Home Health Care Management & Practice recent issues

I Was Thinking

Gingerich, B. S. — Fri, 25 Sep 2009 14:54:13 PDT

Lessons

Skrine, R. B. — Fri, 25 Sep 2009 14:54:13 PDT

Prospective Payment System 2008 Home Health Therapy Utilization Trends

Herr, R., Sarbach, M., Lang, C. — Fri, 25 Sep 2009 14:54:13 PDT

The focus of this article is to identify therapy trends in prediction and utilization since the 2008 Home Health Prospective Payment System changes were implemented on January 1, 2008. The interdisciplinary attention is on the utilization of therapy services, including physical therapy, occupational therapy, and speech language pathology, in the home health setting, specific to beneficiaries using the Medicare Part A benefit.

How Do SLPs Improve Outcomes in Adults in Home Care?

Brown, J. — Fri, 25 Sep 2009 14:54:13 PDT

Home care agencies that have not employed speech—language pathologists (SLPs) may not be aware of their potential to advance other rehab and nursing goals for patients with communication, swallowing, and cognitive impairments. This article provides an overview of the professional requirements and scope of speech—language pathology practice. Quality reporting in health care and various organizations engaged in performance measurement are described. The American Speech-Language-Hearing Association’s National Outcomes Measurement System has developed specific outcomes measures to track SLP intervention. Case studies illustrate how speech—language pathology services can enhance the effectiveness of other rehabilitation services and have an impact on hospital readmission, a primary quality measure in home care.

Doing Therapy Out of My Purse: A Personal Reflection

Webb-Henderson, S. — Fri, 25 Sep 2009 14:54:13 PDT

The practice of speech—language pathology in the home health care setting is challenging, requiring complex organization of information, deductive and diagnostic skill, and grasp of functional outcomes targeting the patient’s goals. Strong interpersonal communication ability is needed to communicate with the patient, family, and team members in the home care environment. This article discusses the need for on the spot training and adapting care to the home care setting. This author discusses how their orientation, education, and training formed the foundation for practice, but the reality provided the true experience for delivery of speech pathology services within the patient’s home.

All for One and One for All: Interdisciplinary Case Management in Home Health

Krafft, C. — Fri, 25 Sep 2009 14:54:13 PDT

Providing care as an interdisciplinary team meets with unique challenges in the home health setting ranging from the physical logistics of care delivery to developing an agency culture that encourages all disciplines to actively participate in care planning. Entities such as Medicare are scrutinizing patient outcomes with ever-increasing urgency, as the move toward a pay for performance model becomes a reality. Successful agencies have all disciplines engaged in the team approach with the patient at the center. The focus is on intentional delivery of positive outcomes. Agencies cannot assume that this mind-set will just happen on its own as it requires structure and support from staff at all levels of the organization.

A Multidisciplinary Approach to Total Joint Replacement

Naville, J., Volz, T., Curry, J. — Fri, 25 Sep 2009 14:54:13 PDT

Baptist Hospital East is proud to be the leading joint replacement center in the Commonwealth of Kentucky. More joint replacement surgeries are performed at Baptist Hospital East than at any other hospital in the state. In addition, the hospital staff has designed a cutting edge total joint replacement program that assists patients from preadmission to postdischarge. Patients attend pre—joint replacement class to help prepare them for the surgery and for postsurgical recovery. After surgery, the staff promptly addresses the need for therapeutic services and pain management. Furthermore, measures to reduce postoperative complications have been implemented and have proven to be very successful. As a result of all of these measures, Baptist Hospital East total joint program has an infection rate below the national benchmark and an average length of stay of 3.7 days, with 70% of the patients returning directly to a home environment.

Administration of an Exercise Regimen in Assisted-Living Facilities to Improve Balance and Activities of Daily Living: A Pilot Study

Wallmann, H., Schuerman, S., Kruskall, L., Alpert, P. T. — Fri, 25 Sep 2009 14:54:13 PDT

Purpose: This pilot study examined the effects of an exercise program on functional balance and activities of daily living (ADLs) of residents in assisted-living facilities. Materials and methods: Thirty-four subjects participated in the initial evaluation, but only 13 subjects participated in the study. All participants completed the ADL questionnaires (Functional Assessment Screening Questionnaire [FASQ] and the Katz Index of ADL), but only 10 completed the 8-week exercise program and balance assessment (Berg Balance Scale [BBS]). Results: Significant differences were observed between the pre- and postmeasurements for BBS ( p = .008) and FASQ (p = .023) but not for the Katz Index of ADL (p = .066). This suggests that strengthening exercises can be beneficial in improving functional balance and ADLs. Conclusion: Further research with a larger sample size is needed to evaluate the impact of lower extremity strengthening exercises on balance and ADL preservation for elders in long-term care facilities.

Are You Prepared for a Medicare RAC Attack?

Veronesi, J. F. — Fri, 25 Sep 2009 14:54:13 PDT

CMS Durable Medical Equipment Prosthetics, Orthotics, and Supplies (DMEPOS) Quality Standards

Gingerich, B. S. — Fri, 25 Sep 2009 14:54:13 PDT

Questions to Answer for Improved Strategic Planning

Chesney, R., Orsini, M. — Fri, 25 Sep 2009 14:54:13 PDT

The Basics of Balance and Falls

Wallmann, H. W. — Fri, 25 Sep 2009 14:54:13 PDT

What Does a 17% Freestanding Agency Profit Margin Mean to Medicare Home Health?

Cabin, W. D. — Fri, 25 Sep 2009 14:54:13 PDT

Obesity: A Worldwide Epidemic

Alpert, P. T. — Fri, 25 Sep 2009 14:54:13 PDT

Fall Prevention for Older Adults

Thobaben, M. — Fri, 25 Sep 2009 14:54:13 PDT

Rural Communication Technology: It's Improving!

Nelson, J. A. — Fri, 25 Sep 2009 14:54:13 PDT

Two Pedagogical Approaches to Cultural Competence: Pros Versus Cons

Xu, Y. — Fri, 25 Sep 2009 14:54:13 PDT

Introducing Rebecca B. Skrine, MS, CCC-SLP, CHCE, COS-C

Gingerich, B. S. — Fri, 25 Sep 2009 14:54:13 PDT

Resource Review: Re-creating Neighborhoods for Successful Aging

Gingerich, B. S. — Fri, 25 Sep 2009 14:54:13 PDT

I Was Thinking

Gingerich, B. S. — Wed, 22 Jul 2009 13:27:18 PDT

Home Health Utilization in Persons with Crohn's Disease

Hall, L., Hamlin, C., Bregman, A. S., Krueger, A., Cooper, J. — Wed, 22 Jul 2009 13:27:19 PDT

Accordant Health Services specializes in Crohn's disease management for health plans and employer groups across the United States. The claims database was used to ascertain patterns of care that might reveal opportunities to improve clinical interventions. One component of the research involved identifying primary drivers for home health utilization. Many Crohn's patients require complex and costly home health services for ostomy care and home infusion services. More in-depth analysis of this cohort reveals additional characteristics such as comorbidities and other traits that increase risk factors and impede adherence to complex treatment regimens. By sharing these findings with the home health community, it is the hope that insight into potential needs specific to the Crohn's population that require home health services will be provided. This information may be used to improve clinical outcomes and reduce the likelihood of hospitalizations for this high-risk population.

Compassionate Care: A Concept Analysis

Burnell, L. — Wed, 22 Jul 2009 13:27:19 PDT

Compassion may be nursing's most precious asset, yet the concept of compassion (or compassionate care) remains notably absent from nursing scholarship and the practicalities related to contemporary care delivery models. The provision of compassionate care is more than a professional mandate or an attribute of a model expressed in theoretical terms; it is the result of an authentic bond between a nurse and a patient. A concept analysis using Walker and Avant's methodology is employed using compassionate care as the virtue that allows a nurse to enter into the pain, suffering, and adversities a patient experiences as a way of establishing a meaningful connection.

Lymphedema: Role of Truncal Clearance as a Therapy Component

Mayrovitz, H. N., Brown-Cross, D., Mayrovitz, B. L., Golla, A. H. — Wed, 22 Jul 2009 13:27:19 PDT

Lymphedema is increasingly being seen in patients receiving home health care and throughout the general population. Substantial risks of complications are associated with failure to recognize its presence, worsening of the condition and the use of inadequate or incomplete therapy. Therapeutic truncal clearance as a component of therapy is universally accepted by professional therapists as being essential, but often rejected by third-party payers. This therapeutic component is based on sound physiological principles, but there has not been, nor will there likely be, peer-reviewed testing because it is deemed unethical to subject patients to therapy without its use. We believe that if the physiological basis for this therapy were more widely understood, its absolute need would be better recognized. Thus, our goal is to describe those lymphatic system features that directly impact lymphedema development and complications emphasizing the role of and scientific basis for truncal clearance as an essential treatment component.

Medicaid 101

Quinlan-Colwell, A. — Wed, 22 Jul 2009 13:27:19 PDT

This article provides an introduction to Medicaid as it relates to individuals who live with chronic illness. It begins with a brief historical synopsis that includes pertinent legislation. Next, the various agencies involved in the Medicaid process are introduced. The challenges with provider participation and access are discussed. Political and ethical implications are explored. It concludes with an evaluation of the effectiveness of Medicaid.

Emergency Preparedness From the Ground Floor Up: A Local Agency Perspective

Hendriks, L., Bassi, S. — Wed, 22 Jul 2009 13:27:19 PDT

Since the aftermath of September 11, 2001, both man-made and natural events have devastated communities in the United States and around the globe. As a result, individual communities now more than ever recognize the need for emergency and disaster planning. Local community-based home care agencies both large and small must be involved in comprehensive planning—anticipating the next event. The purpose of this article is to describe the yearlong preparation of a local Visiting Nurse Association as they committed to vigorous professional development and subsequently developed the necessary protocols for their own agency. This project was conceived by the authors to serve as an independent study for academic credit for the author enrolled in a RN-MS program and to address an important goal of the home care agency's strategic plan.

Free Choice?

Veronesi, J. — Wed, 22 Jul 2009 13:27:19 PDT

Stretching and Flexibility in the Aging Adult

Wallmann, H. W. — Wed, 22 Jul 2009 13:27:19 PDT

Promoting Excellence in Home Care for Older People: The CHAMP Program

Totten, A. M., Naik, D. — Wed, 22 Jul 2009 13:27:19 PDT

Where's the Home Care?: A Short Trip Through the Obama--Biden Health Reform Plan and Health Provisions of the 2009 Recovery Plan

Cabin, W. D. — Wed, 22 Jul 2009 13:27:19 PDT

How to Avoid Medication Errors: Six Tips for Clients/Caregivers

Thobaben, M. — Wed, 22 Jul 2009 13:27:19 PDT

Point-of-Care Resistance

Nelson, J. A. — Wed, 22 Jul 2009 13:27:19 PDT

Keeping Patients Safe: Ethnopharmacology and its Challenge to Health Care Providers

Yu Xu, — Wed, 22 Jul 2009 13:27:19 PDT

Exercise Works

Alpert, P. T. — Wed, 22 Jul 2009 13:27:19 PDT

Resource Review: Investigations in Long-Term Care Facilities: Implementing a Standardized Model

Gingerich, B. S. — Wed, 22 Jul 2009 13:27:19 PDT

April 2009 OASIS Questions and Answers

Niewenhous, S. S. — Wed, 22 Jul 2009 13:27:19 PDT

Home care clinicians have been dealing with "OASIS" for nearly 10 years. Many questions in the data set continue to give pause and require clinicians to think "How do I answer that question when this particular circumstance exits?" In addition to providing the latest information available on OASIS issues as disseminated from the Centers for Medicare & Medicaid Services (CMS), this new column will deliver to the reader the latest answers to OASIS data set questions posed to CMS by agencies and home care clinicians.

I Was Thinking

Stover Gingerich, B. — Tue, 12 May 2009 14:01:27 PDT

From the Issue Editor

Cabin, W. D. — Tue, 12 May 2009 14:01:27 PDT

Evidence-based Research Challenges Home Care PPS Patient Benefits, Costs, and Payment Structure

Cabin, W. D. — Tue, 12 May 2009 14:01:27 PDT

A neglected area of discussion in home care is the relationship and dissonance between evidence-based research on effective home and community-based interventions, Medicare home health practice, and the Medicare Home Health Prospective Payment System (PPS). PPS is critical because the literature increasingly indicates that the PPS reimbursement framework drives home health agency and practitioner resource allocation and practice decisions. However, the PPS system does not have an evidence-based evaluation process to evaluate the effectiveness and cost-effectiveness of new, or existing, intervention. The article reviews existing evidence-based research on the effectiveness of home-based environmental skills building, counseling, and support group interventions, which benefit patients, caregivers, home health agencies, and Medicare. The article indicates these interventions have never been evaluated, nor are they covered by Medicare. The article asserts the need for such an evaluation process to evaluate intervention cost-effectiveness and related changes in Medicare coverage, eligibility, reimbursement, and outcomes measurement criteria necessary for their adoption.

In-Home Chronic Disease Management in Diabetes: A Collaborative Practice Model for Home Health Care and Endocrinology Providers

Hartman, A., Litchman, M. L., Reed, P., Burr, R. E. — Tue, 12 May 2009 14:01:27 PDT

With the rate of diabetes increasing in the elderly, home health care agencies must creatively approach disease management in this high-risk population. Specialized training programs, standardized policies and procedures, and strategic staffing patterns support agencies to systematically and effectively manage diabetes in the home. Collaboration with endocrinology providers assists agencies to incorporate and appropriately use national standards in diabetes care. Additionally, home health partnership with endocrinology providers will enhance a disease management program with increased provider participation and oversight, improving patient clinical outcomes and serving as a resource for home health agencies managing patients with diabetes.

What To Do About a Union Neutrality Agreement?

Gilliland, J. C. — Tue, 12 May 2009 14:01:27 PDT

As union organizing of home health agencies increases, many agencies will be asked by a union to enter into a "neutrality agreement" with the union. Whether to agree to such an agreement is a very significant decision for an agency. It requires an agency to understand how such an agreement affects the unionization of its employees and the agency's own goals with regard to unionization.

Psychosocial Care in Home Health Policy: Missed Opportunities and Possible Solutions

Ji Seon Lee, , Rock, B. D. — Tue, 12 May 2009 14:01:27 PDT

As of summer 2008, health care reform has become an important part of the 2008 presidential election. However, long-term care has been absent in the discussion of health care reform by presidential candidates. This article examines policies that govern the payers of long-term care, specifically home health care (HHC). HHC is the fastest growing industry within long-term care, as there is a growing number of older adults in need of both skilled and unskilled home care. Medicare and Medicaid are the two major payers of HHC; yet these payers do not address the psychological and social needs of the patients. Furthermore, there is a long-term care disconnect between Medicare and Medicaid that creates even larger problems for older adults in need of long-term care.

The Legal, Regulatory, and Policy Challenges of Infection Control in Home Health Care, 2008

Kenneley, I., Madigan, E. A. — Tue, 12 May 2009 14:01:27 PDT

The practice implications of the Centers for Medicare & Medicaid Services hospital payment policy change are likely to influence the relationships between home health care agencies and their referring/receiving hospitals. Maintaining infection control measures can be difficult in the home environment, which was not designed for health care provision and where family members, friends, and pets are present. In addition to the hospital payment changes, there have been epidemiologic changes, with increasing recognition of multidrug resistant organisms and increasing virulence. The purpose of this article is to identify the scope of the practice changes that might be expected in response to epidemiologic and policy changes and activities that home health care agencies can undertake in response. Increased calls for transparency, accountability, and high-quality care, along with threats of denied reimbursement, will force changes across the entire continuum of care.

Shifting Focus: The Impact of the Deficit Reduction Act and Medicaid Regulations on National Mental Health Policy

Koyanagi, C., Stine, L. — Tue, 12 May 2009 14:01:27 PDT

Over the past 20 years, state mental health agencies have shifted the bulk of funding for community mental health services to the federal-state Medicaid program. Over this same period, states adapted their Medicaid programs to more comprehensively address the service needs of people with mental illness. Adopting the financing mechanism that primarily funds other health care for low-income people moves mental health more toward the mainstream. But it is a policy with risks. Changes to Medicaid are now outside the purview of those most concerned with mental health issues. In 2006, Congress radically altered Medicaid, making fundamental changes to the law. These were soon followed by further proposed shifts in federal administrative policy. This article describes these federal policy changes and assesses their impact on individuals and on state mental health policy. (It should be noted that most administrative changes have since been halted by the Obama Administration).

Smoking Cessation: Difficult but not Impossible

Alpert, P. T. — Tue, 12 May 2009 14:01:27 PDT

Coping With Congress, Regional Home Health Intermediary, & Office of Inspector General 2009 Auditing of Home Health Therapy Visits

Cabin, W. D. — Tue, 12 May 2009 14:01:27 PDT

Obtaining Referrals in the Face of Regulation

Orsini, M. — Tue, 12 May 2009 14:01:27 PDT

Health Care Reform Isn't for Wimps

Veronesi, J. F. — Tue, 12 May 2009 14:01:27 PDT

Office of the Inspector General's 2009 Work Plan

Stover Gingerich, B. — Tue, 12 May 2009 14:01:27 PDT

The Cost of Change

Nelson, J. A. — Tue, 12 May 2009 14:01:27 PDT

Introducing William D. Cabin, PhD, JD, MSW

Stover Gingerich, B. — Tue, 12 May 2009 14:01:27 PDT

Cultural Competence: "Took Kit" and "Snapshot"

Yu Xu, — Tue, 12 May 2009 14:01:27 PDT

The Handbook of Structured Life Review

Stover Gingerich, B. — Tue, 12 May 2009 14:01:27 PDT

I Was Thinking

Stover Gingerich, B. — Mon, 30 Mar 2009 10:32:54 PDT

Description of Symptom Severity in Heart Failure: Review of the Literature

Landrum, L. — Mon, 30 Mar 2009 10:32:54 PDT

The purpose of this article is to critically analyze research that describes symptom severity in heart failure. Medline, CINAHL, Psych Info, and Science Direct databases (2000 to July 2006) were searched to locate published studies that described or defined symptom severity or like terms in heart failure. A total of 323 publications were initially reviewed, from which 21 articles (6.51%) were selected based on the inclusion criteria for this article. Multiple terms are used synonymously, and inappropriately at times, to describe symptom severity. Rarely, symptom severity is adequately defined or fully described. Varying instruments and methods are used to measure symptom severity. The literature includes inappropriate measurement methods of symptom severity. Symptom severity should be clearly defined, differentiated from related terms, and measured appropriately. Comparisons across studies are impeded when terms are not clearly defined or inappropriately measured.

WebQuests: A Viable Solution to Meeting the Continuing Professional Education Needs of Home Health Care Nurses

Maxwell, S. M. — Mon, 30 Mar 2009 10:32:54 PDT

The nursing shortage, coupled with growing case loads, limits the available time for nurses in home care to attend continuing professional education programs necessary to keep abreast of the changes in nursing practice and enhance their clinical competency. The purpose of this case study was to evaluate the effectiveness of the WebQuest, a Web-based inquiry-oriented model congruent with the pedagogical approaches and cognitive activities commonly used with nursing education, in providing continuing education content to nurses in a mid-sized home health care agency. A convenience sample of registered nurse case managers completed a researcher-designed WebQuest, modified for independent learning, on diabetes education utilizing their personal computers from home. WebQuests proved to be an innovative and creative approach to provide new information, promote higher level thinking skills, and develop nurses' confidence with computer technology.

Assistive Robots in Health Care Settings

Nejat, G., Yiyuan Sun, , Nies, M. — Mon, 30 Mar 2009 10:32:54 PDT

Excellence in patient care is achieved through the very latest in technological advancements such as assistive robots. The purpose of this article is to review the literature on the use of assistive robots in various health care settings. The article includes a discussion of the strengths and limitations for noninteractive and interactive robots in health care and a summary of the implications for practice.

The Effects of Telehomecare on Quality and Agency Revenue: A Literature Review

Atteberry, G. — Mon, 30 Mar 2009 10:32:54 PDT

This article reviews the literature that examines the effects of telehomecare on the quality of patient care. This type of research is important, as home care reimbursement transitions to a pay-for-performance model in which quality indicators determine revenue. Research supports the positive effects of telehomecare technology on the quality of patient care; however, no articles discuss the subsequent effect this increased quality of patient care may have on home care agencies' revenue in a pay-for-performance model. Previous research on whether a home care agency should invest in telehomecare technology has focused on the cost-savings an agency can realize by decreasing costs through the substitution of more expensive traditional home visits with telehomecare virtual visits. Research is needed on the effect telehomecare has on enhancing reimbursement so that home care agencies can add this factor to any investment cost analysis in estimating telehomecare's revenue-producing potential.

Internet-Based Health Information Seeking Among Low-Income, Minority Seniors Living in Urban Residential Centers

Campbell, R. J. — Mon, 30 Mar 2009 10:32:54 PDT

This article discusses the results of an exploratory study designed to measure low-income, minority elderly adults Internet-based health information—seeking activities. The study is a part of a program designed to teach residents, living in high-rise urban communities, how to use the Internet to locate health information. By teaching minority seniors how to locate Internet-based health information, it is hoped that they will seek more information regarding their health conditions, treatments, and medications. The results of the study draw five inferences regarding participant's health information—seeking behavior: The retrieved information helps the elderly understand their health problems; retrieved information will not lead the elderly to engage in self-care, nor will it engage them enough to change health care providers; retrieved information can change elderly eating and exercise patterns, and retrieved information can affect the treatments the elderly receive for their illnesses.

The Lowdown on Social Intelligence

Veronesi, J. — Mon, 30 Mar 2009 10:32:54 PDT

Telehealth in the Community: A Research Update

DePalma, J. A. — Mon, 30 Mar 2009 10:32:54 PDT

National Recovery Audit Contractor (RAC) Program Expansion

Stover Gingerich, B. — Mon, 30 Mar 2009 10:32:54 PDT

Complementary and Alternative Medicine (CAM) Therapies: Which Are Your Clients Using?

Thobaben, M. — Mon, 30 Mar 2009 10:32:54 PDT

An Ounce of Prevention Is Worth a Pound of Cure?

Alpert, P. T. — Mon, 30 Mar 2009 10:32:54 PDT

Why Research Supports Home Care PPS Coverage and Reimbursement of Counseling and Support Groups

Cabin, W. D. — Mon, 30 Mar 2009 10:32:54 PDT

Caught Up in the Web: Online Strategies for Marketing Your Home Health Care Agency

Orsini, M. — Mon, 30 Mar 2009 10:32:54 PDT

Personal Navigation Technology in Home Care

Nelson, J. A. — Mon, 30 Mar 2009 10:32:54 PDT

Establishing Rapport and Quality of Health Care Delivery

Yu Xu, — Mon, 30 Mar 2009 10:32:54 PDT

Accepting the Challenge: Validation Techniques in Dementia

Stover Gingerich, B. — Mon, 30 Mar 2009 10:32:54 PDT