term care facilities assist those with ongoing medical issues or disabilities with daily living. Clinical labs complete diagnostic tests ordered by doctors and other providers to diagnose and monitor patient health. Hospices care for terminally ill patients by a team of medical and support professionals. Healthcare administrators manage the business operations of facilities and their responsibilities vary depending on the type of facility and care provided.
This document discusses priorities for health and social care reform in Australia. It argues that current boundaries between healthcare, long-term care, and retirement living are unsustainable. It also claims that payment systems for doctors and hospitals are outdated and impede integrated care. The document advocates for breaking down barriers between health and social care systems, changing payment incentives to focus on quality over quantity of care, and strengthening the linkage between medical and social care.
This document summarizes elder abuse and neglect claims against nursing homes and assisted living facilities. It discusses the types of facilities, applicable regulations, common liability claims, and avenues for recourse when serious physical injury has not occurred. The most common liability claims involve violations of regulations addressing resident care, assessments, planning, and nursing processes. Regulations provide standards for proving negligence claims, though facilities may be revising some regulations to reduce burdens. When litigation is not feasible for less serious neglect, other options like ombudsman processes are available.
The Benefits of Home Health Care Services for Elderly PatientsOmniMD Healthcare
If you have an elderly patient who needs medical assistance around the clock, you may consider home health care services. Continue reading the post to know how exactly this system can help. OmniMD's innovative home healthcare solutions are tailor-made to empower seniors and support their families. It offers resources to set up fully functional home healthcare agencies with the least possible glitches.
The document discusses various perspectives on quality healthcare including those of the government, patients, and healthcare providers. It outlines the government's national strategy for quality improvement and focuses on better care, healthy communities, and affordable costs. The patient perspective values compassionate care, time with physicians, timely appointments, and preventative programs. Providers value proven outcomes and reduced errors. The document also discusses opportunities to lower costs through standardized care and reducing unnecessary variations in treatment and costs. It provides examples of accountable care organizations and bundled payments that aim to improve care coordination and reduce costs.
Home Care Services: Empowering Independence and Well-being | Enterprise WiredEnterprise Wired
The core ethos of Home Care Services lies in enabling patients to receive professional healthcare without needing hospitalization or residing in long-term care facilities.
After reviewing the information from the articles Ive chosen on the ca.docxchristina345678
After reviewing the information from the articles I’ve chosen on the care and transition of elderly patients into long-term facilities I have come to a series of points to tackle for my project on order they are.
1:What are the Critical Junctures of Nursing at Long-Term Health Care facilities? The Critical Junctures of Nursing at LTCF’S are “ Care transitions (CT) are critical junctures in the healthcare delivery process. Effective transitions reduce the need for subsequent transfers between healthcare settings, including nursing homes. Understanding social services (SS) involvement in these processes in nursing homes is important from a quality and holistic care perspective†(Galambos, 2022).is the transition of elderly patient from their previous home or facilities into new ones. This coupled with their adjustment to life in the new facilities and use of specialists , in helping them transition, with the utilization of specialized workers such as Social Services staff , coworkers, and family to help the patient transition successfully. The second Critical Juncture is discharge to a hospital or another specialized facility for specialized treatment
2:What are some of the challenges for Nursing Home Facilities Patients?These patients face a number of issues such as . Cognitive issues, atrophied muscles, inability to complete the activities of daily living safely, or some combination of these and other risk factors often make it unsafe for Medicare patients to go straight home after a hospital stay(NCBI ,2022)
3:What are SNF’S ? Is the role of SNF’S? SNF’S or Skilled Nursing Facilities are specialized patient care facilities whose role is to safeguard a patient during a step-down from a hospital stay or for prolonged care when a patient requires a high level of ongoing care. SNFs provide medically necessary short-term or long-term care when those needs are best met in a semi-clinical environment. Providing ongoing care post-discharge from a hospital often leads to a higher quality of life as well as a lower lifetime cost of patient care. But the daily cost of a SNF can run from a low of $140 to a high of $700+. The average daily cost is around $250, which is beyond the average American’s reach. Therefore, payment becomes a vital issue(Farber , 2021).
4: What are the inadequacies of the Nursing facilities system?How have some facilities improperly handled the care of elderly patients? To give an example locally within my current state of South Carolina , an elderly woman in question with a number of errors that the facility committed including a lack of supervision, employees, or resources . The consequence of all these missteps, in their opinion, was that resulted in the patient in this case suffering abuse, dehydration, malnutrition, and a variety of other harms.†(Law center LLC 2022) . The offers of both participants for settlement being weighed closer other claimants “ The family’s demand was higher than the d.
This document provides an overview and introduction to palliative care. It discusses that palliative care focuses on relieving pain, symptoms and stress of serious illness to improve quality of life. Palliative care is delivered by an interdisciplinary team and can be provided at any stage of a serious illness alongside curative treatments. The document summarizes research finding that palliative care can reduce costs by lowering hospitalizations and emergency visits while improving quality outcomes like symptoms and satisfaction. It also outlines strategies some health payers and organizations are taking to integrate palliative care, like targeting high-risk patients, dedicating case management resources and reimbursing providers.
The document discusses a recent Medicare ruling that will affect Kindred long-term acute care (LTAC) hospitals. Key points:
- The ruling from the Centers for Medicare and Medicaid Services (CMS) is designed to ensure appropriate payments to LTAC hospitals for treating severely ill patients.
- Under the ruling, Medicare payments to LTAC hospitals are expected to be $5.3 billion for 2007. The CMS Administrator said the policies aim to ensure seriously ill patients receive necessary care with appropriate payments.
- The Kindred Healthcare CEO commented that while payment reductions may not address issues with LTACs, Kindred hopes CMS will develop certification criteria to ensure only complex patients are treated at LTACs.
The document summarizes the benefits of a telemedicine program called HealthPerx. It addresses the challenges of affordable and accessible healthcare by providing individuals and employers with 24/7 access to physicians by phone or video at no cost. Studies show this reduces medical costs by decreasing unnecessary visits. Additional benefits include discounts on prescriptions, dental, vision, and hearing care. Employers benefit from reduced absenteeism and healthcare costs. The program offers a turnkey solution to current healthcare issues.
Home Health Care At Home
Emergency Healthcare at Home: Doctor Tips
Description:
In times of medical emergencies, having the right knowledge and preparedness can make a significant difference in ensuring the well-being of yourself or your loved ones. With the "Emergency Healthcare at Home: Doctor Tips" guide, you can access essential information and expert advice to handle urgent medical situations effectively and promptly from the comfort of your own home.
This comprehensive guide is designed to provide practical tips and insights from medical professionals on managing various emergency healthcare scenarios. Whether it's a sudden injury, an acute illness, or a potentially life-threatening situation, the guidance within this resource will help you stay calm, take appropriate actions, and potentially save lives.
Inside, you'll find:
Recognizing Emergency Signs: Learn how to identify the warning signs of a medical emergency, including symptoms that require immediate attention. Understanding these signs will enable you to react promptly and seek appropriate medical help.
First Aid Techniques: Discover essential first aid techniques for common emergencies such as burns, choking, heart attacks, strokes, and more. Expert recommendations will guide you on providing immediate care until professional medical assistance arrives.
Emergency Supplies Checklist: Prepare yourself for emergencies by understanding the crucial supplies and medications to have on hand. This checklist will help you assemble a well-stocked emergency kit, ensuring you're ready for unexpected health crises.
Communication and Contact Information: Find out how to effectively communicate with emergency medical services and provide accurate information about the situation. Learn about important contact numbers and resources that can be vital during a healthcare emergency.
Managing Chronic Conditions: Gain insights into handling emergency situations for individuals with pre-existing chronic conditions, such as asthma, diabetes, allergies, and more. Discover strategies to mitigate risks and manage emergencies specific to these conditions.
Psychological Support: Learn about the psychological aspects of emergencies and how to provide support to individuals who may be experiencing trauma or distress. Understand the importance of emotional well-being during and after a healthcare crisis.
By utilizing the valuable information and expert advice presented in this guide, you can enhance your emergency preparedness and be better equipped to respond effectively in critical situations. Stay informed, be proactive, and ensure the safety and health of yourself and your loved ones with "Emergency Healthcare at Home: Doctor Tips."
MORE DETAILS CLICK HERE : https://tinyurl.com/bdcv9u99
Similar to Proposal - Respiratory Care Attendant Program (20)
1. A BETTER WAY: IN HOME
CARE FOR TEXANS WHO ARE
VENTILATOR DEPENDENT
A Model Program to Reduce the Need for Nursing Home Care
OCTOBER 23, 2014
DOROTHY HILL, FLORA A. BREWER AND FRIENDS
4816 Blackstone Dr. River Oaks, TX 76114
2. 1
Proposed: Improved Home Care for Ventilator Dependent Texans
Over 500 Texans who live supported by a respiratory ventilator use Texas long term care
programs. Experience shows that quality home care is the best option for these Texans. But
improvements are needed to meet the needs of this special needs group. Improvements in home
care for ventilator dependent Texans is a win-win-win scenario: Better health outcomes; Lower
healthcare costs; and Economic development. We’ll show you how.
Who We Represent: 24/7 Ventilator Dependent Consumers
Dorothy Hill, is a post polio, 24 hour ventilator-dependent Texan with quadriplegia who lives
at 4816 Blackstone Drive, River Oaks, TX 76114. In 1949, at age 14, polio left her totally
paralyzed and in an iron lung. After two years, she came home, finished school and eventually
started her own business (in which she employed four other severely disabled persons with
quadriplegia). Since 1987, she has been ventilator dependent. Then and now, she has needed
breathing aids. Then and now she is active in trying to resolve unmet needs for the disabled.
During the ‘60's &’70's, while operating her own business, her efforts resulted in the first curb
cut in downtown Fort Worth and gaining City Council support for the first handicapped housing
in Fort Worth. Since then, she has been fighting another battle to improve care for ventilator
dependent patients. For 62 years she has known the fears of those dependent on machines for
their very next breath for survival, along with the fear of “Who will take care of me?”
Conditions Facing 24/7 Ventilator Dependent Consumers in Texas
Less than 1% of all the nursing homes in Texas will consider accepting a
ventilator dependent patient. Reason: They are either inadequately staffed or unable
to meet the unique needs of a 24 hour ventilator dependent patient including cost of care and
liability increases. “Among the nation's seven most populous states, Texas ranks last in the
number of long-term nursing facilities for adult patients who can't breathe on their own, and near
the bottom in how much it will pay for their care.” (2002 Houston Chronicle) Those nursing
facilities that accept the additional funding available from Medicaid still struggle to provide
quality care in an institutional setting for ventilator dependent patients. For example, in 2007, a
Celina nursing home facility that undertook the task of caring for ventilator patients was closed
due to a state investigation finding unsanitary conditions, improperly set ventilators, humidifiers
and improper use of equipment. (“'Squalid' Conditions Found At Celina Nursing Home” CBS
July 2007)
Nursing homes are ill-equipped to care for ventilator dependent patients. According to a
nursing home floor supervisor, Dianna Sawyer, nursing homes are so understaffed that it is very
difficult to give the care that is needed for these unique clients. Nursing schools teach only the
basics about the respiratory system and nurses are told “the RT [Respiratory Therapist] takes
care of the rest”. But RRT’s [Registered Respiratory Therapists] are not available in nursing
homes for every vent patient admission. Even after being assured by a hospital that a client is
stable and would not need any "extra equipment", patients may arrive requiring humidified O2,
suctioning every 4hrs and a specially-sized new cannula. Equipment has to be borrowed and may
not be available. If the appropriate size cannula is not available, the nursing home must call 911
and send the patient to the nearest ER for a new trachostomy if it becomes dislodged.
A Better Way: Home-based Care for Ventilator Dependent Consumers
3. 2
The needs of Texans who are 24 hour Ventilator dependent are uniquely suited to home care.
If a patient is sent home with the correct equipment and a trained attendant, emergency
department charges and unnecessary hospital stays are avoided. Dorothy uses the Consumer
Directed Services option, in which the individual hires and supervises their attendants,
maximizing independence. Dorothy has experienced nursing home, in-home, and managed care,
through waiver and non-waiver programs. Based on Dorothy’s experiences in all care delivery
modes, home care with trained attendants has been the most effective in meeting the special
needs of vent dependent patients, keeping them out of nursing homes and ICU’s, and assuring
that attendants are adequately trained and supported.
Dorothy has managed her post-polio disabilities all of her life and now assists other vent
dependent patients. Today, she trains her own caregivers in a rigorous and structured 3 week
program that she has perfected over decades. She does this while enrolled in a Star Plus non-
waiver program, using the Consumer Directed Services option. Dorothy’s dream is that all 24
hour vent patients (as she calls herself) could experience the health and quality of life advantages
of living in their own homes with (a) caregivers who are paid a living wage to assure quality and
reduce turnover and (b) are paid during a consistent training program provided by a qualified
instructor, specialized in respiratory care. None of our current home care programs assure these
elements.
The cost of nursing home care for ventilator dependent patients was 1.7 times DADS home
care cost. (Other program data was not accessible to DADS. No cost data is available for Star
Plus patients.) As of 8/29/2013, according to the DADS Quality Reporting Unit, there were 536
ventilator dependent patients in Texas Medicaid funded nursing facilities and home care
programs (CBA, MDCP, and the Star Plus waiver program). Annual average charges for CBA
ventilator dependent patients were 3.2 times the average cost for all CBA program participants.
Annual average cost for nursing home care for ventilator dependent patients was 2.5 times that
for all nursing home patients.
What it takes to make Home-based Care Successful for Ventilator Dependent Consumers
The second recommendation from the Interim Report to the 83rd Texas Legislature from the
Joint Committee on Aging, January 2013 states “in order to ensure that our aging population is
receiving the best quality of care possible, Texas must invest in the workforce that cares for them
on a daily basis. Strategies that address this need include proper training and payment of direct
care workers, geriatric medical training, and continuing education throughout the career of health
professionals on the unique needs of the aging population.”
Personal care attendants in the CBA/Consumer Directed Services program are paid
approximately $9.77 per hour (given a 2.7% unemployment tax rate) for largely part time work.
Wages in the Star Plus non-waiver CDS programs range from $8.68 to $10.80 per hour
depending on the managed care company chosen. Attendants in the traditional agency model are
paid less. These professionals get no health insurance, must use their own vehicles without
reimbursement to get to their clients, and make wages that make them eligible for state and
federal welfare benefits (SNAP, Medicaid, housing subsidies, etc.). Their poverty makes it
difficult for them to provide consistent care for their clients. A car breakdown can put them out
of business. A majority of personal attendants are single women with dependents. According to
4. 3
the Center for Public Policy Priorities (www.cppp.org), in Tarrant County, a single parent with
one child without employer paid health insurance and no extra money for savings would require
a wage of $21 per hour to afford local affordable rents, transportation, food, health and child
care. The wage required goes down to $15 per hour if the employer pays for a health insurance
premium. Only for a single adult, with no children and with employer paid health insurance
premiums, does the wage requirement go down to $10.42 per hour with $27 per month allocated
to savings for emergencies.
No specialized training or license is required or provided for personal care attendants, except
that required by state law. The client is responsible for all training in the CDS option. The work
of caring for a medically intensive person with disabilities requires a great deal of skill,
knowledge, and emotional intelligence. A common cold sends a ventilator dependent patient
toward respiratory failure. All vent patients are admitted directly to the ICU at $2300 per day.
Proper care limits hospitalization and saves Medicare & Medicaid dollars. Dorothy’s last 3-day
ICU hospital stay cost $40,000.00.
The CBA/CDS (or Star-Plus Waiver/CDS) in-home long term care program, structured and
scheduled properly, is the most cost effective way for a vent dependent patient to remain in their
home. CDS is the only program offering client-trained attendant care, providing for more
individualized care. In the Consumer Directed Services (CDS) option, a home can be
transformed into a miniature ICU unit without the infection dangers of institutional
care. Institutional care in nursing homes cannot compete with home care in cost or quality of
health outcomes. However, none of this is either possible or sustainable without regard for the
care givers. Trained attendants for vent dependent clients require the basic skills of the Certified
Nurse’s Aide license plus CPR; basic respiratory therapy care; respiratory equipment
sterilization and operation; as well as some physical and occupational therapy tasks.
1) Specially trained attendants must be assured of an hourly wage that is sufficient to support
their own health care, child care, and maintenance of their primary vehicle. This is necessary
to give patients continuity of care in their attendants. We recommend that CBA and Star
Plus programs provide an average wage of $15 per hour, leaving room for experienced
employees to receive performance increases with skill and longevity. The median annual
wage for Certified Nurse’s Aides in Fort Worth nursing homes is $23,763
(http://www1.salary.com/TX/Fort-Worth/Certified-Nursing-Assistant-Nursing-Home-
salary.html) or about $12 per hour including employer paid benefits, making a $15 per hour
wage competitive for the attendant in an independent home care environment with a
medically intensive patient. Further, moving portions of attendant hours to Protective
Supervision at a lower rate is inappropriate for attendants of ventilator dependent consumers.
As evidenced by the sample schedule of tasks attached, there is no time when a person of
lesser skill can be useful to a ventilator dependent consumer. Doing so jeopardizes their
health. Paying skilled caregivers less for a portion of their hours will result in turnover.
Attendant reliability and skill are the keys to success.
2) A high quality in home care program for vent dependent patients requires professional
support, including the case manager and a Registered Respiratory therapist working as a team
to support the client’s evaluation and training of attendants. The case manager or RRT
should be available 24/7 for telephone inquiries to provide coaching to the patient and
minimize emergency department visits and make a quarterly in-home visit to monitor patient
5. 4
condition and adequacy of care. The patient’s Durable Medical Equipment provider must be
experienced in supporting in-home patients and be supervised by the RRT or case manager.
The CBA program provides for trained supervision, but not all vent dependent patients are
placed in CBA. The waiver program, (Primary Home Care) is not adequate to support vent
dependent patients. Dorothy was previously on PHC and was only authorized XX hours of
attendant care per week and was hospitalized sometimes 3 - 4 times per year. When she
convinced her RN case manager to authorize more attendant hours and developed her current
attendant training program, she has only been hospitalized 2 times in 5 years, neither of
which was respiratory-related. This saved hundreds of thousands of dollars per year and
substantially increased her quality of life.
3) Transportation accessibility was one of the three recommendations of the Texas Joint
Committee on Aging to improve the health and welfare of aging and disabled Texans. A
simple improvement would be to remove the prohibition against personal care attendants
driving their clients to appointments, shopping, and to engage in community activities.
Ventilator dependent consumers cannot travel without a caregiver. Allowing the caregiver to
drive as well as accompany the consumer makes good economic sense.
4) Without caregivers who are well-trained and dependable, when a ventilator dependent
consumer contracts an infection, it currently means an expensive trip to the ICU. These
consumers can be well-managed at home, even through recovery from an upper respiratory
infection. But to do so takes an increase in direct care service hours. Currently, programs do
not allow for increased service hours during recovery from an infection. Caregivers either
work without pay, if they can, or the consumer goes to the hospital. Case managers of
ventilator dependent consumers must be able to authorized increased hours during an
infection to help avoid ICU costs and fairly pay workers.
Nursing Home Care for Vent Patients Can be Improved through the CDS Model
The Ventilator Dependant Consumer needing 24/7 care who has no home or family to turn
to, can have quality care by utilizing the CDS trained attendant care program while placed in a
long term care facility. Currently, CMS will not allow CDS attendants to be paid when the
consumer is in a facility. Unfortunately, facilities don’t have the capacity to maintain trained,
available direct service workers just for a vent dependent patient who might be admitted.
Further, the facility must quickly provide equipment and staff familiar with the patient’s needs.
This usually means that care suffers for CDS consumers in facilities, unless their attendants work
without pay. With some specific policy changes, facility care could be improved in the
following ways:
Upon contacting a long term care facility regarding admitting a ventilator dependant
consumer, whether for respite or long term care, the facility would notify the CDS, RRT
Case Manager to coordinate with the facility to set up services for their evaluated care
and equipment needs and those needs to be in place prior to admission.
A trained vent care attendant would come for an authorized number of hours per week,
same as In-Home Care, to cover the unique personal care needs, equipment checks and
availability for special needs outside of the facility normal services.
A Vent Care Program R.R.T should be available for conference calls, emergencies and
equipment troubleshooting. The facility nurse would support the do patient’s daily
physical condition checks, meds, etc..
6. 5
By utilizing the CDS trained attendant care program the long term care facility will be
relieved of liability concerns by having assurance that a ventilator dependant patient who
faces possible respiratory distress at any given time - has watchful care that ordinarily
might be overlooked by the regular staff, with limited time per patient.
Where the Money Comes From for Better Wages and Training:
As with many funding gaps in public policy, challenges lie in the fact that the cost savings
and cost to implement are in different fiscal pockets. According to the Joint Commission on
Aging Interim Report, “any efforts on the state’s part to reduce nursing home to hospital
admissions [are] in the best interest of CMS. Not only would it reduce federal Medicare
expenses associated with hospitalization, but it would also reduce the risk of poor health
outcomes for residents since hospital admissions increase the risk of injury and of hospital
acquired infections.” Waiver programs that adequately fund direct caregiver wages and training
will be more likely to obtain the desired health and cost of care benefits.
First, Money Follows the Person (MFP) funds can be allocated to fund a pilot program that
would move ventilator dependent nursing home residents out into a home care program. The
Medicaid waiver process can help states obtain CMS funding for reducing hospitalizations. The
Joint Commission cites the Balancing Incentives Program and the Texas Dual Eligibles
Integrated Care Demonstration Project as other sources of funding. Cost savings can be more
directly attached to cost of care in the new Texas managed care model in which acute and long
term care services are becoming co-managed: savings in ambulance, emergency department and
intensive care unit hospitalizations can be easily compared with better attendant wages and
training expense.
Summary and Recommendation for Research
This proposal recommends a list of steps to improve vent patient care:
Preference for home care over institutional care, especially in a consumer directed
model to decrease cost and improve health outcomes;
Sufficient attendant hours to assure health maintenance;
Living wages for personal care attendants to increase dependability and continuity of
care;
Paid training program standards for attendants including respiratory-specific care;
Professional teams that include RRT’s with case managers who are easily available
by phone and visit the patient at least quarterly.
Flexible increases in direct service hours that allow case managers to authorize
increases in home care service hours to help consumers heal from infections at home and
avoid the ICU.
Changes in policy to allow CDS trained respiratory attendants to serve their clients
when facility care is necessary thereby decreasing nursing facility liability and
improving patient care to eliminate ambulance trips to the hospital, Emergency
Department and ICU costs.
To evaluate the effectiveness of care for persons who are ventilator dependent, some of the
highest cost patients in Medicare and Medicaid systems, we recommend that evaluation be
7. 6
conducted to accumulate all the costs of care, frequency of hospitalization, morbidity and
mortality in various types of treatment settings (home vs. institution, waiver vs. non-waiver)
associated with variables such as number of hours of attendant care, attendant turnover, hourly
wage, amount and type of professional supervision. We must develop best practices for vent
patient care that maximizes health and reduces cost. Managed care companies should be
required to support this investigation and publish findings widely. Incentives should be base on
use of best practices. Texas hospital spent over $16 billion in 2011 on hospital stays for patients
who were on invasive ventilation equipment. Twenty-six percent of these patients died. 16% of
these expenses went to Medicaid. If even a portion of these hospital stays could be eliminated
through improved home care of ventilator dependent patients, the savings in both dollars and
lives would be significant.
8. 7
Sample Schedule of Tasks for Personal Respiratory Care Attendant: 7AM - 11:30 AM
KNOCK: Open Door- “HELLO”, it’s me (say name to identify).TURN FRONT PORCH Light OFF.
7:00 AM Open up blinds as you enter - Each side of front door - Office & Living room (unless still to dark)
Monday & Thursday AM >TRASH DAYS> To CURB before 7:30 AM to comply with city rules. Wash
Hands Thoroughly! TURN ON COFFEE MAKER.
7:15 AM TO Dorothy’s Room: Turn on lights. Push IPPB table back; Put remotes in place, Peep Valve in
place; Move tissues from bed. Turn covers back as instructed; PM pillows off bed & place properly. GET
ON BEDPAN. Push VENT table back; Scoot “D” Up In Bed. Put “D” on Bedpan & Cover up “D”. Raise
head of bed up all the way. Place Bed tray on bed, give D a drink of water. Get Mask Sterilization Cup &
Put on Bed tray. TURN ON HUMIDIFIER. Change out Vent mask Tube & adapter to day adaptive
mouthpiece for intermittent/or continuous breathing. Change Vent from night settings to day settings.
STERILIZE MASK: Put Mask In Cup; take mask to bathroom sink, Fill with cold water, Put in 1 Efferdent
tablet, set cup on top of toilet tank to soak; set timer for soaking Time to avoid damage to mask.
PUT WATER/COFFEE ON BED TRAY. TAKE MORNING MEDS. DRINK 1 CUP COFFEE:
Same time frame: Fold T.P. for D’s hands, Wet paper towels for “D”s off bedpan use.
7:45 AM Clear Bed tray: Water & Coffee to table.
Breathing Treatment Prep: Hang IPPB TUBES in post bracket; Is Med Cup clean? Get out med, Put in
place,
Start Treatment: Uncover IPPB Mouthpiece, Put Med in Cup; Hand tube to DH.(Treatment takes 30
minutes to stretch out air ways with assisted cough needed intermittently to clear airways)
Off Bedpan Give T.P. & Wet paper towels to “D”, Move bed tray, Lower head of bed part-way; Take
Night Pillow from head, PLACE VENT TUBE; Stool/Pillow in place for assisted cough. WHILE DH
cleans private parts with wipes;
Empty/Sterilize BEDPAN and Prep bathroom: Sterilize sink/Commode thoroughly. Get out clean wash
cloths, Fix Tooth Brush, Anti-Plac & salt rinse.
During Treatment: BEGIN DRESSING: BRACE ON as instructed; Put bottoms & hose on foot board;
Assist W/coughing; all other clothes on clothes rack, P. J. Bottoms off; Hose &Clothing bottoms on;
Place lift seat & Back.
TREATMENT END: Check D’s capacity numbers; Turn off IPPB Machine. Cover IPPB mouthpiece wash
med cup, put in place; hang up tube. Hand D VENT TUBE.
8:30 AM UNPLUG CHARGERS (3) Put cords in place; TURN OFF ELECTRIC STRIP For CHARGERS.
PREP LIFT: Roll Lift into place over DH; Plug Orange cord into electric strip, Lower lift; Hook up Lift Seat
& Back as instructed; Place D’s Hands on T-Bar ready for Transfer to Chair.
TRANSFER: HOLD D’s NECK!! Raise lift up all the way; TURN Ankles/legs around/over Bedside;
Push & Position over Chair. LOWER LIFT - Push D back in chair securely- remove lift seat & back, fold &
put in place. Unplug lift; Roll & hang cord on T-bar & put back in storage place.
8:45 AM IN CHAIR: TURN OFF HUMIDIFIER; Turn bedside vent OFF - Turn on chair vent ON – Check
settings. FINISH DRESSING: Shoes on; Tops On. Assist with hair; Grooming & Oral hygiene.
9:15 AM While DH brushes teeth & washes face up, do following: Go to IPPB & Table: PREP IPPB &
Table for next treatment. IPPB tube in place; CK Tissue Boxes, Check Cough lozenges, drops in bedside
sack in case needed in the night. Refill HUMIDIFIER BOWL with distilled water. Rinse Mask / Put in Place
to dry.
9. 8
9:30 AM TO KITCHEN AND/OR LAUNDRY ROOM
Laundry room: Shower Days: Change/Wash linens. Non shower days Wash clothing as needed &
instructed. Washer takes 35 to 40 minutes per load. Dryer takes 60min or more.
Toileting
KITCHEN: Prepare & assist with eating Breakfast; Wash/Dry dishes, Sweep kitchen If needed.
10:00 AM Percussion Treatment: (20 minutes in percussion machine with attendant operating machine.
During Treatment Assist W/coughing.
10:25 AM To D’s ROOM: MON, WED, FRI OR SAT: Change out all VENT and IPPB, circuits, filters, and
corresponding adapters. Put Reusable tubes and parts in sterilization bowl. TUES, THURS, SAT OR
SUN: Shower /Shampoo Days > Important to Rid allergens, airborne germs, etc. from body. Prep all
needed items prior to entering shower to conserve time due to vent dependency. (Shower days) Change /
wash bed linens.
Make up bed each day as instructed / Turning back & fix covers as instructed. Important to allow for
body movement during night when D’s alone. Put needed pillows on bed. Be sure knee, Heart pillows &
other assist cough pillows to be in place if hasty access is needed.
Check all equipment: Wipe down with Clorox wipes. Check “D” ROOM! Is All Prepared for the mid-day
assistant’s tasks? Check Bedside Vent Table: Mirror is OK; Tissue box is full; Tubes are in order for next
treatment.
11:15 AM Check ice trays, fluids intake very important. Ask about LUNCH FOOD> Anything from freezer
to thaw, etc.? Dry/put up dishes; Clean off Counter Top; Wipe Out Inside Microwave.
11:25 AM Toileting, Be Sure D. Has Liquids on Table Before Leaving & Small Snack If Needed.
10. 9
A Proposed Model: In-Home Attendant Training – Ventilator Dependent Patients
Instructor: A Clinical Registered Respiratory Therapist experienced in setting up and overseeing
vent patients in a home care setting.
Program Content and Methodology: While the following topics are consistent with basic state required
agency training or a certified nurse aide course, agency employees rarely get more than 4 hours training
and Consumer Directed employees typically have none as none is required. The following training must
be conducted in the home, “hands-on” with the attendant and the particular ventilator dependent client.
All topics are intended to cover exactly the needs and issues of the particular patient adapted to their
home and their equipment needs, which are never included in basic programs.
Topics:
Cleanliness techniques:
Many emergency department visits result from lack of proper cleaning. Germ or a virus
ingested can cause Diarrhea, leads to electrolytes issues, nausea/vomiting, danger of
aspiration.
Applies to Bed Linens, laundering, washing dishes (washing techniques for sterile dishes),
and other kitchen areas needing special cleaning.
Cleaning House (Dust is a respiratory hazard), arranging Furniture to incorporate equipment
needs.
Bathing/Personal Hygiene, quick baths/showers (considering client’s vent dependency); grooming & nail
care.
Dressing /undressing while working around tracheotomy and vent equipment.
Routine, Hair & Skin Care needs, working around tracheotomy and vent equipment, including training to
identify possible Decubitus Stage 1 Ulcers and treatment
Transfer /Ambulation/Positioning; Exercising/Range of Motion, specific to working around a tracheotomy
and/or vent tubing & equipment.
Bowel and Bladder Program, specific to patient
Meal preparation, Eating/Drinking with difficulty swallowing, (usually present with breathing difficulties)
including feeding tube techniques, techniques for safe, effective assisted cough.
Accompany Client along with equipment on trips to obtain health care services, Personal and/or
Household Shopping.
Prescribed methods for assisting with self administered medication,
Respiratory Equipment operation and care:
Set-up ventilator equipment, enter prescribed settings and controls for client, monitoring same.
Change out and sterilize all equipment circuits & filters, clean equipment
Charge and keep charged all external and internal batteries.
Troubleshoot equipment problems including terminology needed to resolve equipment problems
over phone with DME provider and RRT.
Maintain status on ordering of equipment, supplies; and maintenance schedules.
Recognize signs and symptoms of infection
Perform tracheotomy care and suction
Administer in line nebulizer treatments and oxygen at home
Quickly activate emergency backup.
11. 10
Other Patient-Specific Skills training:
Vital signs
Blood sugar monitoring for diabetics
Sterile technique for in and out catheterizations
Incontinent care
Sterilization of all reusable equipment
Non-sterile dressing changes
Communication, Reporting and Coordination of Care
Monitor and notify nurse of medication changes
Recognize and communicate with Nurse/RRT regarding any condition change.
The RRT Manager or Nurse Case Manager would be responsible for performing the following if needed:
Monthly Foley catheter change; Administration of I.V. antibiotics
Medi-Port and I.V. care
Sterile dressing changes
Monthly visit for well check
Communicate with MD/NA/RT any sudden condition change
Monthly and PRN tracheotomy inner cannula
Sample list of classes for the Vent-Dependent Consumer Caregiver Program (note some overlap with
personal attendant training requirements and Certified Nurse Aide programs):
1. Introduction
2. A&P of the Respiratory and Cardiac system
3. Vent instruction
4. Circuit changes & cleaning
5. Infection Control
6. Trach Care and Trach changes
7. Vital Signs and signs and symptoms of infection.
8. Cleanliness of the home
9. Preparing meals
10. Suctioning, oxygen, and inline neb treatments, IPPB and other equipment
11. Diabetes Care
12. Catheter changes
13. Enteral Feeding. (Food Pump vs. Bolus Feed)
14 Good Body Mechanics
15. Bathing a patient with dignity
16. Trach Collar/Mist
17. Passy Muir Valves
18. CPT
19. Handling family dynamics
20. Emergency Preparedness
21. Trach Collar and Mist therapy
22. End of life issues
23. Testing
12. 11
Procedure for Initiating Home Care for Vent Dependent Patient
Ventilator patients and their attendants are not adequately prepared by DME provider Respiratory
Therapists. Current practice requires only that the equipment be delivered and that someone be shown
how to operate the equipment without sufficient time to ensure competency.
Two attendants (to assure back-up) should always be trained to assist the patient
Patients must be assessed at the hospital to include reviewing the chart and meeting with the
client and family to review their care and equipment needs. Patients and family members should
be informed concerning what to expect about the home care and what training will be required.
A home assessment must be conducted to identify potential problems and safety issues such as
adequate electrical capacity for equipment operation; adequate water supply for sanitation; mold;
adequate heating and air conditioning
The RRT Case Manager/Instructor should deliver other equipment and supplies a day or two
before discharge to give the family or attendant time to get everything arranged.
Following training, caregivers must be tested over the equipment and stay overnight with the
patient, preferably at least 2 nights before discharge and perform total care of that patient.
On the day of discharge, the instructor should plan to spend the majority of the day with the
family. Once the patient is home and established in care, the instructor may leave briefly, only to
return to assist with any additional questions or techniques later in the day.
Before ending the training, the RRT case manager should assess the effect of the move on the
patient and determine whether additional oxygen or other changes to treatment are necessary.