Happy New Year! This home care column highlights and updates some of the changes occurring in home care practice and operations. As home care begins its third year in the revised prospective payment system, we have come further and learned more about improving patient care and payment methods then we ever thought possible!
In keeping with the theme of this issue of Geriatric Nursing , this section also lists new resources related to Alzheimer disease and other dementias. Please email me at news@marrelli.com if you have a topic or issue you would like to see addressed in a forthcoming column related to home care, hospice, or community health.
The 15% cut in home health reimbursement
As we go to press, it appears that hope for rescinding the 15% cut in home care reimbursement, which began October 1, may continue into the next Congress. It is important that your congressional representatives know about this issue. Remember that if Congress does not act before April 1, the 10% rural add-on that home health agencies have been getting for non-MSA (metropolotian statistical area) patients will be taken away. Remember, those who are newly elected need to know about this issue, particularly if it comes up early in the next session, and be asked to vote to delete the 15% cut and extend the 10% rural add-on.
JCAHO accreditation changes
The Joint Commission on Accreditation of Healthcare Organizations (JCAHO) has published the 2003 Comprehensive Accreditation Manual for Home Care (CAMHC) . The 2003 manual includes the standards, intent statements, scoring and aggregation rules, decision rules, and updated accredited policies and procedures. The format has been reorganized into the following services: home health, personal care and support services, hospice, home care pharmacy, long-term care pharmacy, ambulatory infusion services, home medical equipment, clinical respiratory services, rehabilitation technology, and compliance tips for each of the home care services. A new chapter, “Simplifying Compliance Activities,” is intended to help home care organizations meet the requirements of different accrediting and regulatory bodies without duplicative efforts. The CAMHC is available for $240.
JCAHO also announced the new “Shared Visions: New Pathways” initiative. Beginning in 2004, JCAHO-accredited organizations will complete a self-assessment tool at the 18-month point of their triennial cycle based on the applicable standards. The self-assessment will support continuous standards compliance and allow time during the on-site survey for surveyors to look at critical performance areas. These activities reinforce the idea that accreditation is an ongoing process. JCAHO says, “Our customers also may want JCAHO to engage accredited organizations on a more continuous basis to promote ongoing improvement and eliminate unnecessary ‘ramp up' costs and activities prior to survey.” For more information, call the JCAHO Customer Service Center at (877) 223-6866.
Diabetes update
All practice settings are seeing increased numbers of patients with diabetes mellitus. According to the Department of Health and Human Services, diabetes finally is being recognized as a serious public health problem. The most common form of diabetes in elders, type 2, comprises approximately 95% of diabetes cases in the United States. The number of people with diabetes increased nearly 50% during the past decade. The increases are reported to be even higher among the subpopulations of women and ethnic minorities. The most recent statistics indicate that 17 million Americans have the disease and 16 million more have “prediabetes”—an increasingly common condition in which blood glucose levels are higher than normal but not yet diabetic. Studies have shown that most people with prediabetes go on to develop type 2 diabetes in 10 years.
To promote a consistent and comprehensive approach to diabetes and its care, the federal National Diabetes Education Program has developed the “ABCs of Diabetes” campaign:
•A = A1C or hemoglobin A1C test, which measures average blood glucose over the previous 3 months
•B = blood pressure
•C = cholesterol
Research has shown that that aggressively treating and managing these three risk areas can lower the risk of heart disease, which is the primary killer of people with diabetes.
More than 20 kinds of insulin therapies and numerous combination drugs are now available to treat type 2 diabetes. In addition, new technologies are emerging to address the variables in control of diabetes. One hopeful sign for the millions of people who administer insulin every day is inhalable insulin. AERxiDMS is the first electronic pulmonary insulin system and is being tested in clinical trials. New data on the electronic inhaled insulin were reported at the 62nd Scientific Session of the American Diabetes Association. The system converts a special liquid insulin formulation into aerosol particles, which then are inhaled deeply into the lungs. Novo Nordisk, a Denmark-based pharmaceutical company, is conducting the trials.
New resources for dementia parients and home care practice
The Alzheimer's Disease Education & Referral (ADEAR) Center is a service of the National Institute on Aging. Numerous publications, dementia rating scales, and family and caregiver educational tools are available through ADEAR. Many are available on the ADEAR Web site at www.alzheimers.org , and some are available in bulk. Many of these resources are quite appropriate to assist teaching family and other caregivers about Alzheimer's disease. Following are some of the latest resources that help in the standardization and care of these sometimes challenging patients:
•Alzheimer's Disease (AD) Medication Fact Sheet —The four currently approved medications to treat mild to moderate AD are described in this useful booklet. Known as cholinesterase inhibitors, these medications are Reminyl (galantamine), Exelon (rivastigmine), Aricept (donepezil), and Cognex (tacrine). The booklet provides information about the recommended dosages, common side effects, and possible drug interactions. The fact sheet is available at www.alzheimers.org/pubs/medications.htm .
•Multi-Infarct Dementia Fact Sheet— Multi-infarct dementia, the most common form of vascular dementia, accounts for 10% to 20% of all cases of progressive dementia, second only to AD. This revised publication describes how this form of dementia is caused by a series of strokes, what happens when a stroke occurs, and some of the main causes of strokes. Risk factors for strokes and symptoms and diagnosis for multi-infarct dementia also are described, and information on treatment to prevent further strokes and an extensive list of resources are provided. The fact sheet is available at www.alzheimers.org/pubs/mid.htm .
•Spanish AD Fact Sheet— A new Spanish fact sheet describes the latest developments in AD, lists approved medications, and discusses possible causes. This translation also describes symptoms and diagnostic advances and provides resources for additional assistance. Also noted are bilingual print and telephone resources. The fact sheet is available at www.alzheimers.org/pubs/adfact-spanish.html .
•Spanish Caregiver Guide— This handy, concise Spanish booklet offers specific tips for day-to-day care giving for people with AD. It discusses diagnosis, communications, bathing, dressing, eating, wandering, driving, and visiting the doctor's office. More than 60,000 caregiver guides in English have been distributed by ADEAR since 2001, and this new translation is a useful addition to the Spanish-language materials that are available. Preview this guide at www.alzheimers.org/pubs/careguide-spanish.html .
TINA MARRELLI, MSN, MA, RNC, is an author, editor, and home health care expert in Boca Grande, Florida. Visit www.marrelli.com
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