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News Roundup: July 15, 2016

Nurse on the go: a day in the life of a home health care nurse

Published by The Daily Progress
July 15, 2016

WAYNESBORO- The job of a nurse does not just end when the patient leaves the hospital or the nursing home. Augusta Health has a special unit of nurses that continue to go and visit patients, checking on them, their medicines and vitals even after they have left the hospital facilities.

Home health care nurses visit around five patients a day, and nearly 20-25 patients per week. On Wednesday, The News-Virginian was able to travel with Augusta Health Home Health nurse Lori Silvestri to a couple of her patients’ homes. Silvestri explained that being a home health nurse was very different, since for starters instead of being located on a floor of the hospital, their office is located in their very own car. The biggest difference between a patient at the hospital and a home health patient is that you get to see them get better and stronger on their own.

“Definitely the patients and the appreciation, and seeing them get well,” Silvestri said. “That makes a big difference. Seeing them the day that you come and they’re sick, and a couple of weeks down the road being able to say: ‘Hey do you remember when I first started coming, you couldn’t walk to the door? Look at the progress you’ve made.’ Whereas, in the hospital, we don’t get to see that. We just get you stable enough and send you home. I get to see what happened to the patient. It’s been great to be able to see people so sick come home and get better and prosper.”

The job of a Augusta Health Home Health nurse begins at 8 in the morning, when they check their list of patients for the day and then call them to see when they would like them to visit.

“It was hard to learn at first, but important to know for the job, that everyone lives differently,” Silvestri said.

As soon as Silvestri entered her first patient’s home she was greeted warmly with a bright smile from her patient and her patient’s husband. While Silvestri took her patient’s blood pressure, checked her ankles for swelling and checked blood sugar, Silvestri talked with her patient about how they had spent their holiday weekend.

“It’s like having an extended family in a sense,” Silvestri said. “You’re helping the people around you.”

Before leaving her first patient’s home, she went over a schedule of care on a bright colored calendar with her patient and went over the medicine she was prescribed. As soon as she finished, Silvestri headed out to her car, ready to visit her next patient.

At her next patient’s home, Silvestri was required to check on her patient, hear an update from her caregiver, and change a leg bandage. As Silvestri went to leave, her patient thanked her for coming and said she would see her in the coming days.

“I think us having an illness we take it for granted, until as a nurse we realize just how stressful it is to be sick, emotionally, financially and spiritually,” Silvestri said. “Everything in your life changes, and you’re having to choose all the time, do I choose my medicine or groceries. I think we take that for granted until something happens. It’s easier said than done.”

Hospital Elder Units Help Seniors Go Home

Published by Home Health Care News
By Mary Kate Nelson
July 15, 2016

The need for specialized hospital units for seniors is high and growing—and the proven ability of these units to return seniors to live at home independently could spell good things for the home health care industry.

Approximately one-third of patients older than 70 years of age and more than half of patients older than 85 are discharged from the hospital more disabled than when they were admitted, according to Kaiser Health News.

That’s not the case at the Acute Care For Elders (ACE) ward at San Francisco General Hospital. The ward, which opened in 2007 and serves more than 400 older patients per year, is meant to address the needs of senior patients—which are markedly different from those of younger patients, Kaiser says.

With younger patients, hospital stays often revolve around treating an original diagnosis. The team in San Francisco General Hospital’s ACE ward, meanwhile, concentrates primarily on how to get patients back home, living as independently as possible, Kaiser reported. Patients are encouraged to practice living independently, as opposed to remaining in bed.

“Bed rest is really, really bad,” Edgar Pierluissi, the medical director at ACE, told Kaiser. “It sets off an explosive chain of events that are very detrimental to people’s health.”

Soon after patients are admitted to the ACE ward, the staff assess their memories and evaluate how well they can walk and take care of themselves on their own.

During their stay, the staff enables patients to practice caring for themselves. For instance, staff may disconnect patients’ IVs and catheters, and encourage patients to get out of bed and eat in a communal dining room, Kaiser reported.

ACE units have been proven to reduce the number of patients discharged to nursing homes, decrease lengths of stay and reduce hospital-inflicted disabilities in senior patients, Kaiser reported.

“If you don’t feed a patient, if you don’t mobilize a patient, you have just made it far more likely they will go to a skilled nursing [facility], and that’s expensive,” Robert Palmer, director of the geriatrics and gerontology center at Eastern Virginia Medical School and one of the minds behind the idea of ACE units, told Kaiser.

Demand for these specialized senior units are high, and space is limited where they do exist, Kaiser reported. After all, there only about 200 specialized hospital units for seniors nationwide.

More Older Americans Cared for at Home

Published by US News
By Steven Reinberg
July 15, 2016

TUESDAY, July 12, 2016 (HealthDay News) -- More older Americans with chronic health problems are opting to live at home, relying on help from family, paid caregivers or friends, a new study finds.

In 2012, half of seniors with a disability had some type of home health care, an increase from 42 percent in 1998, University of Michigan researchers found.

"The majority of seniors would prefer to stay at home rather than go to a nursing home," said Dr. R. Sean Morrison, past president of the American Academy of Hospice and Palliative Medicine.

But the unintended consequence of being cared for at home is the strain it puts on caregivers, added Morrison, who is also with the Icahn School of Medicine at Mount Sinai in New York City. He wasn't involved in the study.

"Research has shown that 40 percent [of caregivers] spend 20 or more hours a week caring for an older relative -- that's half of a full-time job," Morrison said.

Besides lost work and income, this can lead to depression and other health issues for caregivers, he said.

Also, most insurance plans, including Medicare, provide only very limited coverage for home health aides, Morrison said.

"We can't say we want more care in the home, less care in institutions, without providing our families the resources that allow them to care for a seriously ill older relative at home," he said.

If rates from this Michigan study are representative of the nation as a whole, more than 3.1 million more American seniors had home help in 2012 than in 1998, said the study's lead researcher, Dr. Claire Ankuda, from the university's department of medicine.

For the study, Ankuda and her colleagues collected data on nearly 5,200 people 55 and older who took part in the Health and Retirement Study by the University of Michigan Institute for Social Research. All had one or more disabling conditions.

People with more than a high school education and above-average net worth accounted for most of the increase in use of paid home health care aides, the researchers found.

This suggests a growing disparity in paid care for disabled seniors. It might also indicate a trend to aging at home, even among those who might be able to afford a nursing home, Ankuda said.

Still, about two-thirds of men and 45 percent of women had no caregiving help, despite some trouble with basic tasks such as making meals, getting dressed, going to the bathroom or managing their medications, she said.

The sharpest increase in home care was observed among seniors with milder disabilities. The researchers also found that paid caregiving accounted for the biggest jump in home health aid, although more seniors also reported relying on spouses and adult children. The percentage using friends for care remained stable.

Support groups can help caregivers cope with the strain, but that's not enough, Ankuda said. Public policy and the health care system need to pay more attention to caregivers to make sure they're supported, she said. This is especially true for unpaid family members and friends, she added.

"While caregiving can be meaningful for caregivers, it can lead to burnout and strain, and that can have poor health effects," Ankuda said. "We have to think about them as part of the health care system."

Morrison predicted the problem will likely get worse.

"In about 20 to 30 years, there are not going to be enough younger adults to care for us, because we are not having as many children," Morrison said. "We have to start thinking about that now or in 20 to 30 years it's going to be a real crisis."

The report was published July 12 in the Journal of the American Medical Association.

Independence at Home Demonstration Could Become Permanent

Published by Home Health Care News
By Amy Baxter
July 15, 2016

A pilot program that incentivizes home-base health care delivery might become a permanent, national Medicare program if lawmakers’ recent legislation is approved.

The bill aims to convert the Independence at Home (IAH) demonstration, a three-year pilot that completed its first performance year in 2015 and provides chronically ill patients with primary care services in the home setting, from its limited reach to the entire nation of Medicare beneficiaries. The program aims to reduce unnecessary emergency room visits and avoidable hospitalizations and readmissions, provide primary care within a patient’s own home and reduce Medicare costs overall.

IAH was extended for another two years last year by the House and Senate. During its first year, the program saved more than $25 million, or an average of $3,070 per beneficiary, according to the Centers for Medicare & Medicaid Services (CMS).

The bill to make the program permanent was introduced by Senators Edward J. Markey (D—Mass.), John Cornyn (R—Texas), Michael Bennet (D—Colo.) and Rob Portman (R—Ohio) in early July.

“It’s time to turn the successful experiment that is Independence at Home into a nationwide practice,” Senator Markey said in a statement. “We can design Medicare so that it works smarter, not harder for its beneficiaries. Independence at Home allows teams of doctors and nurses to continue to care for severely ill Medicare patients in the home, bringing the house calls of yesteryear into the 21st century.”

During the first year of the demonstration, 17 participating practices improved quality in at least three of the six quality measures, according to CMS. The agency will award incentive payments of $11.7 million to nine participating practices that reduced Medicare expenditures and met quality goals during the first demonstration performance year, CMS said last year.

“I have seen the benefits the Independence at Home program has provided for seniors in Northeast Ohio during the demonstration program—it has reduced hospital readmissions, prevented costly hospital and nursing home admissions, and most importantly kept patients healthy and in their preferred care setting,” Senator Portman said.

More than 100 industry groups have said they support the Independence at Home demonstration.

“IAH successfully fills a critical gap in health care for our frail and elderly that few programs have been able to achieve,” Dr. Mindy Fain, president of the American Academy of Home Care Medicine, said in a statement. “Independence at Home will help care providers better coordinate care management, reduce costs and allow individuals to have more control over their care plan.”

If approved, the bill would make the program permanent within 18 months after the date of the legislation’s enactment.

Home-Based Care Increases 20%, But Many Still Left Out

Published by Home Health Care News
By Alana Stramowski
July 15, 2016

There has been a sharp spike in the number of seniors receiving in-home help, with the greatest increase among those paying for the services.

Half of disabled seniors had some form of in-home help in 2012, which is up nearly 20% since 1998, according to a recent study published in the latest issue of JAMA by a team at the University of Michigan Medical School.

The largest increase for in-home caregivers was seen among those who had milder disabilities, which may be due to these seniors hoping to age in place, the study suggests. If the rate of increase found in the study were applied to the American public, as a whole, there were 3.1 million more seniors in the U.S. who had in-home help in 2012 than there were in 1998.

“Caregiving is essential for keeping people at home and out of nursing homes. But we were surprised by the size of the increase from 1998 to 2012,” Claire Ankuda, M.D., the study’s lead author and a Robert Wood Johnson Clinical Scholar at U-M’s Institute for Healthcare Policy and Innovation, said in a prepared statement.

There was also a large disparity between older disabled adults who were less educated and had less wealth and older disabled adults who were educated and had wealth, the study found.

The numbers for in-home caregivers were higher for those seniors who had more wealth than those with less wealth.

“We need to make sure all older adults are receiving the informal and formal caregiving that they need, not just those who have more wealth,” Deborah A. Levine, M.D., senior author of the study, told Home Health Care News.

When comparing informal in-home caregiving and formal in-home caregiving, spouses and adult children were found to be the most common informal in-home caregivers and also saw an increase from 1998 to 2012. The largest rise was in formal, paid in-home caregiving, and the number of seniors who received in-home help from friends stayed flat.

Given the sharp increase of in-home caregiving in the last decade or so, there will be a greater need for in-home caregivers in the future as the Baby Boomers age, explains Levine.

“We suggest that there will be an increased demand for in-home care, both formal and informal, as a greater number of older adults age in place at home,” she says.

The rise in in-home caregiving in the future also means that ways to help caregivers need to be recognized. There are benefits to caregiving and some states have started providing payment to family members who care for disabled people at home. But there are also risks including caregiver strain, increase risk of depression and other health problems, and opportunity costs like giving up their jobs and other activities in their own lives, Levine points out.

“As we see more of an emphasis by seniors on staying in their homes, and valuing their independence, and as the size of the senior population grows, we need to be thinking as a society about the potential ways to help caregivers, and ease the strain it can cause,” Ankuda said.