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Robert, a senior patient with existing health issues, was admitted to a hospital after being discharged with a chest tube called a Pleurex catheter. The patient’s wife, Dorothy, was understandably very worried about him and his declining condition.

The chest tube — which helps remove fluid from the chest cavity — was integral to helping Robert breathe. For the catheter to function properly, the Pleurex had to be replaced on a weekly basis. Unfortunately, Robert’s previous hospital did not have this exact type of chest tube available; alternatively, the hospital planned to replace the Pleurex catheter with a standard chest tube that attached to the wall (for drainage).

Robert was already on a ventilator and his prognosis was poor. Dorothy did not want him to have to undergo any additional procedures, and with her husband’s supply down to one last Pleurex, she was looking for assistance in obtaining more. Knowing her husband was in very serious condition, Dorothy wanted to make sure he could continue using the same chest tube to help him be as comfortable as possible in what would be his final days. She was having trouble expressing to the hospital staff how important the catheter was to her husband’s care.

End-of-life planning is a complicated process; the added complications of COVID-19 make it even more urgent. Robert and Dorothy’s story is just one of many affirming the urgency of end-of-life planning in our COVID-19 world. The high number of cases among older adults puts additional pressure on a sector of the healthcare system that was already stretched.

Families caring for an older adult during a pandemic are faced with emotionally heavy health decisions — and with very little time to engage in pertinent discussions:

Do we bring an older loved one home from the hospital to recover there?What if doctors have to intubate my loved one?Is my loved one in a nursing home going to contract COVID-19?Should we put an older loved one on a ventilator if he/she contracts COVID-19?If I can’t visit in person, how can I talk to my loved one about end-of-life planning?

To prepare for the worst-case scenario, more families are now seeking resources about end-of-life care. And fearing the complications related to COVID-19, many older adults are changing their living wills, according to Modern Healthcare. Providers across the healthcare spectrum should be prepared to support their patients and families during this time.

Avoidance and action: Disparities in end-of-life planning

In the midst of the unprecedented health care changes incurred by COVID-19, two things have remained constant: no one can predict end of life and no one knows what their decision-making capacity will be at the end of life.

Hence the utter importance of end-of-life planning.

According to a 2013 national survey conducted by The Conversation Project, 90% of people say that talking with their loved ones about end-of-life care is important. And in terms of decision making for advanced care, Pew Research Center data from 2013 said that 52% of respondents would “ask their doctors to stop treatment if they had an incurable disease and were totally dependent on someone else for their care.” Another 35% said they would “tell their doctors to do everything possible to keep them alive — even in dire circumstances, such as having a disease with no hope of improvement and experiencing a great deal of pain.”

Despite 90% of respondents agreeing on its importance, only 27% had moved forward with end-of-life planning. Most people feel unequipped to have uncomfortable decisions or make complicated decisions when faced with mortality. The emotional implications and the weight of perhaps having to decide for another can be extremely overwhelming.

The importance of communication

For physicians and clinicians to begin having end-of-life care discussions, it’s important that they feel comfortable when doing so. While these conversations are some of the most difficult to have, they are valuable for setting appropriate goals for the patient, according to Dr. Gregory Gadbois, an executive medical director at naviHealth. Unfortunately, from the physicians’ perspective, it can also be a sign of defeat.

Dr. Gregory GadboisExecutive Medical DirectornaviHealth

“If you ask a physician, we’ve been taught that our goal is to cure. In many cases, physicians feel like they’re in a battle they must win and that death equates to failure,” said Dr. Gadbois. “It comes down to understanding that end-of-life care is more than what it’s depicted as. This is another step in the healthcare journey for the patient. It’s important to understand how you can help with as much dignity and grace as possible. That’s where our goals should lie. But it is hard to figure out when to transition to these conversations.”

Dr. Gadbois believes that creating a strong line of communication between a patient, their loved ones and those who are treating the patient is key to alleviating some of the stress when planning for end-of-life care.

“These conversations are not just for those who have a terminal illness or are truly at the end of their life. These conversations should happen if you have an advanced disease, a chronic disease with no cure or any condition that may lead to special circumstances regarding treatment options,” Dr. Gadbois said.

End-of-life care has no age range — in the blink of an eye, you can find yourself in a turbulent situation.

One of Dr. Gadbois’ former patients, a 40-year-old who had just married the previous week, was suddenly diagnosed with Stage 4 colon cancer. For the next six months, the patient went through aggressive chemotherapy treatments. Unfortunately, a CAT scan of the patient’s abdomen showed that the cancer had metastasized.

One night after a shift, Dr. Gadois received a phone call from his patient, looking for some advice. The oncologist told the patient that they could try more treatment options and medicine but the patient was unsure if they could keep fighting.

“I mentioned hospice to let the patient know that it’s there, and I could immediately hear the sense of relief in their voice. The patient didn’t want to let down her family and friends,” Dr. Gadbois reflected. “But when I told them about hospice, it was almost as if they just needed someone to give them permission to stop fighting.” The patient passed away peacefully two months later while in hospice.

The stories of Robert and Dorothy and the 40-year-old cancer patient are all too familiar. In order to better understand the end-of-life care plan for Robert, Dorothy needed more than just the replacement Pleurex catheters. She needed someone she could connect with and openly communicate to during one of life’s most painful moments.

Thankfully, Robert’s care team was able to step in and help keep Robert as comfortable as possible while they searched for the correct catheter. While it may have only given Robert just a little more comfort in his final days, having clear communication with the clinical team helped give Dorothy a sense of relief in a time when she felt helpless.

Many resources are available to guide patients, families and providers through the complicated process of end-of-life planning, although starting the conversation is often the most difficult part. As for health care providers —particularly dealing with the uncertainty of COVID-19 — it may mean an extra level of open communication to help support patients and their loved ones.
The post How COVID-19 reinforced the need for end-of-life planning appeared first on naviHealth.
Source: Navi

Karen ChambersVP of Market Clinical OperationsnaviHealth

As I’ve reflected on the last few months and the pandemic we have faced together as a nation, I have found myself revisiting flashbacks of patient stories. The story of the daughter who made the tough but right decision to send her mother to long-term care amid COVID-19; the senior patient that lost both her dog and cat after being admitted for a fall and then faced the harsh mental health impact of isolation and depression upon returning to an empty home; and the numerous clinical colleagues that, time and again, chose to run “into the fire” for the patients they served. 

It has been an emotional and heart-wrenching few months amid COVID-19. And yet, at the same time, this a period of fast and furious teachings as healthcare organizations learned how to adapt quickly in order to best serve the needs of critical COVID-19 patients. From the jump to virtual care to addressing unnecessary administrative burdens and enabling home-based senior care, alongside our trusted provider and health plan partners we faced the challenges presented by COVID-19 with grace despite the immense pressure.

Making the move from in-person to virtual care a reality

Our clinical team also had to adjust to this change and make a fast transition from in-person care, patient education and training – to virtual care, education and training. Making the change to virtual was not optional, by any means, and it was not easy.

Nonetheless, our clinicians worked hand-in-hand with our clients to provide patient-centered care in a newly fashioned model – face-to-face by computer or voice-to-voice by phone.

The first challenge naviHealth faced alongside our provider and health plan customers was the need to enable virtual care by employing telemedicine. While a seemingly easy change given the advent of technology, the reality is that things like current standards, infrastructure, regulations and reimbursement procedures were not already set-up to properly and swiftly adopt virtual care.

Reducing unnecessary administrative burdens

A second challenge we worked diligently to address was quickly reducing any and all administrative burdens for our provider and health plan partners. Efforts such as streamlined communication and detailed collaboration went a long way toward making sure that quality patient care remained priority one despite the many hurdles encountered during COVID-19.

We also worked closely with our clients to adhere to all guidance and applicable waivers from the Centers of Medicaid and Medicare Services (CMS). This included reducing or waiving pre-service expectations and expediting prior authorization requirements in order to more quickly work through discharge planning so that appropriate patients could be transitioned safely. This seemingly minor administrative change saved hours of time and resources and ensured that more beds were available in acute settings for COVID-19 patients.

Enabling home-based senior care

Amid these challenges, a variety of lessons learned were achieved. Perhaps, most notably, the critical importance of enabling home-based models of care that integrate both traditional patient care – as well as non-clinical care and support. One important lesson COVID-19 taught us was that we need to embrace new models of care that allow people – especially seniors – to heal in the comfort and safety of their homes.

In addition, COVID-19 put a spotlight on the need for a more holistic approach to care that includes and prioritizes social determinants of health. If a patient has recovered from hip surgery but has no access to having groceries and medications delivered, then that patient’s health and safety will be compromised, and they will be at a greater risk of being exposed to the virus.

Much of the work our team did during COVID-19 was not just clinical in nature, it was human-focused – such as helping people get access to Meals on Wheels, calling patients to check-in on their mental health and to make sure they were able to manage social isolation appropriately during the pandemic, and even coaching patients and/or their caregivers on how to use technology for virtual care appointments and apps for grocery deliveries when needed.

Many of the patients we served during COVID-19 were vulnerable because they were seniors with chronic conditions and more susceptible to the illness. This experience ignited a new vision for what senior-centered care can and should look like – including the need to make home-based care a reality in order to adopt value-based care initiatives and support the growing number of Americans who are aging and will be in need of more care in the years to come.

COVID-19 is a reminder of the power and ability we have as healthcare workers and leaders to help heal and to use human touch and empathy to provide care and support for those who need it most. As we trek forward and apply the lessons learned from COVID-19, we are more committed than ever to our core purpose – to provide patient-centered care that helps seniors live more fulfilling lives.
The post Achieving patient-centered care collaboration during a pandemic appeared first on naviHealth.
Source: Navi

Healthcare aides make up 59% of nursing home workers and 76% of residential care workers, according to the CDC. These healthcare professionals are responsible for performing the brunt of the work in elderly care — helping patients eat, bathe, monitor their vitals and other health signals and take their prescribed medications. They also provide much needed companionship, which is crucial given the current loneliness epidemic.

Despite the pivotal role these healthcare professionals play, nursing assistants and orderlies earned an average of just $14.25 per hour in 2019, according to the U.S. Bureau for Labor Statistics. Health aides fared even worse, earning just $11.57 per hour. As a result, an estimated 44% of these employees live in poverty, according to Robert Espinoza, vice president of policy at PHI, a research firm focused on elder and disability services.

Underpaid and underappreciated, nursing assistants were already in short supply before the COVID-19 pandemic; when the coronavirus hit the United States, the shortage of geriatric workers turned into a full-blown staffing crisis. Faced with unsafe working conditions and lacking adequate personal protective equipment (PPE), nurses began to work less or not at all, according to a survey of more than 1,100 nurses by IntelyCare. In one case, a nursing home was forced to evacuate 80 residents after more than a dozen workers failed to show up for work.

The media soon declared nursing homes “‘ground zero’ for COVID-19“. To date, the virus has claimed the lives of more than 55,000 American seniors. As a result, people began referring to these facilities as ‘death traps’ — recent estimates from the New York Times back up these claims. While just one in 10 Americans with COVID-19 live in nursing homes, 42% of deaths from the disease take place in these long-term care facilities.

This notoriety poses a challenge for the organizations that run nursing homes. More than 1 million new health aides plus an additional 137,800 nursing assistants and orderlies will be needed by 2028,  according to the U.S. Bureau for Labor Statistics. Given the high-risk, low-reward nature of the profession, leaders must find creative ways to attract and retain talent.

Three approaches for attracting geriatric workers

“There are at least three approaches that can make a job more appealing to aides,” explains Dr. Joseph Ouslander, professor and senior advisor to the dean of geriatric medicine at Florida Atlantic University’s Schmidt College of Medicine. “The first is to create a career ladder within the nursing assistant position. You start off as a nursing assistant. As you get more experience and show that you’re a good worker, you get a specialty assignment and a little higher pay for that. Then you progress to a third step, where you have even more responsibility.”

Dr. Joseph OuslanderProfessor of Geriatric MedicineFlorida Atlantic University

Career ladders reward staff for greater competency — resulting in superior outcomes while helping employees feel valued. They also help people understand how and where they can grow within the organization, contributing to employee retention.

Having consistent assignments for nursing assistants can also help with worker retention, according to Dr. Ouslander. This arrangement benefits both parties: Residents receive aid from someone who knows their preferences, reducing unnecessary effort and worry. Nursing aides experience more rewarding work as they get to build close relationships with the people they serve.

“The third is to give nursing assistants tools, so they feel like they’re a meaningful part of the care process,” says Dr. Ouslander. A tool that helps them track patient conditions over time, for example, can be very useful and help aides meaningfully contribute to patient outcomes.

“The key is to make them feel like they’re an important part of the team,” Dr. Ouslander concludes.

The role value-based care could play

There are two ways to approach the challenge that lies ahead: the short game and the long game. The underlying parallel between both is choosing to invest in specific areas within geriatrics to attract more qualified candidates to the profession. The opportunity that implementing value-based care at long-term care facilities can provide is immense, particularly with attracting medical students to geriatric work.

“As more medical students take on more debt to pay for their medical school education, it has forced them to select higher paying specialties to have the capacity to pay that debt back. As a result, most of the primary care specialties are less attractive, including geriatrics,” said Vince Mor, Ph.D., a Brown University researcher. “With value-based care, primary care physicians are able to provide and ultimately get reimbursed for keeping people healthy and avoiding and controlling chronic diseases.  This will make specialties like geriatrics more attractive to medical students.”

In other words, they would be paid according to patient outcomes. For example, a post-acute care home model that prevents hospital readmission would earn more than one that failed to do so. Everyone wins under this model, according to the New England Journal of Medicine. Seniors pay less for better health, and geriatric workers earn more for a job well done — payers, suppliers and the country also benefits.

“I believe that the more collaboration that there is between health care providers, including doctors, nurses and therapists, better care is provided,” Mor said. “Patients have better outcomes, and the satisfaction of those providing the care is greater. This will make specialties like geriatrics more attractive.”
The post The importance of geriatric nursing assistants in a post-COVID world appeared first on naviHealth.
Source: Navi