Occupational Therapy and Data Collection in Home Health

by Karen Vance, BSOT, Senior Managing Consultant | Clinical Operations Specialist, BKD Health Care Group

Karen Vance_HHQIThe Patient-Driven Groupings Model (PDGM) portends significant changes to the way Medicare currently pays home health agencies (HHA) under Prospective Payment System (PPS). PDGM is an effort to transition from volume- to value-based payment. Occupational therapy (OT) can provide assistance to home health agencies (HHAs) in several ways to improve the accuracy of those payments received as well as the effectiveness of the clinical outcomes achieved.

The Centers for Medicare and Medicaid Services (CMS) summarizes the Patient-Driven Groupings Model (PDGM) as 30-day payment periods placed into different subgroups for each of the following categories:

  • Admission source (two subgroups): community or institutional admission source
  • Timing of the 30-day period (two subgroups): early or late
  • Clinical grouping (twelve subgroups): musculoskeletal rehabilitation; neuro/stroke rehabilitation; wounds; medication management, teaching, and assessment (MMTA)
  • Functional impairment level (three subgroups): low, medium, or high
  • Comorbidity adjustment (three subgroups): none, low, or high based on secondary diagnoses.

The overview can be found here.

The biggest change from PDGM affecting therapy is the removal of therapy thresholds triggering additional payment based on combined visit utilization. PDGM accounts for therapy provision on the plan of care based on patient characteristics, namely diagnoses and functional scoring.

OT can and should assist in identifying the diagnoses or conditions that best explain the reason for the home health episode. Providing such input improves the accuracy of the clinical grouping into which the patient is categorized. In many cases, a nurse is performing the comprehensive assessment and selecting the diagnoses meant to drive the plan of care, even when the original referral may be more focused on therapy need. The nurse’s selection may also drive a less accurate clinical or comorbidity subgroup without input from OT regarding the focus and intensity of OT services.

161843047OT involvement is most critical to ensure data accuracy when painting the picture of the patient’s functional status. The patient’s Outcome and Assessment Information Set (OASIS) scoring on grooming, dressing, bathing, transferring and mobility, as well as the risk for hospitalization, make up the PDGM functional impairment level portion of the payment. Once again, OT collaboration with other members of the home health team can greatly improve the accuracy of the data collection, and hence the accuracy of the resources available for therapy utilization on the plan of care.

The opportunities for collaboration on diagnosis and functional scoring depend, of course, on each HHA. Regardless of an agency’s current processes, OTs should make opportunities to communicate and collaborate with other disciplines about the results of their assessments. Optimizing communication technology is the most obvious, and easy, method for immediate dissemination of assessment results, particularly regarding specific areas relating to key OASIS items. Case conferences are also a wonderful venue for sharing specifics of an individual patient while simultaneously revealing assessment ideas for gathering more accurate data on all patients. For example:

  • A patient’s ability to put on and take off clothing may be easily observed during a nurse’s head-to-toe assessment to answer M1810 and M1820, but environmental issues identified during the OT Activities of Daily Living (ADL) assessment may impact the patient’s ability to safely obtain clothing out of dressers or closets. A patient who has to let go of the walker to pull on a drawer that sticks, or reach too high in the closet may have compromised balance.
  • A patient with chronic obstructive pulmonary disease (COPD) may be able to demonstrate getting in and out of a shower during a ‘dry run’, however standing in a warm, moist environment for twenty minutes may compromise breathing capacity.

Diagnosis coding has always been an important function of the PPS payment, however ‘muscle weakness’ has been overused to explain the need for OT services. Even though OT may be on many plans of care for patients with musculoskeletal or neuromuscular diagnoses, the most common diagnoses in home health are chronic conditions such as COPD, congestive heart failure (CHF), hypertension and diabetes. OT has much to contribute to these types of patients such as energy conservation, pursed lip breathing and environmental modifications to improve their safety and daily function. As important as it is to assist in identifying the most appropriate diagnosis, it is as important to develop a plan of care that is most appropriate to the patient.

OT contribution is indeed critical to the accuracy of data collection and coding in preparation for PDGM as well as now. However, in addition to the accuracy of payment, it is also important to remember that accurate data collection also improves the accuracy of the clinical outcomes of an agency. If OASIS items are not properly captured at the beginning of an episode, then the improvements made by the end will not be truly represented.

As mentioned earlier, agencies may not currently have processes in place for good collaboration on OASIS data collection, however OTs can make opportunities to do so and model best practice for their agencies. The American Occupational Therapy Association is developing resources and education to help with this transition. See more information at www.aota.org/value.

Watch the American Occupational Therapy Association’s (AOTA) video, Payment Shift from Volume to Value: Maximizing the Opportunity for OT 2018.  This is for Post-Acute Providers including home health and the role of OTs.


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Home Care… we have a problem!

By Tina Hilmas, RN, BSN, MS, CPPS
Center for Patient Safety, Assistant Director

March2019_CenterforPatientSafety_logoDid I get your attention? Good! We do have a problem, and it’s not the usual having to deal with Conditions of Participation (CoP) or with the ever-changing reimbursement model, but the problem is with patient care. You see, this week (March 10–16) is Patient Safety Awareness Week. This week highlights the need for everyone to increase their awareness that patients are suffering harm – ranging from mild to severe – and even death due to preventable medical errors. And patient harm doesn’t just occur in hospitals, it is occurring under our watch in home-based care.

The Institute of Medicine (IOM) came out with an initial report 20 years ago which estimated that there were approximately 98,000 deaths per year due to preventable harm. In 2016, a journal article estimated that number to be even higher, more around 250,000 deaths per year, making it the third leading cause of death. And even more importantly, there are documented patient safety events reported that show harm is coming to patients in home-based care, including falls that cause intracranial bleeds and medication errors that send patients to the emergency room. The Center for Patient Safety, as a federally designated patient safety organization (PSO), identifies over 1,800 patient safety events in the home-based care environment that demonstrate adverse events are occurring under our watch.

Have you ever heard of patient safety organizations (PSOs) before? If you answered no, I am not surprised. Even though these organizations have been around since 2008, it can be hard to define exactly what a PSO is and what services they offer. The Agency for Healthcare Research and Quality (AHRQ) website provides in-depth information on PSOs. However, simply put, PSOs collect and aggregate patient safety incidents with the goal of improving patient care. The benefit of working with a PSO is that active participation provides legal protections that are supposed to remove fear of legal liability.

This can be important because as the original IOM report noted, a large factor that is a barrier to improving patient safety is the culture of healthcare. Unfortunately, we are not very good at trying to use mistakes as learning opportunities. Think for a moment about what the response would be to the following scenario:

nurse and man with walkerYour nurse goes out to do a Start of Care (SOC). While completing the SOC, the patient’s adult child bursts into the house, aggravated and angry. The patient whispers that the child has been involved with the law due to a drug problem. The police are called, the situation is resolved, and the nurse finishes the SOC. When you, as a supervisor, are reviewing the paperwork, you notice the fall risk assessment wasn’t completed and there was no assessment of the house for fall hazards. As you notice this, you get a call from the patient’s spouse stating that the patient tripped and fell over a rug and is in the Emergency Room with a broken hip. Do you:

  1. Call the nurse, inform her of the situation and tell her she is suspended pending investigation of the incident, and that this incident will go into her personnel file?
  2. Call the nurse, explain the situation, then tell her the incident is not her fault and absolve her from all responsibility?
  3. Call the nurse, ask her to come in and do a root cause analysis together to not only look at the situation that was present during the SOC, but also to review your agency’s policies, processes and the system that goes into completing SOCs?

My hope is that you would choose option 3. However, too many organizations fall into the category of option 1. It may seem that, of course, this is the logical answer. Nurses should know what goes into a SOC. They should know that a fall risk assessment should be completed with every admission. Let’s take this example a step further. What if the nurse who completed this SOC was your star performer? The patients like her. She always goes by the book and submits her paperwork on time. She also knows how to coordinate care and the rest of the team really likes her. But how would you respond if it was not your star performer? Let’s say this event happened to one of your borderline nurses. This nurse is always a little late with paperwork and you regularly need to monitor her. While the care she provides to her patients isn’t bad, and for the most part her patients seem to like her, she seems to do the bare minimum. Would your response be different or would you treat them the same?

I’m certain you would like to say both nurses would be treated the same, but many times this is not what happens. This type of behavior points to the culture of the organization. Yep, that’s right, culture. I know it sounds soft. Culture is not hard science and it isn’t black and white. It’s… touchy-feely stuff. I get it. However, your culture plays a huge part in the quality of care being provided to your patients.

Think about your turnover rate. How high is it? Do you do exit interviews? Do you know why employees are leaving your organization? Also, think about your Quality Assurance and Performance Improvement (QAPI) projects. How do you know you’re being successful? Do you know how your staff views the organization and it’s quality improvement projects? Do you truly know if your employees trust the organization and feel challenged/engaged to participate in quality improvement projects? Or do they think it’s just the flavor of the month and if they keep their heads down and avoid attention that things will just go back to where they feel comfortable and they won’t really have to change?

Check ListThese are hard questions to answer. Many organizations send out employee engagement surveys, which are good to an extent, but they don’t really measure how your staff views the organization. The best survey would be one that measures your organization’s culture and asks staff if they believe the organization is committed to supporting it’s staff and protecting it’s patients. Lastly, the survey should be administered by a third party. This last point is very important. If your organization is one that is punitive in response to errors and the survey is administered by leadership, employees may worry that they will be identifiable based on their answers. This won’t provide the organization with a starting point to change it’s culture. You want your staff to be truthful because to be successful in quality improvement, the culture of your organization must support it.

Home-based care is faced with many challenges to maintaining patient safety that other areas of healthcare don’t face, with the main challenge being the actual environment in which healthcare is provided. But that doesn’t mean we should just shrug our shoulders and say that patient safety is a province of hospitals. It means that we need to find ways to take the lessons learned regarding patient safety from hospitals and figure out how they can be applicable to our setting. You see, our future depends on it. Home-based care is being challenged and pushed to meet the same safety and quality standards that other areas of healthcare are expected to achieve without any of the tools that were developed to help these other areas. We need to push for research regarding patient safety in our area. We need to push for ways to improve the culture of our organizations. And lastly, we need to keep patient safety and quality of care top priorities in all the care we provide.


HHQI University Offers Free Patient Safety Courses

HHQI University_logoLearn more from Tina in the following HHQI University courses which include free nursing CEUs:

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New Cholesterol Management Guidelines and the Effects on Home Health Patients

by Misty Kevech, HHQI RN Project Coordinator

Cholesterol plaque in arteryHeart disease is the leading cause of death in the U.S. for men and women (CDC, 2017). Every year, 735,000 Americans have a heart attack (CDC, 2017). Cardiovascular health is important to the well-being of people for primary and secondary preventation of atherosclerotic cardiovascular disease (ASCVD), which can lead to heart attacks and strokes. The CDC (2015) states, “People with high cholesterol have about twice the risk of heart disease as people with lower levels.” Your home health patients often have a high cholesterol diagnosis, but do they understand and have a plan to address the levels?

Patient Confusion & Non-Adherence

Patients are often confused over how to interpret their blood lipid panel results and to differentiate common myths from evidence-based facts. For example, many people think that heredity affects cholesterol levels, not lifestyle choices. The truth is that lifestyle modifications are recommended for everyone, no matter their cholesterol level. Yes, heredity does factor in for some patients, but there are important lifestyle changes everyone can make. Many Americans continue to not eat heart-healthy diets and are not getting enough exercise. The U.S. Department of Health and Human Services recently released the second edition of the Physical Activity Guidelines for Americans that reinforces the 150 minutes to 300 minutes/week recommendation, if physically able, but now adds that any amount of exercise is beneficial (HHS, 2018). Would exercising 5 to 10 minutes several times a day sound more reasonable to your patients?

Lipid-lowering medications are added to lifestyle modifications for people with higher levels of cholesterol or to reduce the level more quickly. Medication adherence for these medications (e.g., satins) is only at 55% (CDC, 2018). The 39.1 million people who are at high risk for an ASCVD event, but are not taking a statin, could reduce their risk of a heart attack or stroke by up to half if therapy was taken regularly (Million Hearts®, 2018). Consider using open-ended questions to ask your patients about how, when, or how they physically feel related to cholesterol medications. Some examples of questions are, “Tell me how/when you take the ___________ pill?” and “How does the pill make you feel?” Explain that there are other medications that can be ordered if there are side effects.

Home Health & Cholesterol Management

HHQI_MyQuestionsWhere does cholesterol management fit into your home health visits? Patient education on cholesterol effects, lipid levels, diet, exercise, and medications are essential for cardiovascular (CV) health. Educating your patients on reducing CV risk factors, especially lifestyle management, often aligns with other chronic disease management interventions you are teaching your patients. You could use pictures or videos as visual education to show the effects of cholesterol on the CV system. Check out the American Heart Association’s Watch, Learn and Live: Cholesterol resources. HHQI’s My Questions about My Heart for My Doctor tool can be utilized to prep your patients to discuss CV concerns with their doctor, including what their lipid results mean.

HHQI_ExerciseA heart-healthy diet often aligns with other disease dietary recommendations and fits nicely into your patient’s care plan. Increasing exercise is also appropriate for most chronic diseases. Consider making a therapy referral to set up a safe home exercise program for your patients, if appropriate. Even older patients with chronic diseases can increase activity levels at home, even if chair-bound. Use the Exercise & Keep Your Seat patient education tool (a diabetes tool, but appropriate for all) for those who need to safely exercise from a chair. This tool is also available in other languages.

Medication teaching is part of the Home Health Conditions of Participation. As a clinician, you need to understand and be able to explain to patients the importance of taking cholesterol-lowering medications to decrease their risk of heart attacks and strokes. You must also educate patients on the common side effects with tips and tricks to address them or work with the practitioner to try alternative medications. Teach your patients to speak up and communicate their concerns about side effects. These interventions will assist with disease management of all chronic conditions.

It is important that home health clinicians to stay up to date with all evidence-based guidelines so you can teach patients the rational and guide them toward adherence with better outcomes.

Updated Cholesterol Clinical Practice Guidelines

In November 2018, the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines released the 2018 Cholesterol Clinical Practice Guidelines. The report was approved by many other leading organizations (see the report for listing). This is the first update since 2013.

The key changes include creating two classifications in the Secondary Prevention group for those patients with atherosclerotic cardiovascular disease (ASCVD) including a “very high risk” and recommendations for these groups (see below). LDL-C threshold returns to the guidelines to assist practitioners with prescribing statins and alternative therapies (see below). The ACC/AHA recommends the use of either fasting or non-fasting lipid panels for monitoring of cholesterol levels. An unusual recommendation is for insurers to consider a no co-pay for cholesterol-lowering medications that are evidence-based (A or B categories).

The report provides the Top 10 Take-Home Messages to Reduce Risk of Atherosclerotic Cardiovascular Disease Though Cholesterol Management (see pages 5-6 for more specifics for each item).

  1. In all individuals, emphasize a heart-healthy lifestyle across the life course.
  2. In patients with clinical ASCVD, reduce low-density lipoprotein cholesterol (LDL-C) with high-intensity statin therapy or maximally tolerated statin therapy.
  3. In very high-risk ASCVD, use a LDL-C threshold of 70 mg/dL (1.8 mmol/L) to consider addition of nonstatins to statin therapy.
  4. In patients with severe primary hypercholesterolemia (LDL-C level ≥190 mg/dL [≥4.9 mmol/L]), begin high-intensity statin therapy without calculating 10-year ASCVD risk.
  5. In patients 40 to 75 years of age with diabetes mellitus and LDL-C ≥70 mg/dL (≥1.8 mmol/L), start moderate-intensity statin therapy without calculating 10-year ASCVD risk.
  6. In adults 40 to 75 years of age evaluated for primary ASCVD prevention, have a clinician-patient risk discussion before starting statin therapy.
  7. In adults 40 to 75 years of age without diabetes mellitus and with LDL-C levels ≥70 mg/dL (≥1.8 mmol/L), at a 10-year ASCVD risk of ≥7.5%, start a moderate-intensity statin if a discussion of treatment options favors statin therapy.
  8. In adults 40 to 75 years of age without diabetes mellitus and 10-year risk of 7.5% to 19.9% (intermediate risk), risk-enhancing factors favor initiation of statin therapy (see No. 7).
  9. In adults 40 to 75 years of age without diabetes mellitus and with LDL-C levels ≥70 mg/dL- 189 mg/dL (≥1.8-4.9 mmol/L), at a 10-year ASCVD risk of ≥7.5% to 19.9%, if a decision about statin therapy is uncertain, consider measuring CAC.
  10. Assess adherence and percentage response to LDL-C–lowering medications and lifestyle changes with repeat lipid measurement 4 to 12 weeks after statin initiation or dose adjustment, repeated every 3 to 12 months as needed.


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Safety First: Winter Driving Tips

by Misty Kevech, HHQI RN Project Coordinator

snowy roadThere have already been several major snow and ice storms across the country this year. Now that the heart of winter is upon us, HHQI would like to provide some driving tips to protect healthcare workers as they travel to care for their patients. Home health is similar to the unofficial motto of the U.S. Postal Service, “Neither snow nor rain nor heat nor gloom of night stays these couriers from the swift completion of their appointed rounds.” While not all parts of the U.S. will see snow or ice this winter, rain can also cause major problems for healthcare providers that need to get to their home-bound patients. In this blog we’ll address each of these problems with expert advice from the American Automobile Association (AAA). Home health agency (HHA) leaders may consider adding these tips as part of their Emergency Preparedness education.

The following are winter driving tips are from the AAA Exchange website.

  • AAA recommends the following winter driving tips:
    • Avoid driving while you’re fatigued. Getting the proper amount of rest before taking on winter weather tasks reduces driving risks.
    • Never warm up a vehicle in an enclosed area, such as a garage.
    • Make certain your tires are properly inflated.
    • Never mix radial tires with other tire types.
    • Keep your gas tank at least half full to avoid gas line freeze-up.
    • If possible, avoid using your parking brake in cold, rainy and snowy weather.
    • Do not use cruise control when driving on any slippery surface (wet, ice, sand).
    • Always look and steer where you want to go.
    • Use your seat belt every time you get into your vehicle.
  • Tips for long-distance winter trips:
    • Watch weather reports prior to a long-distance drive or before driving in isolated areas. Delay trips when especially bad weather is expected. If you must leave, let others know your route, destination and estimated time of arrival.
    • Always make sure your vehicle is in peak operating condition by having it inspected by a AAA Approved Auto Repair facility.
    • Keep at least half a tank of gasoline in your vehicle at all times.
    • Pack a cellular telephone with your local AAA’s telephone number, plus blankets, gloves, hats, food, water and any needed medication in your vehicle.
    • If you become snow-bound, stay with your vehicle. It provides temporary shelter and makes it easier for rescuers to locate you. Don’t try to walk in a severe storm. It’s easy to lose sight of your vehicle in blowing snow and become lost.
    • Don’t over exert yourself if you try to push or dig your vehicle out of the snow.
    • Tie a brightly colored cloth to the antenna or place a cloth at the top of a rolled up window to signal distress. At night, keep the dome light on if possible. It only uses a small amount of electricity and will make it easier for rescuers to find you.
    • Make sure the exhaust pipe isn’t clogged with snow, ice or mud. A blocked exhaust could cause deadly carbon monoxide gas to leak into the passenger compartment with the engine running.
    • Use whatever is available to insulate your body from the cold. This could include floor mats, newspapers or paper maps.
    • If possible run the engine and heater just long enough to remove the chill and to conserve gasoline.
  • Tips for driving in the snow:
    • Accelerate and decelerate slowly. Applying the gas slowly to accelerate is the best method for regaining traction and avoiding skids. Don’t try to get moving in a hurry. And take time to slow down for a stoplight. Remember: It takes longer to slow down on icy roads.
    • Drive slowly. Everything takes longer on snow-covered roads. Accelerating, stopping, turning – nothing happens as quickly as on dry pavement. Give yourself time to maneuver by driving slowly.
    • The normal dry pavement following distance of three to four seconds should be increased to eight to ten seconds. This increased margin of safety will provide the longer distance needed if you have to stop.
    • Know your brakes. Whether you have anti-lock brakes or not, the best way to stop is threshold breaking. Keep the heel of your foot on the floor and use the ball of your foot to apply firm, steady pressure on the brake pedal.
    • Don’t stop if you can avoid it. There’s a big difference in the amount of inertia it takes to start moving from a full stop versus how much it takes to get moving while still rolling. If you can slow down enough to keep rolling until a traffic light changes, do it.
    • Don’t power up hills. Applying extra gas on snow-covered roads just starts your wheels spinning. Try to get a little inertia going before you reach the hill and let that inertia carry you to the top. As you reach the crest of the hill, reduce your speed and proceed downhill as slowly as possible.
    • Don’t stop going up a hill. There’s nothing worse than trying to get moving up a hill on an icy road. Get some inertia going on a flat roadway before you take on the hill.
    • Stay home. If you really don’t have to go out, don’t. Even if you can drive well in the snow, not everyone else can. Don’t tempt fate: If you don’t have somewhere you have to be, watch the snow from indoors.

The following are wet weather driving tips are from the AAA Exchange website.

  • General Wet Weather Tips
    • Replace windshield wiper inserts that leave streaks or don’t clear the glass in a single swipe.
    • Make sure all headlights, taillights, brake lights and turn signals are properly functioning so other drivers will see you during downpours. Turn on your headlights whenever you drive.
    • Proper tire tread depth and inflation are imperative to maintaining good traction on wet roadways. Check tread depth with a quarter inserted upside down into the tire groove. If you can see above Washington’s head, start shopping for new tires. Check each tire’s pressure, including the spare, at least once a month… and be sure to check the pressure when the tires are cold.
  • Avoid Cruise Control
    • Most modern cars feature cruise control. This feature works great in dry conditions, but when used in wet conditions, the chance of losing control of the vehicle can increase. To prevent loss of traction, the driver may need to reduce the car’s speed by lifting off the accelerator, which cannot be accomplished when cruise control is engaged.
    • When driving in wet-weather conditions, it is important to concentrate fully on every aspect of driving. Avoiding cruise control will allow the driver more options to choose from when responding to a potential loss-of-traction situation, thus maximizing your safety.
  • Slow Down and Leave Room
    • Slowing down during wet weather driving can be critical to reducing a car’s chance of hydroplaning, when the tires rise up on a film of water. With as little as 1/12 inch of water on the road, tires have to displace a gallon of water per second to keep the rubber meeting the road. Drivers should reduce their speed to correspond to the amount of water on the roadway. At speeds as low as 35 mph, new tires can still lose some contact with the roadway.
    • To reduce chances of hydroplaning, drivers should slow down, avoid hard braking or turning sharply and drive in the tracks of the vehicle ahead of you. Also, it’s important for motorists to allow ample stopping distance between cars by increasing the following distance of the vehicle in front of them and beginning to slow down to stop for intersections, turns and other traffic early.
  • Responding to a Skid
    • Continue to look and steer in the direction in which the driver wants the car to go.
    • Avoid slamming on the brakes as this will further upset the vehicle’s balance and make it harder to control.
    • If you feel the car begin to skid, continue to look and steer in the direction you want the car to go. Don’t panic, and avoid slamming on the brakes to maintain control.


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Why Time Spent on Your Phone Can be Disastrous for Your Sleep Patterns

By guest blogger: Sarah Johnson – sjohnson@tuck.com 

Dec2018_tucksleeplogoWorking night shifts or staying up late can be a nightmare for your internal clock, but there’s something else that might make your hopes of getting rest even worse — the iPhone or Android you use to pass the evening when there’s nothing else to do.

The light shining on you from your smartphone is hitting you with blue-ish lighting that research has since revealed can have devastating effects on your ability to sleep normally. It’s unfortunate that long-lasting, environment-friendly lighting has such a serious downside, ranging from sleep problems to potential health risks.

Read on to learn about the negative consequences of staying on your phone late at night.

Blue Light Is Great For Everything but Your Sleep Patterns

cell phone in bed.jpgBlue lighting’s reputation was exclusively linked to how great it is for energy savings. For example, residential LED lights burn approximately 75 percent less energy than traditional incandescent lights. It’s even estimated that by 2027, this type of lighting will save Americans more than $30 billion.

The shift in emphasis on energy and cost savings means blue lighting is a growing part of the average person’s life in one way or another. The most common exposure these days is through the TV, laptop, and smartphone. It means you get daily exposure to a light source that research shows interferes with your circadian rhythm, that is, your daily wake and sleep cycle. Studies show that it increases your alertness and suppresses the hormone melatonin. This makes it harder to fall and stay asleep.

Phone Lighting and the Night Shift Disturbing Your Sleep

Interestingly, the ability of blue light exposure to increase alertness might have short-term benefits on the job, if you’re working late at night. This might help you avoid the feelings of tiredness that come with the job. Even so, the long-term consequences could be severe. There are already studies that show night shift work can have a negative impact on overall sleep patterns. Combined with prolonged exposure to certain electronics, things could get worse.

What You Can Do to Sleep Better

There are steps you can take to improve your overall quality of sleep as best you can. When working the night shift or staying up late, consider reading a book rather than hopping on your phone. If you do decide (or need) to get on the phone, consider using blue-light-blocking glasses. The less you expose yourself to blue light, the less you have to worry about it interfering with your body and health. At home, swap blue LED lights for traditional red light bulbs in the bedroom. It’s also a good idea to cut back on use of your laptop or phone a few hours before bedtime. Lastly, practice good sleep hygiene. These are daily habits and behaviors that make it easier for you to enjoy a good night’s sleep. Getting to bed at a good hour, turning off electronics, and avoiding nighttime distractions are all examples of helpful ways of practicing good sleep hygiene.

Sleep doesn’t always come easy or naturally to night shift workers. If you happen to work late, it’s only natural to avoid zoning out or outright sleeping on the job. However, continuously sitting on your smartphone is not the best way to go about staying awake, and the potential risks just aren’t worth it.

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Celebrating Our Home Health Aides

Guest post by Loretta Goggins RN, BSN, Home Health Resources, Inc., Houston, TX

Nurse holding hand of senior woman in pension homeNovember is Home Health Aides Appreciation Month, and in honor of this special month, I’d like to take this opportunity to celebrate the home health aides on our team!

Home health aides are an integral part of our home care team, working closely with the patient, families, nurses, and therapists to provide our patients with the very best. Much of the time they are only in the home short-term, while the patient’s needs are greatest. One of the challenges of this reality is that the home health aide needs to be skilled at caring for the patient, getting to know them, and helping them be comfortable in the given situation. They gracefully manage the difficult task of providing personal care for their patients, many of whom have never needed to depend on anyone else for this help, let alone from a total stranger.

As part of the healthcare team at our home health company, our aides work with patients that have a variety of needs. They follow the care plan set up by the admitting nurse and stay in contact with the patient’s case manager, especially if there is anything unusual to report or pertinent information to share.

HHQI University_logoOur home health aides strive to be the best that they can be in their role. They are always eager to gain more knowledge in order to improve themselves and the care they provide. This past summer we began taking advantage of the learning opportunities available to us through HHQI University. These classes are tailored specifically to the population that our home health aides serve. We have participated in courses to learn about the skills of skin observation, caring for the diabetic patient, and protecting our patients/ourselves during the flu/pneumonia season. Even our most “seasoned” home health aides have enthusiastically welcomed the additional education and have found these sessions valuable.

By just visiting with our home health aides, it’s easy to understand why they do such a good job and why they are so well liked by our patients and their families. When I recently asked one of our aides what she liked best about her job she initially said that it was difficult to pick any one thing, saying that “it depends, because it is different when working with a variety of patients.” Then her face lit up and she said, “One of the things that I like best about my job is that I can help patients feel good about themselves. It’s different for every patient so part of what I need to do is to figure out what each patient really wants. For one patient, it is just a good shower and shampoo. For another it may be to have help putting on makeup. Another patient may really enjoy having their hair set or someone else it is to have a good shave. I try to tap into that because I know that when you look better you feel better about yourself. When you feel better about yourself, you are more likely to feel good in general.”

WOW, what insight! That sums it up! Being a good home health aide takes such commitment. It is not an easy job. Our aides travel a lot, juggle patient preferences (times to be seen and more), and they work with and around the other disciplines involved in the patient’s care. Our aides get to know the patient and their family members really well, and they are always looking out for each patient’s safety and well-being. At the heart of the matter is that the home health aides “get it.” They understand what was stated above – the importance of helping patients feel good about themselves generally instills in them a sense of hope and motivation. Those that are more motivated generally try to take better care of their health. How awesome!

Home health aides are indeed a special group of people, with a special set of skills, doing a very important job. To say that they are invaluable is an understatement. We appreciate all that they do as we serve those that are entrusted to our care.

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Learn More About Sepsis Screening & Education – It Could Be a Life-Saver

By investing a few minutes, home care clinicians can make a world of difference

Chris Chimenti-HHQIby Chris Chimenti, MSPT, ACCH, Senior Director of Clinical Innovation, HCR Home Care

What is sepsis? According to the Centers for Disease Control and Prevention (CDC), “Sepsis is the body’s extreme response to an infection. It is a life-threatening medical emergency! It happens when an infection you already have – in your skin, lungs, urinary tract, or somewhere else – triggers a chain reaction throughout your body. Without timely treatment, sepsis can rapidly lead to tissue damage, organ failure, and death”.1

The figures are staggering:

  • Over 1.6 million people are diagnosed with sepsis each year in the U.S.2
  • The risk of death from sepsis increases by 8% every hour treatment is delayed.2
  • The onset of sepsis occurs outside of a hospital setting in nearly 80 percent of cases.3

Nurses and therapists working in the home health care setting are uniquely positioned to detect sepsis, and detect it sooner than later with routine screening. Time is of the essence when sepsis begins… it’s an emergent event. Clinicians should educate patients who have an infection or are at risk of infection about the warning signs of sepsis. Family members and anyone involved in the care of the patient should be informed as well.

Who is at risk?

  • Children < 1 year old
  • Adults 65 and older
  • Individuals with an impaired immune system
  • Patients with chronic illnesses such as diabetes or cancer

What are the warning signs?

  • Confusion or disorientation
  • Rapid heart rate
  • Shortness of breath
  • Hyperthermia or hypothermia
  • Shivering
  • Sweaty or clammy skin
  • Extreme pain

At HCR Home Care, sepsis screening is an integral part of our daily patient assessments. The Home Care Association (HCA) Sepsis Screening Tool4 is embedded in our electronic medical record (EMR) system. This standardized instrument streamlines the clinical assessment to promptly identify the critical signs and symptoms of sepsis. Upon completion of the three screening questions, the EMR automatically generates follow-up actions that align with established medical standards.

What are the three items included in the screening tool?

  • Active infection or potential source of infection
  • Fever, tachypnea, or tachycardia
  • Organ dysfunction (e.g., altered mental status, hypotension)

HCR Home CareOur nurses and therapists have conducted the standardized sepsis screens during every home visit over the past 12 months. During this time, over 175,000 individual screens have been performed. 141 patients presented with symptoms consistent with severe sepsis and required immediate transport to a local hospital emergency room. During the same time period, another 125 patients met criteria for sepsis and physician notification immediately followed.

At times, sepsis may not be included as a diagnosis in hospital discharge instructions. This may be due to the fact the symptoms associated with sepsis resolved during the hospital stay. According to the Sepsis Alliance, 62 percent of patients who develop sepsis are likely to be re-hospitalized in the subsequent 30 days.2 Eliminating potentially avoidable hospitalizations is a critical focus in home health practice today. Awareness of sepsis can make a difference in keeping patients at home and out of the hospital.

Sepsis deserves to be understood, appreciated, and closely monitored. The condition can result from a simple scrape, urinary tract infection, or surgery. Early detection and prompt medical attention are needed to prevent the worst…amputation, organ failure, or death. Be prepared to ask yourself…“could this be sepsis?” You could just make a world of difference for your patient.

Sepsis Webinar Info


1 What is Sepsis? Accessed on 9/6/18.

2 Sepsis Fact Sheet. Accessed on 9/6/18.

3 CDC: Most Sepsis Cases Start Outside A Hospital. Accessed on 9/5/18.

4 Stop Sepsis At Home. Accessed on 9/7/18.


sepsis infographicAdditional Resources:

Signs of Infection and Sepsis at Home (Great Plains QIN)

Sepsis Information Guides (Sepsis Alliance)

Stop Sepsis Tools & Resources (Home Care Association of New York – HCA)

Sepsis – It’s About TIME Infographic (sepsis.org)

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