On November 29, TEDMED, a multidisciplinary community of innovators and leaders dedicated to creating a better future in health and medicine, held a panel discussion via webcast titled The Caregiver Crisis. Members of the panel included upper-level management from the Center for Long Term Care Research & Policy, the National Family Caregivers Association, the Case Management Society of America, the Families and Health Care Project, and CarePlanners. This thought-provoking discussion raised many points:
Kindred’s leadership has been discussing these and related issues in other forums as well. Said Sean Muldoon, MD, MPH, FCCP, Senior Vice President and Chief Medical Officer for the Kindred Healthcare Hospital Division: “We have talked about caregivers taking increasingly greater roles in care in the last few days prior to discharge from post-acute care.”
Good hand hygiene is critical in preventing the spread of influenza. All employees should perform hand hygiene before patient contact; after patient contact; after contact with blood, body fluids, or contaminated surfaces (even if gloves are worn); before invasive procedures; and after removing gloves. “All of our hospitals have alcohol-based gel in the hallways and in the patient rooms to make it easy for staff, patients and visitors to practice good hand hygiene,” says Sheila Fletcher, Infection Prevention and Control Clinical Specialist in Kindred’s Hospital Division.
Most Kindred facilities use “Secret Shoppers” to make sure employees are following hand hygiene protocols. “Secret Shoppers are volunteers who monitor physician and staff hand hygiene practices,” says Fletcher. “They are encouraged to step in and speak up if they see someone who fails to perform hand hygiene or is not doing it appropriately.”
Providing 24-hour care to a loved one is a difficult job, and caregivers are often so focused on taking care of their family member that they don’t take time out for themselves. November is National Family Caregiver Month, which is a good time to remind family caregivers that they need an occasional break. Kindred provides short-term respite for caregivers who need a few days, or even a few weeks, off. “Patients who are brought to our facilities for respite care are given a private or semi-private room in our rehab suite,” says Zachary Ballard, Admissions Coordinator for Kindred Nursing and Rehabilitation -Bashford. “We provide nursing care, along with comfort and support, to the patient until he or she is able to transfer back to the home environment.”
November is National Hospice and Palliative Care Month, a time to recognize those who care for our patients at the end of life’s journey. Kindred’s hospice program utilizes a team approach that includes nurses who provide case management and hands-on care, home health aides who help patients with activities of daily living, social workers who help with community resource needs and social support, and spiritual care coordinators who support the patient and family through prayer and other types of spiritual support. “We also have volunteers who visit with patients and sometimes provide respite for family members,” says Kristina Basicker, Director of Operations, PeopleFirst Home Care & Hospice.
Invited speaker Seth Kahan, author of the book “Getting Change Right: How Leaders Transform Organizations from the Inside Out,” challenged Clinical Impact Symposium participants to take the experience of the last two days back to their own facilities and use it to effect positive change.
Mr. Kahan described four stages of transformation, beginning with what he labeled “the call.” This could be something like a sudden promotion, a new opportunity, the illness of oneself or a family member, or, in this case, the decision to attend the symposium. The threshold stage, said Mr. Kahan, is the point when a person crosses from the normal reality to the reality of the ritual – arriving at the hotel, checking in, the adjustment of the mind to the process. “Time out of time.” The transition to a place where we have permission to have long conversations about topics we care about, and think deeply about things we normally might not have time to think about, Mr. Kahan said.
Timeliness. Legibility. Objective terminology. Those are just some of the features of SmartTX mobile technology, which made its debut in the RehabCare Division in September, 2012. The patient care tracking application can be used on Apple iPads, iPhones and iPods, which are provided to employees using the technology. SmartTX was demonstrated on the iPad mini at Kindred’s fourth Clinical Impact Symposium – Care Across the Continuum.
SmartTX has already proven to be invaluable at the point of care and beyond. The application, now in use at all nursing facility locations and most hospitals, optimizes patient care and scheduling. Built-in information filters in the program ensure that treatment plans are compatible with the patient’s diagnosis information and health care coverage.
Palliative care was the subject of a presentation this morning at Kindred’s Clinical Impact Symposium – Care Across the Continuum. The speakers, Mark Rothman, MD, Chief Medical Officer for Kindred’s Nursing Center Division, and Bonnie Austin, Senior Director of Compliance and Interim Senior Director of Clinical Services at PeopleFirst Homecare and Hospice, described some of the barriers that clinicians, patients and families face in accessing palliative care, and they addressed the importance of appropriate utilization of palliative care.
The presence of not one, not two, but three Accountable Care Organizations (ACOs) makes the Dallas-Fort Worth market a truly unique place with distinctive challenges, according to two leaders who know it well, Audra Early, Executive Director for Kindred’s Hospital Division in the Dallas-Fort Worth Market, and Julie Anderson, District Director of Sales and Business Development for the Nursing Center Division in the Rocky Mountain/ Texas District.
“We have three ACOs in Dallas-Fort Worth and they are all operating differently,” Early said.
Plus ACO is a 50/50 partnership between Texas Health Resources (THR) and North Texas Specialty Physicians, a group of 900 doctors, Early said. THR came to the partnership with a group of 500 physicians, so the ACO now features a total of 1,400 physicians. It is a pioneer ACO and they are taking an innovative approach, she said. Plus currently covers 20,000 lives and is adding 50,000 more, making it a dynamic force in the market.
The Las Vegas healthcare market has shifted almost as quickly as the action on a casino table.
There are 13 hospitals and three healthcare systems there. The area has a population of roughly 2 million, with about 83 percent in managed care.
Two years ago, there were 420 individual on-staff doctors. But a year ago, internal medicine physicians consolidated into five “super groups.” Now most of the hospital systems in Las Vegas use contracts with hospitalist groups rather than employing physicians. Physicians generally direct referrals to those that cover post-acute settings, and patients are placed when and where the care is appropriate.
Four years ago, the patient mix shifted from 65 percent Medicaid patients to mostly patients covered by commercial plans and Medicare Advantage.
Before long, Kindred employees will be able to access patient information without being tied to a PC to get it. Mobile devices like iPads and iPhones are part of the company’s transition to “cloud-based” information systems meant to convey and access information quickly – and benefit patients.
Cloud-based means information will no longer be tied to individual computers and servers. It will free information from local sites because it can be stored in a data center anywhere in the world and be accessible to anyone, anywhere and anytime, if the person is authorized to see it.
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