Tablets Help Home Health Agency Boost Care Coordination, Cut Costs

CHIME is chiming in on the value of mHealth.

The College of Health Information Management Executives unveiled a case study this week that examines how a California-based home care and hospice agency is seeing benefits by using tablets.

The process wasn't easy, though. The 11-page case study points out that the organization spent a decade working with laptops and smartphones – and experiencing problems with each – before moving on to tablets. It's indicative of an mHealth movement that is moving by fits and starts toward acceptance.

Sutter Care at Home, an affiliate of Sacramento-based Sutter Health with more than 1,300 caregivers in 23 counties throughout northern California, transitioned to tablets running on the Android system in 2012. According to Jennifer Brecher, Sutter Care at Home's project manager, the tablets offer caregivers instant access to important information from the system's Epic electronic medical record, as well as real-time communication with fellow caregivers for care coordination.

“Tablets have sped up the flow of the process,” she said in the case study. “In the past, if one of the clinicians went to see the patient on Monday and the physical therapist would go on Tuesday, the therapist would not have the electronic information about the Monday visit available. This is better from a productivity standpoint and better for the patient.”

Phil Chuang, Sutter's chief strategy officer and former director of information services, said the group had tried for about a decade to bring mobile computing into the home care process. They started with laptops, then tried smartphones, but each had limitations that affected how the caregivers did their jobs in sometimes-remote parts of the state.

They then switched to 7-inch tablets equipped with 4G mobile broadband access, and have seen noticeable results.

With the tablets, Brecher said, caregivers can now finish documentation on a visit in 24 hours, rather than the three days it took before tablets were introduced. They can also enter photos into the medical record, consult with specialists and order medical supplies (the agency reports a 20 percent per-visit decrease in supply costs in the first year that tablets were used).

“If we want to achieve better outcomes for care, we need to be sure that we are staying on top of best clinical care practices,” he said in the case study. “It’s unfair to expect a field nurse to keep up on what is best practice in all areas. This system helps drive best practice; a wound care nurse manager determines what supplies should be on the formulary and keeps it updated as improved supplies become available on the market.”

Chuang said the agency spends 18 hours training a new nurse to use the tablet, a process that includes classroom time and encouragement to take the tablet home and practice with it. The program also requires a lot of work from the IT department, which has to keep track of a thousand devices spread out all over northern California. Sutter officials said they purchase tablets commonly available to consumers, the only requirement being that they run on Android.

Among the advantages, Chuang said in the case study: IT can manage the devices from afar.

“Mobile device management is a way to bring consistency to the devices out there,” he said. “The system allows us to know where a device is, to wipe a device, to push out new policies. Our level of control is far more powerful than anything we had with laptops. We know the status of every device, without any user intervention.

“There are always issues with security compliance with any device,” he added in the case study. “If someone loses a laptop, how do you know if it was encrypted? The last time it was on the network is the last time we can tell. When our security office wants to know whether a device was encrypted, we can tell them exactly when, and we can issue a wipe command and erase the device immediately. We have a level of security that we never had with laptops.”

Sutter officials say the tablets will improve care coordination and documentation for homecare nurses, who face unique challenges in their mobile environments. They can improve their documentation, communicate and consult with other caregivers and share data and resources with their patients. Chuang expects the project will be even more meaningful as accountable care measures take root, putting more emphasis on care coordination, prevention of hospital readmissions and data transparency.

“That’s the power from a patient care perspective, that we can communicate with you and the patient wherever you are,” he said. “That’s what the mobile technology gets us.”

Written By:Eric Wicklund - Editor, mHealthNews

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Seniors and Driving

As we grow older health issues and medications can negatively affect our driving ability. Seniors, their family members and caregivers need to openly discuss this issue.

Following are a few questions to consider:

Does he or she get lost on routes that should be familiar?

Have you noticed new dents, scratches, or other damage to his or her vehicle?

Has he or she been warned by a police officer or received a ticket for a driving violation?

Has he or she experienced a near miss or crash recently?

Has his or her doctor advised him or her to limit or stop driving due to a health reason?

Does he or she take any medication that might affect his or her capacity to drive safely?

Does he or she stop inappropriately and/or drive too slowly?

Does he or she suffer from illnesses that may affect his or her driving skills?

If you answered “yes” to any of these questions, a caring, respectful and non-confrontational conversation about safety needs to take place.

You might consider riding with the older driver to observe his or her competency. Encourage your older driver to get a vision and hearing evalua- tion. An older driver safety class would refresh the rules of the road. You could also discuss any concerns with your loved one’s physician and ask for recommendations.

The good news is that older drivers may be able to adjust driving habits to increase their safety. For example, they may limit driving to daylight hours and good weather and avoid highways or high traffic areas.

Above all else, show genuine concern for your loved ones safety as well as the safety of others on the road.

i
nformation above provided by the National Highway Transportation Safety Administration

Caring for 2 Million Home Health Workers-in home care providers will double by the year 2020

According to the Bureau of Labor Statistics, the demand for in home care providers will double by the year 2020. This increase in

Caring for In-Home Care Aides

demand is the product of an aging population, more people living much longer, and the changes to the healthcare industry that is aimed at moving patients away from long hospital stays to home care.

Currently, there are an estimated 2 million home health care workers, or home care aides, who are caring for elderly and infirm individuals across the country.

The profession is expected to become “the No. 1 growing occupation in the next 10 years (CNN).”

An effort has begun to help provide more support to these caregivers, with the Obama administration extending the Fair Labor Standards Act to cover home care aides and other workers. This is intended to provide these workers with the same overtime protection that other workers have received for decades, but which weren’t applied to this labor force.

The majority of the in home care providers are women and through the years, the work that they do and the care that they provide has largely been marginalized. The reasons for this marginalization may have more to do with the inherent misunderstanding about the type of care that they provide, and the level of experience and knowledge that some believe is needed to perform this work.

Caregivers are unique to the American workforce as they are individuals who support themselves by providing support to those in need. According to advocates for in home care providers, raising wages and offering more benefits, and more support, will be one way to help lift many of these providers out of poverty. It would also allow family members who are juggling raising a family and caring for elderly loved ones an opportunity to grow professionally themselves.

There are others who believe that raising wages for this level of workers would force agencies and other businesses to cut back on their workforce, effectively leaving numerous elderly and other individuals in need without the caregivers that they may require.

Care providers are an invaluable part of the healthcare industry and for many years their contributions have been downplayed. However, as more seniors age, and as people live longer than ever, it’s going to become more important to take care of the in home care workers who provide the support that elderly Americans require. Determining the best way to support them, and to give them more opportunities in the future, is at the core of today’s debate over wages, benefits, and more.

MARCH 19, 2014 BY VALERIE VANBOOVEN

7.9 million people with Medicare have saved over $9.9 billion on prescription drugs

37.2 million Medicare beneficiaries received free preventive services in 2013

On the 4th anniversary of the signing of the Affordable Care Act into law, new information released today by the Department of Health and Human Services (HHS) shows that millions of seniors and people with disabilities with Medicare continue to enjoy lower costs on prescription drugs and improved benefits in 2013 thanks to the health care law.

Since enactment of the Affordable Care Act, 7.9 million seniors and people with disabilities have saved $9.9 billion on prescription drugs, or an average of $1,265 per beneficiary. In 2013 alone, 4.3 million seniors and people with disabilities saved $3.9 billion, or an average of $911 per beneficiary. These figures are higher than in 2012, when 3.5 million beneficiaries saved $2.5 billion, for an average of $706 per beneficiary.

Use of preventive services has also expanded among people with Medicare.  In 2013, an estimated 37.2 million people with Medicare took advantage of at least one preventive service with no cost sharing, including an estimated 26.5 million people with traditional Medicare, and more than 4 million who took advantage of the Annual Wellness Visit.  This exceeds the comparable figure from 2012, when an estimated 34.1 million people with Medicare, including 26.1 million with traditional Medicare, received one or more preventive benefits with no out of pocket costs.

“Thanks to the Affordable Care Act, we saw a stronger Medicare program in 2013,” said HHS Secretary Kathleen Sebelius. “Seniors are saving billions of dollars on their needed medications and continuing to enjoy benefits that will lead to healthier lives and lower costs in the long run.”  

Closing the prescription drug “donut hole”

The Affordable Care Act makes Medicare prescription drug coverage more affordable by gradually closing the gap in coverage where beneficiaries had to pay the full cost of their prescriptions out of pocket, before catastrophic coverage for prescriptions took effect. This gap is known as the donut hole.

  

Thanks to the health care law, in 2010, anyone with a Medicare prescription drug plan who reached the prescription drug donut hole got a $250 rebate. In 2011, beneficiaries in the donut hole began receiving discounts on covered brand-name drugs and savings on generic drugs.

People with Medicare Part D who fall into the donut hole this year will receive discounts and savings of about 53 percent on the cost of brand name drugs and about 28 percent on the cost of generic drugs. These savings and Medicare coverage will gradually increase until 2020, when the donut hole will be closed.

For state-by-state information on discounts in the donut hole, please visit: http://downloads.cms.gov/files/Donut-Hole-by-State-2013.pdf

For more information about Medicare prescription drug benefits, please visit:

http://www.medicare.gov/part-d/.

Medicare Preventive Services

By making certain preventive services available with no cost-sharing, the Affordable Care Act is helping Americans take charge of their own health. By removing barriers to prevention, Americans and health care professionals can better prevent illness, detect problems early when treatment works best, and monitor health conditions.

For Medicare, the Affordable Care Act eliminated coinsurance and the Part B deductible for recommended preventive services, including many cancer screenings and other important benefits. For example, before the Affordable Care Act, a person with Medicare could pay as much as $160 in cost-sharing for a colorectal cancer screening. Today, this important screening and many others are covered at no cost to beneficiaries (with no deductible or co-pay). This will help many seniors to stay healthy.

For state-by-state information on utilization of preventive services at no cost sharing to beneficiaries in Medicare, please visit: http://downloads.cms.gov/files/Beneficiaries-Utilizing-Free-Preventive-Services-by-State-YTD2013.pdf

Caregiver Tips for Traveling With The Elderly

When traveling with seniors, all you need is a little extra preparation so that you and your loved ones can vacation in comfort—and worry-free.

Travel can be one of the most rewarding experiences in our lifetime, whether the goal is to see the world or to visit long-distance friends and family. However, when we travel with our elderly loved ones, we may be faced with challenges we don’t anticipate—issues that simply aren’t there when traveling on our own. Our loved one may not be mobile without a wheelchair, or they may have a specific health condition such as Alzheimer’s disease or heart problems; any of these can make vacationing much more complex, regardless of whether you’re traveling by plane, cruise ship, or your own family car.

As with any other vacation, preparation is key: plan ahead for some of the most common senior travel needs so that you and your family will be able to enjoy a hassle-free trip that’s memorable for the right reasons.

1. Consult with a doctor for travel approval and recommendations.

The all-important first step is making sure your loved one is cleared for travel by his or her primary care doctor, especially if you’re accommodating a health condition such as Alzheimer’s disease. Make sure the chosen destination is appropriate to your parent’s limitations, and ask the doctor for specific travel tips as well as any necessary vaccinations or extra medications.

2. Arrange special services ahead of time.

If your loved one needs a wheelchair at the airport, advance boarding of the airplane or train, or special seating in a disabled row or near a restroom, get in touch with the airline personnel or travel company to make sure these are available upon arrival. Remember the TSA security checkpoints, too: be aware of any surgical implants that might set off metal detectors, and wear easy-to-remove shoes. Contact the airline in advance to arrange for special screening if your loved one has disabilities or special needs, and contact hotels to check on things like shower bars and accessible rooms.

3. Research medical facilities at your destination.

Especially if you’re traveling to an unfamiliar area, make sure you know where the nearest hospitals and care centers are, in case of emergency, suggests the New York Times New Old Age blog. Bring contact details for your own doctors, too, and any necessary insurance information.

4. Prepare all necessary documentation and identification.

First, make sure travel documentation is in order: passports, if needed, as well as driver’s license, travel tickets and itineraries—and make multiple copies. You’ll also want to pack medical documentation: Medicare and insurance cards (and photocopies) as well as any prescriptions or physician’s statements. The Family Caregiver Alliance suggests wearable identification for loved ones with dementia: an ID bracelet or wearable GPS unit, for example.

5. Make sure your loved one always has a way to contact you.

Providing your loved one with a calling card or a prepaid cell phone, if they don’t already have one, is an ideal way to make sure they can get in touch with you at all times. Make sure your phone number is programmed in. If your loved one has cognitive impairment, you may want to put your name and phone number on an ID bracelet. Carry a photo of your loved one with you in case you get separated and need help to find them.

6. Pack essential items in a bag that’s easily accessible.

Make sure you have essentials close at hand: an ample supply of necessary medication, important documents and phone numbers, favorite snacks or drinks, a deck of cards or other entertainment, a light sweater, a hat, sunscreen, a travel pillow. These should be kept in a carry-on bag, or a tote that’s readily available inside the car rather than locked away in the trunk.

7. Pack as lightly as possible.

This is particularly important if you are traveling with a loved one who needs special care and assistance. “Less in your hands will help give you more attention to focus on your care recipient,” says the Family Caregiver Alliance.

8. When possible, maintain a predictable daily routine.

Maintaining a routine or a predictable schedule is critical to reducing stress and anxiety in a loved one with cognitive impairment or Alzheimer’s. Keeping mealtimes, medication schedules, and rest times as consistent as possible—and planning flights and car trips accordingly—will lower the risk of agitation.

9. Plan for breaks and downtime in the schedule.

There’s nothing less relaxing during a vacation than having to rush from place to place, and quiet time is even more important if you’re a caregiver for someone with dementia symptoms. Plan to arrive for flights earlier than you normally would, to make sure your loved one has plenty of time to get settled. On road trips, plan to take plenty of breaks, whether it’s taking the time for a full meal or simply a short restroom break.

10. Plan a schedule that accommodates your loved one’s needs.

Alzheimer’s patients tend not to do well traveling in the late evening or at night because of Sundowners’ syndrome, so take this into account when making your travel plans. Travel when your loved one is mostly likely to do well, and both you and your family will get much more out of the experience.

by Sarah Stevenson

Lawmakers pile on against Medicare Advantage cut

More lawmakers are joining the effort to stop the Obama administration's proposed cuts to Medicare Advantage.

In a letter sent Wednesday, nearly 200 members of the House urged administration officials to keep Medicare Advantage rates flat to avoid harming seniors' care.

The effort was spearheaded by Rep. Bill Cassidy (R-La.), who is hoping to unseat Sen. Mary Landrieu (D-La.) in November. 

"Medicare Advantage serves our constituents well, particularly those with high rates of chronic disease," the lawmakers wrote. 

"We believe that the cuts … are inconsistent with our healthcare policy goals to promote more high quality, coordinated care for Medicare beneficiaries."

Fifty Democrats signed on to Wednesday's letter, including Blue Dog Democrat Rep. John Barrow (Ga.), highlighting the issue's political potency.

"Georgia is home to hundreds of thousands of Medicare Advantage beneficiaries who are worried about the stability of the program," Barrow said in a statement.

"Further cuts to Medicare Advantage would dramatically alter the standard of care that folks have come to rely on."

Federal health officials are proposing a reimbursement cut of roughly 2 percent on average for Medicare Advantage plans next year, and are expected to make a final decision on April 1. Outside analyses have found the cut may be as high as 6 percent based on other factors.

The reduction reflects cuts ordered by the Affordable Care Act and an annual update determined by the Medicare agency.

Obama officials and many Democrats argue that the private insurance plans under Medicare Advantage are significantly overpaid compared with traditional Medicare.

Paring back reimbursements is the fair and fiscally responsible move, they assert.

The private program receives more funding on average per beneficiary thanks to GOP-backed policies.

The insurance industry has launched a substantial lobbying campaign against the Medicare Advantage cuts.

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Congressman Walden issues letter to colleagues in Congress stressing negative consequences of deep Medicare home health cuts on seniors' access to care and home healthcare jobs.

WASHINGTON, March 12, 2014 /PRNewswire-USNewswire/ -- The Partnership for Quality Home Healthcare – a leading coalition of home health providers dedicated to improving the integrity, quality, and efficiency of home healthcare for our nation's seniors – today thanked Congressman Greg Walden (R-OR-2) for issuing a letter to his colleagues in the U.S. Congress calling attention to the "devastating effect" deep funding cuts to the Medicare home health benefit are having on the program's most vulnerable beneficiaries and on small businesses and jobs across America.

As part of the Affordable Care Act (ACA), funding for the Medicare home health benefit was cut by an unprecedented 14 percent cut over four years (2014-2017) - the maximum allowable by law.  Such a deep funding cut, according to the Centers for Medicare and Medicaid Services (CMS), will drive "approximately 40 percent" of providers to net losses by 2017.  Avalere Health's analysis of the ACA cut reveals that nearly two-thirds (72%) of Oregon's home health agencies will suffer net operating losses by 2017.

Recent analyses, as pointed out by Congressman Walden, demonstrate that every state will experience job loss and business closures and consolidations due to the rebasing cut. As a result, the Medicare program's most vulnerable patients could lose access to quality skilled home healthcare.

"Congressman Walden has long been a steadfast advocate for seniors' access to quality home healthcare services.  He has strongly opposed funding cuts that threaten seniors, rural communities, and hardworking home healthcare professionals, and we applaud him for his compassion and leadership," said Eric Berger, CEO of the Partnership for Quality Home Healthcare. "In the Congressman's home state of Oregon, more than 15,000 homebound seniors and nearly 3,000 home healthcare professionals are directly impacted by the ACA cut, demonstrating the critical need for relief to protect these vulnerable patients and healthcare jobs."

In the month of February alone, the home health community lost 3,800 jobs according to the Bureau of Labor Statistics (BLS), the largest cut seen in home health in more than a decade.  Since this job loss occurred in just the second of the 48 months in which the Obamacare cut is being implemented, home health leaders are warning that – unless corrected – the Obamacare cut will cause thousands of additional jobs to be lost.

"Thanks to Congressman Walden and other lawmakers' leadership, Congress is recognizing the devastating effect this cut is having on seniors nationwide.  We applaud them for considering much-needed relief to the Medicare program's frailest patients and home healthcare professionals across our nation," added Berger.

Across Oregon, 21,161 seniors receive the Medicare home health benefit, which is widely recognized as clinically advanced, cost effective and patient preferred.

The Partnership for Quality Home Healthcare was established to assist government officials in ensuring access to skilled home healthcare services for seniors and disabled Americans. Representing community- and hospital-based home healthcare agencies across the United States, the Partnership is dedicated to developing innovative reforms to improve the quality, efficiency and integrity of home healthcare. To learn more, visit www.homehealth4america.org. To join the home healthcare policy conversation, connect with us on Facebook, Twitter and our blog.

SOURCE Partnership for Quality Home Healthcare