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Part III. Transfer from hospital to rehabilitation: It can be a vulnerable time.

News

Posted on March 19, 2021 by Elder Care Consultants, Inc.

At discharge, the patient is transported to the rehabilitation facility, typically by ambulance or wheelchair van unless the patient is being transferred from the hospital to their Inpatient Acute Rehabilitation. The staff must quickly begin the task of getting to know its new patient which may be simplified if the transfer is in-house.

When the patient arrives, nursing staff will have reviewed the patient’s current hospital records, but typically knows little about his/her other medical or social history. Once the patient has arrived, his/her medications are ordered according to the records sent from the hospital, some of which may have been changed during the hospitalization. Nursing staff will physically examine the patient and test the patient’s mental acuity. Both the physical and mental status exam can be stressful for the patient. The initial mental status exam may not reflect the resident’s true mental acuity, but rather reflect a reaction to the multiple transfers (home or residential facility, to hospital, to rehab).

Within 24 hours, the patient and records will also be examined by the staff physician or the physician’s nurse practitioner who can make medical and rehab recommendations. The rehab staff (PT, OT, ST) and dietician will also meet the patient to begin forming the initial treatment plan.

Patients may be confused by his/her new surroundings, staff, and routines. Staff will be wearing masks and other protective clothing, which can be further disorienting to the patient.

The task of getting to know the patient, particularly important medical history may be complicated by COVID precautions.  Some patients may be unable to provide much information about his/her medical history, medication regimen, or even dietary preferences.

Sub-Acute Rehabilitation and Acute Inpatient Rehabilitation staff work hard to provide care to patients who are COVID positive or are ill with COVID-19 and to keep the rest of the residents and staff safe. There are significant differences in how facilities manage this care. Some facilities will not accept COVID positive patients while others segregate them from the rest of the residents. Providing quality care and rehabilitation to all residents has become a challenge.

The impact of the lack of contact with the familiar faces and voices of loved ones cannot be underestimated. Residents feel lonely, confused, and sometimes depressed. These emotional states can negatively impact rehabilitation, appetite, and ultimately the patient’s recovery.

How are we helping patients and families? It is important for rehab staff to gain as accurate a picture of the patient as possible. By coordinating with families and the community physicians even prior to transfer to the rehab, we are able to work closely with nursing, rehab, and social work staff and their assistants to help them get to know the patient more fully and accurately from early in the rehab stay. How well was the patient functioning prior to the hospitalization? Where was he/she living and where would he/she likely live at the end of the rehab stay.

We can be in the best position to advocate for the most optimal rehab goals and outcome. When appropriate, we can advocate for more rehab sessions or more frequent treatment plan reviews. We also work with families and residents to bridge the physical distance by using various technologies to communicate and see one another, helping to mitigate the impact of the separation. We then work with patients and families as they look forward to the day rehab at the facility ends and a plan for future care is put into place.

Be sure to read Part I on In-Patient Acute Rehabilitation vs. Sub-Acute Rehabilitation and Part II on Hospital Discharge Process to Inpatient Acute Rehabilitation or Sub-Acute Rehabilitation.

https://eldercc.com/wp-content/uploads/hospital-rehab.jpg 1028 2121 Natalie Rose https://eldercc.com/wp-content/uploads/elder-logo-topnav-1.png Natalie Rose2021-03-19 14:05:212021-03-19 14:05:21Part III. Transfer from hospital to rehabilitation: It can be a vulnerable time.

Part II. Hospital Discharge Process to Inpatient Acute Rehabilitation or Sub-Acute Rehabilitation

News

Posted on March 15, 2021 by Elder Care Consultants, Inc.

It can be confusing … but we can help.

While the differences between Inpatient Acute Rehab (IRF) and Sub-Acute Rehab (SNF – Skilled Nursing Facility) seem straight forward, the path from hospitalization to either rehabilitation setting may not be, especially during the pandemic.

Although it may seem to patients and families that discharge from the hospital comes up suddenly, on the hospital side the process actually begins when the patient is admitted. Hospital discharge staff have many patients, facilities, and factors to consider:

  • Is the patient COVID positive?
  • Has he/she been vaccinated for COVID?
  • Does he/she have dementia?
  • What other conditions does the patient have?
  • Where do loved ones live?
  • Which facilities will be accepting new patients at the time of discharge?

A facility that had availability for patients last week may not have availability this week. Discharge staff are working under more pressure than ever, especially during the pandemic to minimize exposure and to free up staff to care for critically ill patients.

Discharge decisions must often be made quickly. The hospital discharge planner will notify the patient and family about a day or so in advance that discharge is scheduled. They will offer some options for the family to investigate depending on whether IRF or SNF is recommended. Even if the patient qualifies for IRF-based rehab, there are far fewer IRF facilities than SNFs, so location will be a significant factor. While there may only be one IRF to consider, there may be several SNF facilities closer to home. Families will be asked to let the discharge planner know which facilities are their top choices.

Prior to COVID, families could quickly arrange to tour and investigate various facilities and let the discharge planner know their top two or three choices. While some facilities are offering limited in-person tours, COVID precautions may require that tours occur virtually, in mock-up rooms, or even that families make decisions based on information on facility websites. The quality of facilities can vary significantly. Additionally, the facility preferred by the family may not have bed availability for the specific discharge day, yet choices must be made quickly.

How are we helping families?

  • We stay abreast of Medicare and insurance guidelines and changes due to the pandemic.
  • We work closely with rehab facilities to determine their current rehab status and COVID precautions or restrictions.
  • We work closely with discharge planners and facilities early in the hospitalization to help ensure that the patient is discharged to the best possible facility.
  • We quickly get a sense of what facilities may work best for the patient and family.

Our care managers’ experience in the field enables us to provide expert guidance to families. We know the facilities well.  We add a breadth of information far beyond what can be gained from a website or even an in-person tour.

Be sure to read Part I on Hospital In-Patient Acute Rehabilitation vs. Sub-Acute Rehabilitation

https://eldercc.com/wp-content/uploads/hospital-rehab.jpg 1028 2121 Natalie Rose https://eldercc.com/wp-content/uploads/elder-logo-topnav-1.png Natalie Rose2021-03-15 09:00:052021-03-15 11:53:30Part II. Hospital Discharge Process to Inpatient Acute Rehabilitation or Sub-Acute Rehabilitation

Part I. In-Patient Acute Rehabilitation vs. Sub-Acute Rehabilitation

News

Posted on March 12, 2021 by Elder Care Consultants, Inc.

Post Hospital Rehabilitation

Following a hospital stay for a planned surgery, an injury or illness, many patients benefit from skilled rehabilitation at a facility after discharge. There are two types of facilities: (1) Inpatient Acute Rehabilitation Facility (IRF); and (2) Sub-Acute Rehabilitation Facility (SNF). Note: SNF refers more generally to a Skilled Nursing Facility, which many people know as a “Long-term Care / Nursing Home.” Many Sub-Acute rehab rooms are located within a SNF.

Both facilities provide physical therapy (PT), occupational therapy (OT), speech therapy (ST), therapeutic recreation (RT), and nursing. Below are some differences.

Intensity:

  • IRF patients must be able to participate in two three-hour intensive therapy sessions, five to six days a week. Typically, the goal is to return patients to the community quickly with an average stay of 12-15 days.
  • IRF treatment teams maintain a vigorous approach toward functional improvement and update the patient’s treatment plan weekly.
  • SNF patients may receive therapy from four to six days a week, but for shorter sessions than at an IRF, one to two hours per day. The average length of stay is 26.4 days. The goal may be to return home, to an independent or assisted living facility, or to a long-term care facility.
  • SNF treatment teams update their treatment plan at least every 30 days while the patient is receiving skilled (rehab) care.

Staffing:

  • IRF’s must have a board-certified rehabilitation physician and a physiatrist on staff. The physician must see the patient at least three times a week and often has an office on-site.
  • IRF’s often have Certified Rehabilitation Registered Nurses (CRRN).
  • SNF physicians must see the patient every 30 days while the patient is receiving skilled care and their office is typically located off-site.

Payment:

Medicare Part A (or other insurance policies) covers the cost of both IRF and SNF skilled care so long as the patient continues to meet the insurance guidelines (www.medicare.gov).

  • IRF costs are covered fully for a maximum of 60 days. If the stay exceeds 60 days, the patient is charged a co-pay for days 61-90 or may use their Medicare Lifetime Reserve Days.
  • SNF rehab stays are covered for days 1-20. Days 21-100 have a co-pay which may be covered (all or part) by the patient’s supplemental plan. Medicare advantage plans may be different.

Who decides which type of facility is best? If the patient meets Medicare’s rehabilitation benefit guidelines for care at a facility, the decision about which kind of facility is made by the hospital treatment team in coordination with the receiving facility. However, the patient, family, or care manager can offer important input:

  • If the patient’s endurance was good prior to hospitalization it may be appropriate to advocate for a trial stay at an IRF, even if the patient may not be able to return home, but perhaps instead to an assisted living facility.
  • If there is no IRF nearby, the family may decide that rehabilitation at a SNF should be considered. While at the SNF, family members or a care manager can advocate for more therapy and more frequent treatment plan reviews.
  • If a patient’s level of functioning is low, then a SNF may initially be more appropriate. If the patient makes significant gains while at the SNF, then a referral and possible transfer to an IRF for more intensive therapy can be considered.
https://eldercc.com/wp-content/uploads/hospital-rehab.jpg 1028 2121 Natalie Rose https://eldercc.com/wp-content/uploads/elder-logo-topnav-1.png Natalie Rose2021-03-12 16:14:242021-03-15 12:01:25Part I. In-Patient Acute Rehabilitation vs. Sub-Acute Rehabilitation

Palliative and Hospice Care: Support for patients and their loved-ones

News

Posted on January 7, 2021 by Elder Care Consultants, Inc.

I will outline two types of important services, palliative medicine and hospice care, that help patients experiencing pain, discomfort, and emotional reactions stemming from injuries or short-term, chronic, life-limiting, or terminal illnesses. When these symptoms are relieved, patients’ lives are improved. Moreover, as patients reach the end of their lives, addressing their physical and emotional discomfort to the extent possible can help ease the end-of-life process for them and their loved-ones.

Palliative Medicine is specialized medical and psychosocial treatment for relief from debilitating symptoms no matter the patient’s diagnosis, or age. Patients may be undergoing concurrent surgical, chemical, radiological treatments or physical therapy. Palliative physicians, nurse practitioners, social workers, and spiritual advisors can help. Practitioners are trained in a wide variety of interventions such as medication review and changes, therapeutic massage, meditation and other relaxation techniques, breathing exercises, to name just a few. For the greatest benefit these specialists could be utilized sooner and more frequently. Patients or their physicians can request a consultation with a palliative specialist whether at home, hospital, nursing home, or assisted or independent living.

Hospice Care. When patients, their loved ones, and physicians determine that curative treatments are no longer the goal, palliative treatment can be broadened to include hospice services. Hospice teams include specially trained physicians, nurse practitioners, nurses, social workers, home health aides, spiritual advisors, and volunteers. Hospice teams provide comprehensive supportive care to the patient and their loved ones during the patient’s life and bereavement services before and after the patient’s death.

The hospice team can mobilize quickly to provide the medicines necessary for comfort care and equipment such as hospital beds, oxygen, wheelchairs and the like. It is often a great comfort to know that there is no need to bring the patient to service providers. Nurses, who oversee the care in consultation with the physicians, visit the patient wherever he/she is living. When the patient is cared for at home, loved-ones don’t feel so alone with a hospice team in place. They can call the hospice – day or night – to get assistance or in-home visits for relief from symptoms as they arise.

A common misconception is that when patients begin hospice services, death is imminent and treatment ends. Instead, treatments are focused on comfort care rather than curative care.

Hospice services are most helpful when begun months before a patient’s expected death. If services are begun too late, the team cannot be as effective as they could be. Patients and families may be fearful or reluctant to use hospice services. But a no-obligation consultation from a hospice service provider can address those concerns.

Patients who qualify for hospice care have a life expectancy of not more than six months, though sometimes patients become well enough to opt-out or be discharged from hospice. Often the hospice service can be extended after the initial six-month period if it is likely that the person’s life expectancy remains about six months. Services may be provided at home, independent and assisted living communities, nursing homes, or specialized hospice care facilities by both not-for-profit and for-profit organizations. Hospice services are covered by Medicare (Part A) and most Medicaid and private insurance plans.

Sorting through the options throughout this continuum of care can be confusing, even overwhelming. When to request a consultation? When to initiate services? What to expect? The care managers at Elder Care Consultants (www.eldercc.com) are well-prepared to answer your questions and help arrange for an individualized care plan that includes comfort and support along the way.

https://eldercc.com/wp-content/uploads/hospice.jpg 1299 2309 Natalie Rose https://eldercc.com/wp-content/uploads/elder-logo-topnav-1.png Natalie Rose2021-01-07 17:28:472021-01-08 09:30:41Palliative and Hospice Care: Support for patients and their loved-ones

Creative Reimagining During the 2020 Holiday Season

News

Posted on December 11, 2020 by Elder Care Consultants, Inc.

During Thanksgiving 2020 we wanted to be with family and friends but the cautions from medical professionals made decisions about what we should do difficult. We were confused, sad, angry, isolated. In addition, some of us are grieving losses.  Now Christmas, Hanukkah, Kwanzaa are upon us, and we face the same challenging decisions.

We still want to find ways to be joyful, thankful, and compassionate. We need connection.

How do we manage the holidays? We can start by determining what is meaningful about the holiday for each of us. We need to shape our behavior accordingly, even if it differs from past holidays.

For example, whether or not there are financial constraints, this may be the year to send cards, homemade items, or other personal gifts. That may touch on the important aspects of the holiday and even move us away from a more frenzied atmosphere of past holidays.

Important decisions need to be made about whether or not to gather together and, if so, with whom. It is important to remember that not all in your family/friend circle will manage their emotions and the restrictions in the same way.

The clearer we are about our own limitations and needs and the more we can be empathic about how others are coping, the more we can listen to one another to find common ground.

When making holiday plans, it’s important to try to reach consensus around how you will each behave during the pandemic, both through the holidays and in the months beyond until it is safe to lift the restrictions. We can assess our own risk factors and those of the others in our circle. We can each identify the ways we will keep ourselves and our loved ones safe, and where we feel able to compromise with others and where, not.

The separation from elderly loved ones, whether they’re living in their own homes or in a senior residential setting creates even greater challenges. You want the holiday to be meaningful and it is natural to want to arrange in-person visits. But can you? You want them to be safe and you have to consider the safety of those with whom you live.

The senior consultants at Elder Care Consultants (ECC) are problem solvers, before COVID-19 and especially now. We can help families gather the information they need to make decisions, and we can help manage the decisions they make.

Here are a few of the ways we have been helping families.

  • Assessment and planning for in-person visits. Determining whether to visit requires a careful assessment. We have been working with families to create a checklist and protocols which assess medical safety, physical or cognitive limitations, emotional well-being, mental health histories and current status. If an in-person family visit is manageable, we can help maximize safety and connection by carefully preparing for the visit with the appropriate PPE equipment and by reviewing symptoms and precautions.
  • Care Manager intervention/visits. If in-person family visits are not possible there are several ways our care managers can help:
    • With precautions, we can visit your loved ones during the holidays. In-person care manager visits can provide with companionship, activity, reassurance and monitoring of well-being. Perhaps they need help sending cards or maybe you would like a special tasty holiday treat delivered.
    • We can help arrange for electronic connections. Often, seniors have difficulty managing electronic devices and apps. We can facilitate their use. We have, for example, set up successful connections through FaceTime, Grandad, Amazon Echo, and Care Hub. We can help your loved-one watch home videos of your family.
    • Often, after an in-person visit by family members or a care manager, it becomes apparent that increased professional assessment or oversight is warranted. Perhaps more help is needed or a move to a more supportive environment needs to be considered. We can work through the options with you and help to implement them.
  • Even under ordinary circumstances most people agree that as enjoyable as the holidays can be, the level of stress increases. ECC care managers are attuned to the stresses throughout the family and our consultations take into consideration not only the well-being of the senior member, but all those who care for them.

Too much stress can result in “caregiver burnout.” Refer to our our article on caregiver burnout.

Every family is unique We help create a plan to celebrate and to mitigate isolation and loneliness that fits your situation. We respect and celebrate the families and caregivers who are doing your best to create a meaningful holiday season.

We can dedicate ourselves to staying safe in 2020 so we can gather for the Holidays in 2021!

https://eldercc.com/wp-content/uploads/creative-reimaging-sized-1.jpg 832 1500 Natalie Rose https://eldercc.com/wp-content/uploads/elder-logo-topnav-1.png Natalie Rose2020-12-11 14:17:372020-12-11 16:13:19Creative Reimagining During the 2020 Holiday Season

Caregiver Burnout-Before, During and After COVID-19

News

If you are caring for a loved one either at home or in a senior living community, like most people there may be times you feel overwhelmed, exhausted, irritable, worried, and confused. There can be good days, even joyful days, but there are also hard days when you – like others – feel you have reached the limit. During the current health care concerns of COVID-19, caregiving situations are even more taxing. With little or no notice people were prevented from visiting loved ones at nursing homes, assisted living or even independent living facilities. Others who were caring for a loved one at home became isolated and rightfully fearful about COVID-19 exposure. Managing care or making decisions became more complex. Such caregivers worry about the helpers they’ve hired to provide home care. Arranging for even routine medical care is more complex. If you may have been considering a move to a nursing home, assisted or independent living community, that confusing decision became even harder. You are trying to provide the best care, but how and where?

It is critical for those who provide the care or arrange for it to take care of themselves. With increased stress, responsibility, and daily demands, it’s easy to ignore your own care. Perhaps some days you find you must respond to the needs of the moment without tending to yourself, but no one can do that for an extended period. Nearly everyone will experience the symptoms of being overwhelmed “burned out” some of the time. Perhaps, though, like others you are starting to feel them too much of the time, and even with great effort, you may be hard pressed to provide the kind of consistent care for your loved one that you want to.

Here are some symptoms to pay attention to:

  • Prolonged Exhaustion
  • Difficulty Sleeping
  • Lack of Appetite or Overeating or Drinking to Relieve Stress
  • Irritability
  • Unrelenting and Unproductive Worry
  • Anger
  • Resentment
  • Frustration
  • Shame
  • Guilt

It’s important to try to prevent burnout to the extent possible. Setting up some good habits early on can help prevent more intractable problems. There’s no one solution for everyone. The things that relieve stress for one person, may not work for you. You will need to pay attention to you and your mood. As you try to respond to your needs, ask yourself if the activity you choose is actually lowering your level of stress or increasing it. For example, reaching out to some people may make you feel better while others may not. Make good choices about whom to call. Use caller ID to take control over whom you wish to speak with and when. Reach out to those you find helpful and accept their help. They may not know what you need, so be specific. Could you use a few groceries or a cup of tea? Perhaps someone can provide time for a break for you do some things that renew you.

Rest. Try to maintain a schedule that allows you to go to bed at about the same time each evening as best you can. Turn off electronic screens at least 30 minutes before going to sleep. Turn off the news and put down the newspaper, except perhaps to do a crossword puzzle if you find it relaxing. Read a book. Meditate, pray, if they help you (meditation apps and relaxation soundtracks can help). Quiet your day and your mind. Take time to exercise, though not at bedtime. Walk outside if you can. If you worry, try to make lists of what worries you and write realistic responses to the items that concern you. If you can’t get away for a few hours on a given day, take “micro-breaks.” Stepping outside, even for a few minutes can revive your spirits. Eat healthful meals. Indulging in comfort foods is fine within reason. Suspend self-judgment when you feel critical about “falling short.”

Your situation is not static. Solutions that worked yesterday may not work today, while options that seemed out of reach, may become more possible. You want to plan ahead, but it’s hard to know how. It can be helpful to know what choices you will have. You are likely trying to chart this course for the first time, but others have done so before you. You may want to consult an expert, such as an Aging Life Care professional in your area. You can search for one and find other resources at their association website.

Remember: Self-care is not a luxury: it’s a necessity.

https://eldercc.com/wp-content/uploads/elder-logo-topnav-1.png 0 0 Sandi Rosengart https://eldercc.com/wp-content/uploads/elder-logo-topnav-1.png Sandi Rosengart2020-10-20 11:49:102020-12-02 11:17:07Caregiver Burnout-Before, During and After COVID-19

America’s seniors, sacrificed on the altar of reopening

News

“As we take steps to safely reopen our country, we must remain especially vigilant in sheltering the most vulnerable older Americans,” President Trump declared last month, duly reading words that had been written for him.

If only he had meant them.

Of all his unkept promises, this one is particularly personal for me.

Read more >

 

https://eldercc.com/wp-content/uploads/elder-logo-topnav-1.png 0 0 Sandi Rosengart https://eldercc.com/wp-content/uploads/elder-logo-topnav-1.png Sandi Rosengart2020-05-24 17:28:042020-12-01 17:24:26America’s seniors, sacrificed on the altar of reopening

Aging Life Care Management During the COVID-19 Pandemic

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Read more
https://eldercc.com/wp-content/uploads/crisis-banner.jpg 450 1400 Sandi Rosengart https://eldercc.com/wp-content/uploads/elder-logo-topnav-1.png Sandi Rosengart2020-05-18 09:52:182020-11-24 17:28:55Aging Life Care Management During the COVID-19 Pandemic

Coronavirus: How do we protect nursing home residents

News

‘It makes no sense’: Feds consider relaxing infection control in US nursing. The federal government is considering rolling back infection control requirements in U.S. nursing homes – even as the long-term-care industry’s residents and workers are overwhelmed by the coronavirus. Read more.

https://eldercc.com/wp-content/uploads/Apple-news-article-.jpg 440 660 Sandi Rosengart https://eldercc.com/wp-content/uploads/elder-logo-topnav-1.png Sandi Rosengart2020-05-04 22:49:002020-11-24 17:33:01Coronavirus: How do we protect nursing home residents

Making a Medical Plan During COVID-19

News

Do you feel prepared with a Medical Plan During Covid-19? We are all in this together. You can do your part by making a medical plan. This plan can help you, your family, friends, and your medical providers.

Read more >

https://eldercc.com/wp-content/uploads/elder-logo-topnav-1.png 0 0 Sandi Rosengart https://eldercc.com/wp-content/uploads/elder-logo-topnav-1.png Sandi Rosengart2020-05-01 14:57:092020-11-24 17:35:01Making a Medical Plan During COVID-19
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