Patients and their families have complimented our nurses for their care, and we always want to continue to provide that kind of exceptional care for our patients. But an increasing shortage of nurses in the coming years may make maintaining that kind of care for our home care and hospice patients more challenging.

The shortage of nurses in the three states Liberty serves – North Carolina, South Carolina, and Virginia – continues to grow. Between the three states, there is a shortage approaching 25,000 nurses. As sobering as that statistic is, the shortage is expected to grow in the next 10 years. In fact, one of every five jobs created in 2012 has been from the health care field, including nurses.

We need to encourage more people to consider the nursing industry, as our population continues to age. But how can it be done? Liberty offers an Educational Assistance Program that has aided some employees.

Capital grants can also aid nursing schools, as can the Nurse Education, Expansion and Development Act. That federal act would give grants to nursing schools to increase the number of nursing faculty and students.  State legislation can also help improve opportunities for future nurses, and relieve some of the expected shortage.

Liberty HomeCare & Hospice Services aggressively recruits the top nurses in our coverage area. We know how vital they are to our patients’ care. We hope that these suggested measures and others can help make a difference, so all patients get the kind of care they deserve.

But there’s another rule that many future caregivers are not aware of that can play a vital role in their loved one’s life. The 40/70 rule states that an adult child should begin conversations with their parents about senior health topics after the potential caregiver turns 40 or their parent turns 70, whichever comes first.

That can be a difficult conversation to have, because many future caregivers are hesitant to talk to their parents about their care. Their parents may be afraid to ask for help, and it can also be difficult for the caregiver to take charge in the relationship.

It can be especially challenging if an aging parent is starting to show signs of declining health. Look for early warning signs, such as memory lapses, trouble with night driving or decreasing balance. But Liberty HomeCare & Hospice Services can help get the process started. We offer free in-home assessments, and can help determine the right next step. Sometimes, home care, physical therapy or other care can make a big difference, both for the patient as well as their caregiver.

That’s what makes the 40/70 rule so vital. Many times, the conversation happens when a parent’s health has declined to a more serious state, and the challenges are multiplied. Liberty HomeCare & Hospice Services staff members understand that each situation is different, and may need to be addressed with a unique approach.

But the most important approach is starting the conversation early. By discussing care options when everyone is able to make clearer decisions, that can help create a better outcome for everyone.

WFNC interview

Liberty HomeCare & Hospice Services can help your family with advance directives through the Five Wishes program. Let us know if you’d like more information.

1. Always store pesticides and household chemicals in a locked cabinet or garden shed
2. Never leave pesticides and chemicals unattended
3. If your home was built before 1978, check for lead based paint
4. Keep plants away from small children
5. Keep medications away from children
6. Do not refer to medication as “candy” to entice kids to take it
7. Do not dump unused medications in open trash containers
8. Dispose of unwanted or unused medications out of reach of children
9. Check medications for expiration dates (if unknown, then consider it expired six months after purchase)
10. Keep list of medications handy for doctors and caregivers
11. Educate seniors and/or caregivers about keeping medication away from children (particularly if they are visiting or watching children for extended time – many poisonings happen when a visitor comes)
12. Learn about drug interactions (some should not be combined with others)
13. Do not have household chemicals near food or drink
14. Keep chemicals in original containers
15. Have a working carbon monoxide protector in your home (especially important with gas stove)
16. Consider having a Home Safety Assessment by professionals
17. If poisoning is suspected, call 1-800-222-1222 for Poison Control.
18. Make a potential victim spit out what they have ingested, but do not induce vomiting until after speaking with Poison Control
19. Keep poison at hand to give information about it to Poison Control
20. Attempt to determine amount ingested, and know victim’s age and approximate weight

With regard to ethics, the revised standards provide that:

Case managers should behave and practice ethically, adhering to the tenets of the code of ethics that underlies his/her professional credential (e.g. nursing, social work, rehabilitation counseling, etc.).

How Demonstrated:

Awareness of the five basic ethical principles and how they are applied:  beneficence (to do good), nonmalfeasance (to do no harm), autonomy (to respect individuals’ rights to make their own decisions), justice (to treat others fairly) and fidelity (to follow-through and to keep promises).

Recognition that a case manager’s primary obligation is to his/her clients.

Maintenance of respectful relationships with coworkers, employers and other professionals.

Recognition that laws, rules, policies, insurance benefits, and regulations are sometimes in conflict with ethical principles.  In such situations, case managers are bound to address such conflicts to the best of their abilities and/or seek appropriate consultation.

Case managers/discharge planners have a special obligation with regard to the ethical principle of autonomy when patients are ready to exercise their rights to choose post-acute providers.  The ethical principle of autonomy requires case managers/discharge planners to provide information to patients so that they can make decisions for themselves and act on those decisions.

Applying this ethical principle to the process of discharge planning from hospitals, it is clear that applicable statutes and regulations require case managers/discharge planners to present lists of skilled nursing facilities (SNF’s) and home health agencies (HHA’s) to patients so that they can make autonomous choices.  Hospitals are also likely required to present lists of hospices to patients.

A “neutral presentation” of the list that recognizes patients’ right to autonomy means that discharge planners/case managers take the list described above to patients’ rooms and say something like the following (and nothing else that may persuade patients to choose particular agencies): “You have the right to choose the provider that you would like to provide services to you.  Here is a list of providers that render services in the area in which you reside.”

If, in response, patients choose providers, then case managers/discharge planners may not try to dissuade them or make negative comments about their choices.  The only response to patients who make choices from case managers/discharge planners must be either “Yes, Ma’am” or “Yes, Sir.”

If patients say they cannot choose, case managers/discharge planners must assist them to do so.  Case managers/discharge planners, however, do not ever make choices for patients.  Instead, case managers/discharge planners may help patients to choose by saying something like the following:

-          “As you can see from the list, our hospital owns this hospice.  Perhaps you would like to choose this one.”

-          “Our hospital has a preferred provider relationship with this provider.  Perhaps you would like to choose this one.”

-          “This provider has a specialty program in orthopedics, which will be the focus of the services you need, so perhaps you would like to choose it.”

Patients are likely to adopt the suggestions of case managers/discharge planners under the circumstances.  There is a clear difference, however, between choosing for patients, which case managers/discharge planners cannot do, and assisting patients with making informed choices.  Discharge planners/case managers must never lose sight of the fact that patients are in the drivers’ seats.  Patients’ choices “trump!”

It may be helpful to compare the process of choosing post-acute providers with obtaining informed consent from patients for surgery.  If patients with mental capacity are unwilling or unsure about giving consent, case managers/discharge planners cannot simply choose for them!

As evidenced from the above standards, case managers are also required to maintain respectful relationships with co-workers, employers and other professionals.  This requirement clearly applies to providers to whom case managers make referrals.  Anecdotal accounts of the treatment of providers by case managers in positions to make referrals to post-acute providers are difficult to hear.  Such conduct clearly violates applicable national standards of care described above.

Stay tuned for more about revised national standards of care.

©2012 Elizabeth E. Hogue, Esq.  All rights reserved.

A doctor in Texas is allegedly the leader of the biggest Medicare fraud in U.S. history, involving more than $375 million from the Dallas, Texas area.

This incident is unacceptable, plain and simple, and doesn’t reflect the important work done by the home care industry. There are hundreds of thousands of home care workers in the Carolinas, Virginia and the rest of the U.S. who do passionate and caring work, and those workers represent the highest moral and ethical standards in serving some of our communities’ most dependent and vulnerable seniors.

Liberty HomeCare & Hospice Services, as well as hundreds of other home care agencies, supports any effort to confront doctors or agencies that are abusing the Medicare and Medicaid systems and the patients we serve. If you are aware of any kind of abuse, or want more information, I urge you to take action by calling me directly at 1-910-815-3122 if it is related to Liberty or by visiting stopmedicarefraud.gov.

The report from Texas is unsettling, but the staff of Liberty HomeCare & Hospice Services remains committed to enhancing the quality of life of our patients. We know that home care is a vital part of the health care industry, and won’t let the regrettable actions of a few taint the positive impact of so many others.

Tony Zizzamia

President, Liberty HomeCare & Hospice Services

Liberty Hospice delivered roses to all of its patients to honor them as part of Patient Recognition Week.

Here is patient Elizabeth Mason of Dunn, NC with Liberty nurse Sherri McNeil

Deliveries were made during scheduled nurse visits Feb. 1-7, as a thank you for those hospice patients and their families for utilizing hospice care with Liberty. The observance continues a commitment by Liberty Hospice, which in the past year has helped provide a new puppy, a final shopping trip, and specially-made Christmas ornaments to hospice patients.

Patient Recognition Week is a national celebration recognized by national healthcare providers as well as the U.S. Army as a way to honor patients.

“Our patients are truly special to us, and it is so rewarding to see the looks on our patients’ faces when they received our deliveries,” said Alanda McLeod, home care and hospice liaison with Liberty in Dunn. “This is just one way we can thank and honor our hospice patients and their families.”

Nurse Pat Young of Liberty Hospice prepares to make deliveries to Aiken patients

Hospice patients throughout the Carolinas and Virginia received the roses, which also included a note of thanks. Patients and their families stated how the deliveries helped brighten their days, and how it reflects the care and compassion that Liberty provides.

“Patient needs go beyond the technical aspects of medical care, and must include empathy and encouragement,” said Liberty HomeCare & Hospice Services President Tony Zizzamia. “By honoring our hospice patients for Patient Recognition Week, we want to show that hospice is not about death, it is about living life to the fullest. All of our patients exemplify that motto. We always try to go the extra mile for our patients, and this is just another way we want to thank them.”

“It has been a godsend,” he said from his home in Southern Pines, NC. “You don’t realize how much it can help until you start it.”

Jim and Norma Roberts with their dog Nubbin.

Jim Roberts said his wife Norma has been suffering from what doctors described as a hardening of the brain cells, and her condition had not improved. By September, the family knew there was little else they could do except to try to make her more comfortable.

A friend had recommended Liberty HomeCare & Hospice Services to Jim, to help provide the care that Norma needed, and assist Jim and his son Mark in her care. Jim Roberts made the call a few weeks later, and said it didn’t take long to see a difference.

“The next day I got a call from Liberty, and they had someone here by that Monday,” he said. “The nurses came out and really helped. They help Norma with her medication and bathing, and set up a comfortable bed for her.”

That provided Jim with peace of mind. Liberty’s nurses check on Norma at least once a week, and check her vital signs and help with pain management. When they first started hospice care, Norma’s condition had worsened to the point where she needed assistance getting in and out of a regular bed, but the hospital bed provided by Liberty gives Jim the chance to monitor her every night and check to see if she needs to go to the bathroom or has any other discomfort.

“That means so much,” said Jim, who has been married to Norma for 56 years. “I don’t have to worry about her. I know I can take care of her while she sleeps, and that she will be O.K. at night.”

Observing his wife – and the changes in her health – hasn’t been easy. Jim said that because of her condition, Norma sometimes forgets where she is, and doesn’t always recognize family members. Jim understands that those kinds of changes are to be expected, but said it is still difficult. He said the hospice care Liberty provides has allowed him time to himself, and to reflect on everything and prepare for what’s ahead.

“We have been so gratified with her care,” Jim said. “I don’t know what I would have done without it.”

The Center for Medicare and Medicaid Services (CMS) has promoted Hospice Services for the last two decades.  That growth could face challenges in the coming years as a result of the Affordable Care Act, which recommends changes to hospice payment authority and a new face-to-face requirement for Medicare hospice patients.

But the proposed HELP Hospice Act can help patients adjust to those changes, while making the transition easier. The HELP Hospice Act, which has already received bipartisan support in the U.S. House of Representatives, features three core segments.

• Any new payment methodology must first go through a two-year, 15-site demonstration program. This pilot program can help develop the reliable, evidence based, comprehensive data needed to determine which payment reform approach is best.
• The HELP Hospice Act would increase hospice survey frequency, on average, to once every three years. This increase from the current average of 6 to 8 years would provide a better certification process, and allow for improved and appropriate regulatory oversight.
• The HELP Hospice Act would modify the face-to-face encounter requirement by allowing clinical nurse specialists and physician assistants to also conduct the encounter, and allow hospice agencies seven days after the initial election of services to complete the requirement. These changes would help all agencies and particularly help small and rural hospices, which face operational constraints and may have to turn down patients who are most in need.

Many of the HELP Hospice Act’s principles do not cost any additional money, while still making a big difference for hospice organizations and their patients. All hospice patients and their families deserve the opportunity for the best care possible, and the HELP Hospice Act is a major step in that direction.

Tony Zizzamia

President, Liberty HomeCare & Hospice Services

But how does home care get started? Here’s a step-by-step guide to establishing home care for yourself or a loved one:

1. Set up an appointment with the primary care physician - Home care is typically established through a doctor’s referral. Doctors can refer a patient for reasons including a new diagnosis or condition, exacerbation of a previous diagnosis or condition, or a recent fall.
2. Ask for a referral to Liberty HomeCare & Hospice Services - Liberty HomeCare & Hospice Services has existing relationships with medical professionals throughout the Carolinas and Virginia, but any primary care physician can set up a referral by phone or through our online form. This referral form is the beginning of the home care process, and is often completed within 24 hours of your visit with the physician.
3. Attend an in-home evaluation – A Liberty staff member (typically a nurse, physical therapist, or speech therapist depending on the diagnosis) will visit your home and determine the frequency of home care visits. Those visits can be weekly or more often, depending on the needs of the patient.
4. Finalize your schedule with Liberty HomeCare & Hospice Services – Liberty personnel will arrange the schedule of home care visits, and will ensure that you or your loved one gets the attention that is needed and deserved.

This process can be completed with little paperwork, and visits can often be done for little cost to the patient. For more information, please contact Liberty HomeCare & Hospice Services, and we will be happy to answer any questions about getting home care started.