Ferris State UniversitySarah McCormick

Case Study Evidence-Based

Service Plan Presentation

2

Assessment

Elder J is an 87 year old female, widowed, and living alone

Hispanic

Resides in Texas

• Current Health Issues

• Background

COPD

Chronic Bronchitis

Coronary Artery Disease

Feeding Tube

3

Formal Care

• Current Providers

Registered Nurse (RN) provided through a home health care agency

• Number of Service Days

Currently twice a week

• Care Provided

Vitals, wound care, and check of medications

4

Informal Care

• Who is providing the informal services?

Neighbors

Family members

5

Types of Informal Services

• List of instrumental activities of daily living (IADLs) provided

Shopping

Medication preparation

Finances

Housework (maintence and lawn care)

• Other services

Setting up appointments

Transportation

6

Providers & Specialist

• Primary Care Provider General Internist

Seen once a month and as needed

• Psychologist Once every 3 months

For Depression and Anxiety

• Gastroenterologist Once every 2 months

For Feeding tube

7

Funding Received

• Financial resources Social Security Estimated at $1,097.00 • Medicare Advantage• Friends Borrows money from friends when needed

Service/Funding Eligibility 3. Social Security - Old Age, Survivors, Disability, and Health Insurance Programs (OASDHI) (Income) 4. Medicaid (Medicaid/Health) 5. Medicaid- Nursing Facility Program (Spousal Impoverishment) (Medicaid/Health) 6. Community Based Alternatives (CBA) (Medicaid/Health) 7. Medicaid Primary Home Care (PHC) (Medicaid/Health) 8. Medicaid Day Activity and Health Services (Medicaid/Health) 9. Supplemental Nutrition Assistance Program (SNAP) (Nutrition Assistance) 10. Merck Patient Assistance Program (Pharmaceutical - Company Program) 11. GSK Access (Pharmaceutical-Company Care 12. Rx Outreach (Pharmaceutical Discount Card 13. Medicare (Health) 14. Medicare Savings Program-Qualified Medicare Beneficiary ( QMB)

Benefits Checkup Website

https://www.benefitscheckup.org

2. Medicare Prescription Drug

Coverage for People with Limited Incomes

and Resources

1. NCOA Reverse

Mortgage Counseling

Service

8National Council on Aging. (n.d.). Can I get help? Retrieved April 18 2015,     from https://www.benefitscheckup.org

15. Adult Day Care

16. Emergency Response Services (ERS) Program

17. Residential Care (RC) Program 18. Respite Care 19. Senior Citizens Program 20. Health Centers for Primary Health Care and

Dental Services 21. Donated Dental Services 22. AUDIENT (An Alliance for Accessible

Hearing Care) 23. Chronic Disease Self-Management Program 24. Texas Health Information Counseling and

Advocacy Program 25. Community Care for Aged/Disabled (CCAD) 26. Tax Credit for the Elderly and Disabled

27. Homestead Exemption

28. Property Tax Exemption for the Elderly and Disabled

29. Property Tax Deferral

30. National Flood Insurance Program

31. Fair Plan (Insurance)

32. VA Death Pension

33. VA Pension-Aid and Attendance and Housebound Benefits

34. Housing Loan Programs for Veterans

35. State Veterans Benefits

36. Elderly Nutrition Program-Congregate or Group Meals

37. Elderly Nutrition Program-Home Delivered Meals

38. Senior Farmers’ Market Nutrition Plan

9

(Continued)

National Council on Aging. (n.d.). Can I get help? Retrieved April 18 2015,     from https://www.benefitscheckup.org

10

(Continued)

39. The Emergency Food Assistance Program (TEFAP) 40. Low Income Home Energy Assistance Program (LIHEAP) 41. Neighbor to Neighbor Texas Utility Assistance Program 42. Weatherization Assistance Program 43. Lifeline (Utility) 44. Specialized Telecommunications Assistance Program 45. Safelink Wireless 46. Lite-Up Texas Program 47. Assurance Wireless 48. ReachOut Wireless 49. USDA Housing Repair Program 50. Alzheimer's Association

Benefits

National Council on Aging. (n.d.). Can I get help? Retrieved April 18, 2015, from https://www.benefitscheckup.org

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Current Unmet Needs

Transportation

Dental

Eye Care

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Future Needs

• What unmet need(s) do you project

for this person five or ten years from now?

• Respiratory Therapy

Oxygen

Home Ventilator

• Everyday Caregiver

• Transportation

• Palliative Care

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Respiratory Therapy

• Specific needs and requirement’s to fulfill the position?

Respiratory therapists care for patients who have trouble breathing and those elders with diseased lungs (BLS, 2014). An example is elder J’s COPD and chronic bronchitis.

• Education

Associate's degree

License requirement (varies by State)

Bureau of Labor Statistics, & U.S. Department of Labor. (2014, January 8). Respiratory Therapists [Occupational Outlook Handbook, 2014-15 Edition]. Retrieved April 19, 2015, from http://www.bls.gov/ooh/healthcare/respiratory-therapists.htm

Respiratory Care Equipment

• Ventilator The equipment needs to be able to supply supplemental oxygen, have a simple interface, be equipped with power failure options such an internal battery, and be compact in size (Kacmarek, Stoller, & Heuer, 2013, p. 1038).

• Example The Carina home ventilator (Draeger Medical) For invasive or noninvasive 100-V or 240-V 2 hour internal battery 10-hour external battery

Kacmarek, R. M., Stoller, J. K., & Heuer, A. J. (2013). Egan's fundamentals of respiratory care (10th ed.). St. Louis, Mo.: Elsevier/Mosby.14

Funding for Respiratory Care

• Who covers this service?

Medicare: Part B

Under the category Durable Medical Equipment

• Elder J’s Medicare Cost

20% of the Medicare-approved amount

$0 for home health services

Centers for Medicare & Medicaid Services. (2005, July 5). National Coverage Determination (NCD) for Durable Medical Equipment Reference List (280.1). Retrieved April 19, 2015, from http://www.cms.gov/medicare-coverage-database/details/ncd- details.aspx?NCDId=190&ncdver=2&NCAId=3&ver=5&NcaName=Air- Fluidized+Beds+for+Pressure+Ulcers&bc=ACAAAAAAIAAA&

15

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Nurses Aide

• Specific needs and requirement’s to fulfill the position?

Nursing assistants and orderlies help provide basic care (BLS, 2014).

• Nurses Aide (CNA)

• Education

State-approved education program

Competency exam

Bureau of Labor Statistics, & U.S. Department of Labor. (2014, January 8). Nursing Assistants and Orderlies [Occupational Outlook Handbook, 2014-15 Edition]. Retrieved April 19, 2015, from http://www.bls.gov/ooh/healthcare/nursing-assistants.htm

Nursing

• Specific needs and requirement’s to fulfill the position?

Registered Nurse (RN)

“Assess patient health problems and needs, develop and implement nursing care plans, and maintain medical records. Administer nursing care to ill, injured, convalescent, or disabled patients. May advise patients on health maintenance and disease prevention or provide case management” (BLS, 2014). • Education Associate’s degree Licensing varies by State

Bureau of Labor Statistics, & U.S. Department of Labor. (2014, January 8). Registered Nurses [Occupational Outlook Handbook, 2014-15 Edition]. Retrieved April 19, 2015, from http://www.bls.gov/ooh/healthcare/registered-nurses.htm17

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Nursing Care Equipment

• Supplies

Hospital bed

Stethoscope

Pulse Ox

Weight scale

Syringes for tube feeding

Gauze

Personal Protection (gown, mask, gloves)

Bag-mask resuscitator

Biohazard bags and sharps container

Disinfectant cleaners

IV pole holder

Feeding pump

Enteral nutrition (liquid meal replacement)

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Funding for Nursing Care

• Who covers this service?

Medicare: Part B

Under the category Durable Medical Equipment

• Elder J’s Medicare Cost

20% of the Medicare-approved amount

$0 for home health services

Centers for Medicare & Medicaid Services. (n.d.). Home health services. Retrieved April 22, 2015, from http://www.medicare.gov/coverage/home-health-services.html

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Transportation

• Who covers this service?“Transportation is provided by the Regional Transportation Authority, including the RTA “B” Rideline for persons with disabilities that are not able to use the regular fixed rural services” (Area Agency on Aging, 2014).  Corpus Christi Regional Transportation Authority (CCRTA), www.ccrta.org

CCRTA B-Line Paratransit Service

Reservations Line, 361-289-5881, B-Line reservations may be made Monday – Friday, 7:00 a.m. 6:00 p.m., Saturday – 8:00 a.m. –5: p.m. and Sunday from 12:00 p.m.– 4:00 p.m., 24 hr. in advance of trip. B-Line is a shared ride public transportation service for people with disabilities and individuals with age-related conditions that prevent them from using fixed route services. Individuals must meet eligibility requirements as determined through an application (Aging and Disability Resource, n.d.).

Area Agency on Aging of The Coastal Bend, & Coastal Bend Council of Goverments. (2014, February 13). Transportation. Retrieved April 19, 2015, from http://www.aaacoastalbend.org/?id=27

Aging and Disability Resource Directory Committee. (n.d.). The Coastal Bend Aging & Resource Directory 2014-2015. Retrieved April 19, 2015, from http://www.cctexas.com/Assets/Departments/Parks-and- Recreations/Files/2014CoastalBendAging_DisabilityResourceDirectory_web.pdf

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Transportation (Continued)

• Other Options

Medical (Medicaid) Transportation Program: 877-633-8747 Medical care transportation for people receiving Medicaid, 48 hr. notice required.

Mobility Options Project: 361-883-8461, 877-988-1999, www.cbcil.org

Texas Department of Transportation Corpus Christi District Office, 361-808-2351, www.txdot.gov

Transportation Coordination Network (TCN) of the Coastal Bend, 361-664-7826, www.tcncb.org Coordinates public transportation network of resources in the Coastal Bend Region

Aging and Disability Resource Directory Committee. (n.d.). The Coastal Bend Aging & Resource Directory 2014-2015. Retrieved April 19, 2015, from http://www.cctexas.com/Assets/Departments/Parks-and- Recreations/Files/2014CoastalBendAging_DisabilityResourceDirectory_web.pdf

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Transportation Equipment

• Wheel cheer accessibility • Defibrillator • Bag-mask resuscitator

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Funding for Transportation

• Who covers this service?

Government subsidies

State assistance (varies by state)

Community service members (faith based, non-profit)

National Association of Area Agencies on Aging (n4a), & U.S. Administration on Aging (AoA). (n.d.). Transportation Options for Older Adults. Retrieved April 19, 2015, from http://www.eldercare.gov/Eldercare.NET/Public/Resources/Brochures/docs/Trans_Optio ns_Panels.pdf

Palliative Care

• Palliative Care Team

Registered Nurse (RN)

Physician

Pharmacist

Allied Health Professional’s

Specialist

• Who covers this service?

Medicare Part B (coverage is limited)

Medicaid (coverage is limited)

The term “Palliative” is not used by either resources24

Offered early in the process of a chronic disease, focused on reliving symptoms, and improving the quality of life (Beers, 2006, p. 223).

Beers, M. H. (2006). The Merck manual of health & aging (2006 ed.). New York: Ballantine Books.

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Future Service Plan Model

Electronic Monitoring

Electronic Health Record (EHR)

Telehealth

.

This service approach requires teamwork and use of technology. It starts with the social worker equipped with the knowledge of resources and insurance coverage. Once needs are determined a team is assembled.

All services including medications are covered under one insurance policy so that provider and patients can focus on healing.

Each provider will work on the basis of prevention offurther decline, teaching in a language and format best suited tothe patients learning needs. Also included is maintaining cognitivehealth and fall prevention.

If services are needed outside of the home the social worker will set-up the most safe and convenient transportation along with a companion such as a nurse aid or volunteer.

The monthly required medications will be delivered directly to the patients home in an easy to understand pill box along with a telecommunicated explanation from the pharmacist.

Weekly check-ins with the patient through a video conference with the whole team to discuss progress, changes, questions, and concerns.

Ideal Future Service PlanLooking Ahead 10 Years

Social Worker

Home Health Aide

Physician

Respiratory Therapist

Physical Therapist

Dentist Pastor

Psychiatric Technician

Pharmacist

Volunteers

Optometrist

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• What Type of Providers are Needed?

“The interdisciplinary team is put into place the second multiple chronic diseases are diagnosed. The primary care physician contacts the social worker, who then functions to create a team, the provider’s only provide in-home care and a set number of patients in the neighborhood”(McCormick, 2015).

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Health Care Worker Requirements

• What preparation would they need?

Geriatric training

“In 1997 the John A. Hartford Foundation funded eight national programs to develop geriatric interdisciplinary team training (GITT) programs for students in nursing, social work, and medicine in order to foster the skills needed for effective team care” (IOM, 2008, p. 159).

Licensing (will vary by job title and state requirement)

Certification (will vary by job title and state requirement)

Retooling for an aging America: Building the health care workforce (Online-Ausg. ed.) (Institute of Medicine of the National Academies, Comp.). (2008). Washington, DC: National Academies Press.

28 Bureau of Labor Statistics. (2014, January 8). Occupational Outlook Handbook. Retrieved April 22, 2015, from http://www.bls.gov/ooh/

Provider’s PreparationTitle Education Licensing Certification

Dentist Doctorate or professional degree

Varies by statewritten & practical exam

Home Health Aide High School Diploma Certificate

Nurse Associate’s degree Varies by stateOptometrist Doctorate or

professional degreeVaries by state

Pharmacist Doctorate or professional degree

Varies by stateMust pass 2 tests

Physical Therapist Doctorate or Professional degree

Varies by state

Physician Doctorate or professional degree

Varies by state

Psychiatric technician

Associates degree Varies by state

Respiratory Therapist

Associate's degree Varies by state

Social worker Bachelor’s degree Varies by state Varies by state

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Health Care Model

• What type of health care model does this idea fit into?

PACE (Program of All-inclusive Care for the Elderly) The patient is the main focus. The goal is aimed at keeping the patient intheir home. It consists of a professional health care team, with services being met in the home, community, or PACE center (Centers for Medicare, n.d.).

Who covers the services?

Medicaid 

If you do not qualify for Medicaid, but have Medicare you are charged a monthly premium for long-term care and a premium for Medicare Part D drugs

Centers for Medicare & Medicaid Services. (n.d.). PACE. Retrieved April 22, 2015, from http://www.medicare.gov/your-medicare-costs/help-paying-costs/ pace/pace.html

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Roadmap to Service

• Feasibility Consideration

These are services that are currently fragmented, but in the future as the number of elders rise this will become an option as the cost-savings become apparent and a better quality of life is achieved

• Demand for Service

The statistics currently show long-term care services provided in the home is the preference among majority of elders

• Potential Stakeholders Actions to Make It Happen

Proactive action will be seen in the near future, through policy change, provider support, and patient or family demand

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Aging and Disability Resource Directory Committee. (n.d.). The Coastal Bend Aging & Resource

Directory 2014-2015. Retrieved April 19, 2015, from

http://www.cctexas.com/Assets/Departments/Parks-and-Recreations/Files/

2014CoastalBendAging_DisabilityResourceDirectory_web.pdf

Area Agency on Aging of The Coastal Bend, & Coastal Bend Council of Goverments. (2014,

February 13). Transportation. Retrieved April 19, 2015, from

http://www.aaacoastalbend.org/?id=27

Beers, M. H. (2006). The Merck manual of health & aging (2006 ed.). New York: Ballantine Books.

Bureau of Labor Statistics. (2014, January 8). Occupational Outlook Handbook. Retrieved April 22,

2015, from http://www.bls.gov/ooh/

Bureau of Labor Statistics, & U.S. Department of Labor. (2014, January 8). Nursing Assistants

and Orderlies [Occupational Outlook Handbook, 2014-15 Edition]. Retrieved April 19,

2015, from http://www.bls.gov/ooh/healthcare/nursing-assistants.htm

References

32

Bureau of Labor Statistics, & U.S. Department of Labor. (2014, January 8). Registered

Nurses [Occupational Outlook Handbook, 2014-15 Edition]. Retrieved April 19,

2015, from http://www.bls.gov/ooh/healthcare/registered-nurses.htm

Bureau of Labor Statistics, & U.S. Department of Labor. (2014, January 8). Respiratory

Therapists [Occupational Outlook Handbook, 2014-15 Edition]. Retrieved April 19,

2015, from http://www.bls.gov/ooh/healthcare/respiratory-therapists.htm

Centers for Medicare & Medicaid Services. (n.d.). Home health services. Retrieved April 22,

2015, from http://www.medicare.gov/coverage/home-health-services.html

Centers for Medicare & Medicaid Services. (n.d.). PACE. Retrieved April 22, 2015, from

http://www.medicare.gov/your-medicare-costs/help-paying-costs/pace/pace.html

Centers for Medicare & Medicaid Services. (2005, July 5). National Coverage Determination

(NCD) for Durable Medical Equipment Reference List (280.1). Retrieved April 19, 2015,

from http://www.cms.gov/medicare-coverage-database/details/ncd-details.aspx?

NCDId=190&ncdver=2&NCAId=3&ver=5&NcaName=Air-

Fluidized+Beds+for+Pressure+Ulcers&bc=ACAAAAAAIAAA&

References

33

Kacmarek, R. M., Stoller, J. K., & Heuer, A. J. (2013). Egan's fundamentals of respiratory

care (10th ed.). St. Louis, Mo.: Elsevier/Mosby.

National Association of Area Agencies on Aging (n4a), & U.S. Administration on Aging

(AoA). (n.d.). Transportation Options for Older Adults. Retrieved April 19, 2015,

from http://www.eldercare.gov/Eldercare.NET/Public/Resources/Brochures/docs/

Trans_Options_Panels.pdf

National Council on Aging. (n.d.). Can I get help? Retrieved April 18, 2015, from

https://www.benefitscheckup.org

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES, & Centers for Medicare &

Medicaid Services. (2015, January). Medicare Hospice Benefits. Retrieved April 19,

2015, from https://www.medicare.gov/Pubs/pdf/02154.pdf

References