OASIS-C (M1012) Q&A, Flu Shots, and Holidays

First, a couple of OASIS-C questions answered:

Q: In OASIS-C (M1012) it asks about inpatient procedures in the last 14 days. Do they want procedures performed in the last 14 days or procedures that occurred while hospitalized in the last 14 days?

A: CMS issued an “OASIS-C Guidance Manual Errata” on December 10 that gives further guidance on this. The 14-day time period applies to the timing of the inpatient discharge, not the date of the procedure. This means that for purposes of counting the 14-day period, the date of admission is day zero and the day immediately prior to the date of admission is day 1.

Q: What if our agency never plans to give flu shots? What is the best response for us?

A: According to CMS: If an agency elects not to administer vaccines to its patients, and the reasons listed in Responses 1-6 (such as vaccine received from another health care provider) do not apply, then Response 7 – None of the Above – would be the appropriate response.

And lastly, this blog will be quiet for a couple of days, due to the fact that the MHCA office will be closed tomorrow and Friday for the holidays. But we’ll be back on Monday, so those of you who aren’t on vacation until the 4th of January, stop by and see what we’ve got to say!

In closing, to quote Krusty the Clown, “So, have a merry Christmas, happy Chanukah, kwazy Kwanza, a tip-top Tet, and a solemn, dignified Ramadan.”

LEDs Make the Holidays Safer

The blog Aging Suite has a great piece on how elderly people can stay safe during the holidays; holiday decorations and extension cords can increase the risk of falls. Home care professionals, make sure you take a moment to look around and make sure there no cords are overloaded or hidden by rugs or debris, and make sure that the tree (if it’s real) doesn’t dry out.

I’d like to add another suggestion: LED lights. LEDs are much safer in that they don’t put out nearly as much heat as traditional light bulbs, and therefore are far less of a fire hazard. (And less worrisome if the patient forgets to unplug them at night.) LEDs are also cost effective and won’t add as much to the electric bill. You can order a cheap set from Amazon.com or pick one up at Target. You can also put the lights on a timer, so that they go off automatically at certain times, thereby eliminating the risks of lights left on over night. You may want to discuss these options with the patient’s family as well.

Last week, my mom and I went to my grandma’s house to help her with her tree. While I searched her boxes of decorations for garland (with no luck, so only a third of the tree bears a sparkly white garland…oh well) I found two boxes of lights from the 1940s. Man, are they cool. And supposedly a collector’s item. I’d sure love to string them up, but if they could talk, I just know they’d say “I’ll melt your curtains”.

Holidays Expose Elder Care Needs

Home care agencies, are your prepared for the onslaught of calls you’ll likely be getting after the holidays? I’m sure I don’t have to tell you that many people don’t realize what condition their elderly parents are in until they go to Grandma’s house for Christmas but this article from today’s Star Tribune serves as a great reminder.

It’s also sad:

Across the nation this holiday season, thousands of families will slam into the reality that life has changed for aging parents — dad is far more frail than relatives thought, mom forgot to prepare the holiday feast, the house is filthy, the refrigerator is bare, or a stack of bills has gone unpaid.

This is known territory for many of the 46 million Americans who help frail, aging relatives and friends — about 900,000 in Minnesota. But for some, it comes as a shock, and they often have little notion of what help is available, or even what is needed.

This type of shock can easily be avoided by a) recognizing that mom and dad are getting old and resolving to keep an eye on their condition and b) planning ahead so that you have a plan in place when the time comes to hire an HHA or PCA or whatever the family decides to do.

Unfortunately most people go with c) wait until there’s a crisis, and panic.

As home health care providers, it’s our job to make sure that a family in crisis mode is able to see us through the fog of confusion and consider home care as an option. One thing we can do is encourage families to find a “trusted advisor” or geriatric care manager, someone who can help steer them through the mist and into the type of care they need.

I’m pleased to see articles like this–it might inspire a few people to plan ahead and therefore avoid hitting the panic button. Home care agencies should take advantage of articles like these; tweet it, facebook it, blog about it, Xerox it with a copy of your company’s information and mail it to household in your county, whatever.

And after January 1st, stay close to the phone.

WOCN Guidance on OASIS-C Integumentary Items

WOCN Guidance on OASIS-C Integumentary Items has arrived. The tool is hot off the presses and available at:

http://www.wocn.org/pdfs/GuidanceOASIS-C.pdf.
Also important to note: On December 10, CMS announced further updates to the OASIS-C manual with several clarifications in the wound section.To review the updates, visit:

http://www.cms.hhs.gov/HomeHealthQualityInits/downloads/OASIS-CGuidanceManualErrata.pdf

CMS ISSUES MORE OASIS CLARIFICATION

The Centers for Medicare and Medicaid Services (CMS) posted a nine-page document with some corrections to the OASIS Guidance Manual. The document is dated December 10 but it made its first appearance yesterday (December 16). Check it out by going to:
http://www.cms.hhs.gov/HomeHealthQualityInits/downloads/OASIS-CGuidanceManualErrata.pdf

Elderly Patients Happier with ‘Informal’ home care?

According to this article, elderly patients are happier informal home care–that is, home care performed by their children, not home care professionals. That’s really not very surprising, considering that most seniors want their families to help, and in fact expect their children to help. I mean, think about it: our culture often tells people, “have kids so that you’ll have someone to take care of you when you’re old” (and, I believe, this is likely common in many other cultures as well), so it makes sense that elderly people expect their children to help, and it makes sense that they would be “happier” when those expectations are met.

However, there’s a sentence in the first paragraph of the article that sticks in my craw: “A new study co-authored by University of Virginia economics professor Steven Stern suggests that you shouldn’t assume a home-care professional can better care for your parent than you can.”
If you’re not a nurse, how can you provide the same care as a trained nurse? We know that families often see the subtle changes in their elderly parents, but don’t recognize warning signs–warning signs that would not go unnoticed by a trained nurse. Additionally, nurses have skills that people who aren’t nurses don’t have. With informal home care, patients can get what they want, but not necessarily what they need. Also, many family caregivers have children of their own to take care of, and can’t afford the opportunity cost of caring for aging family members (eg, missing work).

The article goes on to say that the study didn’t measure patient health: The comprehensive survey…includes questions on health, family characteristics (including demographic details of one’s spouse and/or children), income and wealth, but does not include any direct measure of health quality. Consequently, self-reported “happiness” was used as a proxy, Stern noted.

…

Stern speculated why this self-reported happiness was more prevalent among those receiving informal in-home care from a child or spouse: “A big part of looking at happiness isn’t the care per se, but the fact that the kid is involved in it.”

So, if what makes patients happy is having their children involved, why can’t they have the best of both worlds? It’s important to blend what patients want–involved children–with what they need: professional care. Families can work with the home care nurses they hire and learn how they can become more involved in their parents’ care. It’s not an either-or situation, nor is it a zero sum game. Professional home care is customizable to allow people to get what they want and what they need.

H1N1 Vaccine Available To All

If you’ve been listening to the radio, reading the news or watching TV at all today, you probably already know this but…Great news! The Minnesota Department of Health announced today that the H1N1 vaccine will be available to all people, not just those in high risk groups.

Health care providers: it’s up to you whether you choose to move on to vaccinating people outside of high risk groups; you can do so as long as your high risk patients have been vaccinated and you have enough of the vaccine to go around.

This is great news for those of you who might be worried about a third wave of H1N1 that has been predicted for January–you can get vaccinated for it ahead of time. Keep in mind that your health care provider may not be able to offer you the vaccine, but also remember that even if you aren’t able to get vaccinated, other people who get the vaccine help stop the spread of H1N1.

Hear that? Getting vaccinated doesn’t just protect you, it helps protect others by stopping the spread of the disease. The vaccine will be available to people outside of high risk groups starting tomorrow, Wednesday December 16th, 2009.

Family Caregivers Don’t Look Online For Help

According to this study, which was tweeted earlier today, many family caregivers don’t look to the internet to find help:

[T]wo-thirds (67%) have rarely or never gone to Internet websites in the past year to find information in any way related to being a caregiver (among this group 48% say they have never done this). About one-third (33%) say they have sometimes or often gone to Internet websites in the past year for such information.

More than three-fourths (77%) of caregivers say they feel they need/needed more help or information on at least one of the fourteen categories we asked about. Almost four in ten caregivers (38%) say they need information about keeping the person they care for
safe at home and one-third (34%) need information about finding easy activities to do with the person they care for.

Home care providers should take this information into consideration–you can’t rely on the internet to get the message out.

Elderly, HIV patients in Rural Areas Left Behind

I just came across an interesting article in the New York Times about the challenges faced by elderly people living in rural areas. The article recounts the story of a rural woman from Wyoming who slipped on a patch of ice and broke her hip. It goes on to say that the trials of growing old are even tougher for those living in rural areas:

Growing old has never been easy. But in isolated, rural spots like this, it is harder still, especially as the battering ram of recession and budget cuts to programs for the elderly sweep through many local and state governments.

With the population disproportionately aging, why does it make sense to cut money from programs for the elderly? It doesn’t. And it’s going to haunt lawmakers, especially given the fact that elderly people vote in higher numbers than do young people.

It’s easy to forget about people in rural areas. Small towns are the kind of places people leave behind–and many of the people living in rural areas are indeed left behind. HIV infections in rural Minnesota are increasing, according to RAAN, the Rural AIDS Action Network. This is mostly due to poverty and lack of education.

I hope that RAAN will be able to continue its work and prevent new infections in rural Minnesota. And I hope lawmakers will realize what a disaster budget cuts to programs for the elderly are.

H1N1 Has Low Mortality Rate

According to an article I found just now on Reuters, H1N1 has a low mortality rate and is “at worst only a little more serious than an average flu season and could well be a good deal milder”.

The article goes on to say that roughly 1 in 2000 people infected with H1N1 dies from H1N1. What are the chances of the major news outlets picking up this story? I don’t mean to sound cynical, but it seems they’d rather show footage of waiting rooms crowded with anxious mothers and crying babies, and sound bytes of people complaining of vaccine shortages, because to run a story that says, “actually…it’s probably not going to kill you” won’t generate ratings.

Meanwhile, you can read the full story here: http://www.reuters.com/article/idUSTRE5B64DL20091207. Or you can switch over to CNN and read about John Stamos’ extortion plot. (I’m not giving you the link for that one).