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How to Prevent Falls at Home for Seniors Print E-mail
Written by AHHC News   
Monday, 24 February 2020 17:37

For people who are 65 years old and older, falls are the top cause of both fatal and nonfatal injuries. The injuries that falls can cause include broken bones, fractured hips, and head injuries. Not all falls result in injuries, but that’s not to say falls that don’t cause injuries are harmless. In fact, seniors who suffer a fall can become fearful or depressed, stemming from concern that they will fall again. Regardless of whether a senior suffers an injury after a fall, the important thing to do is take action to prevent it from happening again. Even better, take action before a fall occurs. As people reach old age, it’s not uncommon for them to fall, but that doesn’t mean it’s inevitable. Rather, a majority of falls can be prevented if one takes the necessary steps and precautions to prevent them from happening.

Talk with Your Fragile Senior Patients

It’s important to speak with your elderly patients about the potential for falls and how they feel about it. They could be concerned about falling and may not have told anyone, or they could be unconcerned about falling and think they won’t suffer a fall. They could also be having health problems in which they’re forgetful or having difficulties performing everyday tasks that used to be easy. Seniors need to know that they can and need to take the necessary steps and precautions to prevent falls.

Fall Proof the Home

People spend a lot of time in their homes, which is why it is important to make sure that your patient’s home is clear of clutter and other potential tripping hazards. In addition, sufficient lighting in a home will also help prevent falls. If a residence needs more lighting, add some where it’s necessary. For example, it’s ideal to have lighting at the top and the bottom of staircases, so consider adding lighting in either of those areas if that’s not already the case. Handrails and grab bars are other things you should consider adding to a senior’s home. Be it for the stairs or the bathroom, handrails and grab bars will help your seniors maintain their balance. Many staircases in a home already have a handrail, but adding another one on the opposite side can further assist with keeping one’s balance, helping to prevent falls.

Regularly Check Vision and Hearing

As we age, our vision tends to deteriorate. In fact, when you become older, less light can reach your retina. This makes it more difficult for you to see. As such, seniors will have a more difficult time spotting tripping hazards and other obstacles that can cause a fall. Knowing this, it is vital that your elderly patients have vision checked annually. If the patient wears prescription eyeglasses, this is especially crucial, as he or she may have had a change in their prescription since their last checkup. For those with lenses that change their tint for the sun, they need to be wary going from the outside to the inside, because it can be difficult to see inside with tinted lenses. Aside from vision checkups, seniors also need to have their hearing checked annually, because you ears play a key role in balance. 

Stay Active

Balance and coordination are things that can worsen as we age, but that doesn’t mean this has to be the case. Maintaining one’s balance and coordination is important in preventing falls, so seniors need to keep these strong. Interestingly enough, some elders may choose to be inactive with the hopes of limiting their risks of falling, but that can actually increase those chances. Staying active and exercising on a regular basis helps you build and maintain your balance, flexibility, and strength. Elderly patients should be encouraged to be active.

Check Medications

As healthcare professionals are well aware, some medications can cause side effects that increase the risk of falling. What's equally true is that some side effect free medications will cause problems when interacting with other drugs. Seniors typically take at least four prescription medicines per day. Examples of such side effects are dehydration and dizziness.

Enlist Family Support

While the seniors themselves should be the ones initiating fall prevention, their family members should also be supportive. Patients shouldn’t need to take such care on their own without help. Instead, they should know their family supports them and will do whatever it takes to help prevent falls. Find family members who will help seniors guarantee that their homes are safe, their health is in good condition, and that they remain active.

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Assisting Hands Home Care is based in Kendall and serves all of Miami-Dade. Learn more at www.assistinghands.com/miami.

Last Updated on Monday, 24 February 2020 18:00
 
Lifelong Learning Key to Successful Healthcare Career Print E-mail
Written by Vanessa Orr   
Friday, 07 February 2020 12:59

According to Wellington Regional Medical Center (WRMC) Associate Administrator Diego Perilla, FACHE, one of the keys to being successful in the healthcare field is to never stop learning. While participating in the Universal Health Services, Inc. (UHS) COO Development Program, he also oversees hospital operations at Wellington, supporting 10 departments throughout the hospital including procedural areas, ancillary services and clinical support areas. 

“I love every aspect of my job,” explained Perilla of the position that he has held for the past year. “I get energized by collaborating with leaders across the hospital to continuously find better ways to provide great quality care for our patients. I enjoy developing strategies with our teams and helping our staff execute these initiatives throughout the year.”

Before joining WRMC, Perilla spent the majority of his career at Cleveland Clinic, in both Florida and Ohio. He led the Digestive Disease Institute as the administrator for Cleveland Clinic Florida (CCF) for three years, prior to which he worked in various roles within regional administration and process improvement in Ohio, leading Lean Six Sigma projects across all Cleveland Clinic regional hospitals. 

According to Perilla, he was interested in the healthcare field from an early age. 

“I have a passion for helping others develop their careers as well as helping people obtain the best care possible,” he explained, adding that he felt his skills and interests would be best applied in a healthcare leadership role. “I am fortunate enough to impact lives daily by empowering members of my team to provide the best care possible to our community.” 

Perilla first joined the American College of Healthcare Executives (ACHE) 12 years ago, and became a Fellow (FACHE) last year. He strongly believes in continuous self-improvement, and actively encourages those in healthcare to take advantage of the expertise of those working in the field. 

“I joined the chapter as a graduate student to meet like-minded individuals who might offer good advice.  I was fortunate enough to have met great mentors,” he said of his time in ACHE. “Now I want to make sure that I am a good mentor for others as well.” 

“To fully grow in any career, you need to surround yourself with experienced professionals that you can learn from,” he added. “I think anyone interested in healthcare management will benefit from the collaboration and idea-sharing that takes place at ACHE events. Moreover, I highly recommend that members pursue FACHE distinction to develop a deeper understanding of healthcare trends and public health needs.”

No matter where an individual is in his or her career, Perilla believes that an ACHE of South Florida membership can help them move forward.

“I am grateful for the connections that I have made and for the many mentors that have helped me advance in my career,” he said. “I encourage future leaders to reach out to me directly or to connect with me in person if I am able to provide any advice for their career development.”
 
Last Updated on Friday, 07 February 2020 18:22
 
CMS Announces Updated Quality Information Including Star Ratings on Hospital Compare Print E-mail
Written by Seema Verma, Administrator, Centers for Medicare & Medicaid Services   
Friday, 31 January 2020 18:39

If there's one thing that distinguishes the Trump Administration's historic healthcare agenda, it's the single-minded focus on patients. Everything we do is about empowering patients, and today <1/29/20> CMS took a major step that empowers those receiving care in America's hospitals. We refreshed our Hospital Compare website with updated measurement data and the Overall Hospital Quality Star Ratings. Today's update puts the most up-to-date hospital quality information at patients' and their families' fingertips so they can make the healthcare choices that are right for them. Hospital Compare is one of our nine Compare websites. Patients and others use it to compare hospitals based on quality, digging down to specific areas of interest - from infection control to value of care to unplanned hospital visits. Hospital Compare reflects a variety of quality data and includes a facility Star Rating, with five stars being best.

Last Updated on Monday, 16 March 2020 11:27
 
Is Direct Primary Care the Solution to the US Healthcare Crisis? Print E-mail
Written by David Fater   
Thursday, 23 January 2020 11:19

Healthcare policy is often portrayed as a fight between government and insurance companies. But one of the most effective cost-saving measures is to cut out both and allow patients to deal directly with doctors. This can be accomplished in a variety of ways, one of which is referred to as Direct Primary Care (DPC), a concept that has been around for several years but is gaining traction. As with any facet of healthcare there are advantages and disadvantages and one has to understand the concept, as well as the benefits and the pitfalls. It also is important to differentiate Direct Primary Care from Concierge Medicine.  There are similarities but there are also significant differences.

Also, it should be kept in mind that many of these groups are pioneering next generation care models as well, incorporating nutrition, mental health and coaching services into holistic treatment plans that strike at the root of chronic disease. These integrated care teams design plans and wellness environments that are about as similar to traditional healthcare as Amazon.com was to Barnes and Nobles.

Let’s look at Todd Gibbons (Patient) from Any City, USA. When he has an aching shoulder or needs a physical, he can call and schedule an appointment on a day’s notice, maybe the same day. His physician is also available for phone consultations and even makes house calls. It all costs Mr. Gibbons $150 a month to cover his family of five. Costs are so low and coverage so good because the Gibbons family goes to PTC Direct Primary Care—a medical practice that treats patients for routine care and procedures for a monthly membership fee. Virtually every routine service—from electrocardiograms and pap smears to stitches and physicals—is included. There are no office-visit fees or copayments. All physician services and procedures offered at PTC are covered, and all without the use of health insurance.

Without third parties taking money and adding overhead, PTC can offer medications and lab tests not covered by the monthly fee at wholesale prices. A cholesterol blood test is $3.20 for a PTC member, but $22 at other in-network providers.  Drugs are cheaper. PTC buys directly from three national wholesalers, which compete to provide medications at the best possible price for any given patient, and PTC resells them at cost. A 30-day supply of the generic equivalent of 40 mg Lipitor for cholesterol is $3.30 at PTC. At Walmart it’s $9. Sildenafil, the generic for Viagra, is 37 cents a pill. The next cheapest option is Safeway at $2.13. Over-the-counter drugs are also cheaper and available in-house at PTC. Cetirizine allergy pills (the generic version of Zyrtec) are 6 cents a tablet at PTC, about half the Walmart price.

Costs are low and transparent. The monthly fee, whether paid by employer or individual, is predictable and easy to budget. It is important to bear in mind that patients still need high-deductible insurance or cost-sharing pools to cover nonroutine procedures and care. But complementing a direct primary care plan with one of those two options still can produce the cheapest coverage.

One of the negatives is that tax incentives currently discourage employers from switching to direct primary care plans. One possible fix would allow patients to use health-savings accounts to pay for membership. The IRS could make this change by redefining a direct primary care membership as an eligible HSA expense. Cutting the middlemen out of daily health care won’t solve all of the medical system’s problems. But altering the tax code to encourage employers to use direct primary care could help control or even shrink costs. Most important, it would improve the quality of care by letting doctors spend less time filling out paperwork for reimbursement and more time helping patients.

Direct primary care could be viewed as yet another in a long line of ideas to help reinvigorate primary care for both doctors and patients. Some view it as a panacea, others as snake oil. I am not sure what it is exactly, but I do know it is not a transformative innovation for making primary care more relevant, responsive, and affordable on a large scale. Simply put, direct primary care is a model for delivering primary care, and only primary care. The doctor charges each patient a monthly fee, generally ranging from $50 to $200, in return for timely, convenient access and a buffet-like menu of mostly basic primary care services. The amount of the monthly fee is presumably set in relation to the scope of services covered, though every practice may do it differently. For services that aren’t covered under the fee, like more extensive management of a chronic disease, the patient’s insurance — if it exists — must be billed to pay for the service or, in some cases, the physician or practice will charge the patient extra fees to cover those services.

On the physician side, direct primary care is appealing to a growing number of doctors. Many are burned out and dissatisfied working in traditional primary care practices, where the administrative hassles are high and physicians do not get to spend enough time with their patients. Many want to return to a time when Marcus Welby, MD practiced and the doctor-patient relationship was more central to the delivery of primary care. Many want greater predictability and control in their work lives.

Five Factoids About Direct Primary Care
 
1. DPC physicians foster an enduring doctor-patient relationship
Developing an enduring doctor-patient relationship through adequate appointment time is a hallmark of Direct Primary Care. A typical Direct Primary Care practice has about 600 patients, compared with 2,500 patients for an average fee-for-service primary care practice. Instead of seeing up to 30 patients or more a day, Direct Primary Care providers typically see less than 10. Many physicians believe a lot of medicine can be done electronically. It should be noted that most Concierge Medicine practices limit their patients to 600 as well; However, the Concierge Fee is greater than the Direct Primary Care fee-ranging from $2,000-$2,500. (Interestingly enough, if you add up 12 payments of $150, you are close to the Concierge Fee-but recognize the Concierge physician does not have a "Family Plan).

Additionally, Direct Primary Care physicians profess that they know their patients by name and have time for them. These longer appointments in the DPC model allow time for discussions between a physician and patient that encompass lifestyle choices with the aim of long-term health and well-being.What everyone really needs to know is that patients do get better care when their doctor is more satisfied with what they are doing. And that takes time. That is what the [fee-for-service] system cannot provide -  time with the patient.

2. DPC is growing and DOs are joining in
In the past decade, the DPC model has grown from just 21 practices to over 1,000 practices in 49 states that care for an estimated 500,000 patients, according to the Direct Primary Care Coalition (DPCC), an advocacy group. The movement has been particularly popular among DOs who estimates that 30-40 percent of the group’s members are DOs, osteopathic residents and medical students.The high level of interest in DPC by DOs may be attributed to an already higher percentage of DOs practicing primary care- But DOs also tend to be a bit more entrepreneurial and independent and their training includes some additional non-traditional treatment techniques.

3. Efforts are underway to enhance DPC
The American Osteopathic Association supports the DPC model, and has urged Congress to support a Primary Care Enhancement Act (PCEA) that includes a DPC model which would allow physicians to provide health care to the full extent of their scope of practice, including providing diagnostic services and dispensing prescription drugs. Currently, the IRS views DPC as a type of health insurance and bars the use of health savings account funds to pay for DPC. The PCEA would allow patients to use the funds from their HSA to pay for DPC. One of the downsides of direct primary care is that it can be challenging to find patients who can afford their membership dues, particularly in medically underserved areas.

4. DPC offers upfront pricing
DPC practices offer transparent pricing upfront. A monthly membership fee (typically under $100 per member, often with family discounts) covers unlimited primary care office visits and services. Patients are encouraged to buy a complementary insurance plan, such as a high deductible health plan, to pay for any complex or catastrophic medical services outside of primary care.While both concierge and DPC charge a periodic membership fee to the patient, most DPC physicians don’t accept insurance. Concierge practices, on the other hand, typically still bill insurance and often add an annual retainer fee that is usually higher than the DPC annualized membership fee.

5. DPC embraces the ‘quadruple aim of medicine’
The triple aim of medicine—to enhance the patient experience, improve population health and reduce health care costs—is well-documented and embedded in the triple aims promulgated by the ACA. DPC providers are focused on “the quadruple aim of medicine” which acknowledges that improving the work-life balance of physicians is necessary in order for the other three aims to happen.

Direct Primary Care will continue to evolve (as will Concierge Medicine). It probably will not be the solution to our broken healthcare system but it does provide some interesting alternatives both for physicians and patients. Primary Care Physicians should consider this concept to include in their practice as the crisis continues to evolve; but this will also entail a change in the mindset of physicians.
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Mr. Fater is CEO, Alda & Associates in Delray Beach, FL.

Last Updated on Saturday, 01 February 2020 14:54
 
What are the Differences Between Home Health Aides (HHA) and Certified Nursing Assistants (CNA)? Print E-mail
Written by AHHC News   
Thursday, 16 January 2020 09:43

If you have disabled or elderly patients who are in need of assistance, there are many things to consider. You may wonder what kind of help they need and how much help they require. You may know that you want to get your patient a home care aide, but you might be unsure which home aide is best suited for him/her: a home health aide (HHA) or a certified nursing assistant (CNA). While home health aides and certified nursing assistants perform some of the same tasks and have similar responsibilities, their roles are not quite the same.

Home Health Aides

The main purpose of a home health aide is to provide clients with personal care and they usually work at the patient’s home. This means HHAs will assist with everyday tasks: bathing, grooming, restroom use, getting dressed, meal preparation, transportation, laundry, light housekeeping, running errands, and more.

With the training they’ve received, HHAs are great helpers and companions to seniors. But HHAs have limited medical training. That said, they rarely provide their clients with medical assistance, cannot provide nursing care, and do not offer medical advice. However, HHAs will monitor their clients’ condition and remind them to take their medication.

Depending on the state you’re in, HHAs need to be certified, which comes after completing the correct courses at a college or vocational school. HHAs can receive national certification from the National Association of Home Care and Hospice, but they do not need to have a college degree or a high school diploma.

Certified Nursing Assistants

CNAs have the same personal training as a home health aide does, so they can assist clients with many of the same tasks that home health aides do, such as eating and hygiene care. In addition to providing direct care, they can also help clients switch positions in bed for comfort and assist them from their wheelchairs to their beds and vice versa.

CNAs work in a wide variety of settings including nursing homes, hospitals, rehabilitation centers, and more. But they also have additional medical training and work under the supervision of either a licensed practical nurse (LPN), a licensed vocational nurse (LVA), or a registered nurse (RN).

With this medical training, CNAs will monitor patients’ health, take vitals, track their symptoms, and can speak with clients about health concerns. Furthermore, they will report their findings to their supervising nurse.

To become a CNA, one has to receive proper training from a certified program — which is offered by community colleges, hospitals, and online programs among others — and then pass a competency exam. The exam consists of a written exam and a practical exam. After receiving a CNA license, one can keep the license active by doing 48 hours of continuing education every two years.

HHA or CNA?

When deciding whether your patient requires a home health aide or a certified nursing assistant, consider their needs and what kind of assistance he/she would benefit from the most. If you determine that an elderly relative could use everyday, non-medical assistance, then hiring a home health aide is a good choice.
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At Assisting Hands, serving Miami-Dade County, FL, we offer a variety of senior care services in which we provide clients with a home health aide for anything they need. We have home health aides who can provide part-time help or full-time help, live-in care or 24-hour care, and more. At Assisting Hands, we will work with clients and their families to develop a care plan customized to your elderly loved one’s needs. Learn more at www.AssistingHands.com/Miami.

Last Updated on Thursday, 16 January 2020 09:56
 
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