5 Steps Toward Quality of Life With Ongoing Chronic Health Problems

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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”.

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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.

 

12 Steps For Medication Safety Prevent Complications and Repeat Hospital Stays

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Larry came home from the hospital where he was treated for a lung infection. He spent 3 days in the hospital receiving IV antibiotics and recuperating from pneumonia. On the last day he received nebulizer treatments to help clear his lungs.

The morning after Larry was discharged home, his home health nurse came to evaluate Larry. An important part of every health care evaluation is the medication review. The nurse gathered all of Larry’s medications that he had been taking prior to going to the hospital and compared the list from the hospital discharge papers.

What the nurse discovered during the evaluation was that Larry had a change in the dose for three of his medicines and he had 3 new prescriptions. Only 2 prescriptions were filled at the pharmacy. Larry also didn’t use his nebulizer at all since he got home.

Larry has COPD. The nebulizer machine helps put the medicine into the form of a fine mist that will reach to all areas of his lungs to make him breath easier and cough up mucus from the infection. Nebulizer medication may be used in addition to or in place of inhalers.

Some people aren’t able to use inhalers properly and the nebulizer medicine gets to the lungs much more efficiently with the machine. In Larry’s case, he was to use the nebulizer four times a day when he is at home, and if he must be away from home, he can use his inhaler occasionally instead of the nebulizer as it’s more portable. The nebulizer helps open all of Larry’s airways so his lungs can clear the infection.

The medicine for a nebulizer machine comes from the pharmacy. Nebulizer machines come from a medical equipment company and is usually covered under Medicare and other insurances with a doctor’s prescription. In Larry’s case, the hospital sent the prescription to the pharmacy but they didn’t send a prescription for the machine to a medical supply company.

When Larry left the hospital, the nurse who reviewed the doctor’s discharge instructions mentioned that he should continue his breathing treatments. She assumed he had been using the nebulizer before. She did not do a complete medication reconciliation prior to his discharge.

Larry mentally prepared and organized all of his belongings for the return home. The discharge instruction review was done quickly as Larry was ready to get home. He failed to pay attention or recognize the importance of the discharge instructions. Larry missed the important details so that he would get his medication routine right when he returned to the safety and comfort of home.

Medication reconciliation is a process that all medical professionals need to follow in an organized way.  This review helps point out changes between the way the medication was intended to be taken and how the individual is actually taking it. Larry and the nurse, if truly doing a medication reconciliation would have discovered that Larry hasn’t used a nebulizer machine before and the problem would have been fixed before he went home.

In another case, Theresa is at the doctor for a check up and her blood pressure is high today. Theresa is to take a blood pressure medicine three times a day. She understands that she is to take the medicine with each meal. In the doctors office the nurse asks her if she is taking her hydralazine. She answers, “yes”. “When do you take it?”, asks the nurse. “At each meal”, Theresa replies. While the nurse is satisfied with this answer, what is missing is finding out the times she takes it. More digging reveals that Theresa gets up at 11:00 am. She eats and takes her blood pressure medicine at 11:30 when she gets a Meals-on-Wheels delivery and then has soup and a sandwich at 5:00 at which time she takes her pill again. She never eats three meals and is actually only taking two doses a day.

Poorly controlled blood pressure may result in a stroke or heart damage, further affecting Theresa’s health and ability to live independently.

As high as one-third (30%) of all patients find themselves back in the hospital less than a month after a hospital stay.

Medication errors are one of the highest causes of repeat hospitalization stays.

Brown bag medication reviews completed by doctors, nurses, and pharmacists often reveal problems. In a typical program, at least some parts of patient medication schedules are inaccurate. Many people also take duplicate medications because they are taking both the generic and brand name for the prescription. Filling medications at the same pharmacy every time will prevent these errors as pharmacists watch for these type of errors when filling prescriptions.

The bottom line, most important result of any medication review is safety. Patients who continue to take medications inaccurately are more likely to require a return admission to the hospital and possibly experience life-threatening medical harm requiring a stay in an intensive care unit.

How can you prevent medication errors from occurring?

1. Keep a current list of your medications in your wallet.

2. Take all of your medications in a bag with you to each doctor visit. Also, pull out your medication list and review it for accuracy as your pill bottles are reviewed.

3. Update your medication list every time a medicine is changed, added, or stopped.

4. Use one pharmacy to fill all of your prescriptions.

5. Pay attention to instructions provided by your health care provider.

6. Be comfortable asking questions about anything that you don’t understand when explanations are provided for you.

7. Request written directions to take along with you, just in case you forget parts of the instructions.

8. Ask someone to attend all doctors visits with you. Ask your companion to listen, take notes and ask questions during the visit to help you recall information later.

9. Review all the information provided you with your companion after you return home. Take notes about any followup questions you may need to talk about with your health care provider.

10. If you are hospitalized and are returning home, ask your family member or designated driver to be there with you for the discharge paperwork review and to help answer any questions at that time.

11. Don’t let the discharge instructions get buried beneath everything once you return home. It is a busy, hectic process to get reorganized when returning home from the hospital! Reviewing the instructions several times is important. There is so much information to remember, it can be overwhelming. Be kind to yourself and review the notes a few times knowing you are taking good care of yourself.

12. Request Medicare-certified home health agency services upon discharge home to assist you in the transition to home. If services weren’t started right after you leave the hospital, you may call your doctors office and request home health visits. The visiting nurse will assist you in assuring that you are taking medications accurately and provide more training and teaching about your health condition(s), medications, diet and fluid management, pain management, and lifestyle changes that are needed to help you remain healthy and avoid a return trip to the hospital. The nurse will make recommendations for other in-home visits such as Physical Therapy, Occupational Therapy, Speech Therapy, Social work services, and even home health aide services to assist with personal care for a short period as you recuperate at home.

13. Always schedule and keep follow-up health care provider/doctor appointments. An appointment to your health care provider is important to be sure that you are recovering well. Your health care provider may make further adjustments as needed to help you continue to recuperate at home.

These tips will prevent many complications in your health, no matter what the medical diagnosis is. In the end, communication is the key ingredient.

The Legacy of the Lamp

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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

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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.

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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.

 

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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.

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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.