program to post-acute care. With February being Heart Month, and knowing that heart disease is one of the readmission penalty diagnoses, I paid attention when I recently read a study in Annals of Internal Medicine from investigator Janet Prvu Bettger and collaborators from Duke and Wake Forest.[i] This study looked at the role of transitional care interventions in patients who had recently suffered a heart attack or stroke. The question was legitimate: what interventions around transitions work to improve outcomes? What they found was sobering.
March is National Social Work Month and a perfect time to recognize the invaluable role social workers play at Kindred Healthcare.
“Social workers are integral to the care provided to patients,” says Stacey Hodgman, Sr. Director, Care Management. “In order for a patient to truly heal physically, their social and emotional needs must be addressed and in balance with their condition.”
Hodgman explains that social workers are an amazing non-medical resource. At Kindred, social workers serve in a multitude of roles including as case managers and discharge planners. They get to know their patients and take a holistic approach to determine the support systems already in place and what type of assistance they might need when transitioning to home.
Activities of daily living including cleaning, grooming, cooking, and countless other actions we do in stride come easily to the vast majority of the population. Imagine that you suddenly find yourself performing these tasks slower than usual, or unable to complete them at all. This can be a reality for much of the aging population.
National Senior Independence Month sets out to help older citizens remain in control of their daily lives. According to the Administration on Aging, “85% of adults over the age of 45 say they’d rather stay in their own homes” as opposed to moving into a facility.
Here are some home safety tips to continue living independently:
A strategic plan that is articulated in Mission, Vision and Value statements can fail when companies become distracted by the challenges of day-to-day operations. Removing barriers to a plan’s success was one of the aspects of a presentation by Barbara Baylis, Senior Vice President, Clinical and Residential Services for Kindred’s Nursing Center Division, and expert Brian Lassiter, president of Performance Excellence Network.
Their presentation, How Prepared Are You for the Future? Addressing Challenges and Capitalizing on Opportunities, was featured at the American Health Care Association/National Center for Assisted Living (AHCA/NCAL) Quality Symposium in San Antonio, Texas on February 11-13.
Baylis and Lassiter discussed the importance of strategic planning to achieving and sustaining performance excellence. She provided examples of proven best practices learned over 20 years in the industry.
“People always think they have more time than they do,” says Jessica Reay, a Private Duty Branch Manager with Professional Healthcare at Home. “Ideally, planning for your later years should start when you’re in your 50s or 60s. Otherwise, you could end up in the wrong place if the decision is left to well-intentioned, but uninformed, children or a court-appointed stranger.”
Reay recommends starting with a financial planner and estate attorney to make sure there are enough resources and long-term care insurance to cover the cost of at-home care or a senior community, and to create a will, living trust, financial power-of-attorney and Advance Health Care Directive.
On Friday, February 8, I attend the Alzheimer's Association’s National Leadership Summit in Dallas, TX.
Dr. Randall Bateman, lead investigator for the Dominately Inherited Alzheimer’s Network (DIAN) Trials Unit at Washington University St. Louis, gave an overview on the research he’s conducting. Through an online registry of over 3,000 people with autosomal dominant Alzheimer’s disease, Dr. Bateman was able to find 240 volunteers for his trial. They are testing the affects of three different drugs from two manufacturers on this group.
Myriam Marquez, a National Early Stage Advisor for the Alzheimer’s Association, lives with the disease and is a member of Dr. Bateman’s trial. She spoke of the devastating effects Alzheimer’s has had on her and many of her family members. She is an advocate and a participant in the study to help future generations of her family and others with this inherited gene.
Valentine’s Day can be a popular day for visiting a loved one, and planning ahead can make for a more successful visit. Lyle Pepin, District Director of Case Management, recommends calling the Case Manager or nurse before you arrive to get an update on the patient’s condition and to see if there are any scheduled tests or therapies that might interrupt your visit.
“The Case Manager can explain your loved one’s progress and planned next steps. This gives visitors something to talk about during a visit,” he says.
Start with light conversation such as news about the family or a favorite sports team. Then, transition into a positive conversation about their status such as: I heard you walked down the hall on your own today and they’re going to take you outside next week.
“This helps reinforce what the patient is hearing from their treatment team and keeps the family involved in their progress,” says Pepin.
For Polly Moore, MD, FACC, helping patients live and die well with heart failure is not just a job, it’s a passion. One that started 25 years ago when she began her career as a nurse and found satisfaction working with heart patients in the emergency room.
Dr. Moore, now a cardiologist with Franciscan Physician Network Indiana Heart Physicians, is director of the practice’s Heart Failure Care Clinic and works with Kindred as a consultant, rounding on cardiac patients at Kindred Hospital – Indianapolis South, and providing clinician education there on the heart disease process.
“I was drawn in particular to the heart failure patients, primarily because of the way heart failure impacts their whole lives,” she said. “I try to teach the patients and their families how to get the heart failure under control so they can live well with it.”
In honor of National Cardiac Rehabilitation Week, we are highlighting a unique monitoring system that ensures that any change in a patient’s condition triggers the appropriate medical response.
Because the care of a cardiovascular patient can be extremely complex, Pamela Zanes, District Director of Clinical Operations, recently implemented simple-to-use, but very effective, systems for monitoring the condition of each patient. Congestive Heart Failure Zone management uses information about breathing, swelling, weight gain, chest pain, and activity level to determine when a physician should be called. The Stop and Watch Early Warning Tool encourages anyone in the room to observe and report changes in patient behavior.
“Someone might notice something different, such as the patient is less talkative than the day before or a sudden weight gain that might be a sign of edema. Heart failure is a long-term condition with symptoms that can begin suddenly,” Zanes says.
Many diners tell Ronnie Barker, Head Chef and Foodservice Director at Kindred Hospital Sacramento, that they feel like they’re on vacation rather than at work. He takes this as “a great compliment to me and my amazing team,” including his assistant, Tifiny Andersen.
“Most people only have 30 to 60 minutes to eat. Tifiny and I want them to come here, relax and have a first-class experience,” says Barker.
Instead of frozen food and bland ingredients, Barker uses fresh produce purchased from local vendors, and specialty items like Persian cucumbers and Japanese eggplant.
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