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Continuity of care 10 31 12 Must Read Power Point Presentation.

Continuity of care 10 31 12 ( Great PDF discussion of Continuity of Care) Please read the link to the power point presentation below and comment on it.  Continuity of care is needed in and across each care setting that claims to offer "Care" or "Assistance" including Assisted Living, Dementia Care, Alzheimer's Care, Memory Care, Hospice Care, Home Care, Elder Care, Senior Care, Senior Living and many others.  Be sure to look for and value Continuity of Care if you want the best health care. Great Continuity of Care Power Point Presentation!  Must Read. http://www2.kumc.edu/coa/Education/AMED900/CONTINUITY%20OF%20CARE.pdf Topic ( index of the above link) Definition of "Continuity of care" ( COC) Types of care continuity Patient related impact of COC Physician- related impact of COC ( This is an important variable to consider.  One needs to consider  what, how and why the physician is affected.   The physician is the person you need to show that you trust, want, and respect them and the services they are offering.  Relationships take two -- patient and doctor.) What COC means for the older adult.Factors that disrupt continuity.Discharge planning The Patient - Centered Medical Home. Areas to focus on: It is not impossible to find a doctor willing to be an old fashioned doctor. it is impossible to expect any insurance company who does not know you to offer you and everyone everything health care can offer.  That is just like paying for it yourself but having the insurance company take 20% off the top.  We do not expect cosmetic surgery paid for, Dental care paid for, and need to realize that things we all need like Senior Care cant be covered by insurance.  If we all use something it is easier to just let everyone pay for it.   However, if you value the doctor, and want a more individual, personal opinion on your own unique health care situation you can get a private doctor.  I liken it to getting the public defender vs hiring a private defense lawyer.   For a small fee you can choose a private doctor who is more responsive to your individual needs and offers the valuable continuity of care.  You may not know that a solo practice doctor needs that extra 2K per person per yr, or 166 / mo from each of you in addition to the 100 or so per visit to cover his overhead and stay in business.  The doctor has difficulty maintaining the office you and he use to provide the private medical opinion and continuity of care you want.   While many will initially think that 2K a year is a very high cost, that is $166/mo.  There are doctors who do that.  Be wary of doctor's who charge more also.  Follow our Golden Rule of meet the doctor and his entire staff.  Just because they charge more per year or month does not mean they offer any extra Continuity of Care.   Also if the doctor is not involved actively in some forms of senior care, Home Care, Case management, Residential Care, Assisted Living, or even Nursing Home care it is less likely they can provide Continuity of Care as you age. That will reduce the value to most seniors and families to paying any premium for Continuity of Care. Do not confuse Financial Continuity of Care, Continuity of the payment, with Continuity of care.  This is a great pdf but we feel strongly that you need to say they do not distinguish continuity of the payment which insurance companies or Assisted Living Facilities provide in lieu of real continuity of the care.   Do not confuse Continuity of Care  which most big institutions claim to offer with Continuity of the Payment and little continuity of care which is what we usually see.  They are not the same at all!!  In a CCRC, Continuing Care Retirement Community, which offers independent living, Assisted Living, and Nursing Home care one might think there is also continuity of care when in fact it is more accurately continuity of the payment and sales force.  In general, you change rooms, staff, and friends each time you move but the money or payment goes to the same llc or chain of corporations. For example Assisted Living Facilities or Institutions often suggest and claim that they can offer you continuity of care as you age, however, that is far from the truth.  In assisted Living Facilities when you move from Assisted Living to the Memory care you change room, staff, and sometimes doctors.  That is practically a move be it out of state or out of the building or to a new locked section far from your previous Assisted Living friends and care setting.  What is preserved is the financial structure receiving your payment. A second, example of not confusion care is when we hear phrases like Obama Care!  In fact, we know that Barack has nothing to do with the care.  He might affect how much they pay for a given care item, or if they pay for it at all but when it comes to providing the care, answering the phone emergent at 2 am or knowing or caring for each individual we all realize when we think about it that the insurance company, or name sake of the financial structure does not provide the care.  We need to meet and come to our own financial agreements with the person who will provide the direct care. Unless we do it is hard to expect any care provider, administrator doctor, nurse, or care giver to do what someone else promises they will do with the same level of responsibility they will feel if they make the agreement themselves.  We all prefer to manage our own money, more of it, and to share less with the many levels of management in between who help us deposit our money in the bank.  Yes, I am a provider.  When you call you get me. WHO NEEDS CONTINUITY OF CARE MOST? WHO BENEFITS MOST FROM CONTINUITY OF CARE?  DO YOUNG PEOPLE REALLY NEED TO PAY MORE FOR CONTINUITY OF CARE WHEN THEY ARE NOT SICK?  Seniors and any younger people with chronic illnesses benefit most from Continuity of care      While many will know at some level that any one who is older or who starts to develop more than one simple medical, social, financial or other problem will benefit from a highly informed and skilled person to assist in coordinating that care.  When you have just one problem it is easy to go to the ER or urgent care and describe your one simple, relatively easy to fix,  issue in a short period of time.  The ER staff doctor can quickly listen and respond.  However, as the history and story become longer, and includes many problems each with  no simple answers for treatment, one can see that just listening to that long history, or reading volumes of old charts or calling many places to get the old charts and then reading them will take more time than that quick care or ER staff can or will invest in that problem. Instead the ER doctor might tell you -- you don,t "need" an hospital stay CALL YOUR DOCTOR when you get home.  What or Who is your doctor?    That is the point of reading and understanding this power point presentation.   Without Continuityof Care you practically do not have a doctor.   We want doctors, patients, family members and others to see what they might be missing by having a very loose relationship with "their doctor".  We want to encourage all to invest in the doctor patient relationship so the patient can benefit.  Now more than ever Continuity of care is the care and caring we all want.     Younger people less than 65 and people with few clinically expressed Chronic Diseases need less Continuity of care.  These are the people who are correct in the financial decision not to pay up for more continuity of care.  While these generally well people make the correct financial decision to get the cheapest insurance possible that decision does affect the rest of society who need care in that these people will undoubtedly get sick and then the payers of last resort will be stuck with paying for this very expensive care and the people who accepted premiums when they were well are let off the hook of providing the care they need when they need it.  That is exactly why basic health care needs to be a public service just like the military. Basic, Public, Universal, Health Care - The only cost effective answer. We can not each raise our private army and the same is true for health care, we cant have a doctor in each of the 50 states waiting for us to get in a car accident on our cross county trip, or can't ensure our job wont move out of state and cause our health care system to change dramatically.  Society is so mobile we need public health care at a minimum.  Second is cost.  Health care is very expensive when you need it.  We need to have everyone pay, much like for military or taxes or social security so that when we get sick, or when bad things happen there is a safety net. That safety net lets each of us be individuals, lets us experiment with work, gives us choice because we know there is some acceptable minimum care, food and housing, we can get if our best efforts fail.  Creativity, and productivity are empowered by all having some minimum health care.  Third, Business will hire more people if they don't have to be stuck with medical insurance.  Indeed, even if businesses offer medical insurance most will share costs with the employee and the employee will decline that coverage leaving them uninsured.  It is a public service and is only needed when you get sick so no one will pre pay for it when they are of moderate means.  This will improve jobs, hiring, and help reduce workers comp since you can get health care when you are working and do not need to fake a bigger disability injury.  Offering health care will also allow us to tighten monitoring for disability and to have a much stricter test for disability since you can get health care after work, before work, take one hour off during work and don't have to just drop work and run up big unnecessary health bills to get minimal health care.  I can go on and would welcome doing so if comments by you blogger ask for more discussion.By Shawn McGivney MD, RFA and Kerry McGivney    Thanks for reading this post .  If you liked this post please help us by sharing the message of Care, Caring, and Continuity of Care by likeing, friending, and following our works on Facebook     (tlcsr.kerrymcgivney), Twitter ( TLCSRLasVegas), Youtube (TLCSRLV),  Joining our Email List and this Blog, and sending this to any sons, daughters, or seniors you know. Here are links to make it easy! Like Our FaceBook Page: Friend Us On FaceBook: Follow us on Twitter: Like our videos on Youtube: Join our Free Blog and Email List: Contact: Shawn McGivney MD, RFA [email protected] www.tlcsr.com www.tlcsr.com/blog/

Discussion of “The Importance of Assisted Living” 10/19/12

 "The importance of Assisted Living" Article that ran in wakeupnv.com. While their message appears clear we feel that the meaning of some of the words can be misleading to many who might define the words differently.  When some one says "Available" you assume it is always and easily available.  Most people assume it is what you need and want.  However, the amount, type and degree of assistance available in many Assisted Living Facilities and any Senior Care Setting might not be as "Available" as the sales lady, the marketer, would indicate.  All care settings say we have caregivers, we have an administrator, we have doctors who come in, etc.  Few introduce you to the direct care team so you can decide how motivated they appear to spend time with you.    We use "Available"  and other key words in the article to spur discussion and review for each reader to consider what the author may mean  and the care setting might mean when they use words. Continuity of care and knowing who is providing the direct care at all levels is essential.  Who is Available?  When, where, and for how long?  Do they stay with you through thick and thin?  Visit you when you are out of your home or Assisted Living small studio room  in a hospital. Review and Comment on the Article The Importance of Assisted Living Posted July 6th, 2012 by Joseph Stevenson.   INTRODUCTION               This article is an example of a sales type of publication for Assisted Living Facilities.  While it does provide some general comments on Assisted Living, many of the words and ideas may be miss interpreted by those looking for Assisted Care, Assistance and personal care.   The goal of this discussion is to bring attention to some ideas, phrases, and words that might be miss interpreted by many readers.  Clarifying these words will help the reader better understand what they want and need in a care setting. This exercise will help to raise awareness to the interpersonal, people, part of assistance and care.   While it is hard to describe people, feelings, caring, character and responsibility, it is very important to strongly consider these things, instead of focusing on the physical plant, or the hotel style “service” of doing your laundry out and housekeeping.  Look not only at the care you want today but also at the care you will increasingly need in the future before you choose a low care alternative today.  Choosing a care setting with more care today will help you feel your best today and will improve the continuity of care and care you receive for the rest of your life.    If you choose the lower continuity of care options today it is likely you will be forced to accept less care when you need it in the future or to move at a time when you are less able to adapt to the changed care setting. We have re- written each paragraph of the Assisted living Article word for word and followed it with our comments on what is stated in the paragraph. The Article The Importance of Assisted Living   Original article text in bold     Our comments- non bold, italics Assisted Living can always be viewed as the finest that can be offered by the two worlds. What are the two worlds he is talking about in line one?  It is implied in this statement that all of ones’ care needs can be met in an Assisted Living Facility.  Of course, maintaining independence is the “best world”, no matter what the setting.   Unfortunately, when most people consider Assisted Living they are already in need of some amount “care” or assistance.  The reality is that as you age, your care needs and the amount of assistance you need to function will increase.  Which is why, it is not the structural facility that is truly important, but it is the system of caregiving and coordination of care that is offered at a facility that is the most crucial factor.   It is the ease and reliability of receiving care you need when it is needed.  These communities grant their residents with the independence they require with the knowledge that care services as well as person care availed to them anytime they require them.  These communities are aimed at offering the inhabitants with assistance in doing their basic activities. This, in fact, is not entirely true.  Generally, Assisted Living facilities are geared to independent people who want a hotel type environment and have very minimal care needs.  They offer levels of extra assistance for personal care, like bathing and dressing, at an extra cost and the assistance needs to be scheduled or planned for in advance.  After the scheduled assistance is provided, the resident is largely on their own.   If you need help in-between the scheduled times, you have to be able to go somewhere and ask for help. Even then you might not get the help you need right away. There may not be someone available to assist you at the time you need them.   If you are independent enough to search someone out to assist you, then you probably do not have a high need for personal care.  For people who do have a need for assistance with personal care, then it would be much more difficult to search someone out and actually receive the assisted care you need.  For example, a resident with incontinence ideally would require a under garment or brief change every 2 to 3 hours to prevent skin breakdown and infections.  This type of personal care assistance is difficult to schedule in advance and can become very expensive as the number of interactions and assistance with personal care increase.    Often when people move in they are largely independent and is not until the need for more personal care arises, that they can actually see what is available, from whom, and when. It is very difficult to know in advance when you will need assistance.   Residential Care Homes offer an alternative type of care and setting in which the service and personal care is offered in more of a family like/home setting with assistance and supervision 24 hrs. a day, on an as needed basis.  The care is more of a friend or mother standing by type of care wince the building is smaller and the staff is constantly around the residents.  This is what we call Family-Style care.   The cost of residential care homes are usually inclusive of all services and care provided.   Assisted Living Facilities tend to offer A La Cart Care, at an additional price, where the care is provided according to the pre -arranged schedule. These activities include dressing, grooming and bathing.  Other states also let these communities to provide medication assistance.  Here, complex medical services are not provided.  This distinguishes them from majority of the nursing homes. Some Assisted Living Facilities do provide a basic level of medication management at an extra cost, with only one or two trained and certified medication techs.  In general, residents go to the medication room to get mediations so that the one med tech is in the med room in case someone wants an as needed medication. At times Medications are dispensed at meal times.  When the one Med Tech goes out to find a resident in the big facility the medication room is often times left unstaffed making it hard for the other residents to get medications.   With only one or two med techs for 50 to 100 residents, it may be difficult to locate the med tech when you need them.  Consider the size and complexity of the building, the number of floors and wings of the building. It can be a very large area to cover when looking for someone.  For more independent people that system works fine, but as you need more help that service might be harder for disabled, older, persons to utilize.  In residential Care homes, usually all of the caregivers are trained to give medications.  With fewer total residents, it is easy to see that access to the med tech and getting your medications is likely to be easier especially if you are not totally independent and unable to hunt down the med tech. They always range from stand-alone homes to being one level of support center.  The environment is made to be attractive to both the potential clients and their people.  A friendly and home-like environment is normally availed.  The apartment elegance typically included a studio and one bedroom designs. Assisted Living Facilities are not stand alone homes.   They usually offer studio or 1 bedroom apartments in an enormous building with 50 to 150 residents.  This does provide highly functional, independent residents with the privacy accorded with ones’ own living space.  On the other hand, it also may contribute to isolation and loneliness for residents who are not as independent and functional.  In contrast, Residential Care Homes provide care in a residential home that has a real family like feel, where there can be a higher level of supervision and interaction.  The staff or caregivers are usually trained in many disciplines, including medication management.  Also, the ratio of administrators, med techs and caregivers to residents is much higher in Residential Care Homes which means it is likely will have better access to the more skilled people in the care team.  For Example, if there is one administrator overseeing  50-150 residents in a large, multi-floor Assisted Living Facility, Compared to one administrator for 10 or fewer residents in a smaller Residential Care Home it is more likely the administrator in the smaller  Residential Care Home will know your name and see you on a regular basis.   The interaction and contact with the administrator is important because the administrator is the boss, the person responsible for coordinating the staff and ensuring the staff are trained to provide the care.  With a smaller resident to administrator/staff ratio the administrator is more likely to have hands on approach which leads to better continuity of care and personal interaction from the administrator and the staff they train or supervise. A number of the clients to these communities are the old with chronic health issues.  This is why they are in dire need of assistance.  When they are assisted in preforming their daily activities, they are left with minimum responsibilities to do. As stated earlier, Assisted Living Facilities are geared to more independent seniors, offering minimal assistance with personal care at an extra cost.  Often Assisted Living facilities are not set up provided higher levels of assistance that one may need as their chronic health issues worsen. Assisted living often has a limited staff of 2-3 caregivers serving 50 or more residents.  Covering such a large building, often with two floors and different wings, is a significant task to supervise.  In order for 3 caregivers to provide assistance to 50 residents, each care giver must assist approximately 16 residents.  Therefore, the caregivers have limited time to spend with each resident and are put on a tight schedule to meet the scheduled tasks.   Unfortunately, caregivers may just complete the task of a shower or dressing,   to save time and stay on schedule.   In many cases, it would be a bigger benefit for the resident if the caregivers encouraged  the residents to do  the things they are able to for themselves, even if it takes longer  like  buttoning there shirt.   Most seniors prefer to do it themselves and they take as long as need to do it.  The residents usually don’t have a high need to do it quickly.  The senior has all day and wants to fill the day up with productive things like doing their own personal care.  It is easy to see why staff /caregivers need to go quickly, but for seniors may feel more empowered, more in control, if the caregiver had taken he time to let the resident do more for themselves.The notion of providing assistance with daily activities for a resident and thus, leaving them minimal responsibility for their own care causes pause.   It is during this time of increasing need and decreasing function that senior residents want to maintain as much control over their own care and do as much care as they can for themselves.  If they want assistance they want to ask for and direct it.  It is important for caregivers to encourage seniors to participate in their own care, even if it takes them longer.  Allowing seniors to remain in control and participate in their own care might be a better goal than doing the task for them to save on time and stay on schedule.Clearly seniors want the responsibility and suggesting it is somehow better to take the responsibility away from them is somewhat concerning for this writer. In such kind of places, meal provision are offered at least three times a day.  Housekeeping and laundry are also done for the clients.  Some provide swimming pool, fitness center, post office, beauty salon as well as transportation.  Others organize events, trips and activities that the dwellers can participate in. Meal preparation, Housekeeping and Laundry services are hotel style services and are not what most consider as “care”. We believe that “care” and “Assistance” are highly interpersonal, people related services, and are quite different from the less personal housekeeping and Laundry Services. Assisted living should let the inhabitants gracefully grow old.  This is so since the necessary support is easily accessible or if not, they have the responsibility of contacting other care offering agencies. This keeps the inhabitants in the society as the level of support rises.  The additional payment is thus paid on top of the regular monthly rent. The important thing to note here is that in an assisted living environment, it may be difficult to grow old gracefully if you have medical problems or chronic conditions.  Be wary of places that outsource care to other agencies or say “if we can’t do it, we can get an outside agency to offer the care you need.”   This is an enormous additional cost to the resident.  In addition, delegating the responsibility of providing care does not support the idea of continuity of care. Personal commitment and responsibility of Facility and Residential Care Home owners, administrator and staff is essential to a frail aging senior with many medical problems. When looking for Henderson Assisted Living make sure you check out our reviews of the best nursing homes. Posted in Health Tagged alzheimers, assisted living, health, las vegas alzheimers’s care, las vegas assisted living, las vegas memory care, memory care  Leave a reply. Summary In Sum, when considering an alternate care setting, like Assisted Living, there are many factors to consider.   It is important to follow the Golden Rule, meet the people who will do the direct care.  Assess how confident you are that the owners, administrator, med techs and staff want to do the work and provide the care.    Just because the sales lady said the staff will do the work does not make it true.  If the caregiver, administrator, doctor are easily accessible and take the time have discussions with you before you move in, it is a good indicator they are more personally invested providing the care and assistance.  If it is hard to meet and speak to all the people in the care team before you move in, it is likely it will be difficult to speak to these people when the need arises.  We believe commitments made by the individual are generally honored more than commitments of your time and efforts made by a sales lady on your behalf.  Meet the individuals who provide the direct care including administrator, med techs, caregivers, owner and others. One blog post and discussion will not answer all the questions.  We encourage you to comment on the ideas brought forward here, to help us continue to educate our communities on topics important to seniors and their families.   Our Golden Rule applies to bloggers too.  Thanks for your comments and help Please comment on this article so we can incorporate your comments to our review coming in a few wks. Read the article below. The thought process and clarification of what one means when they say Care or Assistance applies in all Senior Care Settings - Assisted Living, Hospital, Nursing Home, Home Care, Elder Care, Senior Care, Senior Living, Respite Care, Alzheimer's Care, Dementia Care, Memory Care, Hospice Care and any others you want to list. Thanks for reading this post .  If you liked this post please help us by sharing the message of Care, Caring, and Continuity of Care by likeing, friending, and following our works on Facebook     (tlcsr.kerrymcgivney), Twitter ( TLCSRLasVegas), Youtube (TLCSRLV),  Joining our Email List and this Blog, and sending this to any sons, daughters, or seniors you know. Here are links to make it easy! Like Our FaceBook Page: Friend Us On FaceBook: Follow us on Twitter: Like our videos on Youtube: Join our Free Blog and Email List: Contact: Shawn McGivney MD, RFA [email protected] www.tlcsr.com www.tlcsr.com/blog/

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