The Legacy of the Lamp

Image


Florence Nightingale is reknowned as the guiding force in the philosophy of nursing. She was born in the English Victorian era of an upper class family who considered it beneath her class to provide menial labor in the service of the ill and disabled.

Florence is attributed with defining what would be considered major health care reform today, for her era of the 1850’s.

She turned around the rodent-infested, cess-pool infected, deplorable conditions for the Crimean war soldiers who were dying in the hospital to which she was summoned and assigned. It is documented that she was able to reduce the death rate of the wounded soldiers by 2/3 by establishing principles of infection control, nutrition and nursing care.

Referred to as “the lady with the lamp” for her lamp-light guided nightly rounds in that Crimean hospital, Florence changed projected fatality for countless soldiers then and future generations of soldiers and civilians. Many would not have survived the deplorable conditions of that war without her direction and care. She established basic changes that we consider to be common sense today, from establishing the use of a hospital laundry, to routine cleaning of patient rooms, use of nutritious food, and assuring proper hand washing to prevent transfer of infection from patient to patient.

Florence Nightingale’s Birthday is May 12. Every year, her birthday is celebrated by nurses and recognized as National Nurse’s Day. Her writings and teachings are memorialized and remain the basic nursing principles of modern nursing. In fact, most allied health sciences including nursing, physical therapy, occupational therapy, speech therapy, nutrition therapy, respiratory therapy are derived from Florence Nightingale’s basic teachings she wrote through the course of her very short life.

This week, National Nurses Week, is celebrated on behalf of the 3.6 million nurses who carry Florence’s lamp and legacy with them in the care they employ on behalf of every patient they encounter. Protecting, advocating, managing, educating, counseling, assessing, comforting, caring are just a few verbs to describe the role. Nurses do many different things and today there are over 100 nursing specialties. Practicing both science and art, nurses direct care of each patient in their charge to prevent harm, maintain and promote health, and improve each patient’s outcome. All nurses are asked to provide care with ethics and to practice at their highest level of training.

The Nightingale Pledge

I solemnly pledge myself before God and in the presence of this assembly, to pass my life in purity and to practice my profession faithfully. I will abstain from whatever is deleterious and mischievous, and will not take or knowingly administer any harmful drug. I will do all in my power to maintain and elevate the standard of my profession, and will hold in con dence all personal matters committed to my keeping and all family a airs coming to my knowledge in the practice of my calling. With loyalty will I endeavor to aid the physician in his work, and devote myself to the welfare of those committed to my care.

Making Old Friends As People Achieve Home PT Goals

Image


 

Wendy Bergeman, PT, MS has been a physical therapist for over 25 years. She has provided physical therapy in many different settings including hospitals rehabs and outpatient clinics. She started working in home care about 15 years ago and knew on the first day that home care was where she was going to be able to make the most impact for her patients. Home care is a unique setting.

You get to see the patient in their own environment. They show you what is important to them and where they are struggling. Many times patients come home after doing well in rehab, but when they get home it all changes. Each house has its own challenges and the thrill for me and the patient is to work through those challenges and return the patient to independent living and enjoying life again.

The difference you see in these patients from the first day to discharge is amazing. On day 1 they are tired and weak —getting up and walking to the bathroom is a struggle. In a week or two they are taking care of themselves and then on the last day they meet you at the door with coffee and you feel like you are saying goodbye to an old friend. A lot of my patients feel like family by the time they are discharged.

image

Wendy Bergeman with her old friend, Mervin Lewis.

Health care is forever changing and today patients are coming home sicker and weaker since they are leaving the hospital faster. There is a huge need for these patients to get physical therapy. Many times without physical therapy, frail patients fail and end up back in the hospital or another type of facility. This is not only a huge cost to the healthcare system but can be devastating emotionally and physically to the patient.

Home physical therapy concentrates on building up strength and improving mobility but also focuses on making that patient safe and functional in their own home. The true goal of a home care physical therapist is to keep a patient in their own home for as long as possible, in the safest way possible. Sometimes this means getting adaptive equipment, making home renovations or hiring help.

This goal: keeping people safely at home, is what makes home care so fun. Each visit is different – somedays it is teaching a patient to get out of bed and other days it is showing them to how to safely take out the trash.

Safety is always the key and falls are always a concern in home care. Falls in the elderly are the leading cause of traumatic hospitalizations and a leading cause of death according to the National Council of Aging. About 25% of the elderly who fall and fracture a hip will die within 6 months and many more will never be able to return to their own homes again. Physical therapy can do a lot to help identify high risk fall issues and intervene to prevent fall injuries. “As home care therapists we stress the need for patients to stay active and safe,” Wendy says.

Wendy has been a member of the Health Calls team since 2013. When Wendy is not working for Health Calls Home Health Agency, she is busy at home. She lives with her husband and three kids- Katie – a senior at PSU, Rachel a Senior at Oley Valley High Cchool,and Richie, an 8th grader at the Oley Valley school district. She spends her weekends at PSU football games, watching Rachel in horse competitions or Richie in sporting events.

Occupational Therapy: Helping People Live Safely At Home


Teri Rothenberger, OTR/L became a licensed Occupational Therapist (OT) because she had an interest in helping people. A high school guidance counselor came up with Occupational Therapy as a possible career that fit Teri’s interests and she now boasts 30+ yrs experience. Teri joined the Health Calls team 6 years ago. As an OT, Teri’s specialties include helping people improve their strength and endurance to be safely independent with the daily activities we take for granted every day like showering, dressing, cooking, and doing laundry.


Teri says it feels great when patients have a “lightbulb moment”, that magic moment when she provides advice that is going to make a difference in the patient’s life. Working in home health, Teri realizes that she is always a guest in the patient’s home.

“I can make recommendations, but ultimately it’s their decision if they follow the advice. I knows it’s not a reflection on how good or effective I am as a healthcare provider if the family doesn’t use my suggestions.”

Teri finds that in many homes she visits, people already have safety and adaptive equipment like shower seats and 3in1 over the commode seats. She always checks the height of all these pieces of equipment because most times they are positioned on the lowest height. When Teri adjusts the height to the proper setting for the patient’s height, families wonder why no one else had thought of this. Families also will often report 3in1’s over the toilet seats don’t have the splash guard in place or say it doesn’t fit over the toilet. With some adjustments, such as removal of the back and lid, it usually fits.
Like the tools that she carries to make the appropriate equipment adjustments, Teri has expert tricks up her sleeves. When someone is discharged from a rehab facility to home, it’s difficult for therapists to know exact sizes of bathrooms and shower areas before the patient goes home. At rehab they send home a tub bench (goes inside and outside the tub), but there isn’t enough area to safely place the bench and therefore families often end up not using it. This also happens when showers have built in seats which make it difficult to find room to place an additional seat in the tub. Teri says one issue patients often have with the benches is where to go with the shower curtain so that water is not all over the floor. There is a simple solution, but most people just put lots of towels on the floor. When she shows them her trick for safe bench use to bathe safely, they are very happy.

Teri shared that one of her patients was having difficulty with his current bathroom with a regular tub. Transfers in and out of the tub onto a tub bench required the help of 2 people. The patient and family decided that since the disability was permanent, a full renovation would make the routine safer and easier. Teri made recommendations, met with the contractor and determined the best renovation for his disability. He ended up with a bathroom in a different part of the home. The new bathroom had a wheelchair height toilet with pull down grab bars, a wheel-in shower with hand held shower head and grab bars all around the shower, and wheelchair accessible sink.

In this YouTube video, Teri shows the proper placement and use of grab bars in a shower.

Teri is truly a rehabilitation expert but her work in her profession is only one part of a very full life. Teri has been a widow for 3 yrs and has 2 sons, a daughter-in-law, and a future daughter-in-law (son #2 will be married in 2018). Teri is very excited for her first grandchild to arrive in a few short weeks. Teri is very active with the music program at her church where she sings in the choir and plays the keyboard and organ. Teri also boasts having many other “adopted” kids through the relationships she has forged working with the youth of her church.

Teri is a person of quiet strength and a true asset to the Health Calls team. She serves many well in her professional and personal life with her desire to help and improve quality of living.

The Power of Rehabilitation at Home


During National Rehabilitation Awareness Week, we pause to recognize the excellence of our therapists. Physical Therapists, Occupational Therapists, Speech Language Therapists and Nurses all work to help people overcome obstacles and accomplish the daily activities we do every day but tend to take for granted.

How can therapists accomplish what is needed when a patient needs to receive therapy at home? Many who are used to the big equipment in a therapy gym often don’t know how therapists adapt therapy to very effectively treat people at home. Home Health therapists have a unique ability to use common household objects for the patient’s therapeutic gain at home. Here are just a few creative ways therapists obtain amazing results with patients in the home setting.

Picnic Cups  are useful for training patients to increase leg strength by encouraging them to step higher, to improve walking balance and to improve the sense the of where feet are while walking. The cups are placed on the floor and the patient walks through or over the cups in an obstacle course, with the mapped path set up to match a degree of difficulty individualized to the patient’s abilities.

Aerobic steppers  and short wooden boxes are useful as a starting place for learning to navigate curbs, thresholds, and steps before advancing on to higher surfaces such as outdoor curbs and stairs.

Yoga stretching strap with loops are helpful to place around the leg while lying down on one’s belly, to stretch the leg into a more flexed position. This is useful, for example in improving a person’s knee range of motion after surgery.

Knee extender is portable and easy to bring to patients for treatment at home. The device is used to extend the knee to 0 degrees, an important goal after a knee replacement.

 

Balance foam creates instabilityImage result for balance foam for physical therapy to challenge balance. Therapists work with the patient on movement while standing on the foam to improve balance and reduce the risk of falling.

 

Image result for heel slides exercises

Image result for furniture sliders for carpetFurniture movers provide a smooth gliding surface and prevent drag resistance against the underlying surface caused by fabric on sheets or bed covers when performing exercises while lying down

Resistance bands are light weight and portable to use to improve muscle strength of arms Image result for therabands for physical therapyand legs and may be used alone or along with weights for therapy.

 

 

The most important benefit of therapy provided at home is providing therapy in the setting where a person lives. (Click on the blue words for additional information).

If a person is at risk for falling or has limited strength and mobility, the kitchen, bathroom, narrow walking paths steep stairs with shallow treads all offer potential hazards and increase the potential for an injurious fall.

Therapists provide a critical eye and make recommendations for adjusting the set-up of a room and how to move through the home environment to improve safety and prevent falls.

Health Calls Home Health Agency’s team of rehabilitation specialists are talented, compassionate, patient, and have tremendous character. We honor the work they do every day to improve the quality of patients lives which supports people to stay where we all want to be: home!

 

Health Calls: Preferred Provider with Penn State Health Partners


Health Calls is proud to announce a preferred partner agreement with Penn State Health Partners. Health Calls remains a privately owned independent home health agency, owned by Mike Little and Maria Radwanski. The contracted agreement signed with Penn State Health Partners adds Health Calls Home Health Agency as a preferred partner in the Clinical Integrated Network made up of independently owned and operated health care organizations and physician groups working together to improve the population’s health, improve the health care experience for those served while stabilizing health care costs.

28161913 - cropped image of doctors shaking hands at desk in clinic

Health Calls joins Penn State Health Partners as a preferred provider.

This clinical integrated network encompasses Mt. Nittany Hospital in Centre County, St. Joseph Regional Health Network in Berks County, and Penn State Health Milton S. Hershey Hospital in Dauphin County; and a network of over 1,000 physicians in Berks County, Centre County, Dauphin, Schuylkill, Lebanon, and Lancaster counties. The post-acute network also includes skilled nursing facilities and home health agencies. Health Calls provides home health services in Berks County and some surrounding neighborhoods.

Mike Little, Chief Executive Officer, stated that “Health Calls was chosen as preferred partner because of our outcomes: the work that staff do every day is reflected in our patient clinical score improvements, low re-hospitalization rates, and customer satisfaction scores. This mirrors the caring our staff provide day in and day out.”

The clinical integrated network is also an accountable care organization, responsible for over 30,000 lives in a Medicare shared savings program.
“Health Calls will be charged with the responsibility for clinical outcomes and quality programs of the Milton S. Hershey Medical Center and St. Joseph Hospital network patients referred for services who are part of the Medicare Shared Savings Plan, orthopedic bundled payment program as well as other anticipated bundled payment programs coming soon,” stated Maria Radwanski RN MSN CRRN, the agency’s Chief Operating Officer.

Goals of the Penn State Health Partners are to enhance the patient experience of care, improve the health of the population of patients contracted to treat and care for, and stabilize the rising costs of health care.

Rehabilitation Matters For Stroke Recovery


The American Heart Association and the American Stroke Association released new guidelines for Adult Stroke Rehabilitation and Recovery. These have recently been released in the professional journal “Stroke” (May 2016). The joint organizational guidelines recommend that, for the best outcome, stroke patients who require rehabilitation following a hospital stay should receive these services in an Inpatient Rehabilitation Facility.

Inpatient Rehabilitation Facilities are considered acute rehabilitation care and are not nursing homes.

As I mentioned in my post Do You Have A Choice?, you have the right to know treatment options and to take part in decisions about your care for yourself or a family member.

The Resource: Making the Right Decision For Rehabilitation Care is an excellent resource describing the difference in settings for rehab services and care.

The American Heart Association and The American Stroke Association also recommended that stroke patients not be discharged from the hospital until they have taken part in a structured fall-prevention program. It should include home safety measures like removing throw rugs and improving lighting, minimizing the fall risk that results from the side effects of medication and training in the safe use of wheelchairs, walkers and canes.

While families may not find that these recommendations may be acted upon by rehabilitation hospitals prior to discharge (depending on the resources available to complete home evaluations with the patient prior to discharged), a home health agency providing stroke rehabilitation should complete a home safety evaluation as part of the home rehabilitation program.

The National Institute of Health offers home safety tips to prevent falls.These general guidelines are customized to the unique needs of someone who has had a stroke to prevent falls and other injuries by the home health agency providing at-home stroke rehabilitation following an inpatient treatment program.

Link


Like many people, I have been an advocate for family members who have been ill. Several years ago my Dad was in the hospital and wasn’t capable of coming right home after fracturing his hip. He wasn’t able to get out of bed or walk without help because of pain, weakness, and confusion.

The health care system is moving very fast, and insurance companies look for ways to decrease health care costs. Like it or not, people are forced to move to lower cost settings in one or two days. It’s rapid fire and you’re left with confusion. In my dad’s situation, the case manager told me Dad was accepted at a rehab, however she didn’t prep me or even ask me which rehab we would choose. Instead, she told me where she was sending him.

Where was choice?

Do you have a choice?

Yes, you do!

Choice is derived from the Patient Bill of Rights. Every patient is given this notice when receiving services in an inpatient setting. It is often housed in a folder or pamphlet provided by the healthcare organization.

The Patient Bill of Rights was adopted by the U.S. Advisory Commission on Consumer Protection and Quality in the Health Care Industry in 1998. Virtually any organization that provides services and bills Medicare and Medical Assistance are required to inform patients of these rights when they start providing services to the individual.

So what does the Patient Bill of Rights say?

  • Information Disclosure: You have the right to accurate and easily-understood information about your health plan, health care professionals, and health care facilities. If you speak another language, have a physical or mental disability, or just don’t understand something, help should be provided so you can make informed health care decisions.

And here is the notice about choice:

Choice of Providers and Plans: You have the right to a choice of health care providers who can give you high-quality health care when you need it.

Additional points in the Patient Bill of Rights include:

  • Access to Emergency Services: If you have severe pain, an injury, or sudden illness that makes you believe that your health is in serious danger, you have the right to be screened and stabilized using emergency services. These services should be provided whenever and wherever you need them, without the need to wait for authorization and without any financial penalty.
  • Participation in Treatment Decisions: You have the right to know your treatment options and to take part in decisions about your care. Parents, guardians, family members, or others that you select can represent you if you cannot make your own decisions.
  • Respect and Non-discrimination: You have a right to considerate, respectful care from your doctors, health plan representatives, and other health care providers that does not discriminate against you.
  • Confidentiality of Health Information: You have the right to talk privately with health care providers and to have your health care information protected. You also have the right to read and copy your own medical record. You have the right to ask that your doctor to change your record if it is not accurate, relevant, or complete.
  • Complaints and Appeals: You have the right to a fair, fast, and objective review of any complaint you have against your health plan, doctors, hospitals or other health care personnel. This includes complaints about waiting times, operating hours, the actions of health care personnel, and the adequacy of health care facilities.

Some additional practical advice to assure that you are adequately informed to make the best possible choices:

  1. Ask to speak to the assigned case manager within 24 hours when your loved one enters the hospital. Ask questions and share your concerns. Ask about the next steps in care and get the case managers advice about any after-care needed. For example, does the case manager expect that your loved one will go right home? Is home health care recommended? Or are the care needs more extensive and require an inpatient rehabilitation facility? Get a list of providers that you can contact to find the right fit for your loved one’s needs. There may be a need for a different level of care than you originally anticipated. In my dad’s case, I told the case manager that my family was not interested in the facility that she chose; it was 45 minutes away and we wouldn’t be able to visit or advocate for him. I asked her to check availability in more local facilities that I knew and trusted.
  2. Pay attention to the care you or your loved one is receiving. Make sure you/they are getting the right treatments and medications. Don’t assume anything.
  3. Make sure staff providing care are introducing themselves and you know what their credentials are.
  4. Notice whether or not the staff are washing their hands. Hand washing is the most important way to prevent the spread of infections. Don’t be afraid to gently remind the caregiver. You and your ill loved one need to do the same.
  5. Be sure the health care professional confirms your/ your loved one’s identity before giving medications or treatments.
  6. Educate yourself about the diagnosis, services provided and the care plan. Gather information. Write down important information the doctor tells you and ask if the doctor has any written information you can take with you to look at later.
  7. Thoroughly read all forms and make sure you understand them before you sign anything. If you don’t understand something, ask for a better explanation.
  8. Make sure you understand how to use any equipment the doctor orders for your care, especially if you will need to continue use once you are home.
  9. Know the medications and why they are prescribed. Ask about the purpose and ask for written information which can be provided by the pharmacy. Know both the brand and generic names of the medications. Know the possible side effects to watch out for. Whenever a new medication is prescribed, tell the doctor about any allergies and other medications prescribed to be sure that it is safe to also take the new medication.

You have rights, you have choice and you have a voice. Use them. Aim to be an educated consumer for your loved one’s successful recovery.

Resources to help you:
Making the Right Decision For Rehabilitation Care