Recovers from COVID-19 in Less Than a Month
By Presbyterian SeniorCare Network

“I could not breathe and had no energy,” recalls Carol about the excruciating painful symptoms she experienced at her Tarentum home on March 31st. “When I could no longer get out of my bed to go to the bathroom, that’s when I called out to my family that they needed to get me to a hospital quickly.”

Several days earlier Carol had been to an urgent care center complaining of flu-like symptoms, where she tested negative for the flu and was encouraged to go home, rest, drink lots of water, and take some over-the-counter medications. For the healthy, active great grandmother who was used to watching her five-year-old great granddaughter three days-a-week, the speed and severity of what followed was unbelievable.

“I remember my son saying he would call an ambulance, and the ambulance workers arriving already wearing their protective equipment and taking me to the Allegheny Health Network hospital in Natrona Heights. And then I don’t remember anything else, because I was in a coma for seven days,” she explains. “I think the ambulance workers and the people at the hospital suspected COVID-19 but I don’t remember anyone saying it,” added Carol.

Carol came to learn that indeed COVID-19 was the culprit and that her family would need to be quarantined for 14 days. Fortunately, none of them developed any symptoms, not even her ailing husband who is battling stage four kidney disease.

But on Friday, April 24^th, Carol was exuberant. After leaving the hospital on April 16 and being admitted for rehabilitation services at the Presbyterian SeniorCare Network Willows skilled nursing center, she was excited about the prospect of going back to her home in Tarentum. “I’m grateful that the Willows would take someone who was recovering from COVID,” noted Carol. “I had the greatest therapists in the world to help me get back my strength and back to being myself. What I was most concerned about was the 15 steps I’d have to go up in my house. But I’m feeling pretty confident that I can do that after the steps they’ve had me doing at the Willows. I feel I can go home and be safe. They gave me exercises to do when I get home. I really feel I will be fine.”

When asked what she would want people to know about her experience, Carol was emphatic, “I experienced a lot that I never want to experience again. I wouldn’t wish this on anyone. If I have to wear a mask the rest of my life, I will.” She added, “It’s a very hard thing to do all that we are asked to do but pay attention, wear your mask, don’t be so anxious to go back to the way things were. We need to be very cautious.”

Carol left the Willows of Presbyterian SeniorCare Network on Sunday, April 26^th happily wearing her mask.

Editor’s Note: Per the Presbyterian SeniorCare Network COVID-19 Admissions Guidelines, Carol was not COVID positive upon admission to the Willows on April 16^th. Previously COVID-19 positive candidates must meet certain criteria to be accepted for admission into our skilled nursing centers and, as an added precaution, are kept isolated in their rooms for 14 consecutive days and cared by team members who are wearing appropriate PPE. Also keep in mind that Carol’s experience may be different than others who have tested positive for COVID-19.

Recovers from COVID-19 in Less Than a Month
By Presbyterian SeniorCare Network

“I could not breathe and had no energy,” recalls Carol about the excruciating painful symptoms she experienced at her Tarentum home on March 31st. “When I could no longer get out of my bed to go to the bathroom, that’s when I called out to my family that they needed to get me to a hospital quickly.”

Several days earlier Carol had been to an urgent care center complaining of flu-like symptoms, where she tested negative for the flu and was encouraged to go home, rest, drink lots of water, and take some over-the-counter medications. For the healthy, active great grandmother who was used to watching her five-year-old great granddaughter three days-a-week, the speed and severity of what followed was unbelievable.

“I remember my son saying he would call an ambulance, and the ambulance workers arriving already wearing their protective equipment and taking me to the Allegheny Health Network hospital in Natrona Heights. And then I don’t remember anything else, because I was in a coma for seven days,” she explains. “I think the ambulance workers and the people at the hospital suspected COVID-19 but I don’t remember anyone saying it,” added Carol.

Carol came to learn that indeed COVID-19 was the culprit and that her family would need to be quarantined for 14 days. Fortunately, none of them developed any symptoms, not even her ailing husband who is battling stage four kidney disease.

But on Friday, April 24^th, Carol was exuberant. After leaving the hospital on April 16 and being admitted for rehabilitation services at the Presbyterian SeniorCare Network Willows skilled nursing center, she was excited about the prospect of going back to her home in Tarentum. “I’m grateful that the Willows would take someone who was recovering from COVID,” noted Carol. “I had the greatest therapists in the world to help me get back my strength and back to being myself. What I was most concerned about was the 15 steps I’d have to go up in my house. But I’m feeling pretty confident that I can do that after the steps they’ve had me doing at the Willows. I feel I can go home and be safe. They gave me exercises to do when I get home. I really feel I will be fine.”

When asked what she would want people to know about her experience, Carol was emphatic, “I experienced a lot that I never want to experience again. I wouldn’t wish this on anyone. If I have to wear a mask the rest of my life, I will.” She added, “It’s a very hard thing to do all that we are asked to do but pay attention, wear your mask, don’t be so anxious to go back to the way things were. We need to be very cautious.”

Carol left the Willows of Presbyterian SeniorCare Network on Sunday, April 26^th happily wearing her mask.

Editor’s Note: Per the Presbyterian SeniorCare Network COVID-19 Admissions Guidelines, Carol was not COVID positive upon admission to the Willows on April 16^th. Previously COVID-19 positive candidates must meet certain criteria to be accepted for admission into our skilled nursing centers and, as an added precaution, are kept isolated in their rooms for 14 consecutive days and cared by team members who are wearing appropriate PPE. Also keep in mind that Carol’s experience may be different than others who have tested positive for COVID-19.

It’s counterintuitive to some, but activity is proven to make all the difference
By Edie Grossfield

Part of the Age-Friendly Health Care Special Report

(Editor’s note: This story is part of a series for The John A. Hartford Foundation.)

In her work as the chief nursing officer for Anne Arundel Medical Center in Annapolis, Md., Barbara Jacobs recently found herself dodging a lot of patients walking in the corridor as she made her way down the hall.

“There were so many people up and moving, and that was a good problem to have,” she recalls. Jacobs is pleased that the hospital’s initiative of the past two years to keep patients — especially older ones — mobile during their time there is working.

Because staying mobile helps maintain muscle function and overall healing, it also reduces the risk of falls.

Like many hospitals around the country, Anne Arundel is recognizing the important role mobility plays in healing, reducing the risk of medical complications and ensuring that older patients will be able to return home after they’re discharged, rather than having to go a nursing home or rehabilitation facility.

Immobility Leads to Problems

“One of the things that is absolute is when a person becomes immobile, the loss of muscle tone is very, very quick — the actual loss of muscle mass is quick,” Jacobs says. “So, when a person comes into the hospital and becomes immobile, it’s significant — even if you’re young, you will go out feeling weak.”

And weakening muscles is just one of the negatives of being in a hospital bed for days.

“When we lay in a bed, our lungs are laying back against the back of our body,” Jacobs explains. “For maximum performance of our lungs, you’re supposed to be standing or sitting, where gravity is helping open our lungs. So, we’re more prone to developing pneumonia (and other respiratory illnesses) because our lungs are not in the position that they should be if we leave you in bed all day long.”

Immobility during a hospital stay is connected to a number of other problems, including frailty, falls and even death, “even after controlling for illness severity and comorbidity,” according to a 2018 article in the journal Gerontology and Geriatric Medicine.

Hospitalized older adults who remain mostly in bed are 34 times more likely to die and six times more likely to end up in nursing homes after their hospital stays than those who move around at least twice per day, according to research that included nearly 500 people age 70 and older.

Mobility Priority at Anne Arundel

In 2017, Anne Arundel Medical Center began its new mobility practices in the hospital’s geriatrics unit, which is an Acute Care for the Elderly (ACE) unit. Anne Arundel’s ACE unit is part of the hospital’s “age-friendly” initiative, with the goal of aligning care to what matters most to each patient.

Patients of all ages, inside and outside the ACE unit, who are able to get out of bed and move are encouraged to do so — ideally at least three times per day.

“It depends on the patient, obviously,” Jacobs says. “There are times when the person is too sick to get up. But for most people, they should be getting up and mobilizing as far as they can every day.”

That means doing some walking, even if it’s only a short distance.

“If the farthest you can get is walking from your bed to the door, great,” Jacobs says. “If you only go from the bed to the door two times today, but the next day you go fifty feet, that’s great.”

To help get patients moving, Anne Arundel has people called “mobility quality technicians,” whose main job is to ensure that patients who are able to move do so daily.

Movement and Socialization With ACErcise

The ACE unit also launched “ACErcise,” a group exercise program that Jacobs says is popular with patients. The groups do chair exercises and walk to and from their hospital rooms. Other hospitals around the country with ACE units have similar programs.

“Part of what makes it great is the socialization of being together,” Jacobs says. “Then, we had some (patients) who said, ‘Can we just eat together?’ So, after ACErcise, we put up a table and they can eat together.”

This emphasis on mobility has been important to patient Cline Warren’s recovery, says his wife Martha Warren. The couple live in southern Anne Arundel County. Cline Warren, 91, who has dementia, was brought into the hospital after he accidentally ingested a caustic substance.

“He’s much better,” Martha Warren says, adding that along with the exercise, the socialization aspects have been especially helpful. “It certainly contributes to being less bored — you know, being in your room alone. And (it helps to) be able to focus on other patients or the activity director.”

Patients ‘MOVE’

At St. Mary Mercy Livonia, a hospital in the Detroit suburb of Livonia, hospitalized patients have been staying active through “Mobility Optimizes Virtually Everything,” or MOVE, since 2017.

“As I was researching this topic prior to implementation of MOVE, I found out that every day a person spends in the hospital bed can take up to four days to regain their strength,” said program manager Belinda Dokic, adding that the hospital implemented MOVE because “mobility can also be a medicine.”

As part of MOVE, each patient receives “personalized mobility goals,” which nurses and aides review daily with patients.

MOVE began in St. Mary Mercy’s observation unit. This included adding full-time ambulation aides who were trained by the hospital’s physical therapists on how to safely move patients to avoid falls and injuries. Toward the end of 2018, the hospital added MOVE to its medical/surgical unit.

The goal of MOVE is to walk patients twice per day. Patients who are unable to walk are encouraged and helped to at least move from their bed to a chair for some period of time during the day.

“Any movement is good.” Dokic says. “Even if the patient is laying in bed and we (adjust) the bed for them to sit up and eat (a meal) that way, or we move them from bed to chair or even help them walk from a chair to the shower — all of this is considered movement.”

Mobility Helps With Fall Prevention, Too

Because staying mobile helps maintain muscle function and overall healing, it also reduces the risk of falls. This is something Dokic has seen at St. Mary Mercy, where the patient falls rate in the two units with the MOVE program decreased from 2.7% to zero from the last quarter of 2017 to the first quarter of 2018.

For some, more movement brings concern of more risk of falls, but a study led by Johns Hopkins Hospital researchers in 2016 found that increasing patient mobility did not increase the number of patient falls with injuries.

St. Mary Mercy carefully trains its ambulation aides, Dokic says. “I think it was four hours of training, where they were shown how exactly to move the patients without putting them at risk to have a fall,” she says.

Patient and Family Buy-In

Nurses and other staff working on mobility programs occasionally encounter concerned family members who believe their parent or other loved one shouldn’t be moving around while in the hospital.

“The family member might say, ‘Well mom’s been sick. Just let her rest in bed,’” Jacobs says. “But we’re actually not helping mom if we just let her rest in bed the whole time. So we have to actually say to the families, ‘No, this is an important part of your mother’s healing, that we get up and ambulate with your mom.’”

Staff also encounter patients who would rather not get up, understandably, because they don’t feel well. In that case, Jacobs says, it’s important to remind patients and families that remaining immobile could lead to a longer hospital stay, or worse.

“There’s a question we ask everybody every day (in the ACE unit), and that’s ‘What is it that really matters to you?’ This is part of our age-friendly work,” Jacobs says. “And the majority of patients answer that they want to get home. Well, the best thing we can do to get you home is to keep you moving. So, if that’s your plan, let us help get you there.”

By Edie Grossfield

Edie is Next Avenue’s health and caregiving editor. In this role, she reports on the information people need to make sound decisions about caregiving, their health and the health of their loved ones. She has been a journalist for more than 20 years, reporting and editing for newspapers and magazines. Edie has a master’s degree in journalism from the University of Wisconsin-Madison. Reach her by email at egrossfield@nextavenue.org.

It’s counterintuitive to some, but activity is proven to make all the difference
By Edie Grossfield

Part of the Age-Friendly Health Care Special Report

(Editor’s note: This story is part of a series for The John A. Hartford Foundation.)

In her work as the chief nursing officer for Anne Arundel Medical Center in Annapolis, Md., Barbara Jacobs recently found herself dodging a lot of patients walking in the corridor as she made her way down the hall.

“There were so many people up and moving, and that was a good problem to have,” she recalls. Jacobs is pleased that the hospital’s initiative of the past two years to keep patients — especially older ones — mobile during their time there is working.

Because staying mobile helps maintain muscle function and overall healing, it also reduces the risk of falls.

Like many hospitals around the country, Anne Arundel is recognizing the important role mobility plays in healing, reducing the risk of medical complications and ensuring that older patients will be able to return home after they’re discharged, rather than having to go a nursing home or rehabilitation facility.

Immobility Leads to Problems

“One of the things that is absolute is when a person becomes immobile, the loss of muscle tone is very, very quick — the actual loss of muscle mass is quick,” Jacobs says. “So, when a person comes into the hospital and becomes immobile, it’s significant — even if you’re young, you will go out feeling weak.”

And weakening muscles is just one of the negatives of being in a hospital bed for days.

“When we lay in a bed, our lungs are laying back against the back of our body,” Jacobs explains. “For maximum performance of our lungs, you’re supposed to be standing or sitting, where gravity is helping open our lungs. So, we’re more prone to developing pneumonia (and other respiratory illnesses) because our lungs are not in the position that they should be if we leave you in bed all day long.”

Immobility during a hospital stay is connected to a number of other problems, including frailty, falls and even death, “even after controlling for illness severity and comorbidity,” according to a 2018 article in the journal Gerontology and Geriatric Medicine.

Hospitalized older adults who remain mostly in bed are 34 times more likely to die and six times more likely to end up in nursing homes after their hospital stays than those who move around at least twice per day, according to research that included nearly 500 people age 70 and older.

Mobility Priority at Anne Arundel

In 2017, Anne Arundel Medical Center began its new mobility practices in the hospital’s geriatrics unit, which is an Acute Care for the Elderly (ACE) unit. Anne Arundel’s ACE unit is part of the hospital’s “age-friendly” initiative, with the goal of aligning care to what matters most to each patient.

Patients of all ages, inside and outside the ACE unit, who are able to get out of bed and move are encouraged to do so — ideally at least three times per day.

“It depends on the patient, obviously,” Jacobs says. “There are times when the person is too sick to get up. But for most people, they should be getting up and mobilizing as far as they can every day.”

That means doing some walking, even if it’s only a short distance.

“If the farthest you can get is walking from your bed to the door, great,” Jacobs says. “If you only go from the bed to the door two times today, but the next day you go fifty feet, that’s great.”

To help get patients moving, Anne Arundel has people called “mobility quality technicians,” whose main job is to ensure that patients who are able to move do so daily.

Movement and Socialization With ACErcise

The ACE unit also launched “ACErcise,” a group exercise program that Jacobs says is popular with patients. The groups do chair exercises and walk to and from their hospital rooms. Other hospitals around the country with ACE units have similar programs.

“Part of what makes it great is the socialization of being together,” Jacobs says. “Then, we had some (patients) who said, ‘Can we just eat together?’ So, after ACErcise, we put up a table and they can eat together.”

This emphasis on mobility has been important to patient Cline Warren’s recovery, says his wife Martha Warren. The couple live in southern Anne Arundel County. Cline Warren, 91, who has dementia, was brought into the hospital after he accidentally ingested a caustic substance.

“He’s much better,” Martha Warren says, adding that along with the exercise, the socialization aspects have been especially helpful. “It certainly contributes to being less bored — you know, being in your room alone. And (it helps to) be able to focus on other patients or the activity director.”

Patients ‘MOVE’

At St. Mary Mercy Livonia, a hospital in the Detroit suburb of Livonia, hospitalized patients have been staying active through “Mobility Optimizes Virtually Everything,” or MOVE, since 2017.

“As I was researching this topic prior to implementation of MOVE, I found out that every day a person spends in the hospital bed can take up to four days to regain their strength,” said program manager Belinda Dokic, adding that the hospital implemented MOVE because “mobility can also be a medicine.”

As part of MOVE, each patient receives “personalized mobility goals,” which nurses and aides review daily with patients.

MOVE began in St. Mary Mercy’s observation unit. This included adding full-time ambulation aides who were trained by the hospital’s physical therapists on how to safely move patients to avoid falls and injuries. Toward the end of 2018, the hospital added MOVE to its medical/surgical unit.

The goal of MOVE is to walk patients twice per day. Patients who are unable to walk are encouraged and helped to at least move from their bed to a chair for some period of time during the day.

“Any movement is good.” Dokic says. “Even if the patient is laying in bed and we (adjust) the bed for them to sit up and eat (a meal) that way, or we move them from bed to chair or even help them walk from a chair to the shower — all of this is considered movement.”

Mobility Helps With Fall Prevention, Too

Because staying mobile helps maintain muscle function and overall healing, it also reduces the risk of falls. This is something Dokic has seen at St. Mary Mercy, where the patient falls rate in the two units with the MOVE program decreased from 2.7% to zero from the last quarter of 2017 to the first quarter of 2018.

For some, more movement brings concern of more risk of falls, but a study led by Johns Hopkins Hospital researchers in 2016 found that increasing patient mobility did not increase the number of patient falls with injuries.

St. Mary Mercy carefully trains its ambulation aides, Dokic says. “I think it was four hours of training, where they were shown how exactly to move the patients without putting them at risk to have a fall,” she says.

Patient and Family Buy-In

Nurses and other staff working on mobility programs occasionally encounter concerned family members who believe their parent or other loved one shouldn’t be moving around while in the hospital.

“The family member might say, ‘Well mom’s been sick. Just let her rest in bed,’” Jacobs says. “But we’re actually not helping mom if we just let her rest in bed the whole time. So we have to actually say to the families, ‘No, this is an important part of your mother’s healing, that we get up and ambulate with your mom.’”

Staff also encounter patients who would rather not get up, understandably, because they don’t feel well. In that case, Jacobs says, it’s important to remind patients and families that remaining immobile could lead to a longer hospital stay, or worse.

“There’s a question we ask everybody every day (in the ACE unit), and that’s ‘What is it that really matters to you?’ This is part of our age-friendly work,” Jacobs says. “And the majority of patients answer that they want to get home. Well, the best thing we can do to get you home is to keep you moving. So, if that’s your plan, let us help get you there.”

By Edie Grossfield

Edie is Next Avenue’s health and caregiving editor. In this role, she reports on the information people need to make sound decisions about caregiving, their health and the health of their loved ones. She has been a journalist for more than 20 years, reporting and editing for newspapers and magazines. Edie has a master’s degree in journalism from the University of Wisconsin-Madison. Reach her by email at egrossfield@nextavenue.org.

September 23 is Fall Prevention Awareness Day!

Learn more about our fall prevention efforts in our care communities.

Every community that serves the older population is looking for ways to reduce falls. There is no one concrete way to prevent falls. "Knowing this, we take special precaution to keep our residents as safe as possible while they are in our care, and one way we do that is through the UPRITE Fall Prevention Education Program,” says Ginny Burke, director of clinical education and quality.

The main focus on the UPRITE Fall Prevention Education is that everyone in the community, from nursing to housekeeping to maintenance, can help prevent falls. In fact, UPRITE stands for YoU help Prevent Resident Incidents with Team Effort!

“All team members who work in the neighborhoods in our skilled nursing and personal care communities know the residents just as well as a nurse does, so we have trained different disciplines to be looking, watching, and pointing out any potential fall risks,” says Ginny.

“UPRITE really focuses on the importance of being aware of what’s going on around you. If a team member is passing through a neighborhood and notices someone is trying to get up alone, they assist them or get a team member that can. If they notice a call light is on, they will pop their head in – a resident may need something that is just out of reach such as the television remote or a tissue. It’s the little things like this that can prevent bigger things from happening,” Ginny says.

In our care communities, we have a larger number of residents who are wheelchair bound, or who use walkers to get around. Because the mobility of some of our residents is limited, they often experience weakened legs and muscles due to inactivity. Ginny says, “In order to assist those residents who have limited mobility, we encourage our team members to frequently ask if there is anything the resident needs, even if they have just helped them or are just checking in. We have found that rounding consistently has improved resident satisfaction and safety.”

Interested in learning more about fall prevention? Check out this article for stats and other facts about fall prevention.

September 23 is Fall Prevention Awareness Day!

Learn more about our fall prevention efforts in our care communities.

Every community that serves the older population is looking for ways to reduce falls. There is no one concrete way to prevent falls. "Knowing this, we take special precaution to keep our residents as safe as possible while they are in our care, and one way we do that is through the UPRITE Fall Prevention Education Program,” says Ginny Burke, director of clinical education and quality.

The main focus on the UPRITE Fall Prevention Education is that everyone in the community, from nursing to housekeeping to maintenance, can help prevent falls. In fact, UPRITE stands for YoU help Prevent Resident Incidents with Team Effort!

“All team members who work in the neighborhoods in our skilled nursing and personal care communities know the residents just as well as a nurse does, so we have trained different disciplines to be looking, watching, and pointing out any potential fall risks,” says Ginny.

“UPRITE really focuses on the importance of being aware of what’s going on around you. If a team member is passing through a neighborhood and notices someone is trying to get up alone, they assist them or get a team member that can. If they notice a call light is on, they will pop their head in – a resident may need something that is just out of reach such as the television remote or a tissue. It’s the little things like this that can prevent bigger things from happening,” Ginny says.

In our care communities, we have a larger number of residents who are wheelchair bound, or who use walkers to get around. Because the mobility of some of our residents is limited, they often experience weakened legs and muscles due to inactivity. Ginny says, “In order to assist those residents who have limited mobility, we encourage our team members to frequently ask if there is anything the resident needs, even if they have just helped them or are just checking in. We have found that rounding consistently has improved resident satisfaction and safety.”

Interested in learning more about fall prevention? Check out this article for stats and other facts about fall prevention.

Midge watches cows being milked on a dairy farm.

Donna paints watercolor masterpieces with just one touch.

Frank belts out tunes on the karaoke machine.

All call the Woodside Neighborhood, a dementia-specific personal care community at the Presbyterian SeniorCare Network Washington campus, home. Each has a different interest that sparks special moments in their lives – many of these moments they do not recall on a daily basis.

With the help of It’s Never Too Late (iN2L), an interactive computer system that engages residents regardless of their cognitive level, the Woodside team is able to rekindle passions like painting, and bring back lost memories of the days on the farm.

Photo Caption: Donna, a resident in the Woodside Neighborhood, enjoys “painting” on the iN2L

“iN2L doesn’t just impact one of our residents, it impacts all of them,” says Susan Lawrence, lifestyle engagement coordinator at Presbyterian SeniorCare Network. She reminisces, “I remember one of our residents who was a ‘War Bride’ from England. She moved to the U.S. and never got to go back home. We received this information from her family and pulled up the Earth view of the town on iN2L. She couldn’t remember the name of her hometown, but when she saw the local Post Office, she leaned in to get closer to the screen. We watched her eyes light up in a moment of recognition and she began sharing stories about her father and her time ‘at home.’ Talk about an impactful moment of remembrance – and all because of the iN2L.”

iN2L provides an element of engagement that you can’t get from anywhere else.

“We have fun with the iN2L. But what’s most important is that we engage. They remember; even if it is just for one moment,” says Susan.

Midge watches cows being milked on a dairy farm.

Donna paints watercolor masterpieces with just one touch.

Frank belts out tunes on the karaoke machine.

All call the Woodside Neighborhood, a dementia-specific personal care community at the Presbyterian SeniorCare Network Washington campus, home. Each has a different interest that sparks special moments in their lives – many of these moments they do not recall on a daily basis.

With the help of It’s Never Too Late (iN2L), an interactive computer system that engages residents regardless of their cognitive level, the Woodside team is able to rekindle passions like painting, and bring back lost memories of the days on the farm.

Photo Caption: Donna, a resident in the Woodside Neighborhood, enjoys “painting” on the iN2L

“iN2L doesn’t just impact one of our residents, it impacts all of them,” says Susan Lawrence, lifestyle engagement coordinator at Presbyterian SeniorCare Network. She reminisces, “I remember one of our residents who was a ‘War Bride’ from England. She moved to the U.S. and never got to go back home. We received this information from her family and pulled up the Earth view of the town on iN2L. She couldn’t remember the name of her hometown, but when she saw the local Post Office, she leaned in to get closer to the screen. We watched her eyes light up in a moment of recognition and she began sharing stories about her father and her time ‘at home.’ Talk about an impactful moment of remembrance – and all because of the iN2L.”

iN2L provides an element of engagement that you can’t get from anywhere else.

“We have fun with the iN2L. But what’s most important is that we engage. They remember; even if it is just for one moment,” says Susan.

Meeting with a physical therapist and educating yourself before you have joint replacement surgery can help you to have a quicker, less stressful recovery.

Patients who meet one-on-one with a physical therapist (PT) and educate themselves prior to knee or hip replacement surgery feel better prepared to leave the hospital and report less pain and joint stiffness during recovery compared to those who did not, according to a study by Hospital for Special Surgery (HSS). The study evaluated the effect of a face-to-face counseling session coupled with web-based education on patient satisfaction and functional outcomes.

The goal of the education session was to manage patient expectations of the surgery and recovery before undergoing the surgery—rather than after the surgery, when they might be dealing with fatigue, pain or anxiety—so they were able to better absorb and retain the information. Researchers followed 126 patients who underwent knee or hip replacement for osteoarthritis.

All patients attended a group education class before surgery—the standard of care for those scheduled for joint replacement at HSS. They were then randomized into two separate groups. In group one, 63 patients attended the one-on-one education session with a physical therapist in addition to the group class and were granted access to an informational web portal featuring videos. The control group of 63 patients attended the standard group class and received a booklet about what to expect after joint replacement—with no further education.

Using patient satisfaction and patient-reported scores to measure pain, joint stiffness and function both before and after surgery, researchers determined that the patients who attended the extra one-on-one PT counseling session indicated they were better prepared to leave the hospital after surgery and were overall more satisfied with the preoperative education they received. Almost 97 percent of these patients accessed the informational web portal, and all of them said they would recommend it for patients undergoing the same procedure.

Almost 70 percent of patients from the group that did not receive the supplemental educational session or web portal access believed they could have benefited from additional education before surgery. Patients who received one-on-one counseling also needed fewer physical therapy sessions in the hospital before discharge and met PT discharge measures sooner, including being able to get out of bed, walk with or without an assistive device and go up and down stairs independently.

The upshot of this research is that, if you are considering joint replacement surgery, ask to meet one-on-one with a physical therapist BEFORE your surgery if that is not your doctor’s standard approach. And take advantage of any and all learning materials your doctor may give you—specifically online videos and information.

The more you know, the better your recovery may be.

Meeting with a physical therapist and educating yourself before you have joint replacement surgery can help you to have a quicker, less stressful recovery.

Patients who meet one-on-one with a physical therapist (PT) and educate themselves prior to knee or hip replacement surgery feel better prepared to leave the hospital and report less pain and joint stiffness during recovery compared to those who did not, according to a study by Hospital for Special Surgery (HSS). The study evaluated the effect of a face-to-face counseling session coupled with web-based education on patient satisfaction and functional outcomes.

The goal of the education session was to manage patient expectations of the surgery and recovery before undergoing the surgery—rather than after the surgery, when they might be dealing with fatigue, pain or anxiety—so they were able to better absorb and retain the information. Researchers followed 126 patients who underwent knee or hip replacement for osteoarthritis.

All patients attended a group education class before surgery—the standard of care for those scheduled for joint replacement at HSS. They were then randomized into two separate groups. In group one, 63 patients attended the one-on-one education session with a physical therapist in addition to the group class and were granted access to an informational web portal featuring videos. The control group of 63 patients attended the standard group class and received a booklet about what to expect after joint replacement—with no further education.

Using patient satisfaction and patient-reported scores to measure pain, joint stiffness and function both before and after surgery, researchers determined that the patients who attended the extra one-on-one PT counseling session indicated they were better prepared to leave the hospital after surgery and were overall more satisfied with the preoperative education they received. Almost 97 percent of these patients accessed the informational web portal, and all of them said they would recommend it for patients undergoing the same procedure.

Almost 70 percent of patients from the group that did not receive the supplemental educational session or web portal access believed they could have benefited from additional education before surgery. Patients who received one-on-one counseling also needed fewer physical therapy sessions in the hospital before discharge and met PT discharge measures sooner, including being able to get out of bed, walk with or without an assistive device and go up and down stairs independently.

The upshot of this research is that, if you are considering joint replacement surgery, ask to meet one-on-one with a physical therapist BEFORE your surgery if that is not your doctor’s standard approach. And take advantage of any and all learning materials your doctor may give you—specifically online videos and information.

The more you know, the better your recovery may be.

How to ensure your loved one will receive good care after the move
By Cari Shane

If you have a parent or other loved one who will soon be released from the hospital after an injury or surgery, he or she might not yet be well enough to return home, even with the assistance of in-home care. That likely will mean a transition to a short-term rehabilitation facility or nursing home.

If you’ve never had this experience, you may not know what to expect. The following are some important tips, and a few cautionary tales, from caregivers and a patient who have been through the hospital-to-rehab transition.

Before You Leave the Hospital

Don’t let your loved one leave the hospital without being “admitted.” Without the word “admitted” stamped on hospital papers, the stay at the rehab facility is not covered by Medicare. It’s this semantics loophole that left Cat Stone’s mother in severe debt after a 2012 hip fracture.

“Medicare didn’t just abandon my mother — she went to her grave ashamed and afraid knowing they’d stolen her life savings, her security and her dignity with an undisclosed loophole,” says Stone, of New Jersey, whose mother was living in a Florida nursing home. Stone wrote about what happened to her mother and family for The CoveyClub.

Medicare covers nursing home care if a person over 65 has been admitted and remained in a hospital for three days, counting admission day but not the day of discharge. Since Medicare only picks up the rehab tab for the first 20 days, a secondary insurance may cover the $170.50/day co-pay for days 21 through 100.

Know you can request a private room. The hospital’s social worker will place your loved one in the facility of your choosing as long as there’s a bed available. Since a private room doesn’t cost extra, you might want to request one to ensure a restful stay. While many temporary roommates can get along just fine, sometimes it doesn’t work out.

“My grandmother[’s] roommate was not a good match,” says Amie Clark, whose grandmother was in a nursing home near Portland, Ore. “Had we not spoken up, she would have had to continue to tolerate a situation that was not healthy for an 88-year-old.” If your loved one ends up in a double room and it’s not a good situation, you can add his or her name to the private-room waiting list.

Plan for a Sunday, Monday or Tuesday discharge time. Since patients do not receive physical therapy from either the hospital or the nursing home on discharge or arrival days, the prime day to transition is a Sunday. At most facilities, Sunday is a typical off day for therapy, so your loved one won’t miss what he or she won’t get anyway.

By that same calculation, being discharged on a Saturday can ratchet up three missed therapy days: no therapy on Saturday (transition day), no therapy on Sunday (off day) and no therapy on Monday because this is the day department heads assess your loved one’s therapy needs. If the rehab facility doesn’t do assessments on Saturdays, a Friday departure would mean four days of therapy missed.

When You Arrive at the Care Facility

Disinfect the room. Studies show that the rails on the bed, over-bed table, bed control wand, nurse’s button and the room’s door handles can be ripe with germs. Get wipes and disinfect.

Get direct phone numbers. It may prove difficult to get a human to answer any of the phone numbers provided in the welcome pamphlet. Since most department heads carry company cell phones, ask for these numbers. Key ones to get: the nursing supervisor, social worker and the doctor assigned to your loved one’s care.

Schedule advocates. Schedule at least one person — a family member, friend or perhaps a paid aide — per day to advocate for your loved one, at least until you feel like everything is going well. An advocate helps draw attention to the person’s needs, especially in an environment where nurses and other care staff often are over worked and in charge of a large number of patients. If you hire someone to be an aide for this, just know the service is not covered by Medicare.

Make sure the staff understands your loved one’s mental condition. When transitioning from a hospital to a care facility, many older adults suffer from some level of hospital delirium. The rehab staff may assume that this is who your loved one is and create a misinformed treatment plan. Some of this is inherent ageism, says Catherine Callahan, 68, who says she tackled head-on the assumptions about her abilities when she arrived at a nursing home in Santa Barbara, Calif., after major surgery. They “may think you are hard of hearing, confused and limited in your determination … I stated up front that I have a keen sense of hearing … and was very committed to doing my program,” she says.

Check with your loved one’s doctor. The facility may require an immediate influenza and/or tuberculosis shot. Since your loved one may already be up to date on these, insist that the facility wait for you to get medical records. And, while you’re on the phone with the doctor, discuss medication changes and contraindications.

Look and ask before your loved one takes medicine. Each time your loved one is given medication, make sure you, your advocate or the patient asks the nurse to state the names of the pills. Lana Wolfe’s 81-year old mother was prescribed oxycodone despite an allergy, which was noted on her chart. “She was given this for two days before I found out,” says Wolfe, of Fort Colins, Colo., whose mother was in a rehab facility near Denver. Also, a few times “the medication was just left with my mom [even though] the nurse is supposed to wait until the patient actually takes the medication,” she says.

Don’t ever accept “we can’t do that” or “you have to do that” as gospel. Patients have the right to turn down treatment. “Many people assume that they have to follow the doctor’s orders and don’t have a choice, but they do,” says Clark, who is also a former long-term care social worker. Also, a family member or other individual who is legally designated can refuse treatment and make other decisions for a person in the hospital or rehab.

While Medicare’s Bill of Resident’s Rights states that patients have the right to be treated with dignity and respect, sometimes it can be a battle. “Nurses aides insisted that my mother wear a diaper even though she could go to the bathroom on her own,” says Dr. Carole Lieberman, whose 101-year old mother spent time in two Los Angeles-area rehab facilities. “Diapers are easier for the staff … but they infantilize the patients.”

Patients also have the right to ask for treatment. “My speech was unclear … [but] my program did not include speech therapy,” says Callahan. “I never gave up asking for it.” She gave doctors specific reasons for why she needed it, “such as therapists not being able to understand me.” By the second week, Callahan was assigned a speech therapist.

You have the right to read all paperwork before signing. Remind your loved ones that they do not need to sign something they don’t understand, haven’t read or for which they do not agree.

If you don’t like how your loved one is being treated, go straight to the top. It may be difficult to get the facility administrator on the phone, but keep trying. If the person remains elusive, demand an internal investigation about your loved one’s treatment from the director of nursing or social work.

By Cari Shane

Cari Shane is a freelance journalist and corporate writer specializing in public relations and social media strategy. She is based in Washington, D.C.@cariinthecity

How to ensure your loved one will receive good care after the move
By Cari Shane

If you have a parent or other loved one who will soon be released from the hospital after an injury or surgery, he or she might not yet be well enough to return home, even with the assistance of in-home care. That likely will mean a transition to a short-term rehabilitation facility or nursing home.

If you’ve never had this experience, you may not know what to expect. The following are some important tips, and a few cautionary tales, from caregivers and a patient who have been through the hospital-to-rehab transition.

Before You Leave the Hospital

Don’t let your loved one leave the hospital without being “admitted.” Without the word “admitted” stamped on hospital papers, the stay at the rehab facility is not covered by Medicare. It’s this semantics loophole that left Cat Stone’s mother in severe debt after a 2012 hip fracture.

“Medicare didn’t just abandon my mother — she went to her grave ashamed and afraid knowing they’d stolen her life savings, her security and her dignity with an undisclosed loophole,” says Stone, of New Jersey, whose mother was living in a Florida nursing home. Stone wrote about what happened to her mother and family for The CoveyClub.

Medicare covers nursing home care if a person over 65 has been admitted and remained in a hospital for three days, counting admission day but not the day of discharge. Since Medicare only picks up the rehab tab for the first 20 days, a secondary insurance may cover the $170.50/day co-pay for days 21 through 100.

Know you can request a private room. The hospital’s social worker will place your loved one in the facility of your choosing as long as there’s a bed available. Since a private room doesn’t cost extra, you might want to request one to ensure a restful stay. While many temporary roommates can get along just fine, sometimes it doesn’t work out.

“My grandmother[’s] roommate was not a good match,” says Amie Clark, whose grandmother was in a nursing home near Portland, Ore. “Had we not spoken up, she would have had to continue to tolerate a situation that was not healthy for an 88-year-old.” If your loved one ends up in a double room and it’s not a good situation, you can add his or her name to the private-room waiting list.

Plan for a Sunday, Monday or Tuesday discharge time. Since patients do not receive physical therapy from either the hospital or the nursing home on discharge or arrival days, the prime day to transition is a Sunday. At most facilities, Sunday is a typical off day for therapy, so your loved one won’t miss what he or she won’t get anyway.

By that same calculation, being discharged on a Saturday can ratchet up three missed therapy days: no therapy on Saturday (transition day), no therapy on Sunday (off day) and no therapy on Monday because this is the day department heads assess your loved one’s therapy needs. If the rehab facility doesn’t do assessments on Saturdays, a Friday departure would mean four days of therapy missed.

When You Arrive at the Care Facility

Disinfect the room. Studies show that the rails on the bed, over-bed table, bed control wand, nurse’s button and the room’s door handles can be ripe with germs. Get wipes and disinfect.

Get direct phone numbers. It may prove difficult to get a human to answer any of the phone numbers provided in the welcome pamphlet. Since most department heads carry company cell phones, ask for these numbers. Key ones to get: the nursing supervisor, social worker and the doctor assigned to your loved one’s care.

Schedule advocates. Schedule at least one person — a family member, friend or perhaps a paid aide — per day to advocate for your loved one, at least until you feel like everything is going well. An advocate helps draw attention to the person’s needs, especially in an environment where nurses and other care staff often are over worked and in charge of a large number of patients. If you hire someone to be an aide for this, just know the service is not covered by Medicare.

Make sure the staff understands your loved one’s mental condition. When transitioning from a hospital to a care facility, many older adults suffer from some level of hospital delirium. The rehab staff may assume that this is who your loved one is and create a misinformed treatment plan. Some of this is inherent ageism, says Catherine Callahan, 68, who says she tackled head-on the assumptions about her abilities when she arrived at a nursing home in Santa Barbara, Calif., after major surgery. They “may think you are hard of hearing, confused and limited in your determination … I stated up front that I have a keen sense of hearing … and was very committed to doing my program,” she says.

Check with your loved one’s doctor. The facility may require an immediate influenza and/or tuberculosis shot. Since your loved one may already be up to date on these, insist that the facility wait for you to get medical records. And, while you’re on the phone with the doctor, discuss medication changes and contraindications.

Look and ask before your loved one takes medicine. Each time your loved one is given medication, make sure you, your advocate or the patient asks the nurse to state the names of the pills. Lana Wolfe’s 81-year old mother was prescribed oxycodone despite an allergy, which was noted on her chart. “She was given this for two days before I found out,” says Wolfe, of Fort Colins, Colo., whose mother was in a rehab facility near Denver. Also, a few times “the medication was just left with my mom [even though] the nurse is supposed to wait until the patient actually takes the medication,” she says.

Don’t ever accept “we can’t do that” or “you have to do that” as gospel. Patients have the right to turn down treatment. “Many people assume that they have to follow the doctor’s orders and don’t have a choice, but they do,” says Clark, who is also a former long-term care social worker. Also, a family member or other individual who is legally designated can refuse treatment and make other decisions for a person in the hospital or rehab.

While Medicare’s Bill of Resident’s Rights states that patients have the right to be treated with dignity and respect, sometimes it can be a battle. “Nurses aides insisted that my mother wear a diaper even though she could go to the bathroom on her own,” says Dr. Carole Lieberman, whose 101-year old mother spent time in two Los Angeles-area rehab facilities. “Diapers are easier for the staff … but they infantilize the patients.”

Patients also have the right to ask for treatment. “My speech was unclear … [but] my program did not include speech therapy,” says Callahan. “I never gave up asking for it.” She gave doctors specific reasons for why she needed it, “such as therapists not being able to understand me.” By the second week, Callahan was assigned a speech therapist.

You have the right to read all paperwork before signing. Remind your loved ones that they do not need to sign something they don’t understand, haven’t read or for which they do not agree.

If you don’t like how your loved one is being treated, go straight to the top. It may be difficult to get the facility administrator on the phone, but keep trying. If the person remains elusive, demand an internal investigation about your loved one’s treatment from the director of nursing or social work.

By Cari Shane

Cari Shane is a freelance journalist and corporate writer specializing in public relations and social media strategy. She is based in Washington, D.C.@cariinthecity

A breakdown of the various offerings and where insurance fits in
By Lisa Fields

After a stroke, only about 10 percent of people recover almost completely without intervention. For everyone else, therapy is a crucial part of the recovery process. Whether you need physical, occupational and/or speech therapy following a stroke depends on your needs, but the goal is the same: to help you regain control of your body and be independent once again. The therapy you receive should be tailor-made to suit your lifestyle.

“Is the goal returning to driving or returning to work, or (is the person) a retiree who needs to take care of their own bodily functions and participate in playing with a grandchild?” says Glen Gillen, professor and director of programs in occupational therapy at Columbia University in New York and a fellow of the American Occupational Therapy Association.

Kinds of Rehabilitation Facilities

Most stroke patients stay in the hospital for five to six days. Their therapy needs are assessed within the first two days, and therapy may begin on the second. Some patients are sent home from the hospital right away. They may receive outpatient therapy sessions three times a week or get therapy at home from visiting nurses or therapists.

“If they’re higher-functioning, they can potentially go to outpatient therapy, if they have the means to get there,” Gillen says. “That is a challenge for many.”

Many stroke patients are discharged from the hospital to inpatient rehabilitation facilities, where they receive therapy at an intensity that’s best for their needs, based on the severity of the disability. Some go to acute inpatient rehab facilities, which offer the most intense therapy for the most responsive patients. Those with a greater degree of impairment may be sent to “subacute rehab” facilities, where the therapy isn’t as intense as acute rehab.

At acute rehab facilities, “people are guaranteed a minimum of three hours of therapy a day, and a physician visits six days a week,” says Dr. Alexander Dromerick, professor of rehabilitation medicine and neurology and chairman of rehabilitation medicine at Georgetown University Medical Center in Washington, D.C. “(At a subacute facility), they may get a few minutes a day, up to two hours a day, of therapy, and a physician visits every few weeks. They’re very different levels of intensity of care.”

Patients who are making great strides in a subacute facility might be moved to an acute facility for more intense therapy. Those who don’t have the endurance to tolerate an acute facility’s therapy, might be transferred to a subacute facility. “A subacute unit can be a way station back to the community,” Dromerick says, “or it can be a way station to go to a nursing home for the long term.”

Types of Therapy for Stroke Patients

Stroke patients often need physical therapy to strengthen their muscles, retrain their sense of balance and coordination and relearn certain movements. They may need occupational therapy to ensure they can do the tasks associated with daily living, like getting dressed, feeding themselves, showering or relearning skills necessary to return to work. Speech therapy also might be required to relearn how to speak or swallow food.

“Sometimes occupational therapists and physical therapists work together, but occupational therapists focus more on mobility activities that have to do with returning to work or returning to their role in their family or community,” says Carolee Winstein, professor of biokinesiology and physical therapy and director of the Motor Behavior and Neurorehabilitation Laboratory at the University of Southern California. “Physical therapists work on fundamental skills that are needed to be functional in their particular life, whatever it is. We work a lot on mobility. We teach people a lot about the importance of remaining physically active.”

Physical therapists help patients overcome physical challenges — this includes when a stroke has weakened or partially paralyzed one side of the body. Medical professionals refer to that side as “paretic.”

“If they’re having trouble reaching and grasping with their paretic side, I have them do it with their less paretic side to remind them what it should feel like,” Winstein says. “A lot of motor skills are implicit — we don’t think; we do it automatically.”

Occupational and speech therapists also address cognitive challenges.

“We consider most tasks physical, like dressing yourself, (but) all tasks that we do across the day have a cognitive component,” Gillen says. “With getting dressed, it’s the sequence of the clothing: which goes on what body part, which goes on first. If cognition is involved after a stroke, it’s a time-consuming process. We know it will take much longer, much more repetition of practice to get them there.”

Insurance Plans Could Limit Therapy

Health insurance may limit how much therapy a person can receive during a single calendar year or during his or her lifetime. If a person can afford to pay out of pocket, he or she may continue therapy without interruption. Otherwise, many therapists offer plans that patients can follow at home or at a fitness center either on their own or with the help of a family member, friend or personal trainer.

“You can keep working on the stroke problems indefinitely,” Dromerick says.

Therapists hope to get stroke patients functioning independently again, even after their sessions are complete.

“They may need a cane and a brace, but (we teach) them how to navigate with their disability so their disability does not become a barrier in their participation of being active,” Winstein says. “If there are certain things they can’t do, we show them what they can do and get them to work on those things.”

To learn more about stroke rehab and recovery, check out the American Stroke Association’s website.

By Lisa Fields
Lisa Fields is a writer who covers psychology and health matters as they relate to the workplace. She publishes frequently in WebMD and Reader’s Digest.

A breakdown of the various offerings and where insurance fits in
By Lisa Fields

After a stroke, only about 10 percent of people recover almost completely without intervention. For everyone else, therapy is a crucial part of the recovery process. Whether you need physical, occupational and/or speech therapy following a stroke depends on your needs, but the goal is the same: to help you regain control of your body and be independent once again. The therapy you receive should be tailor-made to suit your lifestyle.

“Is the goal returning to driving or returning to work, or (is the person) a retiree who needs to take care of their own bodily functions and participate in playing with a grandchild?” says Glen Gillen, professor and director of programs in occupational therapy at Columbia University in New York and a fellow of the American Occupational Therapy Association.

Kinds of Rehabilitation Facilities

Most stroke patients stay in the hospital for five to six days. Their therapy needs are assessed within the first two days, and therapy may begin on the second. Some patients are sent home from the hospital right away. They may receive outpatient therapy sessions three times a week or get therapy at home from visiting nurses or therapists.

“If they’re higher-functioning, they can potentially go to outpatient therapy, if they have the means to get there,” Gillen says. “That is a challenge for many.”

Many stroke patients are discharged from the hospital to inpatient rehabilitation facilities, where they receive therapy at an intensity that’s best for their needs, based on the severity of the disability. Some go to acute inpatient rehab facilities, which offer the most intense therapy for the most responsive patients. Those with a greater degree of impairment may be sent to “subacute rehab” facilities, where the therapy isn’t as intense as acute rehab.

At acute rehab facilities, “people are guaranteed a minimum of three hours of therapy a day, and a physician visits six days a week,” says Dr. Alexander Dromerick, professor of rehabilitation medicine and neurology and chairman of rehabilitation medicine at Georgetown University Medical Center in Washington, D.C. “(At a subacute facility), they may get a few minutes a day, up to two hours a day, of therapy, and a physician visits every few weeks. They’re very different levels of intensity of care.”

Patients who are making great strides in a subacute facility might be moved to an acute facility for more intense therapy. Those who don’t have the endurance to tolerate an acute facility’s therapy, might be transferred to a subacute facility. “A subacute unit can be a way station back to the community,” Dromerick says, “or it can be a way station to go to a nursing home for the long term.”

Types of Therapy for Stroke Patients

Stroke patients often need physical therapy to strengthen their muscles, retrain their sense of balance and coordination and relearn certain movements. They may need occupational therapy to ensure they can do the tasks associated with daily living, like getting dressed, feeding themselves, showering or relearning skills necessary to return to work. Speech therapy also might be required to relearn how to speak or swallow food.

“Sometimes occupational therapists and physical therapists work together, but occupational therapists focus more on mobility activities that have to do with returning to work or returning to their role in their family or community,” says Carolee Winstein, professor of biokinesiology and physical therapy and director of the Motor Behavior and Neurorehabilitation Laboratory at the University of Southern California. “Physical therapists work on fundamental skills that are needed to be functional in their particular life, whatever it is. We work a lot on mobility. We teach people a lot about the importance of remaining physically active.”

Physical therapists help patients overcome physical challenges — this includes when a stroke has weakened or partially paralyzed one side of the body. Medical professionals refer to that side as “paretic.”

“If they’re having trouble reaching and grasping with their paretic side, I have them do it with their less paretic side to remind them what it should feel like,” Winstein says. “A lot of motor skills are implicit — we don’t think; we do it automatically.”

Occupational and speech therapists also address cognitive challenges.

“We consider most tasks physical, like dressing yourself, (but) all tasks that we do across the day have a cognitive component,” Gillen says. “With getting dressed, it’s the sequence of the clothing: which goes on what body part, which goes on first. If cognition is involved after a stroke, it’s a time-consuming process. We know it will take much longer, much more repetition of practice to get them there.”

Insurance Plans Could Limit Therapy

Health insurance may limit how much therapy a person can receive during a single calendar year or during his or her lifetime. If a person can afford to pay out of pocket, he or she may continue therapy without interruption. Otherwise, many therapists offer plans that patients can follow at home or at a fitness center either on their own or with the help of a family member, friend or personal trainer.

“You can keep working on the stroke problems indefinitely,” Dromerick says.

Therapists hope to get stroke patients functioning independently again, even after their sessions are complete.

“They may need a cane and a brace, but (we teach) them how to navigate with their disability so their disability does not become a barrier in their participation of being active,” Winstein says. “If there are certain things they can’t do, we show them what they can do and get them to work on those things.”

To learn more about stroke rehab and recovery, check out the American Stroke Association’s website.

By Lisa Fields
Lisa Fields is a writer who covers psychology and health matters as they relate to the workplace. She publishes frequently in WebMD and Reader’s Digest.

The contagious bacterial infection can be more serious for older adults
By Mark Ray

When you were a child, did you worry about monsters hiding under your bed or lurking behind your closet door? It turns out one monster — clostridium difficile, or C. diff — may actually be closer at hand, at least in hospitals and nursing homes.

Transmitted via fecal matter, the C. diff bacterial infection can cause severe diarrhea, nausea, fever, dehydration, abdominal pain, kidney failure and even death. Older adults are more vulnerable to it because of naturally weaker immune systems, more likelihood of underlying health issues and more time spent in health care settings.

1. diff is resistant to some antibiotics, but there are some shown to work against it. In serious and recurrent C. diff cases, patients may undergo a fecal transplant or surgery to remove a portion of the colon.
2. diff spores adhere to every imaginable surface, including toilet seats, faucet handles, doorknobs, linens, bedrails, nurse call buttons, chair arms, ceiling vents and even floors. A 2017 study in the United Kingdom detected it in floor corners in 86 percent of hospital rooms that had undergone routine cleaning.

Since its spores resist standard cleaning methods and alcohol-based hand wipes, C. diff is tough to eradicate. “We know those spores can last nine months or more in a room,” says Dr. Kate Mullane, an infectious disease specialist at The University of Chicago Medicine. “It takes a high concentration of bleach to kill the spores: a cup of bleach in a gallon of water.”

And killing the spores is critically important because C. diff itself is a killer. The most common microbial cause of health care-associated infections in the United States today, it causes nearly half a million infections and 15,000 deaths annually — almost as many deaths as drunk driving and HIV/AIDS combined,  according to the U.S. Centers for Disease Control and Prevention (CDC). Eighty percent of C. diff deaths occur among people 65 and older, and one in 11 patients in that age group dies within 30 days of diagnosis.

A two-pronged approach can keep this microscopic, but deadly killer, at bay. Prong one is antibiotic stewardship; prong two is infection control.

Antibiotic Stewardship

You’ve doubtless heard the world uses far too many antibiotics, wasting money and contributing to the growing problem of antimicrobial resistance. The Pew Charitable Trusts reported that 30 percent of outpatient antibiotic prescriptions in the U.S. are unnecessary (antibiotics prescribed for a viral infection, for example).

Doctors are getting more judicious in their use of antibiotics, but Mullane says patients should still talk with their doctors about the drugs they’re prescribing. If you can avoid antibiotics, or at least broad-spectrum antibiotics, you will be less vulnerable to C. diff. This is because, along with the bad bacteria the drugs are after, antibiotics also kill much of the good bacteria in our intestines. This leaves C. diff an opportunity to overwhelm the gut and cause illness.

1. Diff Infection Control

Given C. diff’s persistence in health care environments, it’s also important to prevent transmission between patients, health care workers and visitors — including people who aren’t symptomatic.

“We know at any one time, about 5 percent of the population is colonized with C. diff,” Mullane says. “They may not be sick with it, but they’re at least carrying it.”

The easiest way to stop transmission is with proper handwashing, according to Anna Barker., a researcher in the medical scientist training program at the University of Wisconsin-Madison. “Even with hospital-grade hand sanitizer, which in many cases is pretty similar to what you would buy out in the community, you do still need to use soap and water,” she says.

“It’s not only the soap and water (that gets rid of the germs), it’s the friction and having your hands under the tap water, which you just don’t get when you use (hand sanitizer) gel,” Barker says. A good rule of thumb to make sure you get rid of the germs: Wash your hands for as long as it takes to sing Happy Birthday to You.

But hand hygiene is just the beginning. In the April 2018 issue of the journal Clinical Infectious Diseases, Barker and two colleagues reported their research on the effectiveness of nine discrete C. diff hospital interventions, including everything from patient hand hygiene to terminal cleaning (deep cleaning of a room after a patient is discharged).

Using computer models, Barker and her colleagues found that daily room cleaning with a sporicidal cleaner plus screening for C. diff at the time of admission reduces hospital-associated infections by roughly 82 percent and asymptomatic colonization by about 91 percent.

“When hospitals try to combat their C. diff rates, they’ll end up doing lots of things at once,” Barker says. “This paper showed you can get a considerable reduction in C. diff with only those two interventions.”

What Patients Can Do

While patients don’t have much control over infection-control practices in a hospital or clinic, they can take two concrete actions.

The first is to ask health care providers if they’ve remembered to wash their hands.

“That’s easier said than done given everything we know about power dynamics and the patient-doctor relationship, but I think that really has a potential to make a big impact,” Barker says.

The other action, perhaps surprisingly, is to reduce the clutter in hospital patient rooms.

“One of the things we hear from the cleaning staff is that it’s very difficult to clean a patient’s room effectively if there are newspapers everywhere or books or food or other items throughout the room,” Barker says. “They can’t, at least at our institution, move the patient’s things for them.”

While decluttering your hospital room may not be quite as simple as switching on the lights to banish an under-bed monster, it can go a long way toward keeping you safe from C. diff.

Mark Ray is a freelance writer who has written for Scouting, Eagles’ Call, Presbyterians Today, Kentucky Homes & Gardens and other publications. He has also written, edited and/or contributed to a dozen books for the Boy Scouts and the Presbyterian and United Methodist churches.

The contagious bacterial infection can be more serious for older adults
By Mark Ray

When you were a child, did you worry about monsters hiding under your bed or lurking behind your closet door? It turns out one monster — clostridium difficile, or C. diff — may actually be closer at hand, at least in hospitals and nursing homes.

Transmitted via fecal matter, the C. diff bacterial infection can cause severe diarrhea, nausea, fever, dehydration, abdominal pain, kidney failure and even death. Older adults are more vulnerable to it because of naturally weaker immune systems, more likelihood of underlying health issues and more time spent in health care settings.

1. diff is resistant to some antibiotics, but there are some shown to work against it. In serious and recurrent C. diff cases, patients may undergo a fecal transplant or surgery to remove a portion of the colon.
2. diff spores adhere to every imaginable surface, including toilet seats, faucet handles, doorknobs, linens, bedrails, nurse call buttons, chair arms, ceiling vents and even floors. A 2017 study in the United Kingdom detected it in floor corners in 86 percent of hospital rooms that had undergone routine cleaning.

Since its spores resist standard cleaning methods and alcohol-based hand wipes, C. diff is tough to eradicate. “We know those spores can last nine months or more in a room,” says Dr. Kate Mullane, an infectious disease specialist at The University of Chicago Medicine. “It takes a high concentration of bleach to kill the spores: a cup of bleach in a gallon of water.”

And killing the spores is critically important because C. diff itself is a killer. The most common microbial cause of health care-associated infections in the United States today, it causes nearly half a million infections and 15,000 deaths annually — almost as many deaths as drunk driving and HIV/AIDS combined,  according to the U.S. Centers for Disease Control and Prevention (CDC). Eighty percent of C. diff deaths occur among people 65 and older, and one in 11 patients in that age group dies within 30 days of diagnosis.

A two-pronged approach can keep this microscopic, but deadly killer, at bay. Prong one is antibiotic stewardship; prong two is infection control.

Antibiotic Stewardship

You’ve doubtless heard the world uses far too many antibiotics, wasting money and contributing to the growing problem of antimicrobial resistance. The Pew Charitable Trusts reported that 30 percent of outpatient antibiotic prescriptions in the U.S. are unnecessary (antibiotics prescribed for a viral infection, for example).

Doctors are getting more judicious in their use of antibiotics, but Mullane says patients should still talk with their doctors about the drugs they’re prescribing. If you can avoid antibiotics, or at least broad-spectrum antibiotics, you will be less vulnerable to C. diff. This is because, along with the bad bacteria the drugs are after, antibiotics also kill much of the good bacteria in our intestines. This leaves C. diff an opportunity to overwhelm the gut and cause illness.

1. Diff Infection Control

Given C. diff’s persistence in health care environments, it’s also important to prevent transmission between patients, health care workers and visitors — including people who aren’t symptomatic.

“We know at any one time, about 5 percent of the population is colonized with C. diff,” Mullane says. “They may not be sick with it, but they’re at least carrying it.”

The easiest way to stop transmission is with proper handwashing, according to Anna Barker., a researcher in the medical scientist training program at the University of Wisconsin-Madison. “Even with hospital-grade hand sanitizer, which in many cases is pretty similar to what you would buy out in the community, you do still need to use soap and water,” she says.

“It’s not only the soap and water (that gets rid of the germs), it’s the friction and having your hands under the tap water, which you just don’t get when you use (hand sanitizer) gel,” Barker says. A good rule of thumb to make sure you get rid of the germs: Wash your hands for as long as it takes to sing Happy Birthday to You.

But hand hygiene is just the beginning. In the April 2018 issue of the journal Clinical Infectious Diseases, Barker and two colleagues reported their research on the effectiveness of nine discrete C. diff hospital interventions, including everything from patient hand hygiene to terminal cleaning (deep cleaning of a room after a patient is discharged).

Using computer models, Barker and her colleagues found that daily room cleaning with a sporicidal cleaner plus screening for C. diff at the time of admission reduces hospital-associated infections by roughly 82 percent and asymptomatic colonization by about 91 percent.

“When hospitals try to combat their C. diff rates, they’ll end up doing lots of things at once,” Barker says. “This paper showed you can get a considerable reduction in C. diff with only those two interventions.”

What Patients Can Do

While patients don’t have much control over infection-control practices in a hospital or clinic, they can take two concrete actions.

The first is to ask health care providers if they’ve remembered to wash their hands.

“That’s easier said than done given everything we know about power dynamics and the patient-doctor relationship, but I think that really has a potential to make a big impact,” Barker says.

The other action, perhaps surprisingly, is to reduce the clutter in hospital patient rooms.

“One of the things we hear from the cleaning staff is that it’s very difficult to clean a patient’s room effectively if there are newspapers everywhere or books or food or other items throughout the room,” Barker says. “They can’t, at least at our institution, move the patient’s things for them.”

While decluttering your hospital room may not be quite as simple as switching on the lights to banish an under-bed monster, it can go a long way toward keeping you safe from C. diff.

Mark Ray is a freelance writer who has written for Scouting, Eagles’ Call, Presbyterians Today, Kentucky Homes & Gardens and other publications. He has also written, edited and/or contributed to a dozen books for the Boy Scouts and the Presbyterian and United Methodist churches.

How to find a place that wants to be a real home
By Denise Logeland

Part of the Transforming Life as We Age Special Report

What makes a nursing home a good place for you or your parents? While “good” can mean a lot of things, it should include qualities like dignity and self-determination for the people who live there. The Pioneer Network offers tips on how to check for those qualities.

Formed 20 years ago, the nonprofit Pioneer Network is made up of professionals who work in long-term care, people who live in long-term care and families who advocate for them. The network, active nationally and through coalitions in 36 states, belongs to a broad-based movement in long-term care that is sometimes called simply “culture change.” That is a movement away from generic, system-based care and toward more individual, person-directed care. With culture change, residents have a large voice in the care they get and have as many of the freedoms they had in their earlier homes as possible.

You can find out if a nursing home is guided by the principles of culture change by asking specific questions when you visit to take a tour. A few examples:

• Can residents wake up when they want to in the morning?
• How do you get to know the people who live here?
• How do you build a sense of community and give those who live here a voice in how things are done?
• What is the turnover rate for the direct care workers on your staff?

There are 18 questions in all to ask at nursing homes, and a similar set of 16 to ask when looking at assisted living facilities. You can see the questions and the answers to listen for on the Pioneer Network website, where they are also available as downloads.

Denise Logeland is a writer and editor in Minneapolis who has covered business, health and health care. She is the author of Next Avenue's ebook, 10 Things Every Family Should Know: Aging With Dignity and Independence.

How to find a place that wants to be a real home
By Denise Logeland

Part of the Transforming Life as We Age Special Report

What makes a nursing home a good place for you or your parents? While “good” can mean a lot of things, it should include qualities like dignity and self-determination for the people who live there. The Pioneer Network offers tips on how to check for those qualities.

Formed 20 years ago, the nonprofit Pioneer Network is made up of professionals who work in long-term care, people who live in long-term care and families who advocate for them. The network, active nationally and through coalitions in 36 states, belongs to a broad-based movement in long-term care that is sometimes called simply “culture change.” That is a movement away from generic, system-based care and toward more individual, person-directed care. With culture change, residents have a large voice in the care they get and have as many of the freedoms they had in their earlier homes as possible.

You can find out if a nursing home is guided by the principles of culture change by asking specific questions when you visit to take a tour. A few examples:

• Can residents wake up when they want to in the morning?
• How do you get to know the people who live here?
• How do you build a sense of community and give those who live here a voice in how things are done?
• What is the turnover rate for the direct care workers on your staff?

There are 18 questions in all to ask at nursing homes, and a similar set of 16 to ask when looking at assisted living facilities. You can see the questions and the answers to listen for on the Pioneer Network website, where they are also available as downloads.

Denise Logeland is a writer and editor in Minneapolis who has covered business, health and health care. She is the author of Next Avenue's ebook, 10 Things Every Family Should Know: Aging With Dignity and Independence.

What person-centered care means and how you can get it

By Patricia Corrigan

The way patients and health care providers think about health care delivery is changing, with an increasing desire to involve patients in decisions and planning. Today, many providers also work to meet patients’ needs that go beyond medical treatments. This philosophy is known as person-centered care.

The SCAN Foundation, an independent public charity (and funder of Next Avenue), defines that philosophy as putting older adults “at the center of the decision-making process” by making use of a care team “that considers the full range of needs of individuals and their families.”

Rebecca Kirch, executive vice president of health care quality and value at the nonprofit National Patient Advocate Foundation in Washington, D.C., is a proponent of the philosophy. “So often in our health care system, when we are asked what’s the matter, the provider’s response to our answer doesn’t always align with what matters in our lives to us or to our families,” Kirch says.

What does person-centered care look like, and how can you get it? Here are some examples and advice to help you start a conversation with your doctor about a broader range of care for yourself or a loved one:

‘We Listen to What Patients Need’

Sharp Rees-Stealy Medical Group in San Diego has committed itself to person-centered care, with the goals of improving communication channels and offering more support services.

“Medical groups across the country are paying more attention to what patients need and want because patient involvement produces the best outcomes,” says Janet Appel, Sharp Rees-Stealy’s director of population health. The organization serves some 220,000 patients who make more than a million doctor visits each year.

Appel added, “If people are not engaged in how they receive care, their health goals will most likely not be met.” The medical group practices person-centered care in several ways, including:

• Phone or video appointments
• Webinars on topics such as diabetes education
• Expanded evening and weekend hours
• Case management services
• Support programs
• Nurse navigators to help with difficult diagnoses
• Texting to receive reminders and health tips

“The texting program is especially popular,” Appel says. “Patients choose how often to receive texts with tips for healthy living, reminders about appointments or information on where and when flu shots are available. They can also text us with questions, and texting answers back to them helps us stay connected at the patients’ convenience.”

Appel noted that Sharp Rees-Stealy actively seeks feedback so it can make changes that will help communications and practices evolve based on what patients want. “We listen to what patients need in order to improve patient engagement to improve healthy outcomes,” she says.

Delivering Care Where Patients Are Is ‘Critical’

At Inland Empire Health Plan (IEHP), a not-for-profit Medi-Cal (California’s Medicaid program) and Medicare health plan, the focus on person-centered care extends to individuals who may need it the most. Based in Rancho Cucamonga, IEHP is a network of more than 6,000 providers and 2,000 team members who serve more than 1.2 million people.

Through the Affordable Care Act, a large pilot program called the Behavioral Health Integration and Complex Care Initiative allows IEHP to provide person-centered care for its low-income plan members at locations convenient to them.

Working with a dozen agencies, IEHP has staff at 30 sites. “We’ve put nurses, behavioral health specialists and care coordinators at primary care offices, behavioral health clinics, substance abuse treatment clinics, adult day care centers, assisted living centers and pain management clinics,” says Dr. Bradley P. Gilbert, IEHP’s chief executive officer.

“Many people we serve face many complicated issues, including with their health, housing, transportation and other challenges, so making sure they are part of the planning and then delivering care to them where they are is critical,” Gilbert says.

The project has made significant improvements in people’s health, based on measurements regarding depression, anxiety, blood pressure and more, Gilbert says. “We’ve had great feedback from members, and providers also say they like the structure of the health care delivery.”

Currently, the pilot program is in transition. The number of sites is increasing, and nurse care managers, social workers and community health workers are being added at each. Plus, IEHP is working to house high-risk members who are homeless.

Ask Your Doctor About Person-Centered Care

What about your needs?

Is it a hardship to arrange transportation for X-rays, screenings or blood tests done across town from your primary physician’s office? Maybe you see specialists in two separate health care systems and you want them to better coordinate your care. Could you benefit from a talk with a social worker about local agencies that help pay some living costs?

Speak up, the experts advise.

“Let your voice be heard,” Appel says. “Ask what patient-centered care means at your doctor’s office, and if it’s not available, ask how you can help get that started.” You may be surprised, she adds, at the doctor’s willingness to listen.

“The medical world has gotten into what retail has done all along — listening to the consumers and then drawing them in by offering what the consumers want,” she says. “Today, there is a lot of competition, with many places to go for health care.”

Person-centered care can be especially important when individuals are coping with serious illness. Kirch, at the National Patient Advocate Foundation, gave this example: “Palliative care, now part of mainstream medicine, presents a bullet-proof case for person-centered care that aligns treatment with the goals and the specific needs of the person and the family affected, rather than focusing only on the disease. Providers must ask about those goals, document them and honor them.”

‘What We Need Now is More Public Demand’

Like Appel, Kirch encourages speaking up for what you want from your provider. “Public demand makes medical practices change faster than any policy or payment incentive,” she says.

How would Kirch assess the status of person-centered care in the U.S. today? “We have more than a toehold, but not yet a foothold,” she says. “We have demonstration programs in place in some pockets of the country, but it’s not yet scaled to where it needs to be. Still, I’m optimistic. What we need now is more public demand.”

© Next Avenue - 2018. All rights reserved.

What person-centered care means and how you can get it

By Patricia Corrigan

The way patients and health care providers think about health care delivery is changing, with an increasing desire to involve patients in decisions and planning. Today, many providers also work to meet patients’ needs that go beyond medical treatments. This philosophy is known as person-centered care.

The SCAN Foundation, an independent public charity (and funder of Next Avenue), defines that philosophy as putting older adults “at the center of the decision-making process” by making use of a care team “that considers the full range of needs of individuals and their families.”

Rebecca Kirch, executive vice president of health care quality and value at the nonprofit National Patient Advocate Foundation in Washington, D.C., is a proponent of the philosophy. “So often in our health care system, when we are asked what’s the matter, the provider’s response to our answer doesn’t always align with what matters in our lives to us or to our families,” Kirch says.

What does person-centered care look like, and how can you get it? Here are some examples and advice to help you start a conversation with your doctor about a broader range of care for yourself or a loved one:

‘We Listen to What Patients Need’

Sharp Rees-Stealy Medical Group in San Diego has committed itself to person-centered care, with the goals of improving communication channels and offering more support services.

“Medical groups across the country are paying more attention to what patients need and want because patient involvement produces the best outcomes,” says Janet Appel, Sharp Rees-Stealy’s director of population health. The organization serves some 220,000 patients who make more than a million doctor visits each year.

Appel added, “If people are not engaged in how they receive care, their health goals will most likely not be met.” The medical group practices person-centered care in several ways, including:

• Phone or video appointments
• Webinars on topics such as diabetes education
• Expanded evening and weekend hours
• Case management services
• Support programs
• Nurse navigators to help with difficult diagnoses
• Texting to receive reminders and health tips

“The texting program is especially popular,” Appel says. “Patients choose how often to receive texts with tips for healthy living, reminders about appointments or information on where and when flu shots are available. They can also text us with questions, and texting answers back to them helps us stay connected at the patients’ convenience.”

Appel noted that Sharp Rees-Stealy actively seeks feedback so it can make changes that will help communications and practices evolve based on what patients want. “We listen to what patients need in order to improve patient engagement to improve healthy outcomes,” she says.

Delivering Care Where Patients Are Is ‘Critical’

At Inland Empire Health Plan (IEHP), a not-for-profit Medi-Cal (California’s Medicaid program) and Medicare health plan, the focus on person-centered care extends to individuals who may need it the most. Based in Rancho Cucamonga, IEHP is a network of more than 6,000 providers and 2,000 team members who serve more than 1.2 million people.

Through the Affordable Care Act, a large pilot program called the Behavioral Health Integration and Complex Care Initiative allows IEHP to provide person-centered care for its low-income plan members at locations convenient to them.

Working with a dozen agencies, IEHP has staff at 30 sites. “We’ve put nurses, behavioral health specialists and care coordinators at primary care offices, behavioral health clinics, substance abuse treatment clinics, adult day care centers, assisted living centers and pain management clinics,” says Dr. Bradley P. Gilbert, IEHP’s chief executive officer.

“Many people we serve face many complicated issues, including with their health, housing, transportation and other challenges, so making sure they are part of the planning and then delivering care to them where they are is critical,” Gilbert says.

The project has made significant improvements in people’s health, based on measurements regarding depression, anxiety, blood pressure and more, Gilbert says. “We’ve had great feedback from members, and providers also say they like the structure of the health care delivery.”

Currently, the pilot program is in transition. The number of sites is increasing, and nurse care managers, social workers and community health workers are being added at each. Plus, IEHP is working to house high-risk members who are homeless.

Ask Your Doctor About Person-Centered Care

What about your needs?

Is it a hardship to arrange transportation for X-rays, screenings or blood tests done across town from your primary physician’s office? Maybe you see specialists in two separate health care systems and you want them to better coordinate your care. Could you benefit from a talk with a social worker about local agencies that help pay some living costs?

Speak up, the experts advise.

“Let your voice be heard,” Appel says. “Ask what patient-centered care means at your doctor’s office, and if it’s not available, ask how you can help get that started.” You may be surprised, she adds, at the doctor’s willingness to listen.

“The medical world has gotten into what retail has done all along — listening to the consumers and then drawing them in by offering what the consumers want,” she says. “Today, there is a lot of competition, with many places to go for health care.”

Person-centered care can be especially important when individuals are coping with serious illness. Kirch, at the National Patient Advocate Foundation, gave this example: “Palliative care, now part of mainstream medicine, presents a bullet-proof case for person-centered care that aligns treatment with the goals and the specific needs of the person and the family affected, rather than focusing only on the disease. Providers must ask about those goals, document them and honor them.”

‘What We Need Now is More Public Demand’

Like Appel, Kirch encourages speaking up for what you want from your provider. “Public demand makes medical practices change faster than any policy or payment incentive,” she says.

How would Kirch assess the status of person-centered care in the U.S. today? “We have more than a toehold, but not yet a foothold,” she says. “We have demonstration programs in place in some pockets of the country, but it’s not yet scaled to where it needs to be. Still, I’m optimistic. What we need now is more public demand.”

© Next Avenue - 2018. All rights reserved.