The year was 1969. Richard Nixon was president. Neil Armstrong walked on the moon. Sesame Street debuted on television. And a young nurse named Naomi “Ginger” Stewart started work at Lakeside Hospital in Kansas City, Missouri, a hospital that would eventually become Kindred Hospital Kansas City.
“I have fulfilled many lifelong dreams that would’ve appeared to be those of a dreamer,” Ginger said in a letter announcing her retirement after 44 years of service. “The most important one was my father and mother’s dream for me to become a ‘real nurse,’ though teaching was always in my heart.”
Ginger credits Kindred with allowing her to pursue that dream of teaching through a position as an adjunct nursing professor at Johnson County Community College.
Her own words sum up her experience best:
“…I was asked to take the position of nurse manager in the skilled nursing unit (I didn’t have a clue what a skilled nursing unit did…) however, you believed in me and our team eventually reached a deficiency-free status. As Director of Patient Care Services, you encouraged and supported me. I learned very quickly that the grass is not always greener on the other side. Kindred allowed me to fulfill my dream of teaching…without hesitation. As nursing supervisor for over 10 years, we may not have always agreed regarding decisions but you were fair, you listened and you respected my opinion, often changing or adjusting when possible.
Words cannot convey the many blessings that God has allowed through my employment to bring into my life and that of my family. The friendship [and] opportunities too numerous to count have brought many beautiful memories that will forever be in my heart.”
Kindred Healthcare thanks Ginger Stewart for nearly a half century of committed service and we wish her a long and fulfilling retirement.
Hospitals that rely on a government subsidy for uncompensated or under-compensated care now face a cut to that subsidy that may make it necessary to cut back on certain services, like cancer care. The subsidy cut is hardest hitting to hospitals in states that opted out of a Medicaid expansion. Read the story
The subsidy, which for years has helped defray the cost of uncompensated and undercompensated care, was cut substantially on the assumption that the hospitals would replace much of the lost income with payments for patients newly covered by Medicaid or private insurance. But now the hospitals in states like Georgia will get neither the new Medicaid patients nor most of the old subsidies, which many say are crucial to the mission of care for the poor.
Oral Health in Elderly a Growing Problem
With advancements in dentistry leading to older people keeping their teeth longer, more attention must be focused on oral health in the elderly, according to a European study. Poor oral health can lead to other health problems and the elderly can often have difficulties keeping their mouths clean on their own. Read the story
Could Cochlear Implants be the “New” Hearing Aids?
Cochlear implants – surgically implanted devices that provide a sense of sound to people who are deaf – might be useful in helping older adults with hearing loss to hear better, but the idea is daunting to some people. Read the story
Project Aims to Make End-of-Life Conversations Easier
Citing a study that showed there are myriad reasons why people don’t discuss end-of-life care, a campaign called “Home for the Holidays” gives people the tools to have these important conversations with loved ones. Read the story
India’s Dementia Patient Population Has Little Access to Care
In India, there are 3.7 million reported cases of dementia, but care services are woefully unavailable, with only 18 dementia-care centers across seven Indian states, and only pockets of residential and institutional care. Read the story
Insurers Look for Ways Around Healthcare.gov
Some insurers have suggested that they work directly with consumers to sign them up for policies, bypassing the troubled healthcare.gov website, but privacy concerns may present problems. Read the story
Genetic Research Utilizes Known Link Between Down Syndrome and Dementia
It has long been known that people with Down syndrome have a high incidence of development of the beta amyloid protein deposits in the brain that signal Alzheimer’s, and half of all people with Down syndrome have dementia by the time they are 50. Only now are scientists using that link to study implications for the general population. Read the story
Mind Over Microbials: Can Bacteria Affect Well-Being?
This blog post examines the question of whether exposure to bacteria – like E. Coli – could have a negative effect on our psychological states. Read the blog
ACA Enrollment Numbers Fall Short
The Obama administration released enrollment numbers for the first month of the new healthcare exchanges, and the numbers have fallen short of expectations. Just over 100,000 people have enrolled nationally and the administration had been aiming for half a million by this time. Technical difficulties are considered largely to blame. Read the story
Study Finds that Price Increases Play Huge Role in Rising Healthcare Costs
A multi-institution team has published the results of a study showing that price increases are responsible for 91 percent of escalating healthcare costs. These include hospital charges, professional services, drugs and devices and administrative costs. Read the story
Opinions expressed in any of the included stories or their publications do not necessarily reflect the opinions of Kindred Healthcare and this blog post is a compilation of news stories from other sources that have appeared during the past week.
Participants at Kindred’s Fifth Annual Clinical Impact Symposium – from senior leadership to the clinicians on the front lines of patient care – say you should not only remember it, but you should use it often!
A big takeaway from the three days of discussions: Communication. Is. Key.
And it doesn’t require fancy devices to communicate effectively; it can be as easy as picking up the phone. Call the next care setting. Or the previous care setting. Talk about the patient. Gather important information. And let it inform great care across the continuum.
Pick up the phone!
In the last presentation of the 2013 Kindred Clinical Impact Symposium, Ronald Leopold, MD, MBA, MPH, Senior Vice President, National Practice Leader, Health and Productivity for Wells Fargo Insurance Services, talked about the business value of a healthy workforce.
People are remaining in the workforce longer than ever before, and perhaps longer than they had planned, Leopold said.
“Your ability to earn a living is your biggest financial asset,” he said.
And companies, in turn, are well-served to encourage a healthy workforce.
“It’s in [companies’] best interest to get their workforces healthier and more importantly, it’s in your own best interest,” Leopold said.
How can individuals do that? First, they can pick realistic goals and stick with them. Have a healthy lifestyle – move around, eat well, consider behavior changes – what are you doing that you shouldn’t be doing and vice versa?
He pointed out that the “real food” is on the perimeter of the supermarket, not in the middle. That sodium hides in restaurant foods. If you have a condition, you’re not the expert, just like a doctor who does not specialize in his own condition should not be treating himself: “The doctor who treats himself has a fool for a patient,” as the adage goes.
How do companies encourage healthy workforces? Leopold suggested keeping some things in mind.
- What are your benefits business objectives? Do we want to be a culture of health and we don’t care what it costs? Or are we looking to lower costs?
- What does your healthcare cost trend look like?
- What is your company size?
- How are your people distributed geographically?
- What is your culture around providing benefits?
- How comfortable are you with carrots or sticks? Incentives?
- What industry are you in? Hiring clinicians is different than hiring people to work on loading docks, for example.
- What part(s) of the country are you in?
- What is your age/ gender distribution?
- What is your average tenure?
- How comfortable are your people with technology?
“Most people agree that healthcare costs are growing and we have to get them down, and if we can get people healthier, we’ll spend less money,” Leopold said. “And most importantly, it’s the right thing to do.”
What are Some Easy Things we can do to Create a Healthier Workplace?
- Walking team meetings
- Mental breaks via meditation
- Facility-to-facility competitions centered around healthy behaviors
NOTE: Jack’s story is purely hypothetical and was crafted specifically for 2013 Clinical Impact Symposium attendees to use as an exercise in care transitions. Any resemblance to a person living or deceased is coincidental.
As the Fifth Annual Kindred Clinical Impact Symposium wraps up, participants came together to make some recommendations for further care of our fictitious patient, Jack, who has many co-morbid conditions and ended up in the post-acute care continuum after being hit by a car while riding his bike, requiring surgery for a broken femur.
After his initial discharge from the acute care hospital, Jack went to a skilled nursing facility, back to the acute care hospital, then to a transitional care hospital and ultimately he was transitioned to home health care. At the current moment, Jack’s home health providers are concerned about his agitated state and resistance to taking medications and exercising.
As Jack continues his journey in the post-acute continuum, CIS participants had some common recommendations for his care:
- It’s all about the patient. At the end of the day, Jack is the most important part of his care team. Ask Jack – patient treatment determination is still a patient right.
- Care coordination across settings is paramount.
- Medication reconciliation is important.
- Improve communication and IDT (Interdisciplinary Team) participation – reach out to colleagues across the continuum. Better communication between settings is critical, and can be as simple as picking up the phone.
- Patient and family education can lead to better outcomes, as their role and buy-in in caring for the patient is crucial.
Later today, CIS participants will disperse back to their respective facilities – all across the country – with Jack fresh in their minds, remembering his story and those recommendations as they care for patients like Jack, facilitating the best outcomes possible across the entire continuum of care.
Said Mary Van de Kamp, Senior Vice President, Quality and Integrated Care for Kindred Healthcare, as she encouraged participants to take Jack’s lessons home with them: “There are lots of Jacks and if we make a difference with just one of them, we’ve made a huge impact.”
Creating Effective Treatment Plans, Safe Transitions and Quality Discharge Planning Factoring in Cognition
Kim Warchol has been an Occupational Therapist specializing in dementia for more than 24 years. One minute of listening to her talk about her field and you can hear the years of experience and passion in every word. But she readily admits that she wasn’t prepared to deal with cognitive impairment when she first started practicing.
Her “aha!” moment came through the work of Claudia Kay Allen, MA, OTR/L, FAOTA, which completely changed her perspective from focusing on the limitations of patients with cognitive impairment to focusing on uncovering what they could do. She hasn’t looked back since and, she says, she is no longer “leaving these vulnerable individuals to fend for themselves.”
In every part of her presentation at Kindred’s Clinical Impact Symposium, Warchol emphasized the need for assessing and understanding the patient’s cognitive abilities to develop the right approaches for caring for that patient. Without knowing the patient’s ability to process information, it’s hard to know if he or she will understand how to use nebulizers, walkers or other equipment, or if what you are asking is possible and safe for the patient.
Warchol emphasizes the importance of prioritizing understanding cognition as a team, including physical therapists, occupational therapists, speech language pathologists and neuropsychologists.
- formalized cognitive tests
- general observations
- listening to the input of the family
She notes that it’s important to use universal language to communicate cognitive assessment results to other team members and that there should be a clear path for communicating the results so they don’t end up buried (and unread) in the medical record.
To most effectively work with patients, Warchol notes that it is critical to “Learn your person and their goals.” One way is through using “Can Do, Will Do, and May Do.”
“Can do” describes what is possible and realistic for the client including:
- cognitive status
- physical status
- sensory status
- mood and behavior status
“Will do” is what the person wants to do and finds relevant. It is related to:
- personal preferences
The “will do” is the person-centered aspect of the Allen Cognitive Model.
“May do” is external to the patient. It is what he or she can be expected to do with the right support.
By using activities that fall into the “will do” category, there is a greater chance of success in helping patients who are in the lower levels of cognition.
If there is one thing attendees should also remember, it is Warchol’s message to, “Adapt, adapt, adapt to where that person is at the moment.” Although the ultimate goal is to achieve a person’s Best Ability to Function, there are different paths for a chronic and progressive diagnosis versus a diagnosis with complete or partial recovery. And patients will be at different levels at different times in their stay or recovery, so it’s important to reassess and adapt the plan as needed.