Are You Prepared to be a Caregiver?

CMS has recently posted a new video titled, Caregiving: Trends and REACH into Indian Country. They state that 20% of us are already caregivers now or have been in the past year and caregiving costs in 2009 were $450 billion per year!

Caregivers provide such services from laundry, meals, housekeeping, and shopping to wound care, medication management, and IVs. Yes, you may need to administer medications via an IV.

So you are saying to yourself there is no way I am going to shower my parent or start an IV. OK, then who do you plan on doing those tasks? If you say Medicare or insurance will pay for someone to perform those tasks you are only partly correct. Qualified individuals may be admitted under the Medicare Part A benefit to either a skilled nursing facility or a home health agency after a hospitalization. Either way, once the patient’s goals have been met, they will be discharged.

So how do you prepare now to be a caregiver for a loved one? 

Talk to your loved ones about long term care insurance. Since caregiving is so costly, you may want to either start saving now or think about investing in a LTC policy. US Department of Health and Human Services has published a list of average health care costs. 

Other than costs, the best way you can prepare now is to be knowledgeable about loved one’s insurance policies, their advanced directives to include healthcare power of attorney or living will, and what community services are out there to assist.

If a loved one has been discharged from a hospital with a new diagnosis or a complex medical need, hopefully their doctor has referred them to a skilled home health agency who can assist you in the transition home and teach you valuable medical management. A good agency will have an MSW that can assist in coordinating other community services such as adult day care, low cost assisted living, meals on wheels, transportation to medical appointments, assistance for ADLs if you are unable to provide, etc…

So can you really prepare yourself to be a caregiver? Probably not. But knowing a little bit about the healthcare system, advanced directives, and  community services can help. When you are faced with that new role, chances are you will need to make changes in your life. It most certainly won’t be a time in your life when you are sitting around thinking, “Gee, I don’t have anything to do. I really need something to fill in my extra time.” It most certainly will be a time when you are working full time, have kids at home, have plans for vacations, and have a certain routine in your life.

 

 

 

Do Your Due Diligence

My job in home health care has been to assure that my staff provides excellent care to our patients in the most cost efficient manner. Of course it’s a little more complicated than that, but that is what it comes down to.

Recently in Indiana, a large home health company has been in jeopardy of losing its Medicare license because of poor patient care.

Nightingale Home Health, according to Indianapolis Business Journal, “won a temporary injunction on Jan. 25 preventing Medicare from immediately terminating payment for its services. That decision spared Nightingale from almost certain death, because 77 percent of the agency’s nearly 900 patients are covered by Medicare.”

What did they do? IBJ reports:

One patient, who had a urinary tract infection, received no visits from Nightingale staff for a month after his usual nurse went on medical leave, the Medicare agency said. He developed sepsis and was taken by ambulance to a hospital. He was discharged nine days later but returned to the hospital within 24 hours and died two weeks later.

A second patient was supposed to have his blood drawn for testing, but the agency said Nightingale staff members failed to show up to do so on several occasions. When staff members did show up, they often were unable to successfully draw blood, with one employee saying “she would have to have a refresher course in lab.

It’s what makes me work late nights and come in before anyone else. It’s what makes me work weekends and holidays. I want to make sure something like this NEVER happens to a patient.

So, when looking for a quality home health care agency, do your due diligence in finding a quality home health care agency. If a suggestion is made by a hospital social worker or physician, follow up on the agency.

How do you follow up? Stay tuned and I will give you some valuable information to determine what home health care agency is best for you or a loved one. 

Is Your Hospital Making You Sicker?

Methodist Hospital Gary Indiana

In a federal report released by Kaiser Health News, 721 hospitals will have their Medicare reimbursements reduced because of a high rate of avoidable injuries acquired in their hospital. Such injuries include infections you can get with a central IV line, a Foley catheter, or other severe complications including blood clots, pressure ulcers, and falls.

Indiana had fourteen hospitals on the list. Three of those were in Lake County:Franciscan Saint Anthony’s in Crown Point, Franciscan Healthcare in Munster, and Methodist Hospitals in Gary. There were four hospitals in Indianapolis: Eskanazi Hospital, IU Health Methodist, Community Heart and Vascular Hospital, and Community Hospital North.

You can find the complete list of all 721 hospitals here.

Infections and other complications can occur even while practicing the strictest forms of infection control and safety. This is a wake up call though to these hospitals, and I am sure they have all taken corrective actions because after all, it is now affecting their bottom line with decreased reimbursements.

If you have a loved one in the hospital, ask questions:

• Is this IV a central line? If it is, how often do the dressings get changed?
• How often is your loved one cleaned? Patients who are incontinent of bowel who also have a Foley catheter are at extremely high risk of getting a urinary tract infection.
• If your loved one is not able to get out of bed or turn them self, how often are they being re-positioned by staff? Should be at least every two hours to prevent pressure ulcers.
• If your loved one has dementia or is elderly and gets confused at night (referred to as Sundowner’s Syndrome) what safety precautions does the hospital take to make sure they do not fall if they try to get out of bed unassisted?
• If your loved one has had major surgery or is not ambulatory, does the hospital give them an injection to prevent blood clots?

These are a few ways you can be pro-active to help make sure a hospital stay doesn’t make you or a loved one sicker!

Kasem’s Case for Advanced Directives

If you don’t already have them, you need to get them….NOW. As we all follow the slow demise of America’s Top 40’s DJ Casey Kasem, we are watching a very public dispute on end of life care.

Kasem cannot make decisions on his life right now so there is a fight between wife of 34 years and his daughter. 

His daughter had to go to court and just won the right to make decisions for Kasem. His wife is furious, and rightly so or not, that’s the law.

If  you do not have a living will or a Health Care Power of Attorney or the new Indiana POST form, then you put your wishes at risk as well as risking family disputes if anything happens to you and you cannot make your own healthcare decisions.

I have both a living will and a healthcare Power of Attorney. My family knows my wishes. It doesn’t matter if you’re 20 or 80. You should have your wishes in writing and/or appoint someone that knows those wishes to make decisions on your behalf.

Are you prepared or will there be a family dispute like Kasem?

 

When Home Isn’t an Option- Kim’s Top 3 Lake County SNF Picks

Sometimes after an acute phase of an illness, patients need additional care. There are times when instead of going home, patients need to be transferred to a Long Term Care or Rehab Unit AKA- SNF). So how do you know which one is best for you or your loved one?

Lake County Indiana has 20 such facilities to choose from. Of course at the time you need one, there may not be a bed available in the one you want. It’s best though to know at least where to look for information on facilities.

Alzheimer’s Disease is a Women’s Disease

When you think of “women’s diseases” the first ones to come to mind are breast and ovarian cancer. You can also add Alzheimer’s Disease to that list as well. The facts are shocking. According to the Alzheimer’s Association, “Nearly two-thirds of those with Alzheimer’s Disease are women.” Even more shocking is the fact that “women over sixty are about twice as likely to develop Alzheimer’s over their rest of their life than breast cancer.”

When Parents Become the Child

It’s very difficult being an adult with a family and then having to care for an elderly parent. It’s even harder if the parent has dementia.

This story from the Washington Post tells the reality of that life.

Caregiver burnout can occur in these situations. So if you haven’t read my previous column, take a look now for some tips on how to avoid it!

More Medicare Advantage Cuts!

Some seniors know they have one. Some seniors think they have Medicare and a supplement. Other seniors don’t have a clue. But what they need to know is that Medicare Advantage plans are taking a cut. According to a recent article in Politico, Medicare Advantage funding is taking a 3.55% cut. 

Why Home Health Care?

It’s the insurance benefit few know about until they need it. Many years ago patients stayed in hospitals for weeks and some even months to fully recover from an illness. In the past 20 years that model has changed and hospitals started discharging patients within days and then there are even some procedures where you are discharged within hours.

Be Careful When Selecting a Home Health Agency

Most people don’t know a good home health agency from a bad one. Patients are usually in a compromised state of health when they need additional nursing or therapy services at home. Most local papers do not print when agencies have bad surveys or good surveys or in the case of Amedisys actually agree to pay millions of dollars to the Department of Justice just to stay out of jail and continue their business practices.