The Struggles and Rewards of Being a Caregiver to a Loved One with Alzheimer’s

by Misty Kevech, RN, MS, HHQI RN Project Coordinator

June is the National Alzheimer’s and Brain Awareness Month. The Alzheimer’s Association also celebrates June 21st as the “Longest Day” which is about love – “Love for all those affected by Alzheimer’s disease.” Alzheimer’s is the most common form of dementia.

A study just released in May by the Centers for Disease Control and Prevention (CDC) indicates that the incidence of Alzheimer’s disease is rising as well as the death rates (55% increase). The large Baby Boomer generation is one of the reasons for the increase in disease, because age is the greatest risk factor for Alzheimer’s. Additionally, the burden of caregiving falls heavily on loved ones.

As healthcare clinicians, we provide or coordinate care for patients with dementia. Many of us also are either a caregiver or know someone personally that is caring for their loved one with dementia. It hits close to home, but we really don’t know the struggles or the joys of caregiving for a person with dementia until we have walked in those shoes.

I had the pleasure of visiting with a nurse of 36 years to discuss her story of caregiving. While she was happy to share her story, she and her family wished to remain anonymous. For the sake of the story, I will refer to the nurse as Sara and to her mother as Marie.

Marie began to develop signs of dementia at about the age of 65. The disease began at a slow progression until the age of 78 when it became clear she could not be alone all day. Marie’s sister moved in to help care for her for two years prior to Marie’s husband’s death, and she stayed on for several more years. Sara and her brother worked together to make it work.

Eventually, Sara moved in with her mother when her aunt relocated to another state and enlisted the help of private caregivers and outside agencies to supplement care. In 2011, Marie developed some serious health issues which advanced her dementia, and her physician said she could no longer be left alone. Later that year, Sara had made the decision to quit her job so that she could care for her mother full-time until they had her PDA Waiver in place, noting that the cost of private caregiving is quite expensive. Sara and her brother enrolled their mother in adult daycare in an effort to provide their mom with socialization and functional activities in a safe environment which allowed some respite for the family. Marie was always happy when she returned home from the daycare, even if she couldn’t say what her day was like.

There was still a huge burden on the family in coordinating Marie’s care, locating and enrolling her into the adult day care, determining how and when to use caregivers in the home, as well as managing her finances and medical conditions. In Fall  2012, the PDA Waiver was finalized and the family began using the adult daycare and caregiving agency for Marie on a more regular basis. Unfortunately, in early 2013 Marie had another serious illness and was frequently hospitalized. This led to another sharp decline in her mental status. When these types of declines occur, there is no return to a baseline. Nevertheless, Sara decided to return to work part-time that Fall. A year later, the medical problems exacerbated, and Sara was often called away from her job when her mother would become ill at daycare and be sent to the emergency department. As Marie’s dementia and health continued to decline, she was no longer a candidate for daycare, and the painful decision to place her in a nursing home was made. She is now very settled in the dementia care unit of a local skilled facility, and her family members visit frequently.

The emotions of caregiving ranged from anger to sadness to depression. The sadness Sara and her brother experienced included the feeling of losing the mother they loved and enjoyed being around. Turning a loved one’s care over to strangers is also a very difficult thing to endure. Looking back, Sara definitely agrees that she did have symptoms of depression while she was caring for her mom, but she didn’t worry about herself because her focus was always centered on caring for her mom. She missed her own physician appointments and didn’t address any of her own health needs. We know this often happens with caregivers but don’t think it will happen to us, especially since we are healthcare clinicians.

One of the surprising aspects of Marie’s disease was the toll that medical complications took on the progress of the dementia. The result of that lengthy 2011 medical hospitalization was clostridium difficile (C.Diff) infections which led to sepsis. Marie’s memory significantly declined during those months of infection and never returned. Caregiving needs increased during this time, but because she was contagious, external caregivers were remiss to continue their services.

In some ways, as the cognitive status declined, some aspects of care became easier. No more fighting over what clothes to wear, or where this goes, or how to use that. Sara’s mother not only listened to what she said, but looked to her for any suggestions and for all the answers that her mind could not provide. Marie’s sleep patterns were fairly good, but for safety reasons, it became necessary to sleep with her, which resulted in Sara not getting a good night of sleep for years. But that was ok – it was all for her mother and it was what she wanted to do, not what she had to do.

This past fall, after recurrent urinary tract infections (UTIs), Marie’s care became too much and a decision was made to place her with the help of an excellent social worker. One of the reason’s the social worker was so attuned to the needs of people with dementia is that she was caring for her own mother with the disease. It was the right thing to do, and the right time.

Sara’s father told her before he died, “Don’t lose your mother.” Her aunt told her that no one should ever pressure their children to promise never to put their loved one in a nursing home. She understood what a hard decision it is for family to make and felt that the burden of breaking a promise just compounded that tough situation.

Sara’s mother is now in a dementia care unit in that nursing home, and she seems happy there. While her functional status has declined, she is surprisingly well cared for and safe. Marie is followed by a geriatrician who has completely stabilized her medical condition of recurrent UTIs.

Sara is now working full-time and is enjoying her work in home health care. She is getting her life back in order and regularly visits her mom. One thing she has found is that there are always little things related to her mother’s care that she needs to handle as she remains her mother’s primary caretaker. Marie enjoys manicures, pedicures, facials, walks, being read to, and laughing at everything, even if neither knows what they are laughing about!

I asked Sara what she thought was the best part of caring for her mother. She said, “It has been my honor to care for my mother, and to pay her back for everything that I put her through when I was growing up. It has made me appreciate how caring for someone so disabled can actually bring one great joy and peace of mind and heart. I felt strongly that I was meant to care for her, and that I should not run from it, but embrace it. I do not regret it for one minute and feel so grateful she is still here. I am so thankful that we are able to have our moments of recognition and happiness together for what is left of her years on earth.”

HHQI wants to thank Sara and her family for their willingness to openly share their story. We also want to thank everyone who shoulders the tough but rewarding role of being a caregiver for their loved ones. We hope that this story will help you to support patient families who are caregivers, as well as yourself or someone in your family that serves as a caregiver.

HHQI University has a course, Meeting the Needs of Caregivers and Care-Receivers, which includes excellent webinars related to Alzheimer’s disease and caregiving. Three hours of nursing CEs are available for successfully completing this course.


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5 Tips and Tricks for Managing Your Medications This Summer

by Michaela E. Leffler, Pharm.D., BCPS, BCGP, Assistant Professor, Pharmacy Practice Department, University of Charleston School of Pharmacy, Charleston, WV

As the busy summer months are approaching, keeping your health and well-being as a top priority is as important as ever. Between spending time outdoors, enjoying the warm weather, and grilling out with family and friends, the last thing anyone wants to worry about is health problems due to mismanaged medications. So here are a few tips and tricks to make managing your medications and health conditions easy with only a small time commitment. By following these simple suggestions, I hope you can keep your body in tip-top shape so you have time and energy to make many wonderful memories this summer!

  1. Use a Pill Box

As a pharmacist, one of the most difficult things I see patients struggle with is figuring out how to take all the medications they are prescribed. Remembering to take medications on time and at the right time can be very difficult when managing multiple medications that sometimes need to be taken more than once per day. One of the most useful tools, and one that I recommend to all my patients, is a multiple compartment pill box. I recommend a pill box that has a section for morning and night medications on every day of the week. If you take some medications in the afternoon, they even sell pill boxes that have three sections for each day of the week. Spend some time every weekend filling your box with the appropriate medications in the morning, afternoon or evening boxes. If you are the type of person that travels around town on a regular basis, get a small individual pill box that will easily fit in your hand bag, wallet or pocket. This way you can take your pills out of your weekly pill box and take them with you on the go. Pill boxes eliminate the need to open multiple pill bottles a day and will put an end to the “Did I remember to take my pills this morning?” question. These pill boxes can be found online by searching for “three times a day pill organizer”, or you can find them at your local pharmacy.

  1. Get into a Routine

Working a designated time to take medications into your daily routine is a great way to reduce the number of medication doses that are forgotten. One way to do this is to associate taking medications with a certain task that you complete at around the same time each day. Some examples include times such as when you are eating meals, brushing your teeth or feeding pets. Additionally, if you find yourself leaving the house for the afternoon or evening, find a way to remind yourself to take your next dose of medications with you. You can do this by storing medications in an area you will pass on the way out of the door or by leaving yourself a reminder note. Medications that are only taken once weekly or once monthly, such as some medications prescribed to increase bone density, can be associated with an event that usually happens once a week  Some examples of these types of activities include going to a church service, grocery shopping or a recurring gathering such as a club or workout class. Another helpful tool in creating a routine is setting alarms to help you remember to take medications. Set alarms on a device such as your cellphone to remind you to take medications at the same times each day.

  1. Know Your Meds & Ask Questions

Try your best to know your medications. I have encountered many patients who blindly take their medications simply because their doctor says that they should. I encourage every person who takes a medication to approach their health, wellbeing, and medical care from a team approach in which the patient, nurse, pharmacist, and physician work together with a common goal. As the patient, your job is to know your medications by name and strength. Also know what the medication is used to treat, how you need to take it, and a few of the major side effects that the medication can cause. If you are left feeling confused after a doctor’s visit or a trip to the pharmacy, then pick up the phone and call. Ask all the questions you need to be answered. Your healthcare professionals are there to help you understand your healthcare and medications better. As a pharmacist, I know that I truly enjoy teaching patients about their medications when they express genuine interest and want to know how to best take care of themselves.

  1. Record Measurements

Some medications and disease states require frequent monitoring to appropriately adjust medication doses and regimens. It is very helpful when patients complete regular monitoring at home and write down results to bring to office visits. For example, when taking medications for high blood pressure, it is useful to have daily blood pressure readings logged or when taking medications for diabetes it is helpful to have consistently timed daily blood glucose readings. There are many other scenarios in which it is helpful for patients to monitor at home so that the physician, pharmacist, nurse, or other health care professional can tailor the medication regimen to the patient. Next time you go to an appointment, be sure to ask your health care professionals how you can help them monitor from home!

  1. Listen to Your Body

A final bit of advice is to make sure you always listen to your body. It is easy to ignore signs and symptoms of poor health when life is busy, but it is often true that the longer you wait the more potential damage done to the body. If something does not feel right, pick up the phone and make an appointment today. Don’t wait!

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Happy Nurses Week!

by Misty Kevech, RN, MS, HHQI RN Project Coordinator

National Nurses Week begins each year on May 6 and ends on May 12, Florence Nightingale’s birthday. The American Nurses Association’s (ANA) theme this year is “Nursing: The Balance of Mind, Body, and Spirit.

The ANA’s theme hopes to encourage nurses to expand their learning to increase their resilience and reignite their nursing heart and soul. It also aims to help nurses identify and manage compassion fatigue, moral distress and burnout.

Below are a few questions for you to think about:

  • What inspired you to become a nurse?
    • Many nurses state to help other people, but what was your motivation?
  • What are the two most difficult challenges you have with your nursing role now?
    • Okay, getting it down to two is hard.
  • Is there something you could do to try to address one or even a part of one of the hardest challenges you have?
    • This takes thought and perseverance. When you have a difficult situation for a patient, you get creative and keep adapting. Apply that principle to yourself.
    • Consider writing down issues and ideas.
  • How do you handle the frequent high stress level?
    • Think about both positives (e.g., take a walk, do something fun) and negatives (e.g., snack, vent at home)
  • So what do you do for fun for yourself? Not your family, but for YOU?
    • Hopefully you don’t have to think about this too long.
    • What makes you feel good?
  • What is something that you can do to improve YOUR health (not your patient’s health)?
    • Make this something simple and share with a co-worker to keep yourself accountable.
    • Think SMART Goals (like we teach our patients):
      • Specific (simple, sensible, significant).
      • Measurable (meaningful, motivating).
      • Achievable (agreed, attainable).
      • Relevant (reasonable, realistic and resourced, results-based).
      • Time bound (time-based, time limited, time/cost limited, timely, time-sensitive). (

Celebrate this year’s National Nurses Week thinking about yourself as a nurse and a person. Develop a plan to keep your mind, body, and spirit health and well!

The Home Health Quality Improvement (HHQI) National Campaign thanks you for the great work you do every day for patients across this country and the role you are playing with healthcare quality improvement.

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Bridging Health Equities Across Communities Begins with You

by Misty Kevech, RN, MS, HHQI RN Project Coordinator

April is National Minority Health Month and this year’s theme is “Bridging Health Equities Across Communities.” The Office of Minority Health (OMH) selected this theme in an effort to promote awareness on issues impacting health disparities and health equity.

The U.S. Department of Health and Human Services (HHS) continues to track and support strategies to improve health equity across all healthcare settings and in the community. The original National Quality Strategy was published in March 2011 by Agency for Healthcare Research and Quality (AHRQ) & HHS. There are three overarching aims that build upon the Institutes for Healthcare Improvement’s Triple Aim®.

  • Better Care: Improve the overall quality of healthcare by making it more patient-centered, reliable, accessible, and safe.
  • Healthy People/Healthy Communities: Improve the health of the U.S. population by supporting proven interventions to address behavioral, social and, environmental determinants of health in addition to delivering higher-quality care.
  • Affordable Care: Reduce the cost of quality healthcare for individuals, families, employers, and government.

(AHRQ, 2017)

AHRQ’s 2015 National Healthcare Quality and Disparities Report and 5th Anniversary Update on the National Quality Strategy report indicates progress is being made, but disparities persist.

HHQI’s Underserved Population (UP) Network focuses on the following groups:

  • Health Disparities (e.g., racial/ethnic, socioeconomic status, health literacy, etc.)
  • Small Home Health Agencies
  • Underserved Populations (e.g., regions, urban vs. rural, etc.)
  • Dual-Eligible Patients (eligible for Medicare & Medicaid)

HHQI provides home health and other healthcare organizations a variety of education, information, tools, resources, and networking opportunities.

Join the movement to Bridging Health Equities Across Communities and join the Education & Networking Opportunities email list.

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Patient Safety – It’s what we do!

by Tina Hilmas, RN, BSN, Project Manager, Center for Patient Safety

Patient Safety Awareness Week is coming up March 12-18 and I’m always excited during this time of the year. You see, patient safety seems so simple yet is so complex and I could literally spend hours talking about it. But what I’d really like to do is intrigue you into becoming as excited about patient safety and patient safety culture as I am. The analogy that comes to mind for me is that of an onion. When you peel away the layers of an onion, you are left with the heart of the onion, or rather the core. The same is true with patient safety. As you begin to peel away the actions of an organization and look underneath at the rationales for those actions, you find the underlying beliefs of an organization, the foundation, the culture regarding Patient Safety and that is where a journey of patient safety must begin.

As a nurse, it seems like patient safety should be ingrained into our daily actions. After all, aren’t nurses supposed to promote, advocate for and protect the rights, health and safety of our patients? But can we honestly say that we have always, in every situation, put the safety of the patient first? How about that day where you were being called for one start of care after another? Or that day when you’d been on call, received multiple calls throughout the night, and began seeing patients the next day with little to no sleep? Were your first thoughts truly of patient safety or more on just how you could keep your head above water with all the visits you needed to complete? More importantly, does your organization have built in safety guards to help protect the safety of your patients?  Does your organization promote a strong patient safety culture?

You see, patient safety is more than just the National Patient Safety Goals (NSPG) of the year. Patient safety is a combination of technical change and adaptive change and it never stops. It’s not something that is “achieved” rather it is an aspect of your organization’s culture and therefore ongoing. Culture, as it pertains to an organization, is defined as a way of thinking, behaving, or working. Safety culture can be defined as the following:

“The safety culture of an organization is the product of individual and group values, attitudes, perceptions, competencies, and patterns of behavior that determine the commitment to, and the style and proficiency of, an organization’s health and safety management.” (Health and Safety Commission Advisory Committee on the Safety of Nuclear Installations, 1993; adapted by AHRQ)

So to break it up, the technical change aspect is focused on those NPSG’s – developing processes and policies for fall prevention, medication education and identification of the patient. The adaptive component of culture is the leadership component, the systems component and looking deeply at human factors engineering. Some nurses have called this the “touchy-feely” part of nursing because it deals not only with processes, but also the on-going evaluation of the organization’s behavior, from leadership all the way down to the home health aide, in regards to a specific item, the heart of the onion – patient safety culture.

So where do we begin this journey? Evaluate your organization’s culture, not just employee engagement, to actually look at how the employees within your organization feel about the organization’s commitment to safety. Look at your processes and what happens when a mistake is made. Is there an investigation or Root Cause Analysis of the event including not just the outcome of the mistake, but review of the system, including policies, and contributing factors? Is there a tendency to discipline or maybe terminate the employee responsible for the mistake with the reason being, if you eliminate the person responsible then the problem is solved? Do the employees in your organization feel comfortable admitting to near mistakes, mistakes that resulted in no harm, or pointing out unsafe conditions? If so, keep up the awesome job! If not, ask why? Is it because of the culture? Does everyone just keep their head down and try to sweep mistakes that didn’t result in harm under the rug? Surveys, such as the Survey on Patient Safety, can help leaders visualize where their organization is on the culture scale. It also allows for identifying a starting point for change.

When trying to change there are multiple frameworks that can be reviewed because change is hard and threatening. In organizations that have success in promoting a strong patient safety culture, there is one factor in common, it all starts with leadership. The leaders have to show that patient safety is a priority and part of the mission of their organization. The leaders should engage with their personnel on a daily basis and they should incorporate patient safety as part of their daily routine. Patient safety will only become a priority when it is incorporated and embedded into everyone’s daily routines.

But in focusing on patient safety, leaders shouldn’t lose sight of their most valuable asset – their employees. Employees need to feel supported and invested in by their leaders. This is where leaders and organizations should ensure they have a strong Employee Assistance Program, but maybe should also look into other supportive programs such as Second Victims. This program trains the staff on how to support a fellow employee who may have been involved in an adverse event. In home care and hospice, this is something that could help not just if an adverse event occurs, but also if a long-term patient expires. Even if it was expected in hospice and home care, relationships develop between the health care team and the patient; a Second Victims Program can help to provide the support needed to those involved in the care of a long-term patient who passes.

So hopefully, I’ve helped you to see why I’m so passionate about Patient Safety.  It isn’t just the technical or the top layer of the onion, but the whole onion, the heart and core that I enjoy dealing with to make certain it is strong, healthy and sweet.

Don’t Miss HHQI’s Next Underserved Populations (UP) Network Webinar

Patient Safety: All in a Day’s Work! – Thursday, April 20, 2017,  2:00 p.m. ET

Ready to learn more about patient safety? Join Ms. Tina Hilmas, RN, BSN and the HHQI team for the next Underserved Populations (UP) Network webinar. During this webinar, you will learn how to begin preparing a Quality Assurance & Performance Improvement (QAPI) plan related to patient safety that will be required by all home health agencies. This will be a 2-hour interactive event that will include work on a QAPI plan. Register Here

About Our Guest Blogger – Tina Hilmas, RN, BSN

Ms. Hilmas has spent more than 20 years in the nursing profession both within hospital walls and outside in the home care arena. Her current work includes collaborating on quality improvement projects that include incorporating a strong patient safety culture. She also reviews patient safety events reported to the Center to analyze for trends and causal factors to assist organizations with changing their culture and improving patient safety.

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The Super Bowl of Super Foods

by Lacy Davidson, MS, RDN, LD, CDE, RYT, Nourish Appalachia

2-3-17_lacy-davidsonGearing up for the big game? I have to admit, at the very moment I’m writing this I have absolutely no idea which teams are even playing in Sunday’s game. I know my brothers would be so proud! At any rate, Super Bowl Sunday has ALWAYS been a part of my life. There have been many years when the big game fell on my birthday, or often times my birthday party was held on the same day. What a great way to kill two birds with one stone, mom!

Recently, a patient asked me what sorts of foods and snacks I might be serving up this year on Super Bowl Sunday. Being a Registered Dietitian Nutritionist, I get these questions quite often, WHICH I LOVE!

You can also submit questions for me to answer by going here and select ‘get started’.

As a child, and nearly every adult year I recall, the foods that are most synonymous with Super Bowl Sunday, besides the birthday cake and ice cream, are chili and nachos with cheese.

As I have grown more health conscience over the years and am aware of the relationship between food and health, the recipes for these ‘holiday’ staples have evolved. For many years, the chili was vegan (err, I was a broke college student and beans were cheap – heart healthy, too). While other years it may have been made with ground turkey, grass-fed beef or my personal favorite, venison!

Soup-er Bowl 2017 will in some ways most closely resemble the way I first noshed on this warm and spicy dish, however this year the menu will be dressed up with a few super food add-ins to tickle the taste buds and stoke the metabolic fire.

Here’s the recipe for this delicious chili dish if you’d like to try your hand.


  • 2 tablespoons olive oil
  • 1 ½ pounds ground venison (deer meat)
  • 1 ½ cups finely chopped onions
  • 1 ½ cups finely chopped celery and carrot
  • 1 ½ tablespoons finely minced garlic cloves
  • 1 cup red wine (and an ounce or so for the chef to enjoy all the commercials)
  • 2 tablespoons ground cumin
  • 2 tablespoons chili powder (we add a pinch of dried habanero or jalapeno, from the garden for a little more heat)
  • 1 tablespoon cinnamon (yes, cinnamon)
  • 2 bay leaves
  • 2 cups frozen corn kernels from the summer harvest
  • 1 cup roasted green peppers, peeled, seeded & chopped into medium dice
  • 1 cup roasted red peppers, peeled, seeded & chopped into medium dice
  • 1- 2 quarts organic canned tomatoes
  • 1 small can organic tomato paste
  • 1 ½- 3 cups dried beans (I prefer a blend of kidney, pinto, and black – soaked and drained at least 36 hours – the key to not blowing everyone away at halftime if you know what I mean!)
  • 2 tablespoons coco powder
  • ½ cup left over coffee
  • 2 tablespoons maple syrup
  • Salt and pepper


Serves 12

Total Prep and Cooking Time: 45 minutes

  • Drizzle a bit of olive oil in a large stockpot (I love using my cast iron kettle), add the onions and garlic and cook until the onions are soft, about 4 minutes.
  • Then add the meat to the pot and cook until it’s no longer pink and it starts to brown, about 5 minutes.
  • Add the wine to the pot, bring to a boil, and reduce it by about half.
  • Put in the cumin, chili powder, cinnamon, and bay leaves and cook until aromatic, about 30 seconds.
  • Add the corn, peppers, tomatoes, and beans.
  • Bring to a boil and then reduce to a simmer.
  • Put in the Super Bowl MVP and antioxidant rich cocoa powder, coffee and the WV maple syrup. Continue to simmer for a few minutes, to gently combine all of the flavors.
  • Season to taste with a dash of salt and grind of pepper.


Meat is optional. Although some wouldn’t call it ‘chili’ if it doesn’t have meat, it will have nearly the same flavor and will satisfy vegetarian guests if omitted. The emphasis on veggies is what makes this rendition so incredibly heart healthy (a little secret my boyfriend doesn’t need to necessarily know to enjoy).

I’ve made this dish many times with the ancient grain, quinoa. Loaded with fiber from the complex carbohydrates while providing nearly the same texture and protein content as the ground meat, it has always gone over well with a crowd.

In my opinion, where you can really take this dish up a notch in both presentation and nutritional status is to have a bar of fresh toppings for the chili like cilantro, limes, sour cream from grass fed dairy cows, coconut cream for the lactose intolerant, heart healthy avocados and diced green onions to add a contrast of color and to entice your guests.

nachosAs for the nachos, I’m not crazy about cheese these days (certainly not the fake cheese spreads, dips, slices, and whizzes out there) and neither is my belly. Some of these cheeses lack nutrients and include questionable ingredients that can make their way into ‘processed cheese products’. This year, I’ll be serving up a rendition on this Epicurious concoction and will be making a few recipe tweaks of my own.

It’s important to ensure that toppings on the nachos are local and organic ingredients (when possible) and that the chips are a variety of non-GMO corn tortillas so that they’re not a total empty calorie bomb. My personal favorite brand of chips is Shagbark Seed & Mill which I can pick up at our local food market.

Having tried it a couple of times, always changing the recipe slightly, I will certainly give this Butternut-Queso a go as well. Beyond that I’m sure I’ll whip up another batch of Cauliflower Buffalo Bites as I have in years past. I’ll probably also serve nutrient dense versions of classic staples like:

  • Spinach Artichoke Dip – double up on the spinach and artichoke and swap the weird ingredients you might spy in the store-bought stuff for real ones.
  • Homemade Ranch Dressing – use a real mayo that’s loaded with herbs like dill and garlic with a base of simply eggs and oil for dunking various veggies.
  • WV Smoked Trout Dip – thanks to a recent fishing adventure, this dip will most likely make an appearance and it will be topped with a few hot jalapeno peppers that we canned from the summer’s harvest.
  • Beverages will abound, but a sparkling water with seasonal grapefruit and mint from the indoor herb garden will certainly be showcased. Vodka or gin may be added at guest’s discretion. I’m not policing but would be remiss if I didn’t mention that a heart healthy serving of alcohol is one 5 oz. glass of wine, a 12 oz. mug of beer, or a 1 oz. jigger of hard liquor per day for women and no more than two for men.
  • Hot Toddy’s using white pine and freshly bottled maple syrup will also be an option for guests, and maybe a knob of Kentucky’s finest bourbon will even make a halftime appearance!

I’m also curious to know:

  1. Who’s playing?
  2. What do you plan to serve?
  3. What are your tricks for pleasing your guests while keeping your dishes penalty-free?

Party on!


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HHQI’s New Easy-to-Use Online Resource Library is Now LIVE

by Misty Kevech, HHQI RN Project Coordinator

happynewyearSince this is the first blog for 2017, the Home Health Quality Improvement National Campaign (HHQI) would like to wish you a Happy New Year! We hope that this is a successful year related to your quality improvement efforts. To assist with those efforts, HHQI has some exciting news. Our new comprehensive online resource library will help you find evidence-based tools and resources quicker and ensure that you haven’t overlooked valuable resources.

It’s the perfect time to make our resources easier to search because of many new, upcoming, and continuing Centers for Medicare & Medicaid Services (CMS) quality improvement initiatives.

  • OASIS-C2 became effective 01/01/2017
  • Home Health Conditions of Participation (CoP) final rule will take effect 07/13/2017
    • Main focus of the CoP changes revolves around developing a Quality Assurance & Performance Improvement (QAPI) program with specific Performance Improvement Projects (PIPs) that create and sustain improvement.
  • Home Health Compare Star Reporting
    • Quality of patient care
    • Patient experience of care
  • Home Health Value-Based Purchasing Model
    • 9 states (AZ, FL, IA, MA, MD, NC, NE, TE, & WA)
  • IMPACT Act for Post-Acute Care Providers
    • Providers include Long-Term Care Hospitals (LTCHs), Skilled Nursing Facilities (SNFs), Home Health Agencies (HHAs), and Inpatient Rehabilitation Facilities (IRFs)

All of these home health initiatives support the CMS Quality Strategy for:

  • Better Care: Improve the overall quality of care by making health care more person-centered, reliable, accessible, and safe.
  • Smarter Spending: Reduce the cost of quality health care for individuals, families, employers, government, and communities.
  • Healthier People, Healthier Communities: Improve the health of Americans by supporting proven interventions to address behavioral, social, and environmental determinants of health, and deliver higher-quality care.

So where do you start? 

educationcircleicon-croppedHHQI should be your first place to look. We search for evidenced-base practices and then compile supportive resources for implementation of the practice. All HHQI materials are free and are in the public domain (no copyright issues). HHQI encourages you to customize the resources to best meet your organization’s needs, including adding your agency’s logo to them.

This month is HHQI’s 10-year anniversary, and we have amassed nearly 1,000 resources on our website. The great majority of these resources live on HHQI’s Best Practice Intervention Package (BPIP) pages but there are also non-BPIP resources located elsewhere on and on our Data Access and HHQI University websites. It has become very cumbersome to search and narrow down a list of relevant resources that might assist you with one of your quality improvement projects. So for the last year, HHQI has been very busy developing a new comprehensive resource library to serve as the “one-stop shop” for the industry’s best free resources, and we are so excited to tell you… it’s live! Check it out now at

The new resource library uses filters to help you narrow your search and find relevant resources faster without visiting multiple webpages or websites. You can pick one or any combination of filters to assist you in the search. You can filter resources by:

  • Best Practice Intervention Package (BPIP)
  • Topic
    • Diabetes, hospitalizations, self-management, quality improvement, etc.
  • Material Type
    • BPIPs, informative resources, interactive tools, webinars, courses, etc.
  • Audience
    • Aide, Leadership, Nurse, Patient, Social Worker, and Therapist
  • Language
    • English, Spanish, Chinese, Polish, Russian, and Vietnamese

So here’s an example of how to use the filters. Your agency is going to work on improving your diabetes disease management program. You are interested in finding diabetes evidence-based practices.

  • Select the BPIP filter for the Disease Management: Diabetes BPIP. All the current guidelines will be included in the BPIP as well as links to many tools and resources related to diabetes to assist with education and implementation.

Next, maybe you want to further limit your search to clinician education resources.

  • Use the Audience filter to specify clinician type, such as
  • Then browse through the results OR refine your search further with the Material Type and/or Language

The best way to try out the new comprehensive resource library is to play around. Think of something you might want to look for and select some filters. A tutorial will be posted soon on the new Resources page. Remember to always feel free to email us at with any questions or if you need assistance.

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