80 percent of depression in the elderly is treatable. Take action and help your patients feel better for the holiday season and all of 2021.
Posts from the ‘hospice’ Category
There are a lot of jokes about 2020 not being such a good year. For me, it is the year that I lost my mother at the tender age of 89 just weeks before her 90th birthday. To be honest, my math skills led me to believe she was 90 and on her way to her 91st birthday. Oh well.
Throughout this long summer while hanging out with Mama, I realized that we were living through history. Like the 1918 Spanish Flu, the Covid pandemic is an event that will continue to influence history for decades. I knew I should be writing about it but honestly, is there anything left to write? Maybe.
I lived through one aspect of Covid that isn’t getting as much attention as the number of cases and the mortality rate. My mother was ill since February and it had nothing to do with Covid. How she was treated and if she was treated had everything to do with Covid. In the end, I wonder if Covid will totally transform our healthcare industry.
My mother, always social, had very few visitors in the months prior to her death. I did not encourage visitors and when people asked if they could visit, I usually refused. I had two parents and my Dad, with Dementia, simply can’t remember to wear a mask correctly. It was uncomfortable for him and also, Mama. Covid would have been a death sentence for either of them. Even after it became clear that my mother was terminal, I would not have wished a Covid death on her. And who would have cared for her and my Dad if my son or I became sick?
Hiring help was similarly difficult. We got very lucky when an aide who is otherwise unemployed became available. She is sitting out the semester in college due to the pandemic and we are learning from the news that she may have made the very best decision. Agency help would have meant an aide that possibly went to different homes and it would be unfair to limit someone’s ability to work. Covid has changed the economic status of many Americans.
At times, I received a lot of encouragement to send Mama to the hospital. Each time her condition exacerbated, I called the local ERs and learned that nobody was allowed to stay with her in the Emergency room and if admitted, only one person who tested negative for Covid could stay with her. This person was not interchangeable. That meant my Dad who would forget rules about leaving the room would not be able to visit and either me or my son would not be able to see her.
Chances are we would have dropped her off at the ER like so much dry cleaning that got lost and we would have never seen her again. I could not do that and I had her written power of attorney for healthcare so it did not happen.
But there were friends and relatives who made life easier. I have a cousin who is a physician who visited. His approach to Mom’s care was like mine – as long as something was not painful or invasive, Mama got it. No extensive treatment or ‘heroics’ (as she called them) were attempted. If Mama were around or if she is reading this blog post, she would tell me to add to it that there is nothing heroic about shoving a tube down the throat of a senior octogenarian simply to prolong a heartbeat. And Mama is always right.
A cousin who is a nurse along with her daughter provided the very best palliative care – chocolate peanut butter cookies from the Snoop Dogg and Martha Stewart collaboration cookbook aptly named From Crook to Cook.
Another local cousin dropped off meals. It was gourmet meals on wheels. Like kids playing a joke on neighbors, the doorbell would ring and nobody would be at the door but when I would look down, there was dinner. There are no words to express how grateful we were for the care packages.
Cards were also delightful especially to mother. The beauty of cards is that they can be set aside when appropriate and read repeatedly when someone is awake.
I tell you all of this because unless a treatment is found for Covid very soon, everyone will have a friend or relative with Covid or another illness that prevents visits. You can still let them know that you care. Snoop, Martha and Cousin Tillie would want you to find a way to bring
Still, I would have hired help earlier had it not been for Covid. I would have maybe, just maybe, taken Mom to the hospital when she first had a GI bleed just to see if the problem was easily correctable. I would have had hospice come in earlier. As it was, I had access to a hospice client who gives excellent care and they were on call for me whether they knew it or not. Thanks Audubon.
Humana saved a ton of money on my mother without changing the outcome of her illness. I realize this a luxury because not everyone can take a break from life to provide total care to an elderly patient but I wonder how many people are not accessing healthcare because of the pandemic. Are outcomes in general significantly changed?
But that’s just my story of how Mama saw a return on investment on my nursing school tuition.
Covid has affected every aspect of our lives from how we work and shop to how we educate our children, socialize and even experience illnesses. Politics has played an inappropriate role in determining our response to Covid.
I hope you’re keeping some sort of record. 102 years after the Spanish Flu, it is the personal accounts of the patients and the healthcare workers, and even the San Francisco Anti-Mask league of 1919 that tell the story of the Spanish flu. Some numbers are just too high to comprehend.
If you are keeping some sort of record, please consider sharing all or part of it with us. You can email me here.
Paperwork is part of the job. Next to patient care, it is the most important part of your job. Wouldn’t it be nice to see your patients and document well in time to don your pearls and cook dinner for your family? Or maybe you just want a cocktail or two while you watch the evening news. Pretty much nobody wants to stay up until midnight documenting so that they can be paid on time.
- Turn off the Cut and Paste function. There are some clinicians who should have a neon sign on their forehead reading, ‘I document. Therefore I clone.’ Turn it off. If you survived nursing school or have an advanced degree in therapy, it stands to reason that you can compose an original note without copying the prior note.
- Write plans of care that address the patient’s issues. No more. No less. If there are two or three pages of orders, the important stuff will be buried in the minutia.
- Read the care plan. That sounds obvious but nurses cannot read care plans if they aren’t present and in the chart. This should be a priority and nurses should refuse to see the patient if they do not have one. At the very least, a verbal report from the admitting or recertifying nurse should be given and documented. It is easy to lower the bar on this but very difficult to raise it. But we are nurses. We do difficult things and we need care plans.
- Payment is often in the details. If you are not in a position to document in the house, keep a pocket sized notebook with you and write vitals and what was taught.
- Blood pressures
- Heart rate
- MD visits
- MD and hospital documentation
- Teach only useful information that your patient can understand. The internet has no shortage of teaching guides available from the web. Look for teaching guides that have been published by reputable organizations such as the American Diabetes Association, the CDC, the National Institute of Health and University hospitals. That way, if the information is bad, you can at least credit a reputable source. Upload this information into the computer in the patient’s electronic record. Then you can chart, ‘reviewed pages 1 – 4 of DM teaching guide and taught page 5’. And remember that teaching guides should vary according to the patient’s needs.
- Complete a short pre-visit checklist the day before your visit that includes calling your patient to confirm the visit, ensuring that appropriate teaching guides are uploaded and available in printed format for the patient, determining if there are additional orders since your last visit and read any documentation that another clinician submitted. This will ensure that you are able to give the best care possible to your patient.
Although going through these steps may seem like more work, it isn’t. Consider driving 15 miles to a patient’s home only to discover they had an MD appointment. If you are unprepared for teaching, you may waste your time and the patient’s. Reconstructing notes and trying to remember vital signs is a task that is slightly less pleasant than a root canal and takes time. Doing the job right the first time saves so many headaches that the manufacturer of Advil would be in jeopardy if everybody bought into the concept
Perhaps the greatest delay in documentation is finding better things to do. It requires discipline to complete quality paperwork within 24 hours of a visit. It is a habit you need if you are to be in home health longer than a week. Believe it or not, there is an app for that. Actually, there are fifteen apps for that. Try one. Because although clean documentation that doesn’t boomerang back to you and is submitted on time gets the agency paid, the effect on your life will be even more amazing.
I must say that everyone is pretty good about conducting a home safety assessment. Throw rugs are removed, lights are bright and shiny and and much of the work done by therapists is to reach the goal of the patient being able to safely navigate in the home environment. Geaux, Team!
We’re missing something. What about employee safety in the work environment? Everyday home health and hospice nurses, aides, MSW’s and social workers go into homes where they are separated from the agency and out of view of anyone who might help them. All but the most serious incidents are overlooked.
In addition to the injuries that happen regularly such as sprains, abrasions and other musculoskeletal injuries due to moving patients, these are routinely addressed in orientation and annual inservices. A risk of workplace violence also exists and recent research shows it is more prevalent than you may think.
Homecare workers (n = 1,214) reported past-year incidents of verbal aggression (50.3% of respondents), workplace aggression (26.9%), workplace violence (23.6%), sexual harassment (25.7%), and sexual aggression (12.8%). Exposure was associated with greater stress (p < .001), depression (p < .001), sleep problems (p < .001), and burnout (p < .001). Confidence in addressing workplace aggression buffered homecare workers against negative work and health outcomes.1
The CDC along with NIOSH has published an online Continuing Education course addressing workplace violence for healthcare workers. It is not specific to visiting nurses but does offer useful advice. It also offers 2.4 continuing education credit but if you want the credit, read the ‘instructions for credit on the first page. It is provided at no cost and includes short video clips, written text and discussion questions.
In taking this course, I learned that when adhering to the strict definitions of Workplace Violence, many homecare workers have experience with verbal and physical aggression. We also under report workplace violence and ‘forgive’ our patients. It may be a fact of life that nurses eat their young but it doesn’t have to be and agencies should not tolerate bullying of their employees. Regardless of the kind of workplace violence that takes place, visiting staff may suffer stress, depression, insomnia and burnout as noted in the study cited above. Without support from management, the agency’s morale will deteriorate to the point where nothing gets done.
If you know of any other resources to reduce the risk of workplace violence in the workplace, please share in the comments. Our workplace includes most zip codes in the country and all types of people. Reducing the risk of violence and supporting visiting workers can go a long way to making sure you’re agency doesn’t lose its best employees to burnout.
Hanson, G. C., Perrin, N. A., Moss, H., Laharnar, N., & Glass, N. (2015). Workplace violence against homecare workers and its relationship with workers health outcomes: a cross-sectional study. BMC Public Health, 15, 11. http://doi.org/10.1186/s12889-014-1340-7