This NYT article raises a good question about activity in the hospital and by extension Nursing Home Rehab where you are on your feet 43 minutes a day. They go on to point out that if you are allowed to walk more, provided an setting or support system that encourages twice or more a day activity that is better than less activity. We add in questioning the definition of the phrase “rehab” since we believe that confuses many who would walk more, do more, if they were allowed to be in a setting that encouraged ambulation. For example being on your feet more, walking to meals, doing day to day tasks that most people would do in a more supervised Assisted Living or structured care setting might give one more activity than in many hospitals or other nursing home type settings. Trapped in the Hospital Paula SpanNursing Home Rehab vs Assisted Living that has adequate staff and continuity of care to do assisted activity with seniors
A nursing home, which is the most common form of senior rehab, might only have them on their feet for 43 minutes a day. While the senior gets “rehab” from a licensed physical therapist they don’t get a lot of walking and ambulation for the remaining 23 hrs a day. If walking and ambulation are rehab then one might get more “rehab” or exercise in an Assisted Living or Residential Care home that focus on continuity of care and activity. Just because the hospitalist doctor, who generally does not know you, and might have less interest in your condition months later since he does not expect to see you, suggests “rehab”, meaning nursing home rehab don’t assume you will get a lot of exercise. In fact, the system delegates your rehab to just the time you are in rehab which is not very long. The staff do their jobs but the floor staff like the senior to rest, and not get up, since they don’t have time to supervise that. If you knew your doctor, your doctor participated in the care both in the hospital and after the hospital he might feel differently about your expected functional decline in nursing home rehab. Now the NYT is confirming this view. We caution that all Assisted Living Homes may not have adequate staff or systems set up to allow or encourage mobility but note that if your setting favors continuity of care and senior independence it might be a good alternative to Nursing Home Rehab. All of these are speculative and each needs to discuss this with their doctor and health care team.Free or paid by Medicare nursing home rehab is not always the best care, most care, or most exercise.
We bring this point up since many hear that nursing home rehab is free or covered by Medicare for 100 days. They want to use up this free resource. At first glance saving a few bucks is a good ideas but when you consider that many my decline further and not regain their previous community mobility with extended nursing home or hospital stays and the inactivity that accompanies them. All nursing homes are not the same. Some staff will get you up and walk with you but practically it is hit or miss. Also management will direct staff to stay on task and walking with residents takes time, time that staff could be doing something else. Also walking with residents is risky for the institution in that the patient might fall so they want to be extra safe. Of course the senior wants to take that risk since to live a full life requires walking. If they fall it wont be the first or last time and that is ok. Aging and life are risky.Example of a Assisted Living Care Option that probably does offer more exercise and supervision than many hospital and rehab settings.
At http://tlcsr.com we have a negotiated risk agreement with falls and encourage people to walk knowing that our encouraging then will encourage them to do more and when they do more they might not ask for help and fall. That is an acceptable risk the patient and family agree to which is the negotiated risk agreement. That should become a model for care. Read this and share your comments. Help us spread the word. Click for Free Ways to help. Click for The Best, Most Cost Effective, Assisted Living and Senior Care Alternatives. Tender Loving Care Senior Residence TLCSR, Costa Brava Dr Shawn McGivney
Read the two articles below and comment. Assisted living vs. Hospice: Who is in Charge? Click on these links for the two articles from the NYT. Assisted Living VS. Hospice: Who’s in charge? http://newoldage.blogs.nytimes.com/2012/11/16/assisted-living-vs-hospice-whos-in-charge/ Managng the Assisted Living VS. Hospice Dilemma. http://newoldage.blogs.nytimes.com/2012/11/19/managing-the-assisted-living-vs-hospice-dilemma/?pagewanted=print The New York Times is right on the money and we applaud them for discussing this. To be fair we believe you need to add many players to the list ofwho is in charge ?
We would add Doctors, Your Doctor, and the financial entities that pay for your medical care and control to various degrees “your Doctor” into the mix. This is precisely the issue, no one, Doctor, Assisted Living, Hospice, Hospice Doctor, the Home Care aide or the office manager who runs the Home Care Company, Family Member, The Government, The Insurance Company — WANT TO BE RESPONSIBLE FOR THE VERY CHALLENGING AND EXPENSIVE TASK OF PROVIDING CARE TO A SENIOR. When it comes to being “responsible” few want that job. That is expected since it is a very difficult and under valued job. While Medical Care use to have a high Value, much of the value came from relationships, continuity of care on both sides, “provider” and “Senior”. However, we have seen a stead decline in the value both sides places on relationships and continuity of care which has gotten us to the assembly line, less personal, style of care we now see. Why, How, that is a discussion we are ready to have and need to have as a society.
The issue is lack of continuity of care.
This is a lack of responsibility by the patient and the provider. To have a responsible party you have to have a person, family, or patient who is participates and respects that responsibility. If the Patient jumps to a new insurance company because a stranger, a sales lady, promises them something new they can’t expect to build and earn a trusting relationship. We believe that health care requires that relationship especially as people age or acquire chronic illnesses for any reason. 30% of people on Medicare are less than 65 yrs old. Accidents do happen, illness is not only for the old and all of us will need health care someday. We need to value it, invest in a cost effective, humanistic, system of care and the basis of that will undoubtedly be Continuity of Care. The power struggle is between financial entities, corporations trying to get your dollars and delegate the work and responsibility. While that is a very good business system and works great when building inanimate cars or objects it fails miserably in dealing with people or providing Health Care which by definition has Emotional Health, Feeling, Depression, Satisfaction, and all the human emotions included in the service or product. If we all were VCR’s then we can roll out care down the wide Assisted Living , Nursing Home, or Hospital Hall and go do to door making the patients wait until our assembly line was turned on. However, in fact the bowl and bladder and entire body and mind work on their own time table making assembly line much less efficient in providing high quality heath care. Do not let the sales lady convince you that her best care, care she will not provide, care she has little interest in once she signs you up, will be as compassionate as care you get from someone you have a professional relationship with. Look for continuity of care. of course the ideal person to be in control is “your Doctor”. They use to have more control but now have had that dissolve. Families, insurance companies, politicians, have all come between the care providers, Doctors, RN, and Caregivers and the patients. As those relationships were lost it stands to reason some care and caring went with them. Now the financial institutions want to be “responsible” for your premium but want to delegate are to unknowing doctors. By Shawn McGivney MD, RFA By 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 Shawn@tlcsr.com www.tlcsr.com www.tlcsr.com/blog/
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.pdfTopic ( 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 Shawn@tlcsr.com www.tlcsr.com www.tlcsr.com/blog/
When choosing a care setting you need to consider the fact that your care needs will likely change many times over the next several years. You will get sick and recover with a net outcome of progressive aging. Aging, unfortunately is progressive. We do what we can to reduce it and to maximize quality of life as we start to need assistance but we often lose sight of the role of the direct care team as a big part of providing the quality of life, continuity of care and flexibility in care options. What you need to look for is a care setting that can accommodate your needs now when you are relatively well with caregivers and staff who can interact with you as friends, family members and well known persons.
If you have a care giver that sees you just a few minutes a day or once a week for a shower they are not really interacting with you on a continuous basis and they will be less likely to sit and talk with you about day to day events. If the caregivers know you, know who visited, called, emailed you over the last few days you can see that all the direct physical care they offer will come with a much higher degree of compassion, trust, and understanding and social interaction since the care giver can remind you of those visits that make you smile so much. When you choose a care setting look for one with caregivers who can be part of the resident’s life, care, now when you are at a higher level of function and as the care needs evolve. Flexibility is part of continuity of care. There is overlap in these terms. When you are choosing a care setting because you feel you are starting to need some back up people around to help consider the staff and how they interact with the senior in addition to looking for other seniors, peers, as the main source of social integration. If the senior can’t initiate and maintain their own social calendar in their own home it is likely they will have some difficulty meeting, friending and then relying on others frail seniors to be their friends. Having friends and peers is needed but also consider the possibility of having staff who are more like friends, more interactive, as part of the social system. Having that type of staff when you are well initially and as you need more help can drastically improve communication, sense of quality of care, for the resident and families who are not able to be there day in and day out. If you under value this aspect of care when you need minimal assistance and you value having other frail senior as the main social system that system has a high degree of failing and leading to stress. You need both highly interactive staff you can rely on and who can adapt and adjust to whatever your level of social needs are as well as other seniors or peers who you can interact with in structured activities.
If you, the family, are planning to be the main caregiver, social support person, you might consider keeping them at home since it will be easier for you to be there day in and day out. However, if providing direct care to a parent is becoming to stress full to your own family life you might consider looking for a consistent, live in, or more integrated staff to allow flexibility in social, emotional, and physical care as those needs change over the next few years. Otherwise, expect to be faced with finding a new, higher level of care, every 6 months as the care needs evolved. Also expect frequent calls since while you hope the other frail seniors and your parent will “just find a social connection and shared activities” that most likely will happen at a limited level. Then they will continue to rely on you as a main social and management system. That is why it is so important to meet the owner and administrator and management team of what every care option you choose. Assisted living, out patient home care WHERE THE DOCTOR, YOUR DOCTOR, is the team leader. If you are relying on the CNA to be the team leader it is likely her very limited medical training will have many large gaps in the care plan. She may not know what the medications are, what side effects there are, how to get them, how to deal with insurances, or how to deal with the complex system of specialist doctors. Moreover, the owner of the home care company is likely just a staffing person with limited medical or case management skills as well. While Home Care sounds appealing since they have the word home in the title in fact that is only 1/2 of the continuity of care. The other half is for the skill people the Doctor, Administrator, and more medical skill people. Family is always important but finding a flexible staff who can work with the family to bridge that social gap is a part of flexibility in care. Having the caregiver, the doctor or Administrative staff allows the family to be family and to focus on what they do best be family. Most care setting claim they can provide many levels of care however, you need to look very closely at the care system from top administrator and owners down to the direct care givers and med tech’s so you can compare which systems are likely to offer the greatest flexibility and continuity of care as the social, emotional and physical care needs change with aging. Flexibility and continuity of care are required eliments of care in any “care” settings — Assisted Living, where Assisted is a synonym for Care, Home Care, Hospice Care, Dementia Care, Alzheimer’s Care, Memory Care, Respite Care, Residential Care, Nursing Home Care or any other care setting.By Shawn McGivney MD, RFAThanks 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 Shawn@tlcsr.com www.tlcsr.com www.tlcsr.com/blog/