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.

The Legacy of the Lamp


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.

Stand Up For Social Work


Recently I had the experience of attending a specialty medical clinic with a family member and we were told one of the people we would be meeting with would be a social worker. An uncomfortable concern entered into mind. Why do we need a social worker? The need for a social worker’s help usually comes during difficulty or perhaps even an unpleasant encounter that will result in a life-changing event. In our situation, the purpose of a social worker was to introduce us to a world of information and support. With this information, we would never feel that we were alone with the new diagnosis. Social workers are champions.

The nation’s 650,000 social workers are champions for some of the most vulnerable people in our society. They stand up by comforting people who are experiencing devastating illnesses and mental health crises, ensuring they get best possible care while on the road to recovery. They stand up and support military personnel, veterans and their families, immigrants, people living with disabilities and people who are LGBTQ.

Child, family and school social workers stand up by protecting children who have been abused and neglected, helping children find new families through adoption, and ensuring young people reach their full academic and personal potential. And social workers work in communities and with national, state and local government to provide services and pass legislation to stand with and help people with the most needs.

Health Calls is fortunate to have three social workers on our team and while each of their roles are different, they are champions in helping our patients and families.

Sue Davidson,B.S. has medical social work experience and uses her skills as Health Calls referral liaison, making visits to patients at the bedside while in the hospital or rehab. She provides a bridge of knowledge and information for patients and families prior to the move back home. She educates the family about our services and educates them as well as making sure that the agency has as much information as possible to ease patients into a safe transition to home.

Aaron Rimby, B.S.W. also has medical social work experience and uses his skills to provide patients and families important information about their insurance benefit and any responsibilities that they might have for home health services. Since some Medicare Advantage and commercial insurance plans have co-pays, and patients may still have a financial deductible that needs to be met, hearing from Aaron prior to the first home health visit lessens anxieties ahead of the visit. Families are better prepared for the home health team’s first visit knowing and accepting any financial responsibility with Aaron’s communications. Aaron is frequently a communications bridge to the team. Aaron is a champion as he provides additional reinforcement to the information that Sue or another referral liaison may have already covered. Families are frequently in crisis mode and overwhelmed as they transition to home and Aaron adds a level of comfort along the path home.

Lillian Chinicci, M.S.W., L.S.W. is the agency’s medical social worker. Lillian provides home health visits to patients and families to support and advise, provides referral to community services and make recommendations to families about additional supports available. Lillian is a champion in her insight, knowledge of resources and her ability to facilitate communication between family members and to find common ground for stressed families in need of referrals to community services to help them.


Individually they stand up with their skill and expertise, making a positive impact for each individual family they encounter. Collectively, they stand up to strengthen the agency’s ability to meet the needs of all families Health Calls provides services to. Champions!

Happy Social Work Month! #SWMonth #SWStandUp

The Answer Lies Within The Collective “Us”

My father-in-law celebrated his 90th birthday on Saturday. As I watched the 4 generations have fun together, I was struck by how much technology has changed in his lifetime while the basics of our needs and our nature as humans remains constant. Let me explain.

Some 50 years ago, my favorite cartoon as a kid was the “Jetsons”. and 30 years before that, when my father-in-law was 5, he and his family gathered around the radio on Sunday nights to listen to stories on the radio. For me the Jetsons was mind-boggling, as it was science fiction. To consider that one day cars would not only drive themselves, but fly the passenger from one place to the next was amazing to me. We are basically “there”, as MTT develops a wheelchair that drives itself, and  I watched my 20-month old grand-niece “Facetime” with her aunt who was 160 miles away but technologically with us during the birthday party.

Barry P. Chaiken, MD, MPH recently wrote an article in which he states:

The rapid expansion and evolution of medical knowledge makes it impossible for any single healthcare professional to assimilate and retain the up-to-date information necessary to properly treat patients”

– See more at:

We find ourselves dealing with mind-blowing technology in health care. As consumers, providers, and advocates for our loved ones who need health care, the reality of today’s science can cure one and be terminal for another. We all must face our mortal as well as technological limitations. Basics of communication and relationship management are key.

As mortals, clinicians (doctors, nurses, therapists, researchers) must work very hard to stay on top of the game. We must increasingly rely on and trust the expertise of our team members who know more about pieces of the equation than we may personally know. We can accomplish the best plan for each individual entrusted in our care when we consider the collective “Us“.

As family members and caregivers, we expect better, in fact the best plan of care for those we care for and about. Since I read the Chaiken article, I have given a lot of thought he presented that compares health care team members to musicians of an orchestra.

There is, in fact, too much complexity in health care for any ONE of us to know; to be the SOLE person responsible, and have the intellectual property and resources to carry off the plan of care. Instead, we must work together on the patient’s behalf. If the patient is surrounded by a symphony of experts, in concert of one another, we have a chance of success. As health professionals, we must recognize that we cannot act alone.

Political views aside, I find irony that our president stated this week that “Nobody knew health care could be so complicated”. Welcome to health care, Mr. President. You may not have known but many do. There are no easy decisions. Health care reform is far more complex than any of us realized. Life (and life-changing decisions) is not black and white. There are many shades of grey in between, that color and shape the right course of action for each person entrusted in our care.

imageAs care coordinators, family caregivers and advocates, we must see ourselves as the conductor, with the baton. You have permission. Take up the baton. The baton communicates and directs the movement of the music. As an advocate, use your baton to identify your loved one’s wishes, facilitate communication between and among health care team members and ask the hard questions to move the care along. The goal will be “what is best, in this situation, with the facts before us”. You alone will not have all of the answers. The answer lies in the symphony.


When Driver Safety is Questionable


Ralph sat in his running car at the gas station when a police officer approached him. “Can I help you sir? It sound like your engine is racing.” Ralph didn’t hear the loud engine because of his poor hearing.

Ralph later told his daughter that his foot was caught in the pedal. The police officer helped him dislodge it. Jane, his daughter, has been worried about his driving for close to a year. It’s frustrating to her that the police officer didn’t realize her dad has been in an unsafe situation before. Who can help when she knows her dad is unsafe behind the wheel?

Being older does not automatically eliminate the privilege to drive, but a number of factors need to be evaluated, including reaction time, cognition, vision, and possible correctible medical conditions like low blood sugar should all be evaluated with Ralph’s physician.


Some suggested steps to take if Ralph refuses to give up his keys and is found to be unsafe to continue to drive include:

  • Contact the state Department of Transportation. This will most likely result in being called in for testing in order to keep license.
  • Involve the Doctor. The person’s physician or any other health care provider involved in the person’s care can also send a letter using the state’s appropriate form with documentation of the individual’s unsafe behaviors or limitations to request revoking the license to drive.

Occasionally, there is an individual who continues to drive despite the drivers license being revoked. What’s a family to do? Disabling the vehicle by disconnecting the battery, removing the distributor cap, or having the car towed are the safest measures to be sure that an unsafe driver does not return to the road. Additional sggestions are available here at


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

Medicare Releases Star Ratings For Patient Experience: Health Calls Receives Top Rating

Medicare released the first “Patient Survey Star Ratings” for Medicare-certified home health agencies last week.

Health Calls Home Health Agency received a 5 star rating in Medicare’s Patient Survey Star Rating.

Health Calls response rate to surveys is 33%, which is “a very strong showing”, according to Mike Little, Health Calls CEO and owner. “The findings show that Health Calls is the best and most well-rounded choice for home health services in Berks County.”

Maria Radwanski, COO and co-owner indicates that patients have the ability to remain anonymous or reveal who they are when completing the survey. “Even so, many patients do reveal who they are and take the time to write a note about the health care providers they saw in their homes.”

One recently surveyed patient wrote ‘this was the best care I have had from any agency. I’ve had several falls and this one was there to push me to understand what I could do and what I shouldn’t’.

This patient received critical safety information, in a manner that reflects that she was given important feedback during treatment to improve. The staff was able to do so in a way that involved the patient in the change process and maintained the patient’s respect and dignity while making the necessary changes.

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