Triad of Innovation

Clinical

by Kristin Rowan | Jan 24, 2024 | Clinical, Regulatory, Vendor Watch

by Kristin Rowan, Editor

The Arizona Healthcare Cost Containment System (AHCCCS American Rescue Plan (ARP) Program has awarded a grant to a collaborative group of care providers, solutions providers, and educators. On January 18th, Arizona home care agency Cypress HomeCare Solutions announced they have been selected at the recipient of this program award along with solutions provider PocketRN and educator Nevvon. As a team, they will implement services that improve client and provider experiences while also creating health system savings.

In Her Own Words

Last week, we spoke with PocketRN CEO Jenna Morganstern-Gaines. “Nevvon and PocketRN are working with Cypress to implement [the use of] PocketRN by Cypress’s caregivers to study cost of care, experience for clients, families, and the care team, and outcomes,” explained Morganstern-Gaines. She further explained that part of the requirements of the grant is to issue quarterly reports and a final evaluation of the program after one year. They are currently through the first phase of the study, which was to onboard patients, families, and caregivers.

PocketRN is a telehealth platform that engages in “whole person clinical care.” It is a flexible, virtual nursing and clinical service application that wraps clinical care around non-medical care in the home. The use a proactive approach by assigning a virtual nurse to each patient who continues to check in with the patient and the family to provide coaching and assistance and to help coordinate care.

“There’s a real reason we use the phrase ‘nurse you back to health’ and not ‘doctor you back to health’. The person that will help follow through is the nurse and PocketRN provides you a one-to-one relationship with a nurse that will follow through with all of your care providers to ensure that you are ‘nursed’ back to health.”

Jenna Morganstern-Gaines

CEO, PocketRN

We will be following this ongoing study and providing updates from the reports we receive.

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Kristin Rowan has been working at The Rowan Report since 2008. She is the owner and Editor-in-chief of The Rowan Report, the industry’s most trusted source for care at home news .She also has a master’s degree in business administration and marketing and runs Girard Marketing Group, a multi-faceted boutique marketing firm specializing in content creation, social media management, and event marketing. Connect with Kristin directly kristin@girardmarketinggroup.com or www.girardmarketinggroup.com

©2025 by The Rowan Report, Peoria, AZ. All rights reserved. This article originally appeared in The Rowan Report. One copy may be printed for personal use: further reproduction by permission only. editor@therowanreport.com

Most Americans Cannot Afford Long-Term Care

Admin

by Kristin Rowan | Jan 17, 2024 | Admin, Clinical

by Kristin Rowan, Editor

with Bob Roth, Managing Partner at Cypress HomeCare Solutions

Saving for Long-term Care Starts in High School

What is the primary focus for an 18-year-old? Graduating high school, getting into the college or career training program of their choice, their first apartment, perhaps their first car, and their first adult job are things that come to mind. As the parent of a 20-year-old and a 16-year-old, I can attest to most of these and have encouraged both my kids to plan for them. Of course, the 18-year-olds might tell you they are focusing on spending time with friends, travelling, having fun, “finding” themselves, discovering their passion, and learning how to adult. These are all important as well. I’m sure there are other items you would add to these lists. But, how many of you would put long-term care on that list? How many of you were planning for private pay personal care services when you were 18? I’d guess not many of you.

One Expert's Opinion

Bob Roth, Managing Partner at Cypress HomeCare Solutions knows all too well that so many families are ill-prepared for long-term care needs for themselves and their families. In his recent article, “The aging dilemma: Long-term care”, which originally appeared in Jewish News, Roth says we should start planning for long-term care when we graduate high school. Not knowing how to provide and, especially, afford this kind of care is something Bob has seen countless times in his more than 20 years in the industry.

Long-Term Care

Long-term care can be a critical part of the health care spectrum as we age and long-term care insurance alone in the United States is inadequate. According to Roth, this stark reality prompts a crucial conversation on the state of continuing care here and around the globe. The costs of long-term care are up, the need for quality care threatens economic fallout, and the current models are unsustainable.

According to a recent study from the Joint Center for Housing Studies of Harvard University, most older adults are unable to afford in-home or assisted living care. The number of older adults continues to rise, as does the number of cost-burdened older adults. Cost-burdened older adults pay 30 percent or more of their total household income for housing. When you add in the costs for food, transportation, medicine, etc., there is nothing left for in-home care.¹

Unanswered Questions

Neither Bob nor I have answers or solutions to this problem. For many years, we’ve talked about the continuity of care across hospitals, doctors, home health, and home care. (Read our article this week on the patient data exchange network.) Perhaps a trusted exchange framework that includes personal care might one day lead to insurance coverage. In the meantime, we are looking for alternative solutions to the widening gap between people who need in-home care and people who can afford it.

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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. One copy may be printed for personal use: further reproduction by permission only. editor@therowanreport.com

Bob Roth is Managing Partner of Cypress HomeCare Solutions. Bob assisted in creating Cypress HomeCare Solutions with his family in 1994. With nearly 36 years of consumer products, health care and technology experience, Bob has successfully brought the depth and breadth of his experience to the home care trade and in doing so, Cypress HomeCare Solutions has been honored to receive a number of awards over the years.

He is a well-respected and knowledgeable member of our community.

1. Harvard (2023) Housing America’s Older Adults Key Facts chrome-extension://efaidnbmnnnibpcajpcglclefindmkaj/https://www.jchs.harvard.edu/sites/default/files/interactive-item/files/Harvard_JCHS_Housing_Americas_Older_Adults_2023_Key_Facts.pdf

Connecticut Home Care Nurse Murdered

Clinical

by Elizabeth E. Hogue, Esq. | Nov 8, 2023 | 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!

No Nurse Shortage Here

Admin

by Tim Rowan | Aug 16, 2023 | Admin, Caring for the Caregiver, Clinical, Marketing, Recruitment & Retention

by Tim Rowan, Editor

When Joseph Furtado, RN, COS-C, moved from one Phoenix-area Home Health agency to another earlier this year, he faced a seemingly insurmountable problem. The new place had dropped to a 600 census during the pandemic and got stuck there. Marketers had nurtured strong relationships with referring physicians, but the agency was turning away most of them for lack of nursing staff.

Over a span of 70 days, Furtado hired 60 nurses. As of our conversation this week, none of them have left.

Furtado, the Administrator at MD Home Health told us about his hiring philosophy that helped grow the company’s census to 1,000 and boost it to second largest in the area. “People want to work here because of the way we treat them,” he said. His plan includes several strategies:

Pay clinicians what they are worth:
- Free up funds for salaries by eliminating marketing positions
- Free up funds for salaries by reducing most training costs
- Reduce training costs by hiring only experienced nurses from other agencies who need little or no training
Treat clinicians like professionals:
- Center orientation days around presentations about company culture, not nuts and bolts of the job
- Include presentations by top employees
- Include presentations by actual patients, who talk about what the company has done for them
- Eliminate obligatory mass training sessions. Replace them with as-needed meetings with nurse supervisors, sometimes in a patient home, sometimes in a nearby coffee shop.
- The invitation is never “you need to stop doing this wrong” but “may I take you to lunch?”
- Adapt schedule and pay policy to accommodate the needs of the professional
- Replace minimum productivity requirement with mission-driven expectation and rewards
Replace marketers with a single visit from the administrator:
- We are the best, we will keep your patients out of the hospital, we will not turn away your referral
Constantly monitor Indeed and other online job sites:
- respond to new job seekers within seconds
- schedule same-day interviews when possible

Favorite Hiring Story

Furtado enjoys telling the story of his favorite hiring win. “I was a few minutes late to call a top-notch, experienced Home Health nurse who showed up on Indeed,” he began. “When I called her, she had just parked her car and was on her way into an interview appointment with another agency. Thinking fast, I said, ‘What do I have to say to stop you from walking in that door?’ She couldn’t believe I was asking her to do that; actually, I couldn’t believe I had said it either. I told her our agency was the best place to work in Arizona and she should get back in her car. I kept her on the phone and said, ‘Let me hear you start your car.’ Then ‘Let me hear you drive away.’ She drove straight to my office and I hired her.

Today, she is our Director of Nursing.

Productivity Without Mandate

He told us that he has heard criticism from peers at various conferences and other meetings for his lack of a visit-per-week requirement. “I use a point system,” he explained to us. “A one-hour visit is one point, an OASIS visit is two, and there are other points for driving distance and other factors. We ask for an average of five points per day, and we pay bonuses when they exceed that. We tell clinicians during an interview that we offer a generous base salary, but that he or she can earn 20 or 30 thousand more than that. By doing that, we achieve two things. We hire an enthusiastic clinician, and we have the luxury of not having to hang onto underperforming nurses out of desperation.

Next Up

Now that MD Home Health has a full clinical staff, Furtado plans to implement a medical scribe system, based on the concept taught to him by his Medicare reimbursement consultant, Michael McGowan, a former CMS OASIS instructor and founding owner of OperaCare. During an OASIS visit, the field nurse consults live on a speaker phone with a QA nurse in the office. There is no computer between the nurse and the patient, and the OASIS is complete, quality checked, and ready to be submitted that day.

“We will make it optional,” Furtado said. “If it works as well as it has for Michael’s other clients, our hope is that more and more OASIS nurses will opt in once they see their co-workers going home at the end of the day with all their documentation already complete.”

©2023 by Rowan Consulting Associates, Inc., Colorado Springs, CO. All rights reserved. This article originally appeared in Home Care Technology: The Rowan Report. homecaretechreport.com One copy may be printed for personal use; further reproduction by permission only. editor@homecaretechreport.com

New COVID Evidence Changes the Way Healthcare is Delivered

Clinical

by Tim Rowan | Aug 19, 2020 | Clinical

New COVID Evidence Changes the Way Healthcare is Delivered

by Tim Rowan, Editor

In its August 12 edition, Smithsonian Magazine summarized new research conducted by epidemiologists and published both in The New England Journal of Medicine and a bulletin of the Centers for Disease Control and Prevention. What these scientists have discovered may have an impact on the way in-home clinicians, therapists, and other caregivers practice.

The report reveals findings that not only larger droplets but also microscopic aerosols can transmit the novel coronavirus that causes COVID-19. In fact, aerosols – measuring one-tenth the width of a human hair – can linger suspended in the air for hours. Droplets, which are expelled by sneezing or coughing, are much larger and fall to the ground or other surfaces much more quickly.

“While the difference is literally miniscule,” the report acknowledges, “knowledge of this route of transmission would result in significant changes in how the public can bring an end to the global pandemic. In the near term, it would inform social distancing and mask wearing recommendations from local governments, and in the long term, engineers and architects will need to rethink ventilation and air filtration in the design of everything from schools to cruise ships.”

Aerosols carry pathogens up to dozens of meters under the right conditions. How long a virus can remain airborne depends on the size of the droplet containing it. “That determines everything about how far it can travel, how long it can stay airborne before it falls to the ground,” says Linsey Marr, a professor of civil and environmental engineering at Virginia Tech.

While suspended in the air for hours, some experiments have shown it is possible for the aerosols to remain contagious “for many hours.” says Marr. Different experiments have produced widely varying results, from “more than an hour” in the NEJM report, to “up to 16 hours,” according to CDC researchers.

New discoveries underscore need for familiar prevention activities

Hand-washing kills aerosols that are picked up while suspended in the air.
Masks block aerosol sprays to varying degrees depending on the type of mask worn.
Social distancing remains important because the concentration of aerosols is heaviest near an infected person.

The Smithsonian report concludes that airborne transmission of microscopic aerosols raises the issue of how to protect workers in healthcare settings. When PPE and respirators are in short supply, they should go to healthcare workers first. Surgical masks offer some protection, but it may not be enough for workers who routinely interact with the public. When an in-home care worker enters a patient’s home, they should be aware of the possibility of airborne aerosols and affix their mask well before someone answers the door. The cough that happened an hour before their arrival could be as dangerous as the one that happens while they are in the home.

Read the entire Smithsonian report here.

©2020 by Rowan Consulting Associates, Inc., Colorado Springs, CO. All rights reserved. This article originally appeared in Home Care Technology: The Rowan Report. homecaretechreport.com One copy may be printed for personal use; further reproduction by permission only. editor@homecaretechreport.com