In October 2011, the Centers for Medicare & Medicaid Services approved the state’s proposed 10% reduction to Medi-Cal rates for all provider types except three: physician/clinic services for children, home health services, and distinct part subacute facilities. This was a crucial victory for Medi-Cal beneficiaries!

Neil’s Spin: The Medi-Cal Home Health Rates are already sub-standard and less than 1% of licensed home health agencies routinely accept Medi-Cal referrals. A 10% reduction would have been devastating to patients currently using Home Health and it would have created an access to care crisis in California.

Included in the SB411 language, a Home Care Agency would be required to pay an annual licensing fee of $3900 plus $165 for each employee. The $165 would be used to pay for administrative taks associated with the certification of home care aides and for maintaining the online public registry of home care aides employed by each agency. The $165 doesn’t include agency costs for completing 13 hours of initial & ongoing training or the LiveScan background check fees.

Neil’s Spin: This bill counteracts job creation as it leaves employers with a disincentive to hire. The more you hire, the more it costs. That’s counterproductive to the State’s economic goals.   Additionally, Home Care Agencies will experience a dramatic increase in operating costs. To compensate, home care fees will have to increase. Many seniors and disabled individuals are having difficulty affording care at its current prices.

CMS Clarified that if a physician’s visit note, referral documentation, or hospital discharge summary contained all of the required elements, the physician could use that documenation to satisfy the F2F encounter.

CMS also stated they will not accept the use of checkboxes and forms with pre-printed statements that describe homebound status and the need for skilled services.

Neil’s Spin: From experience, we know that the physician’s documentation rarely contains all of the required elements. To no fault of physicians as CMS has not properly educated them on F2F requirements.   So, F2F continues to frustrate physicians and home health providers but enables CMS to deny or delay payment for services.

According to an article posted on MSN, two of the top 10 jobs in 2012 will be Home Health Aides and Registered Nurses.  As the population in the US continues to live longer and the baby boomers come of age, the need for healthcare workers will continue to soar.  One of the fastest growing business industries in America is Home Health Care.

Additionally, home health agencies are already experiencing a shortage of physical therapists, occupational therapists, and speech therapists. Typically, these clinical disciplines are working in private practice or in a hospital, where the pay can be better.  In the hospital, however, the demands are much greater than working one to one in a patient’s home environment.

Here is a link to the article posted on MSN http://msn.careerbuilder.com/Article/MSN-2854-Job-Info-and-Trends-Best-bets-for-jobs-in-2012/?SiteId=cbmsnhp42854&sc_extcmp=JS_2854_home1

“20 Things You Didn’t Know About
Accredited!”

1. The Accredited
   Family of Home Care Services is comprised of five corporations: Accredited Home
   Health Services, Accredited Nursing Services, Accredited Nursing Care,
   Accredited Respite Services, Accredited Financial Management Services.

1. The Senior Management
   Team has over 80 years of combined service with Accredited.

1. Medicare statistics
   show Accredited makes the most home health care visits of any private owned company
   in Los Angeles County.

1. Accredited Nursing
   Care was the first Private Duty Agency to receive CAHSAH’s Home Care Aide
   Organization Certification.

1. We are obsessive
   number junkies when it comes to our agency’s Medicare Scores.  Check out
   our Quality Outcomes on www.medicare.gov.

1. In recognition of
   our 25^th anniversary, United States Congressman Brad Sherman
   presented Accredited with a United States Flag that flew over the Capitol.

1. Accredited’s
   proudest accomplishment:  In a time of deep recession, we provide
   employment to 2,500 people weekly and 6,800 annually.

1. As a 50^th
   birthday gift from staff, Accredited founder Barry Berger was presented with an
   original Olympic Torch from the 2002 Salt Lake Games.

1. Several of our
   caregivers have 20+ year tenures with Accredited.

1. Past Accredited ventures included; nanny services,
   hospital staffing, and physician house calls.

1. The most common name of our employees is Maria – We have
   over 300 Marias on staff.

1. More than 80% of our department managers have been
   promoted from within the company.

1. At our 30th Anniversary Gala in April 2010, there wasn’t
   a dry eye in the house after hearing one of our patient’s amazing life story.

1. Accredited makes over 500 referrals to our competitors
   annually.  We’re all in this together!

1. Accredited has provided care to 4 generations of Neil’s
   family – his daughter, himself, his parent, and his grandparent.

1. Our ‘Celebrity’ List of Patients is enormous and ever
   growing… I’m dying to publish the list. Alas, HIPAA prevents me!

1. Receiving a patient’s handwritten note of gratitude is
   our favorite type of mail.

1. CEO Computers and Lazar & Co. Accounting have been
   our vendors for over 25 years.  We’re loyal customers!

1. Accredited’s Leadership Team participated in more than 40
   meetings with State & Federal Legislators last year.

1. We really, really love when you respond to our E-mail
   updates and like us on Facebook!

Three weeks ago, my wife’s grandma fell and fractured 3 vertebrae.  She was hospitalized, had a procedure to cement the vertebrae, transitioned to a Rehab Facility for a couple of weeks, and the family is moving her into Assisted Living facility today.  Thankfully, Grandma is wanting to live in Assisted Living as she fears being alone and falling again. Even though we had Lifeline for her, it wasn’t enough for her to feel safe.

To help ease her transition to assisted living housing, I’ve arranged for home health care using Registered Nurses. Physical Therapists and Occupational Therapists to help manage her incision healing, work on endurance/strength, and provide training for ADLs in her new environment.  In addition, I have a caregiver on stand-by in case she needs more 1:1 support throughout the day.

As I was thinking about her transition to senior assisted living, I wondered what families do when they don’t have the same educational background (gerontology and social work) as I have or they don’t work in healthcare.  So, I found a great article  on the National Center for Assisted Living’s website to share.  Here is what they say -

Based upon their personal experiences, many residents suggest you see the actual apartment or unit that you will move into and take measurements. Ask the administrator or director what furniture, if any, the residence will provide. Some residences may provide minimal furniture, such as a bed or chair upon request; other residences encourage you to bring whatever furnishings will make you feel comfortable in your new home. Experience indicates that making choices about personal possessions is difficult at the time; however, one resident said, “It’s not as bad as you think . . . Try to remain positive and have family and friends help you.”

Residents suggest that you might want to leave large pieces of furniture at home, since your apartment will probably be smaller than your current home. They also suggest that you bring smaller prized possessions to create that “at-home” feeling in your new assisted living apartment. And, for those possessions that you can’t part with but aren’t sure that you want to bring with you, consider putting those items in a storage unit or asking family to temporarily store the items for you. This way you will have time to determine which items are important to have with you at your new home.

You should start packing well in advance of the actual move. Sort through your clothes and decide what you will need and how much your new closets will hold. Residents advise to be sure to look at available closet and storage space to avoid bringing more than the closets can hold. Avoid bringing too many of one thing such as coats.

Moving Day Helpers

When moving day arrives and you are ready to set up your new home, ask family and friends to help arrange and organize your apartment. Many assisted living residences have staff members who can help move your furniture and other heavy pieces into your new apartment. You will want to find out what assistance the residence offers before you arrive on moving day. Although staff, family members, and friends are there to help you, it is important that you decide how your apartment is arranged. Remember, arranging your apartment to suit your preferences will make your adjustment easier.

Making the Emotional Transition

Moving is hard. It can make anyone feel overwhelmed and stressed. However, these feelings are generally temporary and disappear after you establish your own routine. “Give it time and you will adjust,” said one resident. In talking with other residents, you will find many of them felt the same way. Some residents found comfort in talking with clergy. Others found comfort in talking to a neighbor or close friend.

Residents say the best strategy is to stay busy, introduce yourself to other residents, and participate in the activities. It is normal to have a tendency to stay in your apartment at first. Yet, getting out and meeting other residents as well as participating in activities were repeatedly identified as the quickest ways to become comfortable with your new surroundings.

Everyone is different. Some people embrace the move with open arms, while for others it may not be as easy. Whatever your feelings, current residents say these feelings are normal. Give yourself time to adjust. If you feel you are taking longer to adjust than what you consider normal, then you might benefit from discussing your concerns and feelings with the administrator or director of the residence.

More Advice For New Residents
• Read all the materials about the assisted living residence before you move in.
•Try and meet the administrator or director and staff before moving day.
•Review the paperwork and contract before you move in so that your questions can be answered in advance.
•Pack wisely. Don’t bring everything.
•Obtain a list from the residence of suggested items to bring.
•Obtain a list of residence policies and familiarize yourself with them.
•Label your clothing if the residence is helping you with laundry.
•Read the activity schedule and choose two or three programs to attend early on to meet your neighbors and other residents.

Advice for Friends and Family Members

Current residents advise friends and family members to be involved before, during, and after the move. Your loved one does not want to be seen or treated differently now that they live in an assisted living residence. Remember, your family member or friend hasn’t changed; it’s only their home address that has changed.

Be aware. Family members and close friends often experience the same emotions as a new resident. These emotions are natural and to be expected.

Suggested Do’s For Friends and Relatives
• If requested, help with the sorting, packing, and moving.
•Listen as your loved one talks about what they left behind.
•Be helpful even if you do not agree with the decision to move.
•Recognize that moving to a new home represents a major change.
•Call and visit often during the first few weeks.
•Be positive. A smile, support, patience, and understanding are required.

Suggested Don’ts for Friends and Relatives
•Make all the decisions or take over the sorting, packing, and moving process.
•Focus only on yourselves. This is about the resident moving, not you!
•Criticize the decision to move into assisted living.
•Make light of the transition.
•Immediately talk about selling the resident’s house.
•Make promises that you cannot keep.
•Be negative.

For more information, visit www.longtermcareliving.com

I’ve seen quite a few GPS Products introduced in the marketplace. The goal of these products is to ensure patient safety if wandering is a problem.  With GPS, the Alzheimer’s patient can be located in seconds.   We’ve heard way too many stories that patients have been lost for hours or days at a time, and the effects of this can be terrible. With simple products like GPS Watches or GPS shoes, the Alzheimer’s Community has some cost-effective solutions for wanderers.

For more information about GPS Shoes, click on this article from USA Today – http://content.usatoday.com/communities/ondeadline/post/2011/10/gps-shoes-for-alzheimers-patients-coming-to-market/1

Evidence-based prevention programs are interventions that are based on evidence that is generated by scientific studies published in peer-reviewed journals. One source of such evidence includes the U.S. Department of Health and Human Services (HHS) sponsored research. As a result of several studies, there is now evidence documenting the effectiveness of risk factor interventions related to medication management.

There is evidence that community based programs to limit medication errors for elders yield positive results. Inappropriate medication usage by community dwelling elderly persons has been documented between 12% and 40%. Errors in medications are ranked as the fourth leading cause of death for people over the age of 65.

The Medication Management Program is a federally funded program under Title IIID of the Older Americans Act. Funds are distributed to local Area Agencies on Aging who use the funds to provide a wide variety of services and information at multipurpose senior centers, at congregate meal sites, through home delivered meal programs and at other appropriate sites.

The purpose of the Medication Management Program is to improve the quality of life for older adults and prevent premature institutionalization by working with them to manage their use of over the counter and prescription medications, vitamin, mineral, and herbal supplements.

The following are examples of activities that are provided:
Pharmacists or Pharmacy students give presentations on how seniors can manage their medications, drug-nutrient interactions, and supplements. The presentation may include a personalized medication review to identify expired medication, answer client questions, and counsel seniors to assure they understand, are following directions, and taking medications properly. The Pharmacists also encourage seniors to communicate with their doctors so they will be better informed of what medicines are being prescribed, why, and what results and/or side effects to expect.
Partnerships with community based organizations to provide “Rx Check Up” clinics.
Distribution of passport size books for seniors to keep records of health and medications. Seniors can take the books with them to share with their doctors and pharmacist.
Distribution of brochures related to medication management.
Distribution of pill minders in various languages to help seniors manage their prescriptions.
Information provided at Senior Health Fairs, through an Info Van, and through the Information and Assistance Program.
Automated medication dispensers for frail/blind clients in the home.

The target population for this program are individuals who are aged 60 years and over; who are aged 60 years and over who live in an area of greatest economic need; who are aged 60 years and over living in a medically underserved area of the region; who are aged 60 and over with chronic medical conditions that can improve with education and non-medical intervention.

Contact your local Area Agency on Aging to determine what services are available in your community