Successfully Navigating Healthcare Center Experiences for ... · Successfully Navigating Healthcare...
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Successfully Navigating Successfully Navigating Healthcare Center Experiences Healthcare Center Experiences for your Ward for your Ward Presenter Karyn Rizzo Presenter Karyn Rizzo Patient Advocate * Educator * Author Patient Advocate * Educator * Author “ “ AGING IN AMERICA AGING IN AMERICA Navigating our Healthcare Navigating our Healthcare System System ” ” 2014 Best Seller 2014 Best Seller www.agingguidebook1.com www.agingguidebook1.com
Transcript of Successfully Navigating Healthcare Center Experiences for ... · Successfully Navigating Healthcare...
Successfully Navigating Successfully Navigating Healthcare Center Experiences Healthcare Center Experiences
for your Wardfor your Ward
Presenter Karyn Rizzo Presenter Karyn Rizzo Patient Advocate * Educator * AuthorPatient Advocate * Educator * Author
““AGING IN AMERICAAGING IN AMERICA
Navigating our Healthcare Navigating our Healthcare SystemSystem””
2014 Best Seller 2014 Best Seller
www.agingguidebook1.comwww.agingguidebook1.com
Presenter
Presentation Notes
It’s my honor to be able to share this topic with this group of Amazing Leaders that care for our elders on a daily Basis! Having worked in the Industry for my entire Adult Career, I’m truly grateful to say that I’ve learned from the Best in the Industry ~ Some right here in this Room! Can we applaud the hard work and sacrifice you do every day? ROUND OF APPLAUSE
Statistics on Aging AdultsStatistics on Aging Adults
70 % of people 65 years young and up 70 % of people 65 years young and up WILL NEED WILL NEED long term long term carecare
77 million people were born between 1946 and 1964, which 77 million people were born between 1946 and 1964, which is defined as the baby boomer era (U.S. Census)is defined as the baby boomer era (U.S. Census)
The senior age group is now, for the first time, the largest The senior age group is now, for the first time, the largest in terms of size and percent of the population in the U.S.in terms of size and percent of the population in the U.S.
Baby Boomers make up 35% of the American adult Baby Boomers make up 35% of the American adult populationpopulation
Life Expectancy Heading for 100 years of age (99.3 years)Life Expectancy Heading for 100 years of age (99.3 years)
QUALITY CARE PARTNERSQUALITY CARE PARTNERS
Physician Management / Home CarePhysician Management / Home Care
Skilled Nursing Facilities (SNF) aka Skilled Nursing Facilities (SNF) aka ““Nursing Nursing HomesHomes””
Assisted Living Centers Assisted Living Centers
Accessing BenefitsAccessing Benefits
Presenter
Presentation Notes
By Partnering with Quality Healthcare Providers. In particular, the ones that set them up for Success are Physician Oversight, Nursing & CNA staff and Home Care (Skilled & Non Skilled). We’re going to discuss how to attract and determine which providers will provide the BEST CARE FOR YOUR RESIDENTS. Retention is all about Closing the Back Door, and we all know the highest number of transfers out of a community is to a Hospital. Let’s explore some reasons why residents get transferred to hospitals.
NAVIGATE SMARTLYNAVIGATE SMARTLY
Hospital AdmissionHospital Admission
Physician ManagementPhysician Management
Home Care Therapies & CareHome Care Therapies & Care
Skilled Nursing (SNF) Skilled Nursing (SNF) Rehabilitation Centers aka Rehabilitation Centers aka ““Nursing HomesNursing Homes””
Assisted Living Center Move InsAssisted Living Center Move Ins
Accessing Benefit ProgramsAccessing Benefit Programs
““MY WARD IS WHERE?MY WARD IS WHERE?””
Presenter
Presentation Notes
It’s a sales counselor’s WORST morning experience – an ambulance is following you on your way in to work at your senior living center. The whole time you are hoping it’s not following me or moving ahead of me. Maybe it’s going to my competitor’s community? YES – they have a ton of problems! UH OH When you pull into the parking lot you get to see all the action. Ambulance, Fire trucks, staff are scrambling, etc. UGH. THAT MAKES HOW MANY OUT NOW? “Who’s going out now?” Stressed Marketer & Management Team
The Hospital Center Experience The Hospital Center Experience for for the Patientthe Patient
Presenter
Presentation Notes
Every local Community has new programs, hospital disease management trials, health intervention, mental health and practical experts that are more than willing to educate the community about their services. Inviting them in to speak at a lunch, dinner, coffee event is an easy, and usually low to no cost way to establish to the community a dedication to health, education, and overall wellness. Networking at different groups is a great way to meet these experts, which may be veteran service officers, senior police officers, or non profit directors.
Hospitals can be StressfulHospitals can be Stressful FOR THE STAFFFOR THE STAFF
NAVIGATING THE NAVIGATING THE HOSPITAL WORLDHOSPITAL WORLD
Have Have ““ICEICE””
In Case of Emergency File Ready In Case of Emergency File Ready to go (Easily Accessible)to go (Easily Accessible)––
Insurance CardsInsurance Cards
––
Living Will / DNR Living Will / DNR ––
Court DocumentsCourt Documents
––
POA / Health Care Surrogate PapersPOA / Health Care Surrogate Papers––
FREE HIPPA DISCLOSURE (www. FREE HIPPA DISCLOSURE (www. Caring.comCaring.com) ) https://www.caring.com/forms/hipaahttps://www.caring.com/forms/hipaa--
releaserelease--form/freeform/free--hipaahipaa--releaserelease--form.pdfform.pdf
Hospital Patient AdvocatesHospital Patient Advocates
BaycareBaycare
Hospitals = Social WorkersHospitals = Social Workers
HCA & Florida Hospitals = Case HCA & Florida Hospitals = Case Managers, NursesManagers, Nurses
VA Bay Pines = Social Workers VA Bay Pines = Social Workers (Consult Basis)(Consult Basis)
Director of Case ManagementDirector of Case Management
Chief of StaffChief of Staff
Insurance Appeals (Utilization or Case Insurance Appeals (Utilization or Case Manager)Manager)
Most Common Most Common Hospital AdmissionsHospital Admissions
Falls & FracturesFalls & Fractures
PneumoniaPneumonia
Urinary Tract Infections / Urinary Tract Infections / DehydrationDehydration
Stoke (CHF, Acute MI, Coronary Stoke (CHF, Acute MI, Coronary Arthrosclerosis)Arthrosclerosis)
COPD / Shortness of Breath (oxygen COPD / Shortness of Breath (oxygen dependant)dependant)
Medication ManagementMedication Management
DiabetesDiabetes
InfectionsInfections
Identify High Risk Wards Identify High Risk Wards
DiabeticDiabetic
Oxygen Dependant (COPD / SOB)Oxygen Dependant (COPD / SOB)
Frequent FallsFrequent Falls
Hearing & Vision ImpairmentsHearing & Vision Impairments
Medication ChangesMedication Changes
DepressionDepression
Psychiatric DiagnosisPsychiatric Diagnosis
Hospital Admission StatsHospital Admission Stats
Presenter
Presentation Notes
CDC Breakdown of the main causes of Emergency Room Visits. In the last 10 years the Heart Condition, and Fall admissions have increased drastically.
INFECTION RATES IN HOSPITALSINFECTION RATES IN HOSPITALS
HospitalHospital--Acquired (Acquired (NosocomialNosocomial) Infections) Infections
NosocomialNosocomial
infections are infections acquired in hospitals infections are infections acquired in hospitals and other healthcare facilities. (To be classified as a and other healthcare facilities. (To be classified as a NosocomialNosocomial
infection, the patient must have been admitted infection, the patient must have been admitted for reasons other than the infection).for reasons other than the infection).
These infections occur:These infections occur:
up to 48 hours after hospital admissionup to 48 hours after hospital admission
up to 3 days after dischargeup to 3 days after discharge
up to 30 days after an operationup to 30 days after an operation
in a healthcare facility when a patient was admitted for in a healthcare facility when a patient was admitted for reasons other than the infectionreasons other than the infection
In the United States, it has been estimated that In the United States, it has been estimated that 9.2 out of 9.2 out of every 100 patients acquire a every 100 patients acquire a NosocomialNosocomial
infectioninfection
Presenter
Presentation Notes
There is a real push lately to avoid Hospital Re-Admissions, and aside from the hospitals losing revenue, these are the chief reasons keep our residents home, Infection Control.
Medicare Hospital Readmission Medicare Hospital Readmission Reduction ProgramReduction Program
Readmission Diagnosis: CHF, MI, Pneumonia, Readmission Diagnosis: CHF, MI, Pneumonia, COPD, COPD, Elective Hip & Knee ReplacementsElective Hip & Knee Replacements
2012 $280 M.2012 $280 M.
2014 Increased to 3% (hospital losing most 2014 Increased to 3% (hospital losing most money)money)
Penalties apply to patients admitted for any Penalties apply to patients admitted for any condition not just 5 used to determine high condition not just 5 used to determine high readmissionreadmission
Example Kidney Failure Patient:Example Kidney Failure Patient:
$15,000 minus a 1.5% penalty of $225 = $15,000 minus a 1.5% penalty of $225 = $14,775$14,775
Physician ManagementPhysician Management
Importance of Importance of Primary Care PhysiciansPrimary Care Physicians
Chief Partner in a PersonChief Partner in a Person’’s Healthcare Journeys Healthcare Journey
Medical Directors of Hospitals, Rehab Centers Medical Directors of Hospitals, Rehab Centers aka aka ““Nursing HomesNursing Homes””
& Home Care Agencies& Home Care Agencies
Support Preventative Home Care Therapies to Support Preventative Home Care Therapies to Prevent Hospital RePrevent Hospital Re--AdmissionsAdmissions
Role of Role of HOSPITAL ONLYHOSPITAL ONLY
PHYSICIANSPHYSICIANS
WWW.HEALTHGRADES.COMWWW.HEALTHGRADES.COMoror
WWW.RATEMDS.COMWWW.RATEMDS.COM
Primary Care Physician Primary Care Physician Fact CheckFact Check
IS HE/SHE BOARD CERTIFIED? (Not all are)IS HE/SHE BOARD CERTIFIED? (Not all are)
WHICH HOSPITALS / REHABILITATION WHICH HOSPITALS / REHABILITATION CENTERS DO THEY PARTNER WITH?CENTERS DO THEY PARTNER WITH?
HOME CARE AGENCIES DO THEY WORK WITH?HOME CARE AGENCIES DO THEY WORK WITH?
ARE THEY THE MEDICAL DIRECTOR OF ANY?ARE THEY THE MEDICAL DIRECTOR OF ANY?
PREVENTATIVE APPROACH TO PATIENT CARE?PREVENTATIVE APPROACH TO PATIENT CARE?
WHICH DOCTORS DO THEY SHARE WHICH DOCTORS DO THEY SHARE ““CALLCALL””
WITH?WITH?
YOU CAN GET SECOND OPINIONS !!!!
HOSPITAL PREVENTION HOSPITAL PREVENTION PROGRAMSPROGRAMS
Home Care Therapy TreatmentsHome Care Therapy Treatments
Veteran Benefits (Retired Military and Veteran Benefits (Retired Military and Spouses) Aid & Attendance Spouses) Aid & Attendance
Medicaid Long Term Care BenefitsMedicaid Long Term Care Benefits
Fall Prevention InterventionsFall Prevention Interventions
Identifying Identifying ““High RiskHigh Risk””
Potential WardsPotential Wards
Home Care Therapy Home Care Therapy ProgramsPrograms
Checking Home Care AgenciesChecking Home Care Agencies
Home Care Agencies http://www.floridahealthfinder.g ov/reports-guides/home- health.aspx
Fall Prevention EducationFall Prevention Education
Vestibular TestingVestibular Testing
Balance / Gait Testing Balance / Gait Testing
Vision & Hearing ScreensVision & Hearing Screens
Hydration Stations Hydration Stations
Low Sodium DietsLow Sodium Diets
Daily Exercise ProgramsDaily Exercise Programs
Yoga, Tai Chi, Water AerobicsYoga, Tai Chi, Water Aerobics
Common Causes of FallsCommon Causes of Falls
Presenter
Presentation Notes
1 in 3 Seniors over the age of 65 will fall each year. There are many reasons why they may say they fell, but these are the actual reasons. “I’m just clumsy” is usually just to cover up for their embarassment. Remember, loss of mobility is also another loss that many seniors get depressed over.
Causes of FallsCauses of Falls
Home HazardsHome Hazards
VertigoVertigo
Low Blood PressureLow Blood Pressure
Medication ManagementMedication Management
Unsteady GaitUnsteady Gait
DisorientationDisorientation
Blurred VisionBlurred Vision
Medication ChangesMedication Changes
Low Sugar / Sodium Levels Low Sugar / Sodium Levels
DepressionDepression
Hospitalist PhysiciansHospitalist Physicians
** They may be a ** They may be a ““SALARIED EMPLOYEESALARIED EMPLOYEE””
of the of the Hospital, with Financial incentives for low patient Hospital, with Financial incentives for low patient
length of stays.length of stays.
** They may also be an Independent Doctor with ** They may also be an Independent Doctor with privilegesprivileges
and onand on--call Status.call Status.
** Some Good Primary Care Drs. are making ** Some Good Primary Care Drs. are making agreements with Hospitalists for their Patients **agreements with Hospitalists for their Patients **
Skilled Nursing Centers aka Skilled Nursing Centers aka ““Nursing HomesNursing Homes””
Navigating the Skilled Nursing Navigating the Skilled Nursing aka aka ““Nursing HomeNursing Home””
WorldWorld
Tour / Market them to form Relationships
Know the Administrator, Director of Nursing & Admissions Director Find out the Short Term / Discharge Weekly Rate Review the ACHA Annual Surveys (in each lobby)
Decide BEFORE which ones you trust with your Ward
Skilled Nursing & Rehabilitation Centers http://www.medicare.gov/nursinghomecompare/sea
rch.html
or www.acha.myflorida.com
Presenter
Presentation Notes
The Realistic Chances a Resident will return after a hospital transfer. A lot has to do with the condition upon transfer, as well as the quality of the local hospitals, rehab centers and home care available. Obviously, the “Celestial Discharges” are out of all of our hands!
SNF Team ManagementSNF Team Management
Have all Have all ““ICEICE””
Paperwork ready Paperwork ready
for Admissionsfor Admissions
Have Medicaid Planning Attorney Have Medicaid Planning Attorney Ready Ready PriorPrior
to Admissionto Admission
Attend Care Plan ConferencesAttend Care Plan Conferences
Have Realistic Expectations for Have Realistic Expectations for RecoveryRecovery
UPON ADMISSIONUPON ADMISSION
Review Primary Care Physician ChoiceReview Primary Care Physician Choice
Discuss Hospital PreferenceDiscuss Hospital Preference
Review Medicare & Medicaid PlansReview Medicare & Medicaid Plans
Discuss Discharge PlansDiscuss Discharge Plans
Provide all Advance Directives Provide all Advance Directives (Distribute with Nursing Staff) (Distribute with Nursing Staff) ““ICEICE””
FolderFolder
Special Needs of the WardSpecial Needs of the Ward
Provide Back Up Contact InformationProvide Back Up Contact Information
Nursing Home Patient Nursing Home Patient AdvocatesAdvocates
Social WorkerSocial Worker
MDS Coordinator / NurseMDS Coordinator / Nurse
Activity DirectorActivity Director
AdmissionsAdmissions
Assistant Director of NursingAssistant Director of Nursing
Administrator Administrator
Director of NursingDirector of Nursing
Conflict Resolution Conflict Resolution OmbudsmanOmbudsman
LongLong--Term Care Ombudsman ProgramTerm Care Ombudsman Program
A volunteerA volunteer--based advocacy organization seeking to improve longbased advocacy organization seeking to improve long--term term care facility residents' quality of life and care. All investigacare facility residents' quality of life and care. All investigations are tions are confidential and provided at no charge. confidential and provided at no charge.
TollToll--freefree
: 1: 1--888888--831831--0404 (toll0404 (toll--free) or free) or 11--850850--414414--23232323
Email us Email us at: at: [email protected]@elderaffairs.org
Write us Write us at: 4040 Esplanade Way Tallahassee, FL 32399at: 4040 Esplanade Way Tallahassee, FL 32399--7000 7000
Florida Abuse Hotline (Department of Children and Families)Florida Abuse Hotline (Department of Children and Families)
TollToll--free free : 1: 1--800800--9696--ABUSE (800ABUSE (800--962962--2873)2873)Web site Web site : : http://http://www.dcf.state.fl.us/programs/abuse/howtoreport.shtmlwww.dcf.state.fl.us/programs/abuse/howtoreport.shtml
Discharges & TransfersDischarges & Transfers
Federal law prevents nursing homes from discharging Federal law prevents nursing homes from discharging (removing) or transferring (moving to another (removing) or transferring (moving to another facility) a resident except for the following reasons:facility) a resident except for the following reasons:
The resident's welfare cannot be met at the facility. The resident's welfare cannot be met at the facility.
The resident's health has improved sufficiently so the The resident's health has improved sufficiently so the resident no longer needs the services provided by the resident no longer needs the services provided by the facility. facility.
The health or safety of individuals is endangered. The health or safety of individuals is endangered.
The resident has failed, after reasonable and The resident has failed, after reasonable and appropriate notice, to pay or have paid under appropriate notice, to pay or have paid under Medicare or Medicaid for residence at the facility. Medicare or Medicaid for residence at the facility.
The facility closesThe facility closes..
SENIOR LIVING CENTERSSENIOR LIVING CENTERS
Team Management Team Management ApproachApproach
Discuss WardDiscuss Ward’’s condition weeklys condition weekly
Involve Wellness Directors with any Involve Wellness Directors with any Physician Appointment ChangesPhysician Appointment Changes
Show Gratitude for their effortsShow Gratitude for their efforts
Keep Management updated on any Keep Management updated on any potential changespotential changes
IT TAKES A VILLAGEIT TAKES A VILLAGE
Best Practices of Great TeamsBest Practices of Great Teams
Team Services:Team Services:––
Hydration & Good NutritionHydration & Good Nutrition
––
Customer Service Customer Service ––
Managing Family Expectations Managing Family Expectations (Marketing/Closing Tools) (Marketing/Closing Tools)
––
Activity Calendars & ProgramsActivity Calendars & Programs––
Fall Prevention EducationFall Prevention Education
––
Education Resources (VA, Medicare, Grief Education Resources (VA, Medicare, Grief & Depression Counseling, Medicaid)& Depression Counseling, Medicaid)
––
Positive and Calm Environment Positive and Calm Environment
ACCESSING VETERAN BENEFITS ACCESSING VETERAN BENEFITS for RETIRED MILITARY & for RETIRED MILITARY &
SPOUSESSPOUSES
VA Aid & AttendanceVA Aid & Attendance
••
PAYS FOR PRIVATE DUTY HOME CARE & PAYS FOR PRIVATE DUTY HOME CARE & ASSISTED LIVING CENTERS ASSISTED LIVING CENTERS
••
IS AN ENTITLED BENEFIT IS AN ENTITLED BENEFIT ••
MUST HAVE SERVED DURING A MUST HAVE SERVED DURING A WARTIME WARTIME ““BOOTS ON THE GROUNDBOOTS ON THE GROUND””
••
DOES NOT AFFECT CURRENT VA DOES NOT AFFECT CURRENT VA PENSION OR SOCIAL SECURITY INCOMEPENSION OR SOCIAL SECURITY INCOME
••
NEW QUALIFICATION SPECIFICS FOR NEW QUALIFICATION SPECIFICS FOR THIS PROGRAM PROPOSED *THIS PROGRAM PROPOSED *
WWW.VA.GOVWWW.VA.GOV
Locating A Veteran Service Locating A Veteran Service OfficerOfficer
LOW INCOME = VETERAN SERVICE OFFICERS LOW INCOME = VETERAN SERVICE OFFICERS (FREE)(FREE)
ELDER VETERANS LEGAL AID GROUP 800ELDER VETERANS LEGAL AID GROUP 800--878878--
21492149
OVER $80,000 IN ASSETS CONTACT AN ELDER OVER $80,000 IN ASSETS CONTACT AN ELDER LAW ATTORNEY TO ASSIST WITH APPLICATIONLAW ATTORNEY TO ASSIST WITH APPLICATION
NATIONAL ASSOCIATION OF COUNTY VETERAN NATIONAL ASSOCIATION OF COUNTY VETERAN SERVICE OFFICERS SERVICE OFFICERS
http://nacvso.org/findhttp://nacvso.org/find--aa--serviceservice--officer/officer/
Mike Dowling Mike Dowling (727) 582(727) 582--78287828Mike Hill Mike Hill (727) 582(727) 582--78287828
Medicare Advantage PlansMedicare Advantage Plans
Limit Prevention Therapy InterventionsLimit Prevention Therapy Interventions
Require Authorizations for Specialty Require Authorizations for Specialty Consults, Tests, MedicationsConsults, Tests, Medications
Contract with fewer Skilled Nursing & Contract with fewer Skilled Nursing & Rehab CentersRehab Centers
May be assigned to a May be assigned to a ““Full RiskFull Risk”” PhysicianPhysician
Those with Limited Income Usually Those with Limited Income Usually Qualify for Community Medicaid Qualify for Community Medicaid www.medicaid.orgwww.medicaid.org
(Florida) (Florida)
MEDICAID LONG TERM CAREMEDICAID LONG TERM CARE
Acts as a Supplemental plan to Acts as a Supplemental plan to MedicareMedicare
Medication BenefitMedication Benefit
Provides Home Care AssistanceProvides Home Care Assistance
Transportation, Counseling (some)Transportation, Counseling (some)
www.medicaid.orgwww.medicaid.org
(FL)(FL)
Choosing Quality PartnersChoosing Quality Partners
––
Physician information Physician information www.healthgrades.comwww.healthgrades.com
or or www.ratemds.comwww.ratemds.com
––
Skilled Nursing & Rehabilitation Centers Skilled Nursing & Rehabilitation Centers http://http://www.medicare.gov/nursinghomecomparwww.medicare.gov/nursinghomecompar
e/search.htmle/search.html
or or www.acha.myflorida.comwww.acha.myflorida.com
––
Home Care Agencies Home Care Agencies http://www.floridahealthfinder.gov/reportshttp://www.floridahealthfinder.gov/reports--
guides/homeguides/home--health.aspxhealth.aspx
––
Elder Law Attorneys Elder Law Attorneys www.naela.comwww.naela.com
––
Veteran Benefit Service Officers Veteran Benefit Service Officers www.va.govwww.va.gov
CAREGIVER BALANCECAREGIVER BALANCE
Presenter
Presentation Notes
Content People Never want to move out!
AGING in AMERICA AGING in AMERICA Navigating our Healthcare SystemNavigating our Healthcare System
2015 EXPANDED EDITION2015 EXPANDED EDITION
Karyn RizzoKaryn Rizzo
Patient Advocate Patient Advocate Educator * AuthorEducator * Author
www.agingguidebook1.com
Karyn RizzoKaryn RizzoPatient Advocate * Educator * Author Patient Advocate * Educator * Author
AGING in AMERICA Navigating our AGING in AMERICA Navigating our Healthcare System, 2015 Healthcare System, 2015
Amazon, Barnes & Noble, Kindle, Amazon, Barnes & Noble, Kindle, Nook Nook
www.agingguidebook1.comwww.agingguidebook1.com
Successfully Navigating Healthcare Center Successfully Navigating Healthcare Center Experiences Experiences for your Wardfor your Ward
