About Maria Radwanski MSN RN CRRN

Maria Radwanski RN MSN CRRN is a certified Rehabilitation Nurse, Vice President and COO of Health Calls Home Health Agency. Health Calls provides rehabilitation-focused Medicare certified home health services throughout Berks County Pa.

5 Steps Toward Quality of Life With Ongoing Chronic Health Problems


I had a recent conversation with several families who are in the throws of caring for aging loved ones. These families admirably discussed the issues involved in providing loving care for their parents. Here is one family’s struggle, poignantly stated:

“My sister and I are trying our best to help our mom deal with her multiple, serious health issues . It seems every time we take her to see one of her multitude of  specialists, we leave with more questions than answers. There doesn’t seem to be one place to get an answer; we are confused and don’t know where to turn”.


Living life with chronic health issues isn’t easy. According to this study on family caregivers, millions of family and friends are helping older adults with chronic disease manage medications and navigate the health system. Most are ill-prepared to take on the role; they are sons and daughters, not caregivers. Who else is there to advocate, ask questions and help parents navigate a very complex health care system? Either self-appointed or asked because your mom needs an advocate, there is some work involved. Here are some suggestions and approaches to helping her through the health care crossroads with complex health issues:

First, talk to your family. Have a family meeting. Sit down with your mom. What does your parent want; what is her goal?

Next, talk with a trusted healthcare professional. Engage in the conversation with a list of questions about the health care of your loved one. Where is she along the trajectory of life? What are her anticipated future health care needs? Equally important is capturing the essence of receiving individualized care, with quality and respect to dignity, if those are important elements to you.

In his book Being Mortal, Atul Gawande writes about the culture of providing health care and medicine to older adults in the United States. He says “Medicine has been slow to confront the very ­changes that it has been responsible for — or to apply the knowledge we have about how to make old age better.”

Being Mortal makes the case for a change in the philosophy of health care. Gawande writes that members of the medical profession, himself included, have been wrong about what their job is. Rather than ensuring health and survival, it is “to enable well-being.” The New York Times

The ultimate take-away from this book is the importance of recognizing when to ask questions, and then act when it comes to the inevitable that we all must face. To die a good death means finding in life, the courage to have caring and frequent conversations with family members and health care providers.

Pay attention to what your mom is telling you.

  • If she starts to talk about her life, she may be preparing herself and you to further express her needs and desires.
  • If she says she is frustrated by the quality of her day, or complains that it is a struggle to get through each day, she may not be happy about the quality of it and the direction it is heading.

Discuss quality of life issues with a specialist.

As this article in the Huffington Post so eloquently details, a neutral person, often a palliative care professional, can help families engage in conversation that will help all family members tackle the tough subject of care coordination, symptom management and quality of life issues. It’s at this juncture where multiple specialists collide, that their recommendations may interfere with how a person with later stages of chronic disease may want to spend their remaining days. A palliative care specialist is a good neutral resource to see through the varying opinions.

With a palliative care specialist’s help,  you will go through a series of questions together to help guide decision-making. One such tool, called “The POLST” (which stands for Physician Orders for Life-Sustaining Treatment), is designed to ensure that seriously ill or frail patients can choose the treatments they do or don’t want and that wishes are documented and honored. The POLST asks how much care a person would want in a variety of situations.  Supportive conversations led by a trusted healthcare professional may help families to interpret the questions to find answers about care decisions.

If Mom is hospitalized, be present to advocate for the wishes she made.

It’s not the time to call to see how she’s doing. You need to be there, helping to figure out what is best for her. The people caring for your mom care about her, but its their job to save lives. A nurse eloquently describes what can alternatively happen in this New York Times opinion piece, “The ICU Is Not A Pause Button“:

When I first realized that in intensive care we held lives in limbo more often than we saved lives, I asked a friend who was a more experienced nurse how she felt about that. She said that sometimes a stay in the I.C.U. lets a patient’s family prepare for his death. But while it may soften the shock of death for the family, being in the I.C.U. is unpleasant and bizarre for the patient.

Ultimately, your mom needs you to be present in the hospital to monitor the care and communicate the wishes that she has provided the answers to.

Thinking about having a difficult conversation in anticipation of loss is not easy. Anticipating the last months, weeks, days together with a loved one’s life doesn’t invoke enthusiasm. However, if your mom has an opportunity to gather those around her that love her and has happy, meaningful, quality experiences during the time that is left AND has a supportive network of providers to see that she is comfortable, the hard conversations are worthwhile.


Take Control With Cold and Flu Prevention Now!


Flu reports are on the rise. In order to prevent a devastating illness and potential death for the very young, very old, and immune-compromised, it is very  important to pay particular care and attention to prevention. Here are some things that you can do to protect yourself, coworkers, family members and those we care for:

1. Wash your hands. Use hand sanitizer frequently. Everyone usually thinks about ourselves and washing hands but understand that young or old, sick people we care for also need reminders to wash hands frequently, throughout the day, every day.Key times to wash hands include after using the bathroom, before meals, after treatments and after coughing, sneezing, or blowing the nose.

2. Wash hands with antibacterial soap and water when they are visibly soiled. Alcohol based hand sanitizer works and is effective when hands are not visibly soiled.

3. Avoid touching your face, nose, mouth without washing or sanitizing your hands first.

4. Cover your mouth. Avoid coughing into the air, even away from people. Cough into a Kleenex or your sleeve.

5. Disinfect! Your keyboard, phone and inanimate surfaces spread germs; so do door knobs, lights switches, faucets, to name a few popular places. Disinfect these surfaces with a Clorox/sanitizing wipe at least on a daily basis and more frequently as needed.

6. Use tissues once and throw away. Keep a bag or trash can close by to discard tissues in.

7. Get the flu shot; its not too late. If you haven’t received the flu shot yet, do it! The flu vaccine not only protects you from lost down time, you in turn protect your loved ones.

8. Stay home if you are ill. Guilt can cause us to get out of bed and drag ourselves to work or still want to attend the family holiday party when we are sick. You will get better faster and decrease the risk of infecting everyone around you if you take the time to rest and recuperate.

Facts about the flu shot and its impact on prevention from The Center For Disease Control: Why get the flu vaccine?

9. A key prevention that many people frequently forget about when caring for someone else is mouth care. There are many germs that live in our mouths. The germs grow very rapidly and exponentially if mouth care isn’t done frequently throughout the day. Brushing teeth and tongue after meals and at bedtime and swishing with antiseptic mouthwash along with handwashing will further the mission toward preventing pneumonia, flu, and other illnesses that are prevalent right now.

If you are concerned you or someone you love has the flu, review . This article on what to do if you get the flu From the Center for Disease Control site.

Following the prevention recommendations will hopefully keep you well. Let’s all stay healthy!

Giving the Gift of Health And Wellness


Coming up with a Christmas gift for that person who has everything can be challenging. Luckily, there are options this year. Gone are the days that one would resort to finding yet another cardigan or scarf for the hard-to-buy-for on your list.

Consider a little something that we are all searching for: a gift to health and wellness. What will you choose? Share your finds!

1. PhoneSoap 2.0 Phone Sanitizer and universal charger

Did you know that our cell phones contain more bacteria than surfaces in the bathroom?

This UV light zaps and sanitizes your phone while charging. Large enough for even the newest large model phones.


2.Extra wide talking scale

Now hear me out: most people would not take too kindly to receiving a talking scale but if your vision is limited and you have a health problem requiring that you check your weight daily, this is an example of a wide-based, stable scale that is perfect for the duty. A person with limited ability to step on curbs will be able to safely step up and down while be able to assure that the restricted carb and salt diet is working!


3.The Calm App for Meditation to Relax, Focus, and Sleep Better

We personally swear by this app. Receive an invitation to meditate for 15 minutes first thing in the morning, take a mid-morning break to focus on breathing to reduce stress and anxiety, or listen to a bedtime story and fall asleep like a baby. This APP will keep your gift recipient serene and well-rested all year long.


4.Phillips Medication Dispenser

Thirty five percent (35%) of hospital readmissions to the hospital are due to medication errors. The monthly fee for this medication dispenser provides piece of mind. A beautiful design which will provide piece of mind.



5. FitBit is for all of our lives


Imagine life with full or limited mobility…FItBit and the FitBit APP helps meet everyone’s  life wellness goals. Weight management, number of steps or activity, water intake, calorie intake, quality of sleep. This is seriously motivating to meet those goals and resolutions and stick to them!

6. An Indoor Wall Pocket Garden

A living wall, made of recycled materials brings the beauty of outdoors in, while reducing stress in the office or home. Improved symbiotic gas exchange between human and plant are added benefits.

Great American Smokeout: Stamp Out the Number One Preventable Cause of Disease and Death Today


Health Calls encourages tobacco-free living during the American Cancer Society Great American Smokeout on November 16. Health Calls is encouraging everyone to commit or recommit to healthy, tobacco-free lives by participating in the American Cancer Society Great American Smokeout today, on November 16, 2017 or any day.

The most important thing smokers can do to improve their health is to quit cigarettes and other forms of combustible tobacco. We are showing our support for people who take those first steps toward making a plan to quit.

Tobacco use is the single largest preventable cause of disease and premature death in the United States. About half of all Americans who keep smoking will die because of the habit. Each year more than 480,000 people in the United States die from illnesses related to tobacco use. This means smoking causes about 1 out of 5 deaths in the U.S. annually.

Yet, because tobacco is one of the strongest addictions one can have, about 40 million American adults still smoke. Doctors and public health officials used to encourage smokers to quit cold turkey on a single day. Today, the evidence shows that quitting is a process. It starts with a plan, often takes time and requires a lot of support.

Health Calls is partnering with the American Cancer Society, which is available 24 hours a day, 7 days a week to provide support as people make their plan to quit. More information is available at cancer.org/smokeout or by calling 1-800-227-2345.

Health Calls wants to help the people in our community to be healthy and happy. During this year’s Great American Smokeout, we hope everyone will join us – and encourage their friends, family and colleagues to join us – in committing or recommitting to year-around, tobacco-free lives.

Here are some tips to encourage people who are in the process of quitting tobacco.

1. Spend as much free time as you can in public places where smoking is not allowed.

2. Take extra care of yourself. Drink water, eat well, and get enough sleep. This could help you have the energy you might need to handle extra stress.

3. Try to avoid alcohol, coffee, or any other drinks you link with smoking. Try a different low- or no-calorie option instead.

4. If you miss the feeling of having a cigarette in your hand, hold something else, like a pencil, a paper clip, a coin, or a marble.

5. If you miss the feeling of having something in your mouth, try toothpicks, cinnamon sticks, sugarless gum, sugar-free lollipops, or celery.

6. Avoid temptation by staying away from activities, people, and places you link with smoking.

7. Make a list of the important reasons you’ve decided to quit, and keep this list with you to continually remind yourself.

8. Take deep breaths to relax. Picture your lungs filling with fresh, clean air.

9. Remember your goal and the fact that the urge to smoke will lessen over time.

10. Think about how awesome it is that you’re quitting smoking and getting healthy. If you start to waver, remember your goal.

11. Remember that quitting is a learning process. Be patient with yourself.

12. Brush your teeth and enjoy that fresh taste.

13. Exercise in short bursts. Try alternately tensing and relaxing muscles, push-ups, lunges, walking up the stairs, or touching your toes.

14. Call a friend, family member, or the American Cancer Society at 1-800-227-2345 when you need support.

15. Eat 4 to 6 small meals during the day instead of 1 or 2 large ones. This keeps your blood sugar levels steady, your energy balanced, and helps prevent the urge to smoke. Avoid sugary or spicy foods that could trigger a desire to smoke.

16. Reward yourself for doing your best.

17. Know that anger, frustration, anxiety, irritability, and even depression are normal after quitting and will get better as you learn ways to cope that don’t involve tobacco and the effects of nicotine subside over time.

18. Go for a walk. Exercise can improve your mood and relieve stress.

Quitting tobacco is a process. Take the first step today at cancer.org/smokeout or by calling 1-800-227-2345.

Improving Sleep Quality


Sleep tight!

A study conducted by the National Institute of Occupational Safety and Health (NIOSH), in collaboration with the Harvard Nurses’ Health Study suggests there is a link between shift work and health.

The study found health problems with pregnancy among nurses. Results suggest that people working night shifts are more likely to experience spontaneous abortions, early preterm births, and menstrual-cycle problems.

There are take-aways for all shift workers from this study. No matter what the profession or trade, shift work, long hours, and sleep deprivation may have a negative effect on healthy lifestyle choices.

Sleep deprivation is associated with changes in hormones that can cause an increase in appetite. Shift work and long hours make it more difficult to find time for exercise. These issues combined increases the risk of obesity.

The shift in the body’s internal clock (circadian rhythm) effects the release of body hormones. The hormone responsible for sleep is melatonin and for awake time is cortisol. A shift in routine can conflict with the time the body normally releases the hormones. Melatonin is released with changes in light exposure. Changing the routine before bed will help shift the hormone release.

No matter the time you go to bed, you can improve your sleep by helping your body prepare for it by following these tips:

• Give yourself enough time to sleep after working your shift. The minimum hours of sleep for health is 7 hours.

• Avoid heavy foods and alcohol before sleeping. Limit caffeine in the form of coffee, soda, and chocolate; and limit other stimulants for several hours before bed.

• Get regular exercise for 25-30 minutes 4-5 days a week. Regular exercise will help reduce stress, stay healthy, and improve your sleep.

• Avoid rigorous exercise for at least 2 hours prior to bedtime.

• Sleep in a cool, dark room so you can fall asleep quickly and stay asleep.

•Reduce “blue light” from computers, television, smart phone and electronic notebooks for at least 60 minutes before trying to fall asleep.

• Get professional help from a healthcare provider if you are having continued difficulty sleeping.

23 (and one more) Best Tips To Improve Health At Any Age

This article is written by Peg Stoudt RN, Health Calls Referral Liaison Team Leader

Today, 12 out of every 100 people in the US are 65 or older, and older adults are the fastest growing population. Simply living longer isn’t enough. Learning how to stay healthy as one ages is! It’s never too soon to adopt habits to improve your health, no matter your age. The facts are that we are aging from the moment of birth and there you have options to improving your health, at any age.

September is the National Healthy Aging Month, a national initiative to help people think more positively about growing older. Aging is an inevitable part of life & the more cheerfully we embrace the process, the easier life can be for ourselves & our families.

Healthy Aging is defined as the development & maintenance of optimal mental, social, & physical well-being in older adults. Healthy aging is certainly different now than it was for our grandparents. Today people are living longer than at any other time in history. Having good genes does help healthy aging but research has found how well one ages largely depends on each individual’s choices for a healthy lifestyle.

It is never too late to make changes that can help one live longer and healthier. No matter when you start, a healthy lifestyle can make a difference in how you feel and what you can do! So no better time to start than NOW.

Healthy Habits Tips to Improving Yourself:

1. Do NOT act your age or what you think your current age should act like. What was your favorite AGE? Picture yourself @ that age and be it!! That is positive thinking—NOT Denial & will truly help one feel great about themselves. TIP: Do not look in the mirror to determine how you behave. Decide your age; you choose!!

2. Be positive in your conversations and actions. When you hear yourself complaining or being negative—change the conversation to positive and you will feel a lot better & lighter.

3. Drop negative friends that complain and talk about how awful everything is. Distance yourself from those who do not have a positive outlook on life as they will drag you down! Surround yourself with energetic, happy, positive people & you will find you are happier and will feel healthier.

4. Stay active—Walk with Vibrancy. Walking is an ideal “heart healthy” activity. Walking only 30 minutes 3 times a week can help you stay fit, mentally sharp, strengthen bones, lift your mood, and lower your risk for falls!

5. Remember and practice what your Mom always told you. “Stand up straight” & knock off the appearance of a few years by doing so.

6. SMILE—it is true those who smile more are happier.

7. If you are feeling lonely—Change it! Pick up the phone-call a friend or neighbor & share how you are feeling. You can also journal—release those feelings through the power of your pencil. Take care of YOU by sharing with someone you trust to lighten your load. Consider volunteering your time to help others as this helps them and YOU conquer loneliness.

8. Make September the month for an Annual Physical Exam, Health Screenings, and vaccines. Vaccines to help keep seniors healthy include Pneumonia, Shingles, and the FLU.

9. Find your inner artist! Use your free time to find undiscovered talent. You may be pleasantly surprised what has been waiting to be discovered.

10. Eat a healthy diet (Low salt/Low fat/High fiber) to reduce risk of age related chronic diseases.

11. Maintain balance to prevent risk of falls. Report dizziness, balance changes, or changes in walking ability. Use a device to aid walking if recommended by your doctor or health care team for your safety & well-being.

12. Make sleep a priority to restore energy levels. The amount of sleep needed remains constant throughout your lifetime (7-9 hrs. a night).

13. Take a power nap & you are 37% less likely to die from heart disease. Short naps—no longer than 45 minutes are best!

14. Aid your memory and improve your personal organization by making lists and following daily routines.

15. Speak up and beat those blues if depressed. Approximately 1 in 5 older adults suffer from depression or anxiety. Both are treatable. Talk to your doctor! Denying or not talking about your feelings of anxiety or frustration can lead to anger & depression which can be toxic.

16. Establish and follow a routine for consistency in taking your medications as prescribed by your doctor. Promptly report any noted side effects.

17. Limit your intake of alcohol and quit smoking.

18. Count yuor blessings! You may not have control over how things are changing in your life but you can control how you deal with them. Things can always be worse. Have an Attitude of Gratitude—this works.

19. Accept the things you cannot change! Sometimes the only thing we can control is our reaction to people and life circumstances. Acceptance can free you, brighten you, & lighten you—TRY IT.

20. Stay Current—Deal with life on a daily basis. Empower yourself to take care of you each and every day.

21. Continue hobbies and or continue to find new ones. This keeps you young, active, happy, and productive.

22. Continue to set goals to achieve. Research has shown those with a clear sense of purpose and drive have a decreased risk for Alzheimer’s disease. One in eight people over 65 have AD. Maintain your brain health!

23. Maintain and grow your spirituality. Knowing there is always someone—a power greater than ourselves—out there looking out for us too is comforting.


And my personal favorite: Laughter is the very best medicine & the only medicine you can take as much as you want!



Consider adopting at least 2 of these strategies a month to develop healthy life long habits. Happy National Healthy Aging Month!!

Rehabilitation at Home: Regaining A “Personal Best”



Rehabilitation at Home: Regain Independence

Bill W. was pretty sick when he was admitted to the hospital recently. He spent time in Intensive Care and was treated with IV antibiotics for septic shock due to an infection of a non-healing wound on his leg. He spent 5 days in the hospital recovering from serious illness. He was encouraged to keep working on his recovery when he transferred to the general medical surgical unit. Bill didn’t feel so great though and was not always welcoming of the help of therapists who came to see him at his bedside.

“Don’t they understand I am sick? I can’t be bothered with walking or washing myself. I’m in the hospital. Shouldn’t they be doing that for me?”, he wondered as the Occupational Therapist talked about bathing at the bedside. So he told the therapist that he “didn’t feel like it today”.


When the Physical Therapist stopped by to take him for a walk he hesitated because he felt weak. Her explanation that it would help him be strong enough to go home helped, so he took a short walk down the hall and back to his bed.

Bill’s daughter and son both visited every day in the hospital and did their best to encourage their dad. When the case manager called Bill’s daughter, she recommended Bill go to rehab to recuperate for a short time after his hospital stay. He had been in bed for an extended illness and she was afraid he was too weak and might fall if he went straight home. Since Bill passed the walking test with the physical therapist, and refused occupational therapy, insurance did not consider him a candidate for inpatient rehabilitation. While they appealed the insurance company decision, Bill’s kids requested home health, in case he didn’t win the insurance appeal.

“I don’t need help,” Bill protested. Unfortunately, Bill didn’t win the insurance appeal and plans were made to go home. When Bill got home, he wasn’t able to make it up the steps to get into his house, so his family was forced to take him back to the hospital. Bill was readmitted to the hospital and received therapy services at the bedside for 4 more days until he was strong enough to do the steps to get into his house.

When Bill went home this time, his daughter Vickie and her mother did their best to help her dad settle in safely at home. Vickie stayed home from work the first 24 hours to help since her mom has health problems of her own. Vickie noticed Bill was pretty tired and  short of breath with the most minimal activity, and she saw his balance was off while he stood to put on a sweater that first afternoon home.

Vickie was pleasantly surprised that the home health agency didn’t just send a nurse out to see her dad. The nurse told the family that Bill would also see a Physical Therapist and Occupational Therapist right away as she also observed his poor endurance and balance problems, too.

Bill, the nurse and therapists formed a bond. Bill and his wife committed to the agency’s home equipment and safety recommendations, and allowed these former strangers into the home to treat his wound, and provide therapy to make him stronger. While some refer to a “personal best” in relationship to fastest sprint or run time in a race, Bill was back to his “personal best” self in his ability to care for himself, with independence, in 3 weeks.

Independence gained or retained through rehabilitation is priceless.

Rehabilitation services occur in many settings. As this website demonstrates,  rehabilitation provides a total approach to treatment and care for people with short term as well as long term mobility and self-care needs for recovery. Some additional rehabilitation facts:

  • Rehabilitation services occur in hospitals, rehabilitation hospitals, nursing facilities, at home with home health agency visits, and outpatient clinics.
  • Nearly 50 million Americans are disabled. Disability may be temporary or permanent. Disability does not discriminate – every person is at risk of disability. Therefore, everyone is a potential candidate for rehabilitation. Rehabilitation lessens the long term impact of disability.
  • Most Americans will require at least one rehabilitation service at some point in their lives.
  • Rehabilitation is an integral part of healthcare and a tremendous component in providing patients with positive outcomes.
  • Rehabilitation saves money and improves lives. For every $1 spent on rehab care, it is estimated that $11 are saved on long-term disability costs. People participating in rehabilitation programs of care are able to regain productivity and return to work, school and independent living.
  • Rehabilitation is individualized so every patient can progress at his or her own ability level.
  • Rehabilitation can lengthen life, improve the quality of life and reduce subsequent illness.