Summer is coming to and end!
Summer is coming to and end!
Helpful Home Care Websites at Your Fingertips
Never before has a home health agency leader required such close contact with so many industry regulatory bodies and changes. Operationally, clinically, and financially the need to keep current is fierce. This week we are providing a handy list of key homehealth related websites. You may have websites you think should be added. Please let us know.
ABN, HHABN, and the Notice of Medicare Non-Coverage, aka Expedited Determination Notice: http://www.cms.gov/BNI/
Abt Associates- “Analysis of Home Health Case-Mix Change 2000-2008:
Billing in Home Health- Chapter 10 Medicare Claims Processing Manual:
CASPER Reports:
http://www.cms.gov/HomeHealthQualityInits/16_HHQIOASISOBQI.asp
CMS new URL-
CMS Sponsored Calls:
http://www.cms.gov/HomeHealthQualityInits/02_CMSSponsoredCalls.asp#TopOfPage
CMS Website Wheel:
http://www.cms.gov/MLNProducts/02_Catalog.asp
CMS ICD9-CM Coding Guidelines:
http://www.cms.gov/ICD9ProviderDiagnosticCodes/
CMS Interpretive Guidelines:
http://www.cms.gov/GuidanceforLawsAndRegulations/06_HHAs.asp
Conditions of Participation (CoPs):
http://www.cms.gov/CFCsAndCoPs/12_homehealth.asp#TopOfPage
CY2011 HHPPS Proposed Rule:
http://edocket.access.gpo.gov/2010pdf/2010-17753.pdf
False Claims Act:
http://www.cms.gov/smdl/downloads/SMD032207Att2.pdf
Food and Drug Association Safety Communications:
www.CMS.gov/Drugs/DrugSafety/PostmarketdrugSafetyInformationfor PatientsandProviders/ucm204882.htm
GROUPER effective October 1, 2010:
www.cms.gov/homehealthpps/05_casemixgroupersoftware.asp/
HHCAHPs:
Proposed PPS Rule
http://edocket.access.gpo.gov/2009/pdf/R9-18587.pdf
CAHPs Survey
https://www.homehealthcahps.org
For plenty of more valuable links, please visit our website from the link below.
Home Health Quality Manuals & Resources
Just for you, (CMS) has posted new and updated quality manuals and other tools and resources that are now available to help with agency quality improvement initiatives.
New and Revised Manuals:
- Process Based Quality Improvement (PBQI) Manual NEW. This is the fourth in the CMS series for OASIS. This manual describes the Process Quality Measure Report in detail. It discusses how the report will be used for quality monitoring purposes.
- Outcome Based Quality Improvement (OBQI) Manual REVISED AND UPDATED. This manual will also be found under OASIS OBQI. This manual discusses the thirty seven (37) risk-adjusted outcome measures derived from OASIS data, which will measure changes in a patient’s health status between two or more time points. The manual has a focus not only on the use of the OBQI Reports but chapters discuss how to interpret those reports as well as how to invest in care processes and plans of action .
- Outcome Based Quality Management (OBQM) Manual REVISED AND UPDATED. This manual will also be found under OASIS OBQM. This manual describes the OASIS-based reports essentially the Potentially Avoidable Event Report (formerly the Adverse Event Report) and agency Patient Related Characteristics Report (formerly the Case Mix Report). This report will display incidence rates for 12 infrequently occurring untoward events.
- OASIS-C Guidance Manual/Errata The manual and both errata updates are available online.
As of September 1, OASIS-C Process Measure Reports are available in the CASPER System and QIES Workbench (QW). Please see the QTSO Memorandum #2010-129 dated August. 13, 2010, that contains detailed information and is available at www.qtso.com.
A users’ guide is available to providers on the OASIS State Welcome Pages and to State Agencies on the “QIES to Success” page under “Training and Education.” Home health agencies that have questions concerning this information can contact the QTSO Help Desk by email at help@qtso.com or by phone at (888) 477-7876.
Additionally, CMS has created a training video on the Process Based Quality Improvement (PBQI) process. CMS plans to place another video on YouTube. This video will review M1810, M2250, and M2400 have scenarios for improved understanding.
Dementia – Part 1: The Disease Symptomatology
Dementia is a syndrome in which progressive deterioration in intellectual and cognitive abilities is so severe that it interferes with the person’s usual activities of daily living including socialization and occupational functioning. An estimated 5 to 10 percent of the U.S. adult population ages 65 and older is affected by a dementia disorder. In this age group, the dementia incidence doubles every 5 years. Dementia makes it hard for an individual to remember, to learn, and to effectively communicate. The brain disorder may cause lapses in memory and disruptive behavior burdening caregivers. This disorder hurts the person afflicted as well as those around him/her.
The Symptoms
Despite its prevalence, dementia often goes unrecognized in its early stages. Many health care professionals, as well as patients and family members chalk up the symptoms to “old age”. Dementia is caused by damaged brain cells due to a head injury, stroke, or, a disease like Alzheimer’s. The Ten Warning Signs identified by the Alzheimer’s Association include:
- 1. Recent memory loss. This is demonstrated in recurrent questions for information already answered. The Alzheimer’s Association states, in contrast, a typical age-related change would be forgetting a name but remembering it later.
- 2. Problems with language; speaking and writing. The person with dementia may not understand what they want or how to verbalize the request. They may exhibit difficulty in following a conversation or call familiar items by an incorrect term. In contrast, the Alzheimer’s Association states that an age-related change might be having difficulty finding the correct word in a sentence.
- 3. Diminished judgment. This person may go outside on a cold day and forget their shoes. They may not pay attention to grooming. In contrast, the Alzheimer’s Association states a typical age-related change might be making a poor decision periodically.
- 4. Confusion with time and space. This person may become confused regarding dates and seasons. In contrast, the Alzheimer’s Association states that an age-related change may include forgetting what date it is but being able to problem solve to find the correct answer.
- 5. Misplacing things and losing the ability to retrace steps. The individual may lose items, put the items in unusual places, and have difficulty retracing their steps to locate the items. In contrast, the Alzheimer’s Association states that any individual may misplace items periodically, such as glasses, car keys or the remote.
- 6. Challenged abstract thinking or solving problems. An individual with dementia may attempt to balance a checkbook but forget the meanings for number categories or they may have trouble following a once familiar recipe. In contrast, the Alzheimer’s Association identifies a typical age- related change might be making an error in the checkbook.
- 7. Difficulty in completing familiar tasks. Sometimes the person experiencing dementia may not remember rules to a favorite game or driving to a location and forgetting how to return home. In contrast, an age-related change might mean requiring assistance with some technology.
- 8. Rapid mood shifts and changes in personality. Families frequently report their loved one will be happy one moment and tearful the next and angry within the next moment. They may also report a loving calm friend is now anxious, fearful, and suspicious. In contrast, the Alzheimer’s Association cites an age-related change may include acquiring a specific routine and becoming irritable if it is disrupted.
- 9. Challenges with initiative and withdrawal from work or social activities. A person suffering from dementia frequently displays lack of initiative and difficulty acquiring new skills or maintaining knowledge of a favorite sport or hobby.
- 10. Difficulty understanding visual images and spatial relationships. A person with Alzheimer’s Disease may exhibit visual and distance judging difficulty as well as difficulty determining color contrasts. An age-related disease may include visual difficulties due to cataracts.
Dementia displays a non-specific illness syndrome in which affected areas of cognition include memory, language, attention, judgment, and problem solving. In later stages, the affected individual is usually disoriented to time, place, and person.
Careful assessment of history is essential to rule out various diseases and disorders that include organ dysfunction. Certain mental disorders can also produce symptoms.
The Alzheimer’s Association has compiled a detailed 64 page compendium of practice recommendations. The recommendations include a strong person and family – centered approach to dementia care. Individualizing care to the abilities and needs of individuals affected by the disease are stressed. This type of approach respects cultural and family values focusing on maintaining the traditions of the family and encouraging personalized care. Relationship building with family members is a cornerstone to care of an individual with dementia. In part two of this series, care and best practices will be discussed further.
Dementia Care Practice Recommendations for Professionals Working in a Home Setting
http://www.alz.org/national/documents/Phase_4_Home_Care_Recs.pdf
Dementia – Part 2: The Disease Symptomatology
The Mental Health Foundation (2006) defines dementia as “a decline in mental ability which affects memory, thinking, problem-solving, concentration, and perception. Dementia is almost invariably a disease of aging.”
Building upon the ten warning signs (see Part I Dementia), the following dementia best practices from the Alzheimer’s Association and other valued sources, focus on early recognition of symptoms with suggested best practice interventions.
Assess the person to determine level of difficulty with activities listed below. A positive finding may be considered an indication for further screening and history identified. A Home Health Agency protocol will no doubt include a directive to report results to the physician.
The Assessment should include:
Learning of new information
- Does the person exhibit repetitive stating?
- Does the person have difficulty remembering recent conversations, events, or
- placement of personal objects?
- Does the person utilize memory aids?
Reasoning ability
- Is the individual able to respond with a reasonable plan for problems at home,
- such as knowing what to do if there were a kitchen fire?
- Do they know how to handle telephone calls from family, from telemarketers?
Language recall
- Does the individual have increasing difficulty finding the correct words to express what he or she wants to say?
- Do they struggle finding the right work for a sentence or call something by the incorrect name and not correct it?
Handling complex tasks
- Does the individual have difficulty following a complex train of thought or
- performing tasks that require many steps such as following a recipe?
- When out walking with a family member, can the patient retrace their path home?
Spatial ability and orientation
- Does the individual have trouble driving, organizing objects around the house, and finding his or her way around familiar places?
Behaviors
- Does the individual appear silent more frequently?
- Does the individual appear more passive and less responsive?
- Is the individual more irritable than usual; is suspicious of others, or misinterprets visual or auditory stimuli?
- Do certain events trigger behavioral responses?
- Is there difficulty discussing current event in an area of interest