Rehabilitation at Home: Regaining A “Personal Best”

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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.

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.

Home Health: A Safe Transition Home

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Home Health is an opportunity to provide care, one patient at a time.

With no distractions, in a patient’s home, nurses and therapists have an opportunity to translate health care instructions into part of a patient’s daily routine.

Sixty percent (60%) of patients have unresolved questions related to their health care at the time of a hospital discharge.

The home health team provides safe transitions to home, providing follow-up care at home following a hospital stay, surgery, illness, or change in condition.

Identify barriers to care in the home.

Ensure doctor’s orders are being followed.

Explain post-hospital care in ways that patients understand.

Evaluate safety and medical needs.

This is the daily impact of a Health Calls home health nurse in a respected team.

 

Nurses in home health provide a highly skilled, broad range of nursing skills including chronic disease management, use astute assessment skills to identify potentially critical acute changes early,  fall risk assessment and interventions, medication management, complex wound care, and patient teaching for complex health needs and disability care.

Home health nurses are respected by the physician providers they work with. Home health nurses find rewards working in an interdisciplinary team alongside the physical therapist, occupational therapist, speech therapist, social worker, and home health aide to help maximize the patient’s abilities.

The entire team are the eyes and ears in the home, identifying and treating potentially health changes events EARLY before they become critical events. Patients will have better outcomes because the clinical team detects problems early and then intervene to prevent complications. These early solutions increase patient satisfaction and reduces medical costs by avoiding a hospital readmission.

 

 

Excellence. Integrity. Quality.

By the way, Health Calls is hiring RN’s. Looking for the best to serve Reading and Berks County.

Call 610-927-3166 or email MRadwanski@healthcallshomehealth.com for more information. FAX resume to 610-927-3164.

 

There’s Value In Connecting With The Good Times

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A couple of years ago, I attended a meeting in Chicago. During some down time, I had the pleasure of exploring the Impressionist exhibit at the Art Institute of Chicago. While I was enjoying this beautiful collection, I was distracted by all of the people who walked in front of my view, and hurriedly took pictures of the art with their phones, and moved on to do the same with the next masterpiece rather than really looking at it and enjoying it. Will they remember how well light was captured at the various times of year in Monet’s Haystacks of Wheat?

What if, in every day life, we looked at life through borrowed eyes or with a sense of Christmas wonder? What if we spent more time with our happy memories?

In meditation, a suggestion is to focus on a memory of a place that brings a sense of peace in order to center on the meditation activity. I usually go to one of two places: the beach, or a quaint cottage I stayed at with my sisters. I hear the trickling of soothing water from the lake. It was peaceful, beautiful and I was so content and happy. Good place to go mentally for centering and happiness. I thought about this while reading an article that reminds us to Live in the Moment.

There’s value in regularly connecting with “the good times”.

As recently shared in the white paper, Dementia Caregiving Guide, spending time talking with Mom (who has Alzheimer’s) about a memory of a happy time with Dad is emotional validation. Life stories, memories from daily life, celebrations, vacations and special trips, and all positive connection of this kind with family and friend is well spent.

What emotion or experience does this picture create for you? Consider asking your parent if they ever saw a beautiful field of sunflowers like this. Where was it at? What were they doing that day? What other happy memories does it bring? What happens when you ask your child or grandchild about the photo? How many colors do they see? Who lives with those flowers? Ask them to tell you a story about the sunflowers. Do they make you happy?

 

Do you ever experience post-vacation blues? Feel overwhelmed and let down with that morp speed experience of ‘back to work’ after a much needed break? Bring some momentos home and print one, or several photos from the trip and keep them at your desk to keep the scenery, activity, scents, smells, and sounds alive. You work hard so you can play hard, so relive and savor it!

Do you wonder how you will manage dealing with your Mom’s new cancer diagnosis with the treatments and appointment schedule when you are trying to balance a full time job, a family, and a home? How about that time you overcame your fear of heights?

Write the story down, tell others about how you challenged yourself, both physically and mentally training for the hike you took and how you felt reaching the summit. Remembering how you overcame your fears will embolden you to pull together your resources and increase your confidence to deal with the current crisis. Remember that you researched and asked others for help while prepping for the hike. You need to do that with this challenge too, so you don’t burn yourself out.

One way to share your story is to write it down. Not a diary with gossipy type of memorabilia, but a journal in which you record the day to day events that have importance in your life. Record vacations, the one lined memorable or remarkable, startling phrases that your children or grandchildren have said. Take special care to note things you are grateful for, generosity others have shown you, things you have done to pay it forward, thoughts you have had while quietly taking a walk. The thoughts and things you record may be valuable and memorable to your family in the future. There are many approaches to journals including Journalling apps, and guided book journals. On-line journalling prompt sites are helpful to start the thought process.

Writers from my hometown just recreated our area’s rich history in a sight and sound extravaganza. Reading, Pa. has experienced tremendous financial loss as manufacturers have relocated elsewhere over the past 30 years. Reading Railroad was also once the largest corporation in the United States. The area’s history is rich, but we mourn who we were and are dismayed by the tougher and rougher times. In an article written about the multimedia performance, This is Reading, the author writes that the story created “a piece of art in a city that has fault lines”. The good news is that there are many strong and good-hearted, generous people who work hard every day to enhance the quality of lives in our town. New manufacturers and small business are finding their way. The People’s Chronicles is a local non-profit of story tellers with a mission to create a richer community through our local stories, told by people who created or experienced them.

Mike Little, Health Calls Owner and CEO was born and raised in Nitro, WV. Each year, Health Calls celebrates West Virginia Day. This is the birthday of the state (June 20) and commemorates the state’s succession from Virginia. It’s not our state holiday, but we respect and celebrate with him because it’s part of our synergistic unique company culture. We hear about differences in the way of life through his stories and we are richer from the experience. You and your loved ones, mine as well: we all have fault lines. With our storytelling, all the wrinkles and faulted lines, meaning…purpose…and community are created.

Carpe Diem. Be. Present. Tell stories. Keep a journal. Express gratitude. Pay attention to cues (the smell of pine, the crackle of the fireplace, the taste of salted caramel, the melody playing in the restaurant) that bring you to a happy memory and tell the remembered story. You and I each have a unique story. Tell it! Encourage your loved ones, people you work with, those you care for to tell their story, the memories of today and yesterday. Keep them in the present, happy and alive.

Enjoy the Fruits of Summer

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Summertime is a great opportunity is to enjoy access to fresh food. Here in Berks County, locally grown food is abundant and available at area farmer’s markets and stands. A complete listing of seasonal and year-round markets and stands is available here.

The Penn Street Market is held in Reading every Thursday this summer from 10-2. The Food Trust is also at the Penn Street Market providing interactive demonstrations and food samples throughout the day. The Antietam Valley Farmers Market , is held in Carsonia Park on Saturday’s from 8:00-12:00 year round. West Reading also hosts an open air market on Sundays May through October in the 500 block of Penn Ave. from 9:00 am – 1:00 pm.

Purchase some fresh food and follow these suggestions to get your family to eat more fresh meat, fruits and vegetables, and less pre-packaged, processed foods. Try  “rebranding ” delicious veggies as this article suggests.

  1. Describe the food in an indulgent, decadent way. As an example, “Juicy, luscious sweet cherries” sounds appealing and appetizing.
  2. Have fun competing to find the prettiest, smallest, largest fresh veggies to take home to try.
  3. Label food in a healthy positive way rather than a restrictive manner. “Suzie Sweet Pea” has had a way into the bellies of more children than simply telling kids the sweet peas are good for them.
  4. Go head to head in a friendly cook-off competition with family and friends for the most flavorful recipe. Invite others to taste test and name the winner of a Veggie Cook-off competition.
  5. Get the most of the experience, be mindful while enjoying the flavor and textures  of the foods you are eating.

Fresh fruits and vegetables abound. Get out there, visit a local market or stand, prepare some fresh foods and enjoy the moments of pleasure they provide!

 

Many Women Don’t Know Their Heart Disease Risks…And Neither Do Their Doctors.

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Did you know that heart disease is the leading killer of U.S. women?

A recent survey of more than 1,000 women between 25 and 60 years of age found 45 percent were unaware that heart disease is the No. 1 cause of death for women in America. Most women said they had had a checkup in the past year, but only 40 percent said the doctor had evaluated their heart health.

 

 

“Eighty percent of heart disease is preventable, yet women’s heart disease is underdiagnosed, under-researched and underfunded,” said British Robinson, head of the Women’s Heart Alliance, a nonprofit organization that paid for the study.

 

 

“It is critical that women ask their health care providers to check their hearts and that health care providers know that when it comes to heart disease, men and women are different — women’s hearts are smaller, their risk factors are different and their symptoms may be different,” she added.

 

What would you find more embarrassing: not being told you had risk factors and developing a critical heart event, or finding out that you have heart disease and hearing that you need to eat better and exercise?

 

Human behavior is interesting because the study also showed that 45 percent of women canceled or postponed a scheduled appointment because of their weight. We would rather bury our heads in the sand, like the ostrich, than keep an appointment, have a crucial conversation and get educated.

 

“We clearly have a lot of work to do to make women aware that heart disease is a bigger threat to their health than all types of cancer combined,” said study leader Dr. Noel Bairey Merz, director of the women’s heart center at the Cedars-Sinai Heart Institute in Los Angeles.

 

SOURCE: Cedars-Sinai Heart Institute, news release, June 22, 2017

Fulfilling Health Calls Mission One Relationship At A Time

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Health Calls received an unsolicited testimonial from a family this past week. It makes us so proud and speaks to Health Calls Mission.

‘Health Calls is a wonderful service! All of the nurses are of the highest quality and you really establish a relationship with them.

 

Health Calls is always available and ready to help no matter the time! I’d never use another agency with my mom’s care!

 

Congrats (to) everyone… associated with this fine organization!’

As invited guests in people’s homes, we must negotiate care. We cannot simply “do”. This is a shift in the perspective  that often accompanies health care provided in a hospital or other clinical settings. In those settings, the structure and processes require patients to adapt to the organization.

In home health, we are the guests.  The ‘house rules’ could get in the way. Instead, Health Calls staff is focused on teamwork, alongside other community professionals to treat patients where they live. This requires actively listening to the patient and family: finding out what is important, what can be negotiated, and then aid and inspire patients to become informed about their conditions and take an active role in their treatment.

The balance of power shifts away from the healthcare team to the individual and their family in a healthy partnership. We support the patient and family while they build skills, and foster their confidence to continue to lead active and fulfilling lives, long after our work
is done.

We are thankful to be invited!