Your Next Home: A Senior’s Guide to Decluttering and Downsizing

by Janet Campbell, Founder of ElderSpark

April is Occupational Therapy (OT) Month. Occupational therapists are a valuable resource for caring for patients at home. Keeping patients safe at home can be a challenge related to bathing, excessive clutter, unsafe pathways, etc. Leverage your OTs to assist working with patients and families to develop a safety plan to reduce hazards. An HHQI Underserved Population webinar, Compulsive Hoarding for Care Managers, can provide insight with the clinical team addressing barriers, including therapists. Today’s blog provides great insights for you as the reader or to share with patients/families or friends.

movingbox_iconLet’s face it. No move is easy. Whether you’re heading off to college, moving in with a significant other, or upsizing to accommodate your growing family, every move has its own unique set of challenges.

One of the most difficult moves of all, however, is your last. While there are many benefits to downsizing as you age — like lower energy bills, less maintenance, and proximity to your loved ones — the physical and emotional strain of packing up and leaving your family home can be overwhelming. In addition to the memories you will be leaving behind, you’ll likely need to significantly pare down your belongings as well.

While the process of going through a lifetime of possessions will almost always be a painful one, there are things you can do to ease the transition. First, give yourself plenty of time. It took nearly a lifetime to accumulate all those things and, more than likely, it will take longer than you think to go through it.

The earlier you begin preparing for your move, the less stressed you will be. Take it one room at a time, and start in an area where you don’t have a lot of emotional attachment, like the laundry room or linen closet. Spend at least a few seconds on each item before you make your decision. If you begin to feel overwhelmed, feel free to move to another room or take a break until you feel better. You may even want to try meditating to ease your mind, calm your breathing, and remind yourself of your goals.

Next, establish some ground rules regarding what you will keep and what you will toss, donate, or give away. If you can, do this before you begin packing and purging, and let it be your guide as you wade through each drawer, closet, and shelf. One easy-to-implement way of doing this is to ask yourself these four, simple questions about your belongings:

  • Do I need it or want it?
  • Does it have sentimental value?
  • Do I use it often?
  • Do I have another item that performs the same function?

Of course, these rules aren’t hard and fast. It will be up to you to interpret the difference between “want” and “need,” for example. And, as difficult as it may be, lose the guilt. If you don’t need it, want it, or use it, and it has no sentimental value, don’t feel obligated to keep the item. No matter who gifted it to you, how old it is, or whether it has monetary value.

HHQI_Decluttering Image_4.20.18

Image via Redfin.com

Finally, don’t be afraid to ask for help. Friends and family members who are less emotionally invested in your belongings than you can be invaluable helping hands (and hearts) as you declutter. From doing the heavy lifting to sharing memories about your favorite items, they can lighten both the physical and emotional load.

Moreover, having your children and grandchildren involved in the process can help you gain clarity when it comes to legacy gifts. It may be easier to let go of those hand-sewn quilts if you know they will find a loving home in one of your children. Likewise, you may feel relieved to put  that grandfather clock up for sale after you find out none of your heirs want it for their own.

If you don’t have any family nearby or need even more help, there are also companies that specialize in helping seniors simplify prior to a move. For a fee, these professionals can help with every part of the process.

Above all, remember to be kind to yourself. A season of your life is coming to a close and, as is always the case, it takes time to make the transition.

 

Janet Campbell founded ElderSpark to fulfill her mission to encourage people to live their healthiest and happiest lives ever. She strives hard to provide information on senior wellness and safety as well as ideas for how to make the most of this beautiful chapter of our lives.

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The ABCs of Kidney Disease Prevention

Dr. Angie Kurosaka - HHQIby Dr. Angie Kurosaka, DNP, RN, CNN, CCM, NEA-BC, Sr. Vice President of Medical Management, Specialized Markets, a division of Centene Corporation

Benjamin Franklin said, “An ounce of prevention is worth a pound of cure” and that holds true today. The healthcare landscape is rapidly changing, and providers must do more to remain solvent and provide better care. How can providers stay ahead of the industry when dealing with kidney disease? What about patients who have been diagnosed with kidney disease? It is challenging to improve clinical outcomes when patients have so many co-morbid conditions. One way is to prevent or delay the progression of kidney disease into the possible need for kidney function replacement therapy, i.e. dialysis or kidney transplantation.

Kidney disease remains in the top 10 causes of death according to The Centers for Disease Control, CDC (CDC, 2017). The latest from the United States Renal Data Service (USRDS) suggests more than 660,000 people in the U.S. have kidney disease, with more than 450,000 of those on dialysis and approximately 200,000 with a transplant (USRDS, 2017). The USRDS is a national data system that collects, analyzes, and distributes information about chronic kidney disease (CKD) and end-stage renal disease (ESRD) in the U.S.

These are alarming numbers, and each year, millions of people walk around with some form of kidney disease and don’t even know it, which is why healthcare providers and the public should have some awareness of the risks of kidney disease. With so many pressures for providers to close gaps in care (pay for performance) and for patients to take a more active role in their care, I would like to offer a solution.

The ABCs of Kidney Disease Prevention

ABCs_revA is for Advocacy. Advance practice registered nurses (APRNs), nurses, doctors and the public must advocate for themselves or their patients. Advocate for yearly or more frequent check-ups if a primary care provider already exists to assess for any co-morbid conditions that could lead to kidney disease. Collaborate with insurance companies who have access to BIG data and analysis, work with Case Managers or hire your own Home Health Case Managers to help in this endeavor; it can be very successful. Early identification and intervention can delay the progression of kidney disease as well as provide significant cost savings.

B is for Boosting Your Knowledge. There are many websites, journals, books, and resources on kidney disease that offer information on preventing or slowing the progression of the disease. Take advantage of these free resources, and provide education to your patients. If one particular web app doesn’t work for them, perhaps offer a different one. We all have personal preferences; some prefer a more comprehensive app while others may enjoy a one-click type approach. Large dialysis organizations, patient organizations, the American Nephrology Nurses Association, and the Renal Physicians Association can provide an abundance of educational material to use. Government websites offer educational material for healthcare providers, most available for free or at very reasonable prices. March is National Kidney Month, so check out the National Kidney Foundation website for excellent resources. Many of these sites have material that can be printed and shared in the community or directly with patients.

C is for Commitment. We all need reminders and goals for ourselves. A Commitment Plan will help patients and healthcare providers to be successful. Creating a plan with the goal of helping a patient with their “ounce of prevention” is second nature for healthcare providers. I cannot stress enough the importance of collaboration with payers and other providers to develop a comprehensive plan to identify and potentially delay the onset of dialysis or kidney transplant. What better time to do that than now during National Kidney Month and specifically today, March 9, World Kidney Day? There are some great websites with ideas and information for caregivers and patients alike listed below.

Let’s review just how important these little fist-sized organs are to the human body.

  • They filter 200 liters of blood daily. Wow, that is a lot of filtering! Imagine this is the equivalent of about 53 twelve-ounce sodas in a day.
  • They regulate salt, potassium, and acid in the body. Salt and potassium are in so many foods that we consume every day. They are mostly used as preservatives in processed foods. Eating healthy and preparing your own foods can limit the vast amount of salt and potassium intake and will give your kidneys a break.
  • They remove drugs from your body. Many drugs, both prescription and over the counter medications, are filtered out of your body by the kidneys. With all the resistant bacteria, we need equally high-power antibiotics to fight these drug resistant bacterial infections. To do so, we need healthy kidneys.
  • They balance your body fluids. We don’t think about how much liquid we consume every day. The evidence suggests we should drink at least 64oz of water each day. However, there are many things we eat, such as fruit or soup, that have water as well. When our kidneys don’t work properly, this causes fluid overload and can result in an emergency room visit or hospital admission.
  • They keep our bones healthy, and who doesn’t want strong bones?
  • Finally, they help with red blood cell production. Many patients with compromised kidney function are anemic due to lack of red blood cell reduction resulting from their reduced kidney function.

161843047As a Certified Nephrology Nurse and a Certified Case Manager, I am always on the lookout for ways to get my patients involved in their care. Studies have shown that member engagement is a key to success (Greene & Hibbard, 2013). Many start-up companies are offering providers and insurance companies ways to improve member engagement. I, personally, try to live the ABCs of prevention when working with my patients with compromised kidney function.

Suggested Resources:

References

Centers for Disease Control and Prevention (CDC). (2017). Deaths and mortality. Atlanta: Author. Retrieved from  www.cdc.gov/nchs/fastats/deaths.htm.

Greene, J.H. & Hibbard, J. (2013).  Activation:  Better  health outcomes and care experiences; Fewer data on costs. Health Affairs, 32(2). Retrieved from https://www.healthaffairs.org/doi/full/10.1377/hlthaff.2012.1061.

United States Renal Data System (USRDS). (2017). Ann Arbor:  Author. Retrieved from https://www.usrds.org/.

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New Year’s Resolutions & Your Heart

by Misty Kevech, RN Project Coordinator, HHQI

A little over a month ago, many people made New Year’s resolutions such as losing weight, exercising more, and trying to quit smoking. Have you started down the slippery slope of forgetting or giving up on your resolutions? Time to relook at some of your resolutions for your HEART!

clockFebruary is American Heart Month. Why is heart disease still important? Heart disease is the leading cause of death for both men and women resulting in 1 in every 4 deaths in the U.S. each year. Every 40 seconds someone in the U.S. has a heart attack, and each minute someone dies from heart-disease related death. (CDC, 2016)

Clinicians and many patients know the risk factors, but heart disease remains the leading cause of death. According to the CDC (2011) almost half of Americans have one of these key heart disease risk factors:

  • High blood pressure
  • High LDL cholesterol
  • Smoking

How are clinicians working on reducing the incidence and consequences of heart disease?  Educating patients and their families to know the risk factors and which ones can be modified with lifestyle changes or medical interventions. Engaging  patients into their care and assisting with developing a reasonable plan to make changes. Start with small changes. The World Heart Federation® states that CVH diseases can be prevented with behavioral risk factor modifications including:

  • Eat healthy and control weight
  • Exercise and get active
  • Improve hours of sleep
  • Manage cholesterol
  • Monitor blood pressure
  • Reduce diabetes
  • Reduce tobacco use
  • Take essential medications

Making behavioral modifications can be difficult. A simple clinical approach with changes are the 3 A’s.

Ask_Advise_Act

ASK the patient which of the modifications they might be able to work on. Listen to what they are telling and not telling you. Allowing the patient to select the area will begin to engage the patient into their care planning.

ADVISE the patient on different interventions that could be used with the modification topic selected by the patient. This allows the patient to hear options and make a selection of something they feel they could and are willing to try.

ACT or ASSIST allows you to provide small steps the patient could work on building upon successes towards a bigger goal.  Assist patients with tools or tips to be successful or to remember concepts.

This cycle is repeatable as the patient progresses. Always give positive feedback and encouragement. Create change in small obtainable goals will assist with putting new behavior into action. To learn more about the 5 A’s and 3 A’s see the Cardiovascular Health: Part 2 Best Practice Intervention Package (BPIP) pages 71-73.

Research continues to modify guidelines and protocols to improve cardiovascular health. The American College of Cardiology & American Heart Association (ACC/AHA) recently updated their blood pressure management guidelines. The update also provided changes in the classifications of blood pressure.

Categories of BP in Adults*

BP table_HHQI

**Individuals with SBP and DBP in 2 categories should be designated to the higher BP category. BP indicates blood pressure (based on an average of ≥2 careful readings obtained on ≥2 occasions, as detailed in Section 4); DBP, diastolic blood pressure; and SBP systolic blood pressure. (Whelton, et al., 2017)

The updated blood pressure guidelines for ACC/AHA and the American Diabetes Association (ADA) are included in HHQI’s Cardiovascular Health Part 1 – 2018 Update BPIP.

One of HHQI’s focus areas over the past five years has been improving cardiovascular health (CVH) of home health patients. We have created several CVH BPIPs to provide the evidence, information, and resources for home health and other community setting providers. Additionally, HHQI has created many other supporting resources including patient and clinician education materials (e.g., tools, videos, puzzles, etc.); all of which are free and can be used to promote heart disease awareness. Below are some examples that you may want to share with staff, colleagues, and patients to promote heart disease awareness this month.

  • HHQI CVH patient and clinician videos (10 total)
    • 8-12 minutes in length
    • Available to download and saved
      • Complete Resource Library – select the following filters:
        • Topic: Cardiovascular Health (any/all topics) and then Material Type: Video
        • MP4 files can be downloaded and saved on laptops or tablets
      • Or can be viewed from YouTube
      • HHQI materials and information
        • Complete Resource Library – select the following filters:
          • Topic: Cardiovascular Health (any/all topics) and then Audience: Patient OR Nurse, OR Therapist…
        • HHQI University’s Cardiovascular Health Course Catalog offers free courses that include free nursing CEs and a few have PT CCUs
          • Blood Pressure Control and Smoking Cessation (1.5 hr)
          • Cardiovascular Health for At-Risk Populations (2.5 hr)
          • Cholesterol Management: The Good, the Bad & the Ugly (1.25 hr)
          • It’s HHQuitting Time – Help Your Patient Quit Smoking (1 hr)
          • Lifestyle Management for Cardiovascular Health (1 hr)
          • Master the Maze if Blood Pressure Medication (1 hr)
          • Tobacco Effects and Cessation Medications (1 hr)
        • HHQI University’s Home Health Aides Course Catalog offers a CVH course geared to home health aides:
          • Heart Attach & Stroke Risk Factors, Signs & Symptoms (Aides; 1 hr and no CEs)

Make a fresh resolution this month to engage patients, caregivers, your family and friends, and yourself in reducing heart disease risk factors!

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Preparing for Winter Weather: What to Have in Case of Emergency

by: Patricia Sarmiento, writer for Public Health Corps

winterBeing prepared in the event of an emergency is important for anyone, but when you have children, elderly family members, or loved ones who have health issues, it’s especially imperative. When the roads become too difficult to travel, a medical emergency can quickly turn dire for some, so it’s best to be prepared for any event.

Although winter weather means many different things according to which part of the country you live in, it can often mean snow, sleet, ice, and very slippery or even impassable roads. Trees and power lines can come down without warning, interrupting or completely knocking out the electricity, which could leave you and your family in the cold and dark.

Fortunately, there are several simple ways you can prepare your home, your automobile, and your family in the event of a winter weather emergency. Working out a plan and making a few purchases will ensure you have peace of mind when the colder months roll around; read on to find out how to get started.

Stock up

Stocking up on essentials like bottled water, bread, milk, batteries, and toilet paper is an excellent idea, but you might also think about what sort of medical supplies you and your loved ones will need should you be stuck in the house for a while. This includes extra insulin for diabetic individuals, prescription medication, a fully-stocked first aid kit, and even over-the-counter pain reliever. If there are children in the house, make sure you have liquid pain reliever/fever reducer and/or cough medicine, just in case. Winter weather often brings with it nasty forms of illness, and if the streets are too dangerous to drive on, it might be a while before you can get to the doctor. Also, think about keeping a box with gloves, hats, extra coats and long-sleeved shirts, and hand warmers so that everyone will be covered. For some great tips on what to include in your kit, check out this article.

This type of preparation should also include an EpiPen for individuals with severe allergies and even Naloxone, an injectable drug that can treat a narcotic overdose in an emergency situation. Talk to your doctor about its uses, side effects, and the pros and cons. For more information on how to handle this and other drug emergencies, click here.

Think about outdoor needs

Supplying your home with canned goods, water, and medicine is the first step in preparing for heavy winter weather; the next is to ensure the outside is good to go as well. This means stocking up on firewood if you have a fireplace, making sure all outside pipes are either insulated or turned completely off so they don’t freeze and burst, and laying aside rock salt, a good shovel and warm gloves, antifreeze, and sandbags for traction if your driveway is steep. If there’s an emergency and the roads are passable, you’ll want to make sure you can get out of your home.

Speaking of those roads…

Your car is the next thing on the list. Make sure it’s in good shape and has plenty of gas at all times. Take it in to have the fluids topped off, the wipers and tires checked, and the oil changed. In the trunk, keep blankets (you can buy foil emergency blankets that will fold down pretty small), a jug of water, a heavy-duty flashlight with extra batteries, a cell phone charger, a small box of snacks such as granola bars and cheese crackers, and road flares. Going out during a storm is not advisable, but if you have an emergency and feel you have no choice, it’s best to be prepared for any situation.

Winter weather is no joke, especially in states where snowfall can amount to several feet very quickly. Map out a plan of evacuation and talk to your family about where to meet in case anyone gets separated. Making sure everyone is on the same page will not only give you peace of mind, it will keep everyone safe in the event of an emergency.

 

Author

Patricia Sarmiento is a writer for Public Health Corps. She played sports in high school and college and continues to make living an active lifestyle a goal for herself and her family.

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Food Banks: Thinking Outside of the Box

by Jodi Gatts, Administrator of Healthy Habits Training Center at Greater Washington County Food Bank

grocery bagFundamental Needs

Food banking as we know it today started with a Phoenix man, John Van Henge, in the 1960’s. He saw a need, developed a plan to rescue food from area grocery stores, and started an organization that is unfortunately still needed today.

One might find themselves in a line for food because of many different reasons – loss of a job, fire, illness, loss of a loved one. A lot of people are only one paycheck away from needing the support of their local food bank. And it is a big undertaking trying to provide a supplemental food box that is shelf stable, nutritious and delicious for the hungry people in our neighborhood.

Regional food banks can offer unique services to support the needs of their communities. Members of the leadership team and staff often think out of the box to try to offer resources, education, skills labs, and opportunities to meet local needs. These services supplement the food boxes and take the willingness of professionals to share their expertise.

Food Bank_Greater Washington CtyGreater Washington County Food Bank (GWCFB), located  in southwestern Pennsylvania, is able to get food to deserving families all over Washington County thanks to federal and state programs. We also have the capability of stretching our dollars farther than the average consumer. For every dollar we receive in monetary donations, we can stretch that dollar to five. That gives us 5 times the buying power! GWCFB delivered more than 2 million pounds of food in 2016-17 fiscal year. More than 33,000 families visited our food pantry locations. Also, thanks to partnerships with Walmart and Sam’s Club, we are also sending fresh produce, meats and bakery to our clients.

Low-income seniors can benefit from the Commodity Supplemental Food Program (CSFP), a federal program administered by the USDA. Qualifying clients over the age of 60 can receive a supplemental box. Produce to People is a once a month distribution of fresh produce that works alongside of the food bank. Each family receives on average 35-45 pounds of extra food and they can go to more than one location per month unlike the food pantries where they can only receive food from one pantry a month.

Innovation

GWCFB recently moved to a new location in Washington County which was 10 miles from our previous location at a retail store with an attached warehouse. GWCFB purchased this building and began construction on their vision of “more than food.” Through grants from Walmart and UPMC, a training center was built consisting of two residential training kitchens and a classroom area with desks, chairs, a smart TV and 10 laptops. Classes are being offered on subjects such as finance, computers, extreme couponing, how to use essential oils, gardening classes, cooking and nutritional classes. These classes are free to attend for our food pantry clients and a nominal donation is asked of non-pantry clients. In the retail section of this building we opened a thrift store. Country Thrift Market is where our pantry clients and the community can purchase clothes, furniture, household items, jewelry, some snack items, and new health and beauty items for a fraction of the cost. All the proceeds from the Country Thrift Market support the Food Bank so we can continue to deliver food to our 49 pantries sites.

tomatoesOur new building sits on 22 acres of old farmland. We are working with the local university to get interns that can help us create a working farm. We have started with a few raised beds and 70 fruit trees that were donated by The Fruit Tree Foundation of Pittsburgh, PA. We envision traditional row crops of tomatoes, peppers, corn, pumpkins and squash. Having fresh produce grown on-site will enable us to save money in gasoline, will cut down on exhaust emissions and will be providing healthy produce to our pantry clients. It will also give the pantry clients an opportunity to give something back by volunteering in the gardens. The knowledge they will gain by helping on the farm can be used at their homes and communities to start gardens for their families and neighbors. Expanding green space in cities and suburban spaces has proven to be spiritually uplifting, and good for the body and soul. We also have plans for the “future” farm. Shipping containers can be turned into hydroponic gardens that will yield as much produce in a 20’ x 40’ space as farming two acres. We are also working with a local school district that has one of these onsite, to engineer 2 to 4 shipping containers to put in production on our back lot. 1500 heads of lettuce can be harvested each week out of one container. Local restaurants have already shown interest in buying from us which will help them promote “fresh, local foods.”

We feel we are providing a well-rounded experience to those willing to come learn and participate in our programs. Starting at ground level, participants are working the soil, planting, growing, bringing the harvest in to cook and preserve, and then taking the biodegradables back outside to feed the soil. GWCFB has adopted a saying, “It takes more than food.” We believe it also takes knowledge. Our vision for the future includes workshops, classes and teaching opportunities, as well as to continue to provide healthy and delicious supplemental foods to the residents of Washington County.

Involvement

It is critical to make appropriate patient referrals to food banks but there may be programs the patient or family members would benefit from as well.

So what is happening at your local food bank? How can you get involve individually or as an organization? Do you have a skill or hobby you would like to share with your neighbors? You can make a difference!

HHQI Resource:  Heart-Healthy Boxes for Food Banks

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Is Diabetes Your Destiny? It’s Not the Native American’s!

Promoting self-empowerment and change through healthy choices and policies.

Susan Gay_Nov2017by Susan Gay, M.A.Ed., CHES., public health training coordinator, Southern Plains Tribal Health Board

You may already know that some racial/ethnic groups have higher rates of diabetes. This is true for Native Americans who have the highest prevalence (existing cases) of diagnosed diabetes among racial/ethnic groups in the United States. What you may not hear often though, are the personal stories of those with diabetes. Travel with me to a small town in Indian Country (Oklahoma), meet Karen, and listen as she shares the story of her journey with type 2 diabetes.

“It’s been five years since I was diagnosed with diabetes. When I found out that I had it, I was devastated and scared. I couldn’t believe it. I remember feeling sad for a few months, but things got better when I talked to friends that had it and they helped me learn more about it,” shared Karen. When I asked her if she felt she was going to get diabetes because she is Native American, she replied, “I knew I might be at higher risk because a lot of the women in my family have it, and I tried to be more active.”

healthy food_asparagusShe also shared, “I have the information and resources I need to successfully manage my diabetes. In the beginning, I learned a lot from other people I knew that had diabetes, like my mom and friends. I started asking my doctor more questions and met with the diabetes program at our clinic and learned more about what diabetes is and what foods to eat. It was really hard to balance my life with diabetes sometimes, but I saw my A1C [a blood test for type 2 diabetes and prediabetes] go from an 11 to a 5.9 and stay there just by sticking with a few healthy changes. I felt better physically and emotionally.” She continued, “Now, to control my diabetes, I watch what I eat a lot more and make sure to take my meds and schedule my doctor checkups. I stopped eating most foods with added sugar and the “white stuff” like white bread, white pasta, and cut back on potatoes.”

She ended by sharing some advice, “Always get your blood sugar checked every year and ask your doctor lots of questions. Talk with other people who have diabetes and see what worked for them. Stick to eating more fresh foods like fruits, veggies, meats, nuts and seeds. I usually pack carrots, a piece of fruit, and some peanuts with me when I’m on the go because sometimes it can be hard to find healthy foods.”

I shared Karen’s story because putting a face to a disease helps us to better understand its impact. It may also encourage those struggling with similar issues. Here are some points resulting from Karen’s story:

  • After finding out that she had diabetes and feeling sad for a few months, she began to seek out information from her doctor and others with the disease by asking. It is important for people to empower themselves with the knowledge, skills, and resources to be able to manage their health condition.
  • They should see themselves as the most important person on their healthcare team, even ahead of their doctor.  They know the symptoms of their disease, how they feel, what works for them and what doesn’t, and thus, are in a better position to engage with their doctor who they may only see once a month.
  • Karen took responsibility for her own health and began making decisions that would help her manage. She made changes in her food choices by choosing healthier options. As a result, she saw a huge improvement in her A1C levels. This in turn affected how she felt physically and emotionally and likely increased her self-confidence in her ability to manage the disease.

What Karen did in taking responsibility for her health is called the individual level in health behavior change. This level has to do with a person’s knowledge, motivation, ability to act, and norms. The individual level is where most health care professionals focus in behavior change. Although it is important that people take the necessary steps to improve their health, it is not the only level that affects health outcomes. Good health depends on many things. Some of these things are:

  • Climate and Environment – Are people able to breathe clean air when they are physically active outside?
  • Neighborhoods – Do children and their families live in safe neighborhoods where they can walk to and from school, or do they fear getting shot or seeing criminal activity on the street corner? Are there parks, sidewalks, cross walks, and other areas where the community can be physically active?
  • Food & Nutrition – Do communities have access to the foods that contribute to good health, such as fresh fruits and vegetables, or are they surrounded by fast food restaurants that make calorie-dense foods more available?
  • Income – Do people with chronic diseases like diabetes make enough money to avoid having to choose between buying wholesome food, paying rent, or taking care of other family expenses?
  • Health Care – Are people with diabetes able to afford health insurance and other health care costs? Do they have to choose between medical expenses and other necessities such as food, housing, transport, and clothing?

American IndianThese are all important things to consider because they all affect health. In other words, health is also affected at the social environmental level (family, friends, social networks), the organizational and community levels (organizations, institutions services, products, leadership, etc.), and the public policy level (national, state, and local laws, economics, natural environment, etc.). These factors affect Native Americans.

Karen recognized that she was at greater risk for diabetes because it was in her family. She made a step towards being more physically active. After she developed diabetes, she took other steps such as changing the way she ate, which significantly reduced her glucose.

There is an important lesson here; though genetically Native Americans and some other races and ethnicities may be at greater risk for diabetes, it doesn’t mean that they must develop it. Taking a fatalistic or a “no-matter-what-I-do-I-will-eventually-get-diabetes” approach will most likely lead to a lack of self-empowerment in making healthy choices and changes. There is growing evidence to suggest that lifestyle behaviors such as inactivity and diet play a greater role than genes in developing diseases like diabetes.

Karen also took advantage of the resources that were available to help her manage diabetes, such as her tribe’s diabetes program.

Programs such as the Special Diabetes Program for Indians, the National Diabetes Prevention Program, and diabetes self-management education help people at risk for diabetes and those with diabetes by providing them with knowledge, resources, and skills that can either prevent them from getting diabetes or help them manage it. Both prevention and management are crucial to preventing diabetes-related complications.

Here’s what you can do:

If you have diabetes, empower yourself, ask questions, and advocate for your own health. If you are a health care professional, a community leader, a politician, or just have an interest in public health, think about health conditions like diabetes using a comprehensive approach that focuses on all levels, as previously mentioned. Advocate for a health-in-all-policies approach that seeks to deal with health issues upstream through policies and strategies that focus on prevention and not merely treatment and rehabilitation. Let’s work together to make the healthy choice the easy choice for all. Is diabetes your destiny? It’s not the Native American’s!

November Health Observances:

  • American Diabetes Month
  • Native American Heritage Month

southern plains  oklahoma area

 

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A New Appreciation for Physical Therapy’s Role in Rehab

by Misty Kevech, HHQI RN Project Coordinator

Carer Helping Senior Man With Walking FrameHHQI would like to specifically thank all physical therapists (PTs) and assistants (PTAs) in honor of National Physical Therapy Month (#ChoosePT). In home health, physical therapists are valuable interdisciplinary team members that provide care to more than orthopedic or mobility issue patients. Physical therapists can assist with disease management, such as heart failure, by improving the patient’s strength and endurance to allow for a higher quality of life.

I have been very fortunate to have worked or partnered with a great number of amazing and caring physical therapists from clinical to administrative settings over the years. Often home health agencies don’t utilize therapists to their full scope of practice, or clinicians work in silos of care vs. an integrated system. But I have worked with organizations that embrace the value of therapists as wound care specialists, educators, quality improvement experts, and as leaders. Integration of therapists into an active care management team goes way beyond interdisciplinary team (IDT) reports via email or phone; it is creating a true interdisciplinary care team.

Therapists come to the table with the perspective of evidence-based practices, objective measurement, goal setting, and a plan-of-care focused approach. Those skill sets are critical in our evolving healthcare environment to improve the quality of care, increase patient satisfaction, and to reduce costs (Triple Aim concept).

Primarily my experiences and partnerships with physical therapists have been in the home health setting. Recently, I was able to experience therapy from a patient’s perspective. I put off having knee replacement surgery as long as I could, but this summer, I could not put it off any longer. I was not worried about the procedure as much as how the process was going to affect my life and job during the rehab process. What surprised me the most was how much I learned during this process.

I really did not have much experience with a total knee replacement beyond doing the start of care, medication/pain/incision care education, and the removal of the staples. I have reviewed many knee/hip replacement patient records for quality improvement but did not understand the post-op process for a total knee from the lens of a patient.

My patient journey started with a pre-op class at the hospital which was taught by a nurse and a therapist. I was thrilled to see evidence-based practices integrated into the acute and post-acute care plans. I learned not just how to perform the pre-op exercises but why they were important for the success of my rehab. The therapists said that it would be very obvious to identify who did and who did not do the pre-op exercises (that was so true). We were provided with detailed information on what to expect with therapy, evidence-based practices, goals, and hospital mile markers toward discharge. A home assessment was completed weeks prior to surgery so that needs were identified early and strategies could be in place to facilitate a good transition home.

As a patient, it was reassuring to know what was expected and planned. The planned goal for the day of surgery was to walk to the door of my room. That did not sound so bad during class – and it really was not bad at all. In fact, I did really well and was able to walk down the hall. The rehab team had a mile marker magnetic board with a tennis shoe magnet for each patient to track distances, which was a great idea for a visual to get to the ambulation goal for discharge. So I was off and running! I participated in group therapy the next morning and found it to be very beneficial. Other patients shared previous experiences or tips for doing the exercises at home. Because my therapist recommended an early discharge for me, the team worked efficiently to obtain discharge orders and make an earlier outpatient appointment.

physical therapyMy outpatient therapy experience was great. The PTs and PTAs worked hand-in-hand to adjust my therapy, attend to my medical needs, answer my many questions, and encourage me toward my goals. I watched other patients who were similar to our home health population as they progressed through their rehab. The therapists guided and encouraged these patients with a caring attitude.

This year, National Physical Therapy Month is more meaningful to me. I have a higher appreciation of what all therapists do, no matter the setting.

HHQI would like to thanks all the therapists that we’ve had the pleasure to work with over the past 10 years. We would also like to share some great resources related to expanding the role of the physical therapists within their scope of practice.

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