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Chronic Disease Management: Bridging The Gap Between Physician Care And Homecare For Improved Patient Involvement In Self-Care.

Chronic disease management in homecare still isn’t getting the outcomes agencies desire. Consider your current program and whether it hasChronic Disease been updated in the last 10 years. If you aren’t seeing positive outcomes, then consider what’s missing from the MD office to the homecare environment. 

Coordinating Care Directly With MD: 

Coordinating care in a meaningful fashion is still tough across the healthcare spectrum. While technology allows access between different realms of healthcare, it doesn’t always translate well. It is tough when an MD practice wants communication in writing, but staff needs to speak with another clinician directly. It’s also difficult for MD offices if orders are not followed in the manner desired. Bottom line is that communication directly with the MD makes a huge difference in chronic disease management. Working with MD practices to develop streamlined chronic disease management will benefit everyone involved in care. Let’s look at how that translates into successful patient care. 

Chronic Disease Management WITH The Patient: 

When the patient is in the MD office, there is some amount of teaching completed with the patient. Because the patient may not see the MD for an extended period, is becomes difficult for the MD to evaluate patient understanding. A recent study showed improved patient engagement and capacity for self-care with 45-minute teaching sessions from medical student after the patient was seen by the MD. This is what homecare needs to emulate the day after the patient has seen the doctor. If the MD office works directly with homecare, the next nursing visit needs to be an extension of the MD visit. The point of disease management is not “sick” care. It is a way to best maintain health and well-being with a patient who believes in his or her own ability to manage the disease. 

What Are The Next Steps? 

In order to coordinate with an MD office on a coordinated management plan, your agency should be well-educated in chronic disease care. This includes all disciplines of clinicians. Here are the steps to take: 

  • Provide Chronic Disease Management Training To All Clinical Disciplines 
  • Update Your Chronic Disease Program 
  • Partner With Local Physician To Pilot Coordinated Program 
  • Frequently Evaluate The Efficacy Of The Program 
  • Use The Partnership And Program As A Marketing Tool 

Chronic Disease Management And Training Programs:

At Kenyon Homecare Consulting, we specialize in education and training programs focused on high quality outcome-based care plans. To see if Kenyon is the right fit for your agency needs, call us at 206-721-5091 or contact us online for your free 30-minute consultation. 

 

In The World Of Homecare, Do You Still Plan Care Like It Is Public Health And Not Home Health? Make Sure You Don’t Miss The Forest For The Trees In The PDGM Picture!

MedicareThe saying that someone can’t see the forest for the trees has been around a long time. With Home Health PDGM, this is important to consider in your agency. It may sound counteractive to all you read regarding specificity of patient care, but it isn’t. Let’s break down this well known saying to how it relates to your agency.

Forest For The Trees In Your Agency:

We have become a very detail-oriented industry, haven’t we? The proper wording is listed in your EMR. All The boxes are checked before you finalize the visits. Here is the issue, we have become so focused on so many details, we don’t see the forest. We only see a bunch of smaller trees. In the process, agencies run more like the public health department of yesteryear. Meaning, patients are held for a long time and everything is managed from A to Z. With PDGM, there is a hyperfocus and intensity of care over a shorter period of time. If you are in the PDGM world, then care planning can’t be 1 week 9.

The Care Plan In PDGM:

If you are an agency that still has a bunch of 485s seeing the patient one time a week consistently, then you need to address this “routine” care before PDGM gets here.  This means eduction to staff about intensity of services. Frontloading care is not the number of visits. It’s about the intensity of the care provided by each discipline each visit. It’s time to put some visit protocols in place and make sure staff is completely coordinated regarding care planning. Consider help to change the care planning paradigm in your agency.

Kenyon Homecare Consulting:

At Kenyon Homecare Consulting, we help you reach clinical and financial goals. Whether staff need clinical education on care planning and Oasis or you need coding support, we have it. In PDGM, agencies that do not function efficiently both clinically and operationally will have a difficulty suviving. Call us today at 206-721-5091 or contact us online to see what services get you to your goals.

Do You Focus On Mental Health As Part Of Your Care Plan? Don’t Be Araid To Take A Risk And Discover The Key To Replacing Outdated Care. You Can’t Consider What Happens In The Heart And Discount What Is Going On In The Brain.

Care planIt is no secret that society is more open to mental effects on physical health today than in the past. However, there is still a lot to be done. Addressing the mental health is often missed unless that patient has a history of mental disease or defect. Those become easy in the minds of clinicians. Let’s look at how mental status really needs to be key in every care plan regardless the primary diagnosis. 

Tunnel Vision In Care Planning: 

There is so much focus on chronic disease management. There should be and we all know it’s because of cost. But we make the mistake of not considering mental roadblocks to success with outcomes. Let’s think through a couple specific case scenarios dealing with congestive heart failure: 

  • Patient A: 59-year-old female recently diagnosed with CHF resulting from chemotherapy taken over 20 years ago. At the time, the chemo was so strong that the patient was in isolation for 3 months in a facility. She was married with two young children. Family was aware there was a 50% chance she could pass from the treatment itself. There was only a minimal chance for remission.  She beat the odds.
  • Patient B: 70-year-old morbidly obese male patient diagnosed with CHF over 25 years ago. No significant lifestyle changes have occurred to combat the exacerbations of illness along the way. Patient is known to smoke 1 pack of cigarettes daily for most of his life. He is divorced and never had children. 

What do these care plans look like in your EMR? They are probably more similar than you think. They may be identical except formaybe some specific weight loss goals for the gentleman? 

Why Do They Need To Be Different? 

The care plan picture for both patients are different. Therefore, the mental state of the patient is so important here. It impacts every aspect to promote success in your care plan interventions. Do these patients suffer from anxiety or depression? How does anxiety manifest itself for one versus the other? Are these items addressed on an ongoing basis?  If there isn’t critical thinking about how this affects the care plan daily, then patient potential for improvement is hindered. Without anxiety under control, how can the patient focus on teaching and interventions to improve? Also, it is important to understand the limitations of the clinicians in recognizing the difference in anxiety responses versus signs of exacerbation. Education and evaluation is key here. 

Mental Health Care Planning: 

Mental health education and its implication on physical health is so important. Clinicians can’t address patients as though we are just the physical. Clinicians need a meaningful way to address these items as a part of routine assessments and not just for an Oasis or medication. Having a trained psych nurse on staff can help so much with your care planning to address psychological issues and mental health while helping to improve outcomes of a physical diagnosis. Chronic disease management isn’t just about the heart it is also about the mind. To exclude one minimizes the efficacy of the other. 

Kenyon Homecare Consulting: 

At Kenyon Homecare Consulting we have senior consultants who know how to paint the entire clinical picture into effective care planning. Call us today at 206-721-5091 or contact us online to see how to help you reach your agency goals. 

Does Your Oasis Assessment Paint The Picture Of Patient Care Needs? Or, Is It An Abstract Piece Of Art No One Understands? Time To Make A Change!

QuestionsFrom the inception of Oasis, it was presented as an assessment tool. If this was its purpose, then why did it evolve to data collection with no clinical implication? The Oasis assessment tool expanded documentation requirements in a huge way. It was long and cumbersome and “took away from patient care” in the minds of clinicians. The industry must move forward with an Oasis that drives the care plan. It can’t be a data collection tool. If it is not integral to clinical function, then you aren’t using it at all. 

Arguments To Use Of The Oasis Assessment: 

Now, you’ve had these meetings in your agency. You hear the tool is used, but don’t see documentation to match it. If you are a clinical administrator, then you can verify. If you aren’t, then we will discuss steps to educate yourself to be more effective addressing clinical items. Here are 4 things you have probably heard from your clinicians: 

  • “We Use It”: In your review of records, there are clearly items of relevant concern in the Oasis that are not addressed in the care plan. 
  • “We Know What The Care Plan Needs Based On Diagnosis”: Since we live in the world of the EMR, canned interventions often leave out patient specificity. And, interventions are often body system-specific and not diagnosis- specific. 
  • “Therapy Does Their Own Care Plan And Doesn’t Pay Attention To Oasis”:  A well-developed care plan executed properly makes everything better including the patient. If therapy isn’t part of the care planning process, then operational change is necessary or PDGM therapy visits will sink any profit margin. 
  • “We Can’t Tell The Aides To Do That”: In a PDGM world, you can’t utilize aides just for baths. Agencies must expand the role of the home health into within the scope of practice. Many agencies still refer to the home health aide as a “bath aide”. This minimizes the resource that usually spends more time with the patient than any other discipline. 

I’m Not A Clinical Administrator: 

Educate yourself. Don’t underestimate the value of a medical terminology course. You will make life much easier if you understand what clinicians are saying. We are not suggesting you need a Bachelor’s level anatomy and physiology course. As in any industry, not knowing the lingo will affect your ability to make decisions. Work with your clinical people to understand operations. 

Moving Forward: 

At Kenyon Homecare Consulting, we work with agencies struggling to mesh the clinical process and produce positive meaningful patient outcomes. The Oasis assessment is key here. We have programs to teach and review Oasis/ ICD-10 Coding and make sure care plans match the clinical process moving forth from admission to discharge. Call us today at 206-721-5091 or contact us online to see how we can help you bridge the gap and make your Oasis assessment useful! 

 

Homecare Education: How To Shift The Paradigm In Your Agency To Manage Chronic Disease Like A Champion!

SWOTIf you want to manage chronic disease properly, then you must start with a paradigm that works. Homecare agencies often spend the dollars on education, but don’t achieve the desired outcomes. Agencies must look at current work flow and determine what needs to change. Let’s look at how to analyze your agency to be the change you want. 

Perform A SWOT Analysis: 

This may seem like a simple task, but to truly perform a SWOT analysis properly, you need to look at your agency objectively. Consider a consultant to put a fresh set of eyes on operations. This allows you a chance to come to staff with an organized approach to your educational program. A true SWOT takes time. If you can whip through it, then it probably needs someone else to take a closer look.  Every aspect from start to finish in the clinical process needs addressed. First and foremost, how is clinical data exchanged? How often do disciplines address the care plan collectively? Does each discipline make the visits on a schedule and when orders are up just discharge? 

Manage Chronic Disease: 

The first step for this process isn’t teaching about chronic disease. Educate clinical staff as to the findings of the SWOT. Strategically, you may have staff involved in the SWOT process. Staff need to understand changes to operational flow. It doesn’t make sense to teach a program before staff have any idea how to integrate it collectively. 

Choosing The Program: 

Consider programs that educate the individual discipline as well as from the complete clinical standpoint. This will help solidify your paradigm shift. All disciplines must have an equal shake and case management depends upon the needs of the patient. Now, let’s look at what the equal shake means here. A truly integrated program where staff work together as a team means the therapist should be your case manager at times. Under a PDGM model, coordinated care that has a game plan for every visit is necessary. It may seem like you already do, but all disciplines should know what the next visit holds for each other. This way goals are addressed collectively. 

Kenyon Homecare Consulting Can Help Manage Chronic Disease: 

At Kenyon Homecare Consulting, we can help through your organizational process to address work flow. We also have a chronic disease management program available online for agencies as well as clinicians. The path the homecare success is management of chronic disease. Make sure you know how to do it well. Call us today at 206-721-5091 or contact us online to speak with one of our senior consultants on a plan that works for you. 

The Veteran At Home: Does You Homecare Have What It Takes To Properly Serve This Demographic?

Veteran at homeYou may read this and immediately want to say yes. This is really the time to think of the veteran at home. At different times, this blog has focused on different patient demographics and how to specialize in them. However, the veteran at home is a demographic often not considered. The needs are different. The experiences are different than others in your community. It is time to consider how to be the provider of choice for these special men and women.  

What Does The Veteran At Home Look Like? 

Often, agencies will see the elderly veteran who was in Vietnam or a discharged soldier with physical limitations. What about your local pharmacist who was activated for the first Iraq war? When that pharmacist has cardiac surgery, should his care plan look the same as someone who hasn’t served? If the answer is yes, then it is time to rethink the care plan. The military comes with a whole different mindset. They are trained to think differently than those of us in a private sector. The experiences of our veterans may mean that illness reminds them of soldiers lost in battle. It may trigger PTSD previously under control. When assessing the veteran, ask about the experience to help guide care planning.  

What About Your Staff? 

Do you have military spouses or veterans on staff? You can learn so much about the mindset, lifestyle, and what it is like for the family unit of a soldier. Take the time to sit down and see where you can train staff on proper assessment and care of the veteran at home. We can specifically target things that aren’t necessary the primary reason for homecare, but absolutely affect the patient’s return to prior level of function. As we in the healthcare industry better understand the effects of mental illness, we can better treat those that suffer from it. If you have never had a panic attack, do you understand how paralyzing it is? Maybe the anxiety has been present, but not to the extent that your heart feels as though it is beating out of its chest and you are sweating profusely. Uncontrolled anxiety alone can be a huge issue for the veteran at home.  

Opportunities: 

Many of you may already service VA patients under contract. If you don’t specialize care, then you won’t achieve goals for this soldier. On the other hand, care of the veteran at home can become a niche’ like no other. Considering the years at war, the demographic will continue to increase. Teach clinicians sensitivity to soldier interaction. Imagine your nurse or aide outwardly opposes something in government or from the military. That individual may have been overseas with his or her life on the line. This is where our personal opinions need to stay that way. How offensive to someone having been in active combat or potentially lost those who were.  

Kenyon Homecare Consulting:

At Kenyon Homecare Consulting, we focus on strong educational and operational planning for agencies. If you need help with either or would like to discuss an educational plan for your agency, then please call us today at 206-721-5091 or contact us online. 

 

Continuing Education: What’s Your Gameplan? Are You Looking To Blow The Competition Away? Start With Nurses And Make Them The Quarterbacks..

teamThe concept of a great team begins with great leadership. This is the way we think of our businesses. Yes? Take it one step further now. In homecare, the leadership of your care team begins with nursing. This should be your approach for continuing education as well. Let’s look at why promoting the leadership in education to nurses converts to the care team that wins. 

How Do Your Nurses See Themselves In The Clinical Picture? 

Do your RNs really manage your care plans? Do they see themselves as management of care planning or just the ones creating the plan? There is a big difference. Challenge your agency to review care plans at the beginning of the cert and at the time of DC. How many things changed? Managing the care plans should show an evolution throughout as the patient situation changes. Is the start of care the same as 3 weeks later? As we move into the world of PDGM,the first 30 days in care planning is more important than ever. 

Changing The Mindset: 

Before you approach clinical education attached to a new payment system, approach your nursing staff. True chronic disease care and clinical success won’t happen without care management. Not in the same sense of the last several years, but a progressive move to give nurses the ability to coordinate and manage care in the sense it is intended. Get them on board with the vision of a successful care management model. This is back to bedside nursing at its finest. 

Continuing Education Moving Forward: 

Consider the last paragraph. You have worked to set the minds of the nursing staff. They are your quarterbacks. They are on board. Now, how do you educated all clinical staff moving forward? Your agency needs to choose chronic disease education that encompasses all clinical staff. You need agency specific and discipline specific. This will guide your agency to continuing education that makes sense in a care management model. It is the step towards a medical home model still missing. If you don’t see your agency as a prime mover in the patient care world, then home health won’t make it there. This model includes hands-on care and frontloading like you own the position of prime mover. The continuing education must be something that promotes a care team and forgets the care plans that don’t work! 

We Can Help Get You There:

At Kenyon Homecare Consulting, we have the chronic disease education for individuals and agencies. Call us today at 206-721-5091 or contact us online today. Let’s talk about how online and additional support for your agency from Kenyon can prep you for success today and tomorrow! 

 

Chronic Disease Education: How Do You Invest The Time And Money When You Haven’t Seen The Outcomes From It? It Starts Here And Now!

education and successChronic Disease Education continues to be a hot topic as homecare moves into further payment reform. In the past, you have probably done it on hire and maybe something at a yearly competency, right? Well, today, we need to talk about it being an effective part of transition and change within your agency. Here are the steps to make your chronic disease program successful and cost-effective.  

5 Steps To An Effective Chronic Disease Education Program: 

If your program is giving employees a self-study with a test, then you probably haven’t seen changes because of your investment. Maybe you teach it once and that’s where it ends. The bottom line is there must be something to follow-up the teaching to make it work. Here are the steps to make sure your education dollars make a difference.  

Alter Work Flow Of Clinical Staff:  

If you want to make a difference in outcomes, then how the clinical function in the fields and out of it are crucial. Without changing job roles or case conferencing objectives, you really haven’t changed a thing.  

Clinical Documentation Needs To Reflect Chronic Disease Management Collectively:  

We want to see a one patient one care plan methodology. If your nursing, aide, and therapy EMR do not address these items as part of routine visits, then it won’t happen. Examine your EMR for what is currently there. Most therapy notes do not have anything specific to address chronic disease management. This means every individual must remember to document certain things that are not part of what is routine. The same exists for aide staff.  The care plan should address specific chronic disease items within the scope of practice. Make chronic disease management present for all disciplines in a meaningful way that can lead to real-world practice changes.  

Educate Staff Before You Provide Chronic Disease Education:  

This means let your staff know the endgame. Explain the changes to communication and work flow. Instruct as to how the documentation will flow between disciplines to show a collective effort towards chronic disease management. If you don’t make it clear what you expect the difference to be, then don’t expect staff to achieve it. 

Pick Your Program:

Consider something online to allow the training to remain consistent and relevant over time. Many excellent programs allow agencies a certain number of uses over time. This allows the agency to have any clinician complete or repeat the training. Online access allows clinicians the flexibility to access the information around client visits.  If you want to consider onsite, then have a way to obtain a copy of the face-to-face education so it can be used in the future. 

Let Your QI Program Show What Needs To Change:  

As with any clinical process, you will measure this for efficacy. Your agency needs to track items related to chronic disease management. Consider Emergent Care/ Hospital Admissions related to chronic disease exacerbation. It also means looking at specific clinical items such as shortness of breath. Check your congestive heart failure and COPD patients. Did staff initiate effective intervention at times according to your disease management program? Or, if it wasn’t addressed properly, determine why. If it is a lack of knowledge, then train again on your protocols.  

Kenyon Homecare Consulting Has The Online Programs You Need:

At Kenyon Homecare Consulting, we have online chronic disease education programs for both the individual and the organization. Call us today at 206-721-5091 or contact us online for your free 30-minute consultation and see how our program and be the change you need.   

 

Check Your Watch Because It is Time! Clinical Education In Homecare Is The Beginning Of Future Success. Don’t Wait Any Longer!

clinical educationSo, let’s talk about your clinical education. How do you approach it? Have there been changes in the last 10 years? Also, how does staff evaluate it? There are many reasons that agencies hold off on educational programs for staff. Let’s first look at those and then consider why to change the current role clinical education plays in your agency.  

Reasons Agencies Don’t Invest In Clinical Education: 

There always seem to be reasons not to invest in clinical education, but in the long run it is worth it to do so. Let’s look at 5 reasons agencies don’t take that step. 

  • Money: We understand budgets are tight and sometimes education takes the back seat to other money spent.  
  • Time: When your agency is busy, it may seem tough to schedule training and still get patients seen.  
  • Understaffed Already: If you are down staff, then the time factor is more difficult. 
  • Doesn’t Improve Retention: If this is your goal, then losing staff despite additional education is frustrating. 
  • Didn’t Improve Outcomes: Ultimately, this is the goal. Improving outcomes with better prepared nurses is a no-brainer.  

Now, Why You Need To Reconsider Each Of These Reasons: 

Even if the previous list checks several boxes in your agency, it is time to take a second look. Consider the following and why you can justify every dollar and minute spent.  

  • Money: There are economical ways to provide staff training today. Consider online webinars or purchasing training you can use more than once. Training on-site at conferences is always great for staff but is not always affordable for agencies.  
  • Time/ Understaffed: While time spent on training does not generate direct revenue at that moment, it does for future referrals. Specialty programs, well designed chronic disease programs, and clinical teams running as well-oiled machines generate referrals. 
  • Doesn’t Improve Retention: Here’s the thing. If you have been burnt in the past with staff leaving after receiving specialty training, then have them sign an agreement to remain on for 2 years post training. If they are invested in your agency, then it will not be an issue. Now, if they are unwilling, then they probably never were and maybe you train someone else. Staff will be more dedicated when administration invests in a meaningful way to make them better.
  • Doesn’t Improve Outcomes: This is a big one. Maybe the training program is the problem. If you invest in the clinical education, there should be some way planned to incorporate what was learned into practice. Many times, the agency spends the money and that is it. So, you need to be clear what you expect as an agency to change with the direction of the training. Let’s look at how to integrate your clinical education. 

Integration Of  A Clinical Education Program: 

Look at staff education that is relevant to all clinical staff. If you train nurses, but not therapists and aide staff, then how can you expect to have a meaning change in outcomes? Look at programs that tackle clinical issues such as chronic disease management for all clinical staff as well as your agency. This way, it gives you the next step of how to integrate the education into meaningful clinical practice. Online purchases will allow you access to train staff as they come on board and everyone remains on the same page when it comes to clinical approach.  

Kenyon Homecare Consulting Can Help! 

At Kenyon Homecare Consulting, we offer a wide range of educational programs to help your agency. Whether you are looking for integrated chronic disease programs or adding specialty programs, we can help you through the process.  Call us at 206-721-5091 or contact us online for your free 30-minute consultation with a senior consultant today to see how we can help you meet your goals.  

Positive Clinical And Financial Outcomes: Do You Realize How Clinical Education Is The Most Important Cog In The Wheel? Let’s Put It First And Foremost In Your Head And Strategic Plan!

chronic disease educationToday, positive and clinical outcomes are crucial for long-term survival in homecare.  However, often we don’t see how the basis for success with both begins with clinical education. Now, you may not see the connection at first. So, let’s look at how you need to visualize the future of your agency. 

Clinical Education: 

Even the most skilled clinical staff needs education. No one will disagree that homecare is different than any other type of institutional care. Only those who live in the world of home and community-based care understand the complexity of putting all the pieces of patient care together. You may have clinical staff who are excellent in the acute care setting, but struggle with all that must be considered in a successful care plan at home. It takes programming specific to our industry. If you miss this step, your clinical staff won’t be comprehensive and set the patient and your agency up for success. This will be despite best efforts by all concerned. There must a training into homecare that deals with more than computer documentation or Medicare regulations. It is about the paradigm shift to a true integration of care. 

Now, that may seem like an impossible undertaking, but it isn’t. Consider the interdisciplinary team functioning in hospice. There is more communication and collaboration in hospice than with skilled care. However, it shouldn’t be that way. None of us know what the payment system will be down the road, but is it so hard to believe that agencies may be responsible for all aspects of covering patient cost much as hospice does now? Imagine your plan for care if this was the case and let’s look how that effects clinical and financial. 

Clinical And Financial Outcomes: 

Hospice nurses manage patients at home. Whether the visits are at 2:00 am or noon. Symptoms are managed by working closely with physicians to keep the patients at home. The home health side does not always approach the proactive nature of care the same way. But, if the mindset was different going into care and care planning, it could be. If you consider the same hospice type approach to finance, then outcomes would also improve. Hospice nurses often have a better understanding of costs related to visits, treatments, medications, and dressing supplies since it all comes out of a per diem.

Other members of the clinical team such as physicians work differently with orders when the patient is under a hospice program too. Ordering IM Lasix for a patient at home at the beginning of a CHF exacerbation with an additional nursing visit to administer it can easily avoid a hospitalization. This type of treatment would be ordered in a heartbeat for a hospice patient. Let’s get there on the skilled side collectively. It begins with chronic disease education and a paradigm shift to care planning. 

Start With Your Clinical Education Process:

At Kenyon Homecare Consulting, we have chronic disease education for clinicians as well as facilities. It helps to train staff individually and the agency to work towards competency and organizational change. Call us today at 206-721-5091 or contact us online for your consultation today. Let us help you meet your clinical and financial goals.