Connecticut Home Care Nurse Murdered

Clinical

Untitled Document

by Elizabeth E. Hogue, Esq.

Joyce Grayson, a home health nurse for Elara Caring, was murdered on October 28, 2023, in the home of a patient where she was providing services. Ms. Grayson was reported missing by a family member to the local police department. The family member was also able to track her last location to the home of a patient she was scheduled to visit at 8:00 a.m. on the day of her death. The patient resided at a halfway house for convicted sex offenders. Police have not yet formally identified a suspect in Ms. Grayson’s death.

This horrible news reminds of steps that staff members and providers can take to protect their staff members:

  • Staff members should be sure of the locations of patients’ homes and have accurate directions. · Employees should contact their supervisors in the event of threatening circumstances.
  • During visits, employees should remain alert and watch for signs of possible violence; such as verbal expressions of anger and frustration, threatening gestures, signs of drug or alcohol use, or the presence of weapons.
  • When employees are verbally abused in patients’ homes, they should ask the speaker(s) to stop. If verbal abuse continues, caregivers should leave patients’ homes and notify their supervisors that they have done so. · If possible, caregivers should identify more than one exit from patients’ homes and keep a clear path to at least one of them.
  • All employees should read or reread The Gift of Fear by Gavin de Becker and take action when their instincts tell them that they should be fearful. · Management should develop a written policy of “zero tolerance” for all incidents of violence, regardless of source. The policy should include animals! The policy must require employees and contractors to report and document all incidents of violence, no matter how minor. Emphasis should be placed on both reporting and documenting. Employees must provide as much detail as possible. The policy should also include “zero tolerance” for visible weapons when caregivers are present in patients’ homes. Caregivers must be required to report the presence of visible weapons.
  • Agencies should develop quality indicators that improve efforts to protect staff. Indicators in quality and safety standards should include patient assault and other instances of violence or threatened violence. The results of these indicators should result in violence prevention plans and training programs in de-escalation of violence.
  • Data systems should be strengthened to monitor the exposure of staff members to aggression. More resources should be invested in measuring aggressive events and specific factors that resulted in exposure, such as patient type.
  • Ongoing education should be provided to protect staff. Education should focus on intentional actions that staff members must take to recognize, document, and counter threatened or actual violence.

The Connecticut General Assembly recently passed a law to increase protection for healthcare workers that does not include home care providers. Now lawmakers are calling for extension of the legislation to include home healthcare staff. Martin Looney, President Pro Tempore of the Connecticut State Senate told the CT Mirror: “More and more care is going to be provided in a home setting, which is generally a good thing. But if that is true, we need to make sure that the people who are providing that care are safe.”

Amen to that, Mr. Looney! Let’s get to it!

©2023 Elizabeth E. Hogue, Esq. All rights reserved. No portion of this material may be reproduced in any form without the advance written permission of the author.

Patient Care in the Palm of Your Hand

Product Review

By Kristin Rowan, Editor

For those of us who didn’t grow up with a smartphone in our pockets and every tool imaginable available on the internet, mobile apps are still a bit of a mystery and a marvel. There are 25 categories of mobile apps, including gaming, finance, education, business, dating, travel, and health. Development, testing, and execution of an app that actually works is difficult, time consuming, and expensive, so it may seem out of reach for most small businesses. Last week, we spoke with the creators of an app that not only coordinates care for your patients and families, but makes it seem like you have your own agency app.

The Story

Dr. TJ Patel, PT DPT, grew up in India, where he studied physical therapy. After landing his dream job, he started to notice a lot of patients returning to the hospital because they got an infection or just didn’t know how to care for themselves. There was no one providing care after discharge; there was no concept of home based care. Patel soon learned that if he was passionate about home-based care he needed to move to a country that had the infrastructure already built because it didn’t exist there.

Dr. Patel moved to the U.S. and received his masters in kinesiology and doctorate in physical therapy. He was working in home health within a week and did 27,000 home visits in his fifteen year tenure. During this time, Patel noticed that in healthcare, “the right hand does not talk to the left hand.” Communication was a huge pain point and Patel set out remedy that.

By combining care management, care delivery, and what the patient wants into one centralized location, it creates connectivity to all care providers for a patient. Thus, Care Coordinations was designed.

The Concept

Care Coordinations is a tech solution for an impactful experience for patients, caregivers, and families. It opens the lines of communication between the parties customized for each patient.

Patient Channels include all caregivers associated with the patient. Users both inside and outside the organization can be added to the channel. Each patient channel is a secure, private channel for all internal and external care providers. The patient channel can include smaller groups within the channel.

Care Circles include the primary agency caregiver, patients, and family members. The app allows for unlimited two-way communication that protects the personal information of the caregiver. This removes the need for the caregiver to use a personal cell phone or give the patient access to personal information like social media profiles. The two-way communication inside the app is HIPAA compliant, unlike standard text messaging.

Group Channels are non-patient specific for other members of your agency to feel connected, especially in a remote working environment. Department specific group channels for marketing, sales, or HR can also be created. Management functions allow for one-way communication to all employees, anonymous employee surveys, and read-only access to all other channels.

CAHPS Survey

The patient and family experience is captured in the CAHPS survey and impacts agency reimbursement rates. Care Coordinations includes a mock CAHPS survey for patients and families that goes out before the CAHPS survey. The agency can make any needed adjustments to the patient and family experience prior to the actual CAHPS survey, improving scores and reimbursement rates.

Additional Features

Care Coordinations integrates directly with EMRs to upload an episode of care.

Robust read-receipts allow you to see if caregivers have seen a notification inside a communication channel.

Phone and video call capability inside the app adds additional secure communication.

Remote patient monitoring is built in with integrations with more than 500 devices to monitor blood pressure, pulse ox, weight, blood sugar, and temperature.

Direct communication to the agency allows the patient or family to notify the agency in the event a caregiver does not show up for an appointment.

Similar to the user experience with Uber and Lyft, the map feature alerts the patient that the caregiver is in route and estimates time of arrival with a pictogram of a car.

Optional 24/7 functionality to allow the patient to contact the agency after hours. Your call center can input details of the call into the app for real-time updates and assist with reaching other family members in case of an emergency when calling 911 is not necessary.

Post-visit surveys are customizable and can help struggling caregivers to improve and recognize high-performing employees.

The Good, The Bad, and The…Just kidding, there’s nothing ugly

Overall, we found the Care Coordinations app to be useful and well-designed. The app is charged on a per patient basis, making it more cost effective to include multiple care providers in one patient channel for increased connectivity. The available integrations, ability to upload files and videos, HIPAA compliant communication, and familiar messaging structure all point to ease of adoption.

As we’ve noted before, many home health nurses are technology adverse and will fight against the adoption of anything new. Care Coordinations stresses the legality of HIPAA compliant communication and not using your personal cell phone as selling points for nurses. Still, we know this isn’t always enough to convince a steadfast (read stubborn) care provider. Caregiver benefits and a gamified system to track timeliness, survey results, and other metrics may add some incentives for those harder-to-convince nurses.

The Uber-like experience for the patient and family to see where the caregiver is and when they will arrive is a great feature. On the flip-side, there is no tracking of the caregiver on the agency side. With increased reports of workplace violence in home-based care, a feature that allows the caregiver to alert the agency of any change in schedule, without constant tracking of caregiver movements, would allow the caregiver and agency some peace of mind.

I found Care Coordinations to be robust and detailed. Current EMR integrations include Axxess, Kantime, and HomeCare HomeBase, all through Worldview. Direct integrations are in the works. As Care Coordinations adds features and integrations, we are bound to hear more from and about them.

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Kristin Rowan

Kristin Rowan has been working at Healthcare at Home: The Rowan Report since 2008. She has a master’s degree in business administration and marketing and runs Girard Marketing Group, a multi-faceted boutique marketing firm specializing in event planning, sales, and marketing strategy. She has recently taken on the role of Editor of The Rowan Report and will add her voice to current Home Care topics as well as marketing tips for home care agencies. Connect with Kristin directly kristin@girardmarketinggroup.com or www.girardmarketinggroup.com

©2024 by The Rowan Report, Peoria, AZ. All rights reserved. This article originally appeared in Healthcare at Home: The Rowan Report.homecaretechreport.com One copy may be printed for personal use: further reproduction by permission only. editor@homecaretechreport.com

Teaching Caregivers How to Help Patients Heal

Clinical

by Elizabeth E. Hogue, Esq.

Noora Health has developed a program of “health companions” in a variety of types of healthcare settings (“Teaching Patients How to Heal,” The New York Times, April 14, 2024) to help patient heal. The basis of these programs is that when medical information is properly communicated to patients and their families, complications of surgeries and illnesses are reduced. An added bonus is that acts of violence by frustrated family members against health care workers are reduced.

If patients are most comforted by their loved ones, why not involve them in the healthcare process? “We realized that caregivers get little to no guidance within the health care system,” said Shahed Alam, a co-founder of Noora Health. Many patients do not know why they are receiving care. Doctors and nurses tend repeat the same information to patient after patient.

In institutional settings, staff nurses literally take over the floors to teach patients and their family members. On cardiac floors, for example, staff nurses tell patients how to cough without stressing their hearts, how to scratch without adversely affecting their wounds, and how pacemakers work. Staff nurses also help patients sift through good and bad information. Classes frequently include how to manage side effects of medications and the importance of handwashing.

Many patients and their family members come to view the staff nurses as therapists, coaches, friends and philosophers all rolled into one. A family member who received help from a health companion described the companion as a “friend” without whom she would not have been able to care for her family member.

Although home care providers, including Medicare certified home health agencies, hospices, private duty home care agencies, and durable medical equipment (DME) companies do not necessarily have a “captive audience” like institutional providers, it is still possible to utilize health companions. Field staff can be trained to provide teaching that is similar to that provided by health companions. Teaching from health companions may also be provided to home care patients and their family members in group settings. Hospices may, for example, provide volunteers to be with patients while their caregivers attend. And, of course, virtual teachings with health companions may also prove valuable.

Providers often consider ways to differentiate their services in a competitive marketplace. Perhaps the use of health companions is one way to do so, Providers may also enhance loyalty from patients and their families, improve quality of care and prevent emergency room visits, hospitalizations and rehospitalizations. Think about it!

©2024 Elizabeth E. Hogue, Esq. All rights reserved.
No portion of this material may be reproduced in any form without the advance written permission of the author.
©2024 This article appeared in The Rowan Report. All rights reserved.

Safeguarding Home Care Heroes Part 2

Clinical by Marcylle Combs, BS, MS, RN, CHCE This article is part 2 of 2-part series. Read part 1 here.  Protecting our Care at Home Heroes Preventive Measures and Safety Protocols To deal with these dangers, several preventive steps have been recommended. Personal Protection...