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News Roundup: October 9, 2015

LIFE programs keep seniors healthy in their homes

Published by Nurse.com
By Carol Gordon DeLooper
October 9, 2015

What nurse practitioner Ahone Ngalame enjoys most about working with a New Jersey-based senior program is being able to collaborate with a team that helps approximately 300 seniors receive the healthcare they need while remaining in their homes.

“I’m able to work as part of a team in my role as a primary care provider, and when I need consultant and collaborative resources, they are available,” Ngalame said.

She works with Living Independently for Elders, LIFE, the local name for Program of All Inclusive Care for the Elderly or PACE, developed in the early 1970s to help frail seniors stay in their homes. Medicare and Medicaid provide funds for the program.

Opening in 2009, LIFE St. Francis is one of four PACE programs in New Jersey; 31 other states also participate. St. Francis Medical Center in Trenton, N.J., administers LIFE St. Francis, with sponsorship by Hope Ministries. Most LIFE senior participants live at home in Mercer or Burlington County. Their healthcare needs are coordinated from the LIFE center, which includes adult day care services, recreational activities, physical and occupational therapy services, social services and wellness visits as well as transportation from their homes if needed.

Most of the participants’ healthcare needs can be met living at home and by using the center as the centralized hub for their healthcare. However, if a participant’s healthcare is too complex or it is unsafe to provide the services at home, they may live in and receive their care at assisted living facilities or nursing homes.

The program continues to follow participants through their life span, including when they require end-of-life care.

Ngalame provides primary care at the LIFE wellness center, visiting with the participants and analyzing and interpreting lab and radiology results. She also attends family meetings and consults with the provider network for care coordination. At family meetings, Ngalame may discuss goals of care, offer education on a family member’s needs and seek ways to improve care. These meetings build trust, enabling LIFE staff to become a friendly, welcome presence in the participants’ lives, according to Ngalame.

She meets daily with an interdisciplinary team that includes nurses from the wellness center as well those in home care, home health aide supervisors, the center’s site director, physical and occupational therapists, social workers, registered dietitians and transportation and recreation therapists to advocate for the patients and make care decisions. The team discusses subtle changes in a participant’s physical, cognitive and functional statuses.

If left unattended, these changes could lead to hospitalization. For example, if an insulin-dependent diabetic cancels a scheduled attendance day because of diarrhea, a nurse will call the participant to see if a home care nurse visit is necessary. The nurse may also arrange transportation to bring the participant to the wellness center, for assessment, intravenous hydration and lab work.

“We are a team working together to make decisions and life plans for our participants,” Tracey Martin, RN, LIFE medication room nurse said. “No issue is too big or too small. Everyone from every discipline collaborates to solve each and every issue that arises with our participants. That is so different to me than working in a hospital or rehab center where you never really know your patient or their family, or their real life.”

The job of the future is ... home health care

Published by Delaware Online
Justin Fox
October 9, 2015

In January 1985, the Bureau of Labor Statistics began keeping track of employment in a new industry category – home health care services.

There are 138,400 home health care workers in that first month, just 0.14 percent of total non-farm employment.

But it was a job with a future. As BLS economist Laura Freeman wrote a decade later in a Monthly Labor Review article headlined “Home-sweet-home health care.”

In October 1994 there were 576,300 home health care workers, and the BLS projected that by 2005 there would be more than 900,000. That didn’t quite happen, because of a late-1990s decline following the passage of the Balanced Budget Act of 1997, which mandated big changes in Medicare. But then the growth resumed. In September there were 1.33 million home health care workers, according to the jobs report released today.

Thanks to the ongoing senescence of the Baby boom, the growth is expected to continue. The BLS has projected that by 2022 there will be 1.9 million home health care workers, making it the fastest growing industry in the land over the coming years, just ahead of the not entirely dissimilar categories of individual and family services and outpatient, laboratory and other ambulatory care services.

I might have used the auto industry as a comparison instead, but that data series only goes back to 1990. Mining clearly has a cyclical element – rising prices for oil, coal and metals brought employment gains starting in the early 2000s, and the U.S. fracking boom drove a lot of growth, too – but its long-term trajectory is basically flat, and it is declining as a share of overall employment.

This helps explain some things about how the overall labor market has changed since 1985. Jobs in mining pay better than the private-sector average, and 86 percent of them are held by men. Jobs in home health care pay worse than average, and 87 percent are held by women.

You can see from this where some of the America-in-decline rhetoric on the Republican campaign trail comes from, and why it resonates so strongly with men in particular. In fact, if you really want to take this pessimistic view to an extreme, there’s this:

Once we were a land of manly men who cut down trees. Now we’re a land of overweight diabetics with failed kidneys. Or something like that.

I’m incapable of leaving things on that down a note, though. And sure enough, after home health care and the other service industries listed above, the next two sectors expected to add jobs at the fastest pace through 2022 actually pay quite well: management, scientific and technical consulting services, and computer systems design and related services. For whatever it’s worth, these are also fields that employ lots of men.

These are good jobs, and the U.S. economy keeps creating more of them. Don’t give up on the country just yet.