Skilled Nursing Services

As the population continues to age, more of us are faced with many decisions regarding our health and the health of our loved ones we thought we would never have to make.  These decisions may occur suddenly following hospitalization, or gradually as we see needs are becoming more difficult to meet in everyday life.  At this point, skilled nursing services may be an option for us to choose from.

Skilled nursing services may be provided to you or your loved one at some point in life.  It is important to be familiar with what this service entails.  Skilled nursing is a type of health care services provided for you when you need licensed and skilled professionals, such as nurses or rehabilitation staff, to manage, observe and evaluate your care.  Skilled nursing care is usually available 24 hours per day for any needs that may arise depending upon your situation.  This will ensure that proper progress is made toward your goals to maintain your optimal levels of functioning.  Skilled services include direct care provided by licensed nursing staff, physical therapy services, occupational therapy and speech therapy.  All of the services mentioned are considered as skilled care by Medicare.  Ultimately, if any service can be provided for you safely by a non-medical person, or by yourself, without the supervision of a nurse it is not considered skilled care.

Skilled nursing care refers to care given and/or supervised by registered nurses.  Skilled home health nursing services generally brings intermittent skilled services by licensed professionals into the home of an individual.  These services serve to restore and maintain his or her maximal level of functioning and health, and have the goal to prevent the current problem from worsening as long as possible.  The care provided is carried out from physician orders and must be performed by a licensed professional due to being inherently complex for a layperson to complete.  Therefore, the care must be provided by a professional so that a desired medical result will occur.  Skilled nursing services must also be reasonable and necessary for the treatment of the current illness or injury.  The nurses provide direct care such as administration of IV medications, immunizations, tube feedings, changing dressings, and educating the patient and caregivers about the current health situation so that they remain 100% informed. 

Nurses also manage, observe and evaluate a patient’s care, meaning they are the ones responsible for all care provided for a patient from other staff below them, such as licensed practical nurses or nursing assistants.  It is then their responsibility to follow-up on the care provided to the patient to ensure efficacy and patient/family satisfaction toward positive progress.  Evaluation by nursing staff occurs by following a plan of care specific to the needs of each patient regarding their health situation.  Evaluation will occur by observing the progress made by each individual toward the goals set forth in their plan of care.  If the nurse sees that progress is not going as well as planned, the care plan goals may be adjusted according to the ability and participation of the individual.  Skilled care provided should always be patient-centered, and the nursing staff should always make sure each patient is as involved in their care as they possibly can be for the best results.

Total Home Health has a program available for those requiring skilled nursing services per physician orders and a developed plan of care.  Skilled nursing visits will be performed in the home for you as much as your condition and situation warrants.  The licensed professionals with Total Home Health will accompany you in your journey into making your life less difficult and get you back into the swing of your everyday life.  Our goal is to keep you as the center of our attention with our skilled nursing services.  Your health and safety will always be our number one concern!

Range of Motion

With the gradual process of aging, with short-term hospitalization, with a disease process, or with an injury, you or your loved ones may experience weakness and observe more and more limitations of the use of your muscles and extremities.  It is at this point where range of motion exercises will become more important than ever to restore and preserve your level of functioning.  They always say, “If you don’t use it, you’ll lose it.”

Range of motion (ROM) is the term that refers to the amount of movement you have in each joint.  Every joint in the body has a range of motion that is considered “normal.”  However, the amount of movement in a joint will vary greatly between individuals.  ROM exercises are different exercises that are completed to preserve flexibility and mobility of the joints on which they are performed.  These exercises will serve to reduce stiffness and will prevent or in a sense, slow down, the freezing of your joints that may occur as the result of a disease process, or as you tend to move less often.  Joints maintain their normal ROM simply by being moved, so if your movement is compromised, the ROM of the joint will gradually decline.  The decline in ROM may cause stiffness, which can make it more difficult to complete the activities you do on a daily basis.  Plus, if range of motion in joints has declined and if they are suddenly used, the individual may experience pain.  It is very important to move your joints each and every day to maintain your optimal ROM to prevent pain and stiffness.

Physical therapists are the licensed professionals that most generally perform ROM exercises, or they may teach other licensed professionals to perform the ROM exercises safely in their absence.  Physical therapists measure range of motion in a joint with an instrument called a goniometer.  This instrument measures joint ROM in degrees from its starting position.

Usually, ROM is the range of flexion and extension of the joints in your body.  Extension is a physical position that decreases the angle between the bones of the limb at a joint.  It occurs when muscles contract and bones move the joint into a bent position.  The opposite movement is flexion, which bends the joint so that the joint angle shortens.  An injury to the soft tissue surrounding a joint often will reduce ROM due to swelling and tissue damage, such as a sprained ankle.  Therefore, regaining ROM in a joint is one of the first phases of injury rehabilitation.  Physical therapists will often prescribe specific ROM exercises for each joint according to how they are affected.  The pain an individual is experiencing must be managed effectively first to ensure the best possible participation and outcomes from the exercises.

Other terms you may hear related to range of motion exercises are abduction, adduction, inversion, eversion, dorsiflexion and plantar flexion.  Abduction is the movement of a joint away from the midline of the body.  Adduction is the movement of a joint more toward the midline of the body.  Inversion and eversion are ROM exercises used for the feet.  Inversion involves turning the sole of the foot medially, toward the midline of the body.  Eversion involves turning the sole of the foot laterally, away from the midline of the body.  Dorsiflexion and plantar flexion are used as ROM exercises for the ankle.  Dorsiflexion involves moving the foot so that the toes are pointing upward, as you may do to stop a door from closing.  Plantar flexion involves moving the foot so the toes are pointing downward, as you may do to plant something in your garden.  Those ROM exercises are just a handful of what you may be asked to perform depending upon you situation.  Your physical therapist will evaluate you thoroughly to develop a plan of ROM exercises that will restore and allow you to regain your most optimal level of functioning. 

Total Home Health has a program available for those that require range of motion exercises. Skilled visits will be performed by licensed professionals in your home for you so that you may complete these exercises according to your plan of care.  Total Home Health professionals will accompany you in your journey so that you may regain independence in your daily life without pain and suffering.

Home Health

As we age we are faced with a variety of health care decisions.  Ultimately it is up to us as to which environment we would like to be cared for in.  Home health care is one option we may choose from for either our care or for the care of someone we love.  There are other options such as placement in a nursing home, adult day care centers, assisted living, hospice etc.  Home health care is an option that brings the professionals to you in an environment that you are the most familiar with.

Home health care simply is a wide array of health care services that can be brought to your own home for an illness or injury you have sustained.  Generally, home health care is less expensive than other options, obviously it is more convenient, and it is just as effective as the care you would get in a hospital or another skilled nursing facility.  The goal of home health care is for you to get better, regain your independence to resume your normal daily activities, and to become as self-sufficient as possible. 

In order to begin home health care services, a physician order, or referral, is needed.  Once your provider refers you for the services, the home health agency, in this case Total Home Health will schedule an appointment with you to come into your home to speak with you and your loved ones about your needs.  During the initial visit, our staff will ask you questions regarding your health to gain a baseline evaluation.  Our staff will be willing to answer any questions or discuss any concerns that you may have regarding our services.  Once care begins, Total Home Health professional staff will keep in contact with your provider about your care and the progress that is being made to restore your level of functioning.  It is important that the Total Home Health staff see you as often as the doctor has ordered, this will require participation and motivation on your part as the patient, so that your goals can be met as quickly and as efficiently as possible.

Home health care staff should include the following criteria to be completed either during the initial visit and/or with consecutive visits to your home:

·      Check to see if the client is eating and drinking sufficiently.

·      Assess blood pressure, temperature, heart rate and breathing patterns.

·      Ensure that you are correctly taking your medications as prescribed.

·      Ensure that you are correctly having other procedures/treatments completed per orders provided by your physician.

·      Assess your level of pain.

·      Check the safety in your home. (Throw rugs, smoke alarms, extension cords, etc.)

·      Provide education about your personal care so that you may increase your independence in the absence of your caregiver.

·      Coordinate care by communicating regularly with your provider and anyone else who provides you with care.

Your home health service professional could be a registered nurse (RN), a licensed practical nurse (LPN), a personal care aide (PCA), a home health aide (HHA), physical therapist (PT), occupational therapist (OT), speech language pathologist (SLP), or a licensed social worker (LSW), and of course, all orders will be carried out from your provider.  Any of these professionals could be involved in your care at any point depending upon your situation.  Their overall duties are carried out as follows.

The RN will be responsible to create a care plan focused on your current situation by establishing goals that may restore your independence and/or previous level of functioning.  The RN will also be the one to educate the patient and family of ways to manage their current illness or injury.  The LPN will most likely provide the hands on basic medical care per the care plan goals that is within their scope of practice, such as dressing changes, medication administration, obtaining vital signs, providing assistance with personal hygiene, etc.  The LPN may also supervise the nursing assistants and aides to see that all their work is completed efficiently and effectively.  The personal care aide (PCA) will assist the patient with their activities of daily living, basically with anything that does not require a medical skill, such as bathing, eating, dressing, doing laundry, washing dishes, etc.  The home health aide (HHA) will do the same things as a PCA but note that they have been through advanced training with their state of employment.  This extra training allow them to be able to recognize any undesirable health changes in the patient, and they must immediately report any changes to the nurse in charge.  If needed a physical therapist (PT) will do their best to improve the patient’s mobility so that they will be safe in their home and community.  Also, an occupational therapist (OT) will work with those who have difficulty in conducting their activities of daily living, with the goal to improve their ability to safely take care of themselves in their own home.  The SLP, if needed, will work with those individuals that have difficulty speaking or swallowing.  Finally, the LSW will assist patients and their families to adapt to their illness or injury and will direct them toward community resources to assist them to accept their condition.

Total Home Health has a one of a kind home health service to provide care for you or your loved one whenever you are ready!  It is always important to never hesitate to contact us regarding any questions or concerns that may arise during your service.  Please know that with Total Home Health you are not alone; we are always available so that your experience is as excellent as possible.

Speech Therapy

At some point in your life, you or your loved one may experience a condition or illness that results in alteration of your speech.In this situation, speech language pathologists, also called speech therapists, are the professionals that will likely become involved in your care.  These professionals will assess, diagnose, and develop a treatment plan to help to prevent communication and swallowing disorders that also could arise.  Speech, language, and swallowing disorders result from a variety of causes, such as a stroke, brain injury, hearing loss, developmental delay, a cleft palate, cerebral palsy, or emotional problems.

To diagnose, speech therapists(ST) typically evaluate patients by initially communicating with them to evaluate their levels of speech or language difficulty to gain a baseline in order to decide upon treatment goals.  During evaluation the speech therapist will determine the extent of communication problems by having the patient complete basic reading and vocalizing tasks, or by administering a simple standardized test.  From the information the ST gathers, a treatment plan will then be formulated specific to each patient with measurable goals that will be worked toward and met to improve their condition, ideally to finally end up near or at the level of speech they were using prior to them requiring therapy services.

The Speech Therapist provides skilled therapy interventions in the treatment of the patient illness, rehabilitative needs and preventative care.  He/she utilizes a holistic approach in the provision of ongoing assessments, problem identification and specific therapeutic interventions, teaching and training activities.  The Speech Therapist is responsible to provide service in accordance with accepted standards of clinical practice, to facilitate problem solution, and thereby, the achievement of individualized patient goals and outcomes.

As far as treatment goes, speech therapists will typically teach patients how to make sounds to improve their voices.  Also, patients will be taught alternative communication methods, such as sign language if the prognosis of their speech is poor due to having little or no speech capability.  If needed for the current situation, speech therapists may work with patients to improve their ability to read and write correctly.  Plus, patients may be educated on how to develop, or restore, and strengthen the muscles used to swallow.  Education and support will be provided in great deal to family and/or caregivers to provide ways to cope with communication disorders.

Speech therapy professionals work with patients who ultimately have problems with speech.  Their patient population may be unable to speak at all or they may have rhythm and fluency problems, such as stuttering.  They also may work with those individuals who are unable to understand language or with those who have voice disorders, such as inappropriate pitch or a harsh voice.  Just like every other medical professional, speech therapists have to keep accurate records.  These records are kept private and include initial patient evaluations and diagnoses, progress of treatment, any changes in a patient’s condition or treatment plan that have come up during therapy, and finally, they complete a final evaluation when patient is finished with therapy services.

In conjunction with treatment from other providers on the interdisciplinary health care team and per the orders of a provider speech therapy can be an option if your situation requires it.  The course of treatment will be specific for each individual situation, and the final outcomes may vary.  Some individuals may progress much quicker than others.  The treatment, as always is performed as tolerated per the patient themselves.  The patient needs should always be met first before attempting to provide care, to ensure the best possible results.  Caregivers should also be provided with as much as support that is needed, as an alteration in speech could pose a hard situation for loved ones to adapt to because it deviates from the norms we expect.

Total Home Health has a program available to provide speech therapy services in the home for individuals once they are referred by their primary provider.  Skilled professional visits will be performed per your specific treatment plan so that you can regain the ability to communicate with those around you as best as possible.  As a part of Total Home Health you will not be alone in your journey; our compassionate staff will be here for you every step of the way!

Physical Therapy

In the healthcare setting, physical therapy is of great importance for the well-being of individuals with compromised health, whether they are receiving it due to a chronic disease process or a surgical procedure, there are various conditions that may warrant the need for this service.  If you or a loved one is admitted into a hospital with a condition such as pneumonia, this may cause you to be immobile for a certain time period.  Furthermore, once you are on the mend you may possibly find yourself weaker than normal from the short immobility, and this is where physical therapy services come into play.  At this point in your situation where your strength needs to be improved and restored, a physical therapist (PT) and/or a physical therapist assistant (PTA), will become involved in your plan of care among the other members of the healthcare team.  As compared with treatment such as occupational therapy, physical therapy aims to remediate any impairments or disabilities you have sustained and promote mobility, functional ability, quality of life and movement potential.

The Physical Therapist provides skilled therapy interventions in the treatment of the patient illness, rehabilitative needs and preventative care.  He/she utilizes a holistic approach in the provision of ongoing assessments, problem identification and specific therapeutic interventions, teaching and training activities.  The Physical Therapist is responsible to provide service in accordance with accepted standards of clinical practice, to facilitate problem solution, and thereby, the achievement of individualized patient goals and outcomes.

Physical therapy is a type of treatment you or your loved one may receive when your well-being has become compromised either with an illness or from a surgical procedure; physical therapy is generally in conjunction with other treatment types dependent upon your unique situation.  The therapy services provided will work diligently toward goals set specifically for you.  Mainly the goal will be to ensure better movement for you in the targeted body areas so that you may once again perform daily routines as usual.  The services provided may also help to relieve any pain you may have been experiencing.  One must be motivated and other underlying conditions must be treated beforehand, such as illness or pain. This will ensure the individuals are comfortable and ready to participate, so the most optimal results are observed from the physical therapy services performed.

Physical therapy may help one to recover after some surgeries; a total knee replacement or rotator cuff surgery, for example.  Your provider may also suggest physical therapy services for you if you sustain certain injuries, or if you have long-term health problems such as arthritis or COPD that may progressively cause deterioration in your functional status.  If you have a long-term health problem such as COPD, physical therapy services can help you to develop alternative ways for you to manage your daily tasks easier, through the difficulty breathing and fatigue you will experience along the way.

Once referred for therapy services by your provider, you will be placed under the care of a physical therapist (PT).  He or she will then work to perform a thorough examination and communicate with you regarding your symptoms to get a general idea of what used to be your normal daily activity functional status.  From the information the PT gathers, a treatment plan and measurable goals, specific for you, will be established for your journey.  The goals will be set with a time frame and will provide you with an understanding of how you should be progressing with the services being provided.  Setting goals, in a sense, serves as a motivator for some individuals because they can track their progression and know what additional steps they need to take to achieve the end result.  The goals will focus on helping increase maneuverability in your joints and to restore/increase any flexibility, strength, endurance, coordination, and balance that you may have lost due to your health situation.  At first a PT usually tries to decrease any pain or swelling that you may be experiencing, if any, so that you are comfortable maintain motivation to participate in the exercises.  Pain and swelling relief may be accomplished by the use of heat, cold, water, ultrasound, or electrical stimulation as tolerated by you and per the discretion of your PT and provider.  Physical therapy almost always includes exercise.  It can include stretching, core exercises, weight lifting, and walking.  With Total Home Health and for your independence in your home, your physical therapist may also teach you an exercise program that is safe and can be done without their supervision in between their visits to help reach your goals as quickly and efficiently as possible.

Do not be alarmed, however please be advised that physical therapy services may cause mild soreness or swelling.  This response is normal, however if you should have any concerns please do not hesitate to consult with your physical therapist or provider.  The goal is that upon discharge of the physical therapy services that you have met each goal that was set as part of your treatment plan with a positive outcome, and that your functional status and mobility has returned to normal so that you may safely perform your own daily routines independently.

Total Home Health has a program available to provide physical therapy services in the home for individuals once they are referred by their primary physician.  Skilled professional visits will be performed per your unique treatment plan so that you can regain your functional independence.  Remember, with Total Home Health you are not alone in your journey; our compassionate staff are here for you every step of the way!

Occupational Therapy

Aging is a process that we all go through causing the tasks we consider as normal to get increasingly difficult as time goes by.  If you see that you or your loved one is having a decline in their daily lifestyle activities, you should consult your provider to determine the best options.  One option may involve being evaluated for occupational therapy services.  Occupational therapy is a treatment option to help people to live as independently as possible.  Occupational therapists work in conjunction with other members of the health care team with people of all ages.  The patient population they work with may be compromised from illness, injury, developmental delays, or even psychological problems.  The occupational therapist will assist their patients in learning alternative skills to help them to ultimately lead the best possible independent, productive, and satisfying life.  Occupational therapists use work, self-care, and recreational activities that the individual enjoys to work toward increasing their independent function.

The Occupational Therapist provides skilled therapy interventions in the treatment of the patient illness, rehabilitative needs and preventative care.  He/she utilizes a holistic approach in the provision of ongoing assessments, problem identification and specific therapeutic interventions, teaching and training activities.  The Occupational Therapist is responsible to provide service in accordance with accepted standards of clinical practice, to facilitate problem solution, and thereby, the achievement of individualized patient goals and outcomes.

Occupational therapy can include tasks that provide assistance and training to you in performing your daily activities.  Each individual will have their own goals and different ways to go about reaching these goals.  Assistance could be given to you by an occupational therapist to increase independence in several areas.  The following are areas that can be evaluated depending upon personal needs and requirements.

                -Personal care activities.  Two examples of this are dressing and eating.  There

            are modifications that can be made to the current way you handle getting dressed

            daily, and in the way you handle your utensils when eating for instance.

            -Home skills.  These skills can be referred to as housekeeping, gardening and cooking.

           

            -Personal management skills.  Two examples of this can include balancing a checkbook

            and keeping a schedule.

-Skills that are important in driving a motor vehicle.  In this way, occupational therapy may be involved in the vision, thinking, and judgment skills needed for driving.  It also may involve finding out whether special adaptations can be installed into the vehicle itself to aid in the drivingprocess.

Occupational therapy involves many tasks that you probably do not even realize you can be helped with or that you even may have a need for.  Physical exercises, to increase good posture and joint motion as well as overall strength and flexibility will be performed.  Education will be provided related to protecting your joints and conserving your energy so that you will not tire out as easily, and to help keep your motivation to continue participation.

Once referred by your provider to receive occupational therapy an evaluation will be performed regarding your daily living needs, along with an assessment of your home and work environments if applicable.  If your occupational therapist determines anything in the assessment can be changed to benefit you, action will be implemented to do so.  After implemented, the changes will be gradually incorporated as tolerated by you so that you may continue your activities.  Occupational therapy may also assist you in the correct fitting of splints and braces if needed in your situation.  Guidance will be extended to family and caregivers that will also be involved in your care from either the occupational therapist (OT) or occupational therapist assistant (OTA), so that your services can be continued to the best of their ability during the time we are not in the home.

There are many different conditions and situations in which occupational therapy can help.  Examples of this include but are not limited to the following:

            -Mental/physical impairments from birth.

            -Recovery after a work related injury to return to the workplace.

            -Sudden, serious conditions such as a stroke, heart attack, brain injury or amputation.

            -Chronic conditions such as arthritis, COPD, or MS.

            -Learning/developmental disabilities

            -Mental health or behavioral issues such as Alzheimer’s disease, eating disorders, etc.

If you or a loved one are currently facing any of these disorders, or you have noticed a decline in the way you are performing your daily activities please consult with your provider.  Occupational therapy may be the correct treatment for your current situation.

Total Home Health has a program available to provide occupational therapy services in the home for individuals once they are referred by their primary provider.  Skilled professional visits will be performed per your unique treatment plan so that you can regain independence to continue to perform your daily tasks with pride.  Remember, with Total Home Health you are not alone in your journey; our compassionate staff are here for you every step of the way!