Archive for May, 2018

Tips to cope when you’re juggling several chronic health issues

Be proactive by learning about and tracking your conditions and medications, and by speaking up when you have concerns.

Published in Harvard Health Letter

We don’t want our golden years to be spent juggling a long list of health issues. But that’s the reality for most older adults in the United States.

The CDC reports that 75% of Americans ages 65 or older have several chronic health problems. And a 2013 analysis of Medicare claims published online by Preventing Chronic Disease found that 68% of beneficiaries had two or more chronic conditions and 36% had at least four.

“Having multiple chronic diseases is common because people are living longer. The older we are, the more chronic diseases we accumulate,” says Dr. Suzanne Salamon, associate chief of gerontology at Harvard-affiliated Beth Israel Deaconess Medical Center.

The challenges

Advances in medicine have improved treatment for many diseases and lengthened life. But those same advances mean that today’s medical care often involves seeing more types of doctors, having more tests, and getting more treatments than in earlier times. In other words, medical care in our golden years is better, but also more complicated.

“People take more medications, both prescription and over-the-counter, to manage these conditions. That’s because there are more effective medicines now than there used to be. However, medications can interfere with each other,” Dr. Salamon explains. In addition, treatment for one problem may make another problem worse. “For example, if you have high blood pressure and a history of falls, and lowering your blood pressure makes you feel lightheaded, your fall risk will increase,” says Dr. Erin Stevens, a geriatrician and palliative care physician at Harvard-affiliated Massachusetts General Hospital.

Doctors do their best to avoid prescribing medicines that are likely to cause problems, but the risk cannot be perfectly predicted. Bad things that are unlikely still can happen. “Another problem is that people get tired of taking medications, or find them too expensive — and so they don’t take them. This can lead to problems of untreated hypertension, diabetes, and other conditions,” Dr. Salamon explains.

Why do we accumulate chronic conditions?

Many factors play a role in the accumulation of health problems. Most diseases involve a combination of genetics and lifestyle. Being born with certain genes can make you more vulnerable than other people to certain diseases. An unhealthy lifestyle can further increase the risk.

Some genes, and some lifestyle factors, influence the risk for multiple diseases. And having one disease can increase your risk for another. “One disease can affect an organ system which then affects another. For example, diabetes can damage nerves, which can lead to loss of sensation in the extremities, which can lead to imbalance, a fall, and disability,” explains Dr. Erin Stevens, a geriatrician and palliative care physician at Harvard-affiliated Massachusetts General Hospital. Or you may have high blood pressure that damages blood vessels, which leads to a stroke.

And sometimes health conditions just go hand in hand, and we don’t know why. For example, depression often accompanies heart disease, diabetes, or Parkinson’s disease. Autoimmune diseases also can run in clusters. “So if you have thyroid disease, you may be predisposed to another autoimmune disease, like rheumatoid arthritis,” Dr. Stevens says.

Taking back control

To avoid missteps, be proactive in your health care with these strategies.

Get educated about your conditions. Talk with your doctor about what you can do (like exercise or eat a healthy diet) to take to control of any conditions you already have and to prevent conditions you worry about getting.

Become a medication expert. Find out what each of your medications does, why you need it, what side effects you should particularly watch for, and how it may interact with other drugs. You can get such information from your pharmacist or from online sources (such as the AARP website).

If you see many doctors, be sure each of them knows what medicines the other doctors have prescribed (they will, if they are all part of a hospital or health care system that shares electronic health records).

To be safe, Dr. Stevens recommends bringing all of your medications to each doctor appointment, including over-the-counter pills. “Then we can be sure the medication list on the computer matches the pills and doses that you’re taking,” Dr. Salamon says.

Keep track of your symptoms and treatments. If you’re having symptoms you think may be side effects of a medicine or an adverse interaction between drugs, use a notebook or a computer to record when you take medications, when symptoms develop, and how long the symptoms last.

Get a good CEO. Just as a corporation needs a chief executive officer to oversee its many departments, you may need a primary care physician to look at the big picture and help you make sure treatment for numerous conditions is well coordinated.

Consider palliative care. It’s a misconception that palliative care is only for the end of life. When you have serious degenerative illness — like heart failure, Parkinson’s disease, or a breathing disorder — your quality of life suffers. A palliative care physician can help you manage those conditions, maximize your function, and preserve as much quality of life as possible. “We want to meet people early on, not in crisis mode,” Dr. Stevens says. “Maybe we can prevent a fall or address pain. We can talk about what to expect, so when something happens over time, it won’t be a surprise.”

Be your own advocate. Finally, remember that no one understands how you’re feeling better than you do. Ask questions about your treatment, and don’t be afraid to speak up if you’re having trouble managing your conditions or if you’re concerned about the way your doctors are doing the job.

 

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How do you celebrate your calling during National Nurses Week?

Published in Nurse.com by Jennifer Mensik, PhD, RN, FAAN

Make a Nurses Week resolution to recognize each other every day.

One of my favorite sayings about nursing is our ordinary is actually extraordinary. We provide an amazing service to the public, whether in hospitals, clinics, long-term care or in the community.

Being a nurse is not something we turn off completely at any time. It doesn’t stop at the end of our shift like many other professions.

We are there to help at a moment’s notice because we care. That perspective of caring is always with us and we believe we are doing what any other person might do in the same situation — that it was our job.

We have become so accustomed to the caring we do and the miracles we assist with daily, that what we and our colleagues do “daily feels” as if it is our job. As nurses, we also don’t like to take credit as we should for the healing that we assist with. Absent our caring, people would not heal and get well, and that is special.

Enter Nurse’s Day and Nurses Week. Celebrated since 1965, the original intent was to raise awareness of the important role of nursing, which mark our contributions to society. Nurses Week was first unofficially observed in October 1954, the 100th anniversary of Florence Nightingale’s mission to Crimea.

It was later changed to May 6 and officially recognized by President Ronald Reagan in 1982. The American Nurses Association expanded the holiday into National Nurses Week, celebrated from May 6 to May 12, in 1990. Over time, this week became the one time of year we as nurses truly expect we should receive external recognition for our contributions.

Organizations may do a variety of things to recognize nurses, ranging from giveaways to receptions. But does this serve the original intent of this week?

Have we all moved away from recognizing the important role in nursing that the outcome of our caring results in one week of food or tchotchkes a year? I am speaking here for administration and all nurses alike.

Let’s make a Nurses Week resolution to recognize each other more than once a year

What if each week throughout the year, you, your unit, department or organization decided to recognize yourselves? What if we recognized each other and ourselves daily? How do we give our gratitude to other nurses? How do we show our caring to others? How might this type of recognition look?

I asked many of my nursing friends how they should celebrate themselves and each other and here are some ideas:

Nursing retreats designed just for nurses by nurses. My colleagues and friends at the Arizona Nurses Association have organized this retreat for four years straight!

The DAISY recognition program is a formal program healthcare organizations can participate in to recognize the work of nurses. This program exists in all 50 states and 18 countries!

In our daily manager and administrative huddles at Oregon Health and Science University we discuss staff who deserve recognition. Clinical and non-clinical staff and managers know to escalate stories so individuals are recognized. There always are several staff members mentioned daily during these huddles.

Celebrate little victories, such as when a patient finds solace in music or speaks for the first time after visiting with a therapy dog. This might be just part of your routine day, but it is yours to celebrate. Take a moment to reflect on how your caring was part of this patient’s victory.

Write a letter to the editor in a non-nursing-related newspaper or magazine that reflects positively on the nursing profession.

Have a nursing school reunion.

Attend your state nursing association conference.

When we do not stop to recognize ourselves and others, we are not supporting ourselves or each other. When we don’t support each other, individually we can burn out and experience compassion fatigue, which makes it harder to provide a healing environment for those in our care.

Patients and families can tell when we don’t or can’t care any longer. Worse yet is we start to exhibit bullying behavior to others, instead of compassion and caring our colleagues and fellow nurses need just as much.

Nurses Week shouldn’t and can’t be just the only time we recognize, celebrate and demonstrate the importance of nursing. Each of us need to commit to a Nurses Week resolution to celebrate our profession, ourselves and each other each day!

Jennifer Mensik, PhD, RN, NEA-BC, FAAN, is division director of care management at Oregon Health and Science University and instructor for Arizona State University College of Nursing and Health Innovation DNP program. She also is treasurer for the American Nurses Association. Formerly, Mensik was vice president of CE programming for Nurse.com published by OnCourse Learning. A second-edition book she authored, “The Nurse Manager’s Guide to Innovative Staffing,” won third place in the leadership category for the American Journal of Nursing Book of the Year Awards 2017.

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How the Hospice Benefit Could Be Redefined

Published in Home Health Care News By Amy Baxter

As recent changes across the health care system over the last few years indicate that person-centered, interdisciplinary care can improve clinical outcomes, boost patient satisfaction and potentially lower overall costs, hospice care could see an evolution ahead.

Hospice has become known as the first truly interdisciplinary benefit, bringing together many types of care under one roof. As more alternative payment models (APMs), managed care organizations and Medicare Advantage plans seek more flexibility in caring for patients with a person-centered approach, hospice is similarly looking for a way into these increasingly popular care models.

Home Health Care News caught up with Edo Banach, CEO of the National Hospice and Palliative Care Organization (NHPCO), to discover how the association is helping push the boundaries of hospice care with a new advertising campaign aimed at consumers and lawmakers, and efforts to redefine the benefit. Banach, who has been at the helm of NHPCO for more than a year, has an extensive background of working closely with the regulations and innovations departments at the Centers for Medicare & Medicaid Services (CMS) before the hospice industry “came calling.”

Here’s where Banach believes hospice is going.

Overall, what are the biggest changes you’ve seen during your career in health care?

Banach: One thing that is positive is when I started working in health care 16 years ago, it was really hard. What I’ve seen is, back then, managed care companies weren’t falling all over themselves to manage coordinated care. You had a really more siloed system than you have now, pre-Affordable Care Act (ACA), pre-[Medicare] Part D.

Managed care companies can now pay for less medical benefits [by supplementing with non-medical benefits]. We’re getting more integrated. We are moving in the right direction. I want to make sure that the integration and technology is used as a tool to help supplement real, compassionate interdisciplinary care, not one-step-removed care.

So, you talk about hospice being a movement. Where do you see hospice moving to?

One way we see it moving is upstream, but it is an absolute shame that people have to give up so-called curative care in order to get palliative care, hospice. It shouldn’t be a choice. You should be able to get both.

I think when people get both, they often see the value of palliative care. There is a demonstration now called the Care Choices model, which is testing out if curative and palliative care saves money or not, [if it] is an improvement on quality or not, and that will be very helpful and telling.

My goal in the next couple years, if not the next couple months, is to create a pre-hospice palliative care benefit that will allow folks to benefit from person-centered interdisciplinary care, that you see in hospice, earlier. When they have a serious illness, [palliative care is] a pathway and a glide path to receive the full-on hospice benefit that they will eventually receive.

Most people are on hospice now for only a couple of weeks, if not a couple days.

Just like former First Lady Barbara Bush.

Yes, she took comfort care and passed away two days later. And I think that’s not enough time for the system of care to actually have the impact that it needs to have.

Part of it is the choice that people make. Do you want curative care or do you want palliative care? You should be able to get both, and I think that’s crucial. That’s something that we will get to.

What are your other top priorities?

The other thing is about the length [of stay]. The problem with Medicare fee-for-service [FFS] now is these black lines—if you’re on one side, it is OK, and on the other side it’s not. For home health it’s skilled, homebound, these are the things we talk about and auditors look at a lot. In hospice, it’s [about if] you have a prognosis of less than six months and a need for hospice care.

That six-month limitation is treated as a clinical issue. It’s not a clinical issue; it’s a budgetary issue. It doesn’t make sense anymore. Ideally, in a couple years we will have much more of a glide-path between [when a person is] going along swimmingly and getting whatever is medically necessary under Medicare and receiving interdisciplinary person-centered care under hospice.

And my hope is that interdisciplinary person-centered care actually becomes the rule rather than the exception. That’s how this movement will have worked. I don’t just want to reshape the hospice benefit, I want to reshape health care.

Seems like a big uphill battle to me, as new Medicare benefits really come along quite infrequently.

Yes and no. For this, it’s not actually as radical as it sounds. This is an APM that I expect will actually happen. There’s interest in it, we’ve had meetings about it. I am hopeful this is something that can be done.

You’re right, Medicare benefits come infrequently. But we are not talking about a new benefit here. We’re talking about flexibility to provide more person-centered care that is not the poked-and-prodded variety. And that’s exactly what is happening over at ACOs and in Medicare Advantage land. As that is happening and plans can now pay for supports and services, it will seem even less logical for FFS Medicare to be in this box. So I think it is imminent.

 

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