Transcript CEU Option

Rochester Area Home Health Consortium
Presents…
HOME HEALTH CARE
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Home Health Care Services
Within the following presentation, Home Care eligibility, statistics
and general information will be discussed.
At the end of this presentation, you will find a 10 question quiz.
Successfully passing the quiz requires a score of 100%. You make
retake the quiz as many times necessary to achieve a passing
score.
This presentation meets the criteria for Two (2) Continued
Education Units (CEUs). Please see the homepage for further
details.
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Why Choose Home Care?
 Registered nurses or therapists provide individual assessments
of patient’s care on a regular basis
 Skilled staff develop treatment plans under the direction of a
physician
 Homecare staff observe and report symptoms, reactions to
drugs, and changes in the patient’s condition
 Therapists and nurses provide rehabilitative and nursing
interventions to assure patient’s care and safety
 Staff coordinate services to other agencies and health care
providers
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Home Care Spectrum of Care
Physician
Personnel
Nursing
Personnel
Therapist
Others
Referring
physician
Registered nurse
Occupational
therapist
Social worker
Family or
Specialty
physicians
Consulting
physician
Licensed practical
nurse
Home health aide
Occupational
therapy assistant
Durable medical
equipment
provider
Physical therapist
Hospice
Physical therapy
assistant
Palliative care
Speech/Language
pathologist
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Infusion pharmacy
Value of Home Health Care
 Promotes healing and keeps families together
 Reduces unnecessary admissions to the ER or hospital
 Increases efficient use of resources (and is often less expensive
than other settings)
 Home health care improves quality of life while aging at home
 There is high consumer satisfaction associated with care
delivered in the home
 Decreases risk of hospital acquired infections
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Medicare Requirements for Home Care
 Care must be provided by a Medicare certified agency
 Patient is homebound
 Services are ordered by a licensed/ PECO certified physician
 Intermittent or part-time care (predictable end)
 Skilled service required, nursing, physical therapy,
speech/language pathology
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Homebound Patient…
Criteria One
The patient must either:
Because of illness or injury, need the aid of supportive devices
such as crutches, canes, wheelchairs and walkers; the use of
special transportation; or the assistance of another person in
order to leave their place of residence
OR
Have a condition such that leaving his or her home is medically
contraindicated
* If patient meets one of the Criteria One conditions listed above, then
the patient must ALSO meet two additional requirements defined in
Criteria Two (next slide)
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Homebound Patient Cont.
Criteria Two
There must exist a normal inability to leave home
AND
Leaving home must require a considerable and taxing effort and
be infrequent in nature and of short duration
*Acceptable reasons for leaving home include:
– To receive health care treatment
– To attend an adult day care program licensed, certified or accredited by the state
– To attend a religious service
– Any absence that is infrequent in nature and of short duration
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Initial Start of Care
 May be initiated only by a verbal or written order from a
physician (NOT a PA or CNP)
 Order should contain the following information
– Patient’s condition/diagnosis
– Specific orders for service/updated medication list
– Disciplines to provide the service
 Face to Face (F2F) Encounter Form completed in its entirety
and specific to the patient
– If patient was hospitalized F2F to be completed prior to DC to
eliminate the need for homebound patient to make a special
appointment for a F2F at a later time
– May be completed 90 days prior to start of care or within 30 days
after start of care
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Examples of Homebound Patients….
 A patient who is paralyzed from a stroke and is confined to a
wheelchair or requires a walker
 A patient who is blind or cognitively impaired and requires the
assistance of another person
 A patient in the later stages of ALS or other neurodegenerative
disabilities
 An individual with arteriosclerotic heart disease and needs to
avoid activity
 An individual who has had a recent joint replacement and
requires additional therapy
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Examples of Homebound Patients
 A person with psychiatric disorder if the illness is manifested
by refusal to leave home or is considered unsafe to leave home
unattended, even if there is no physical disability
 An individual who just returned from a hospital stay involving
surgery resulting in weakness and pain and activities are
restricted by a physician
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Functional Limitations Related to Homebound Status
 Unsteady gait, prone to falls
 Impaired functional limitations
 Shortness of breath with slight exertion
 Acutely ill or contagious disease
 Dependent upon equipment
 Draining wound(s)
 Fractured lower extremity
 Amputation or paralysis
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Homecare Assisted-Living Discharges
 Client is discharged with Medicare eligible services:
– Need order signed by physician
– Need completed F2F
– Separate referral to Medicare Certified Agency
 Client is discharged without Medicare eligible services:
– If there is a change in condition or medication, return to assisted
living must be coordinated with the on-site RN. RN needs to update
orders/care plan
– If client returns after hours/weekends there may not be an RN on-site
to coordinate orders/services
– Client MAY return after hours if family agrees to assist until new
services/medications are coordinated
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Skilled Nursing
 Observation and assessment
 Direct skilled procedures
 Teaching and training
 Management and evaluation of patient care plan
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Skilled Therapies
 Physical Therapy
– Can stand alone under Medicare/open and case manage patient
 Occupational Therapy
– May not initiate care but may continue as a qualifying service after
RN, PT or ST established the need for services
 Speech/Language Pathology
– May stand alone under Medicare/open and case manage patient
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Physical Therapy…Referral Criteria
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Functional limitations
Impaired balance, ambulation, or mobility
Weight bearing instructions
Poor endurance for functional activity
Decreased ROM or muscle strength
Prosthetic/orthotic training
Impaired stair climbing
Frequent falls
Pain in movement
Need for assistive devices or equipment
Home safety
Occupational Therapy…..Referral Criteria
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Impaired dexterity/coordination
Decreased upper extremity, ROM or strength
Cognitive/perceptual impairment
Need for adaptive equipment or training
Energy conservation education
Impaired ability for self care
– Feeding, bathing, dressing, grooming, homemaking
 Home safety assessment
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Speech Language Pathology…Referral Criteria
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Impaired swallowing
Dysphasia
Communication impairment
Impaired expression, comprehension, voice
Non-verbal communication
Oral/facial muscle weakness
Aphasia/dementia
Home Health Aides
 HH Aide Services must be:
– Reasonable and necessary
– Provided in conjunction with a skilled service
– Supervised by a skilled service professional every 14 days
 Examples
– Bathing, dressing, oral hygiene, shaving
– Skin care
– Assisting with ambulation and activities that support skilled therapy
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Personal Care Assistant (PCA) Eligibility
 Be on Medical Assistance
 Be able to make decisions about their own care or have a responsible
party
 Live in a home or apartment
 Be determined eligible by a PHN or SW/Case Manager if on a waiver
(generally you need help with ADLs or health related tasks or need
observation and redirection of behavior.)
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Personal Care Assistant (PCA)
 Assist with activities of daily living (bathing, grooming, dressing,
eating, positioning, mobility, transfers, and toileting)
 Assist with health-related procedures (ROM, assist with selfadministered meds, and interventions for seizure disorders)
 Behavior redirection
 Instrumental activities of daily living such as light housekeeping,
grocery shopping or accompanying to appointments
 PCAs may also accompany a client in the community for normal life
activities if the health or safety of the client would be jeopardized if the
PCA was not present
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Examples of Skilled and Non-Skilled Interventions
Skilled
NonSkilled
Examination
Preoperative visit
Patient education/training
Screening
Monitoring an established program
Functional Mobility
Gait training
Transfer training
General Mobility
Ambulation practice
Performance of transfers
Therapeutic Exercise
Routine Exercise
Functional strengthening and ROM
Revision of exercise program
Overall fitness and flexibility
Supervision of exercise program
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Setting Goals
 Each discipline must set goals related to the patient’s diagnosis
and care intervention
– Realistic
– Measurable
– Time specific
– Attainable
– Outcome specific
Quality care for positive patient outcomes
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One License, Two Levels
 Basic
– Assistance with ADLs
– Homemaker tasks
– NO licensed health professional
– NO skilled nursing services
 Comprehensive
– Can provide all basic services
– All skilled services
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Nursing
Physical, Occupational and Speech Therapy
Medical Social Services
Delegated tasks
Extended Hour Nursing
What is Extended Hour Nursing:
 Extended Hour Nursing Services (also known as Private Duty Nursing Services)
are deemed medically necessary by a physician with proper orders and
authorization to qualifying agencies
 Qualifying agencies assess clients cares for appropriate nursing hours and
develop a plan of care which is then authorized by the consumer’s physician
and appropriate payer source
 Nurses observe, monitor, intervene, and evaluate clients during their shifts
based on plan of care
 Services can be provided in a client’s home or outside the home (school, work,
or public settings depending on the client’s condition)
 Typically, in order to be considered “Extended Hour Nursing,” clients qualify for
4 or more hours per day; services can be up to 24 hours a day 7 days a week
 Often, Extended Hour Nursing is an alternative option for a client with complex
medical needs who would otherwise require hospital, transitional care or
nursing home level care
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Respite
 Is intended to temporarily relieve family caregivers in their
absence
 Respite Services are provided in or out of the client’s home
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Mental Health Services
 Mental Health Services includes:
– Adult and Pediatric In-Home Therapy
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Mental Health Behavior Aide (MHBA)
Diagnostic Assessment
Skills Training - Individual and/or Family
Supervision
Day Treatment (children ages 5-16)
Crisis Assessment
Adult Group Therapy
Adult Rehab Mental Health Services (ARMHS)
How
much does
Cost in Minnesota?
One
License,
TwoCare
Levels
 According to the Minnesota department of Human Services, the
average cost of care for one year is:
$20,000 for an average of 2 to 3 home care visits per week
About $40,000 for care in an assisted living facility
Over $62,000 for care in a nursing home
Source: http://mn.gov/dhs/general-public/own-your-future/gatherinformation/financial-planning/care-cost.jsp
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There’s No Place Like Home…..
Home Care is about Hope, Dignity and Peace of Mind.
The Hope of continuing to live in the place we all love and want
to be…..HOME
The Dignity of receiving care in the privacy of home and not
surrendering your healthcare choices to a facility
The Peace of Mind of having a home care professional to meet
health care and lifestyle needs
Quality patient care with Quality patient outcomes
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Aging & Health in America
Nearly 90 percent of people over age 65 indicate they want to stay in their
home as along as possible. (AARP)
The number of people 65 years old and older is expected to rise by 101%
between 2000-2030. (CDC)
In 2050, age 65 and over is projected to be 83.7 million, almost double the
population of 43.1 million in 2012. (Census.gov)
Loneliest older people were nearly twice as likely to die during their
six-year study as least lonely. (The Guardian)
18 percent of seniors live alone, while 43 percent report feeding lonely on a
regular basis. (Aging Care.com)
1 in 7 people with Alzheimer’s disease live alone. (Alzheimer’s Association)
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Quiz - Slide 1 of 2
1)
2)
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5)
Continue to next slide
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Quiz - Slide 2 of 2
6)
7)
8)
9)
10)
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