Disease Process Education

The human body is an amazing creation, the numerous processes that must work together without fault every second of every day is rather hard to put into perspective.  The body works hard for us, so it is important that we do all we can to take care of it.  In cases of compromise, a disease can occur, and not just in humans, but also in animals and plants. 

Related to humans, a disease is defined as an impairment of the normal state of the living thing or one of its parts that interrupts or modifies the performance of its vital functions.  The process of the disease is typically manifested by distinguishing signs and symptoms that the individual will perceive as abnormal, it is a response to environmental factors (malnutrition, industrial hazards, or climate), to specific infective agents (bacteria and viruses), to inherent defects of the organism (genetic anomalies), or to a combination of any of these factors. 

If you or your loved one is faced with a health disease at some point in your life you will see that it occurs in a process that may ultimately result in death despite all medical attempts for cure and care.  The disease will progress naturally with your treatment depending solely upon the symptoms the disease is causing your body to manifest at any given time.  The treatment you seek will have the potential to interrupt the disease process, which is the goal, so that your functioning will return to normal.  Basically a disease process is the natural progression, including its symptoms and treatment, from the initial diagnosis to its final outcome.  Your disease can be resolved, become chronic, or result in death in any given amount of time.

The path your disease decides to follow and how it progresses depends upon your unique situation.  Various factors can play a role in the specificity of the path of your disease process.  Following is a list that describes factors that may play a role in the process of your disease:

Ø  Age.  This is a big factor, if you are considered elderly (especially over age 65) generally you will have an overall decrease in body functioning, whether it be your heart, liver, lungs, kidneys, or something else that is not working at its most optimal level.  A decrease in any or all of these areas may delay healing or allow for your disease process to occur more quickly. 

Ø  Nutritional Status.  A well-balanced diet is what everyone is expected to follow, however it is easier said than done.  You may be deficient in various vitamins, protein, or other components.  There are diseases that require you to adapt your diet to accommodate the disease process itself, or even for the medications you will be prescribed to take in order to maintain the symptoms.  Diabetes is a condition in which a person should pay closer attention to what they consume in their diet daily and there are also dietary items that should be avoided if you take medication for diabetes.  You must adhere strictly to the orders of your provider if you wish to achieve the best outcome.

Ø  Family History.  Genetics play a role that may predispose you to acquiring a disease that will most likely begin to worsen as you age.  Your risk will further increase if one or both of your parents also have the disease.  An example of this would be heart disease.

Ø  Gender.  Depending upon whether you are male or female may play a role in the process of your disease.  An example again is heart disease, in which men are generally at a greater risk.

Ø  Obesity.  Overall, excess weight tends to worsen almost any condition.  It is a good idea to discuss ways to manage your weight with your provider to prevent as many complications as possible.

Ø  Stress.  Your level of stress may have an effect on how fast or how slow your disease progresses.  A piece of advice is to determine ways that you can cope with stressful situations in your life should they occur, because unrelieved stress can be dangerous to your health.

The factors mentioned above can play a part in the process of your disease.  It is important for you to be educated on ways to make your outcome the best it can possibly be related to the factors that are present in your own unique situation.  There are many more factors that can also be taken into consideration that were not listed here.  Our team of highly professional staff with Total Home Health will provide you with all the information you may need so that you can take the right route to your most optimal level of functioning at any time during the disease process.

Coordination with DME Services

Durable medical equipment (DME) refers to any medical equipment used in the home to aid patients to conform to a better quality of living.  It is a benefit included in most insurance policies.  In some cases if the patient has Medicare Part B benefits, they generally will pay for the equipment if it meets certain criteria.

If you or your loved one has Medicare Part B (Medical Insurance) you will find that it covers medically necessary durable medical equipment that your provider will prescribe for you to use in your home.  Only your doctor can prescribe medical equipment for you.  Durable medical equipment needs to meet these criteria:

ü  Prescribed equipment should be durable (long-lasting)

ü  Should only be used for medical reasons

ü  Equipment is not usually useful to someone who is not sick or injured

ü  Should be used in your home

If DME does not meet the criteria listed above, it will not be covered by Medicare Part B and you must find an alternative.  What are some items that fall under durable medical equipment (DME) that are covered?  Here is a list of various items that are included, but it is not limited to:

·      Blood sugar monitors

·      Blood sugar test strips

·      Crutches

·      Commode chairs

·      Hospital beds

·      Patient lifts

·      Suction pumps

·      Traction equipment

·      Walkers

·      Oxygen equipment and accessories

If your supplier accepts assignment, you pay 20% of the Medicare approved amount, and the Part B deductible applies.  Medicare pays for different kinds of durable medical equipment (DME) in different ways.  Depending on the type of equipment, you may need to rent the equipment, you may need to buy the equipment, or you may be able to choose whether to rent or buy the equipment.

You should be advised that Medicare will only cover your DME if your doctors and DME suppliers are enrolled in Medicare.  Doctors and suppliers have to meet strict standards to enroll and stay enrolled in Medicare.  If your doctors or suppliers are not enrolled, Medicare will not pay the claims that are submitted by them.  It is also important to ask your suppliers if they participate in Medicare before you decide to get DME to avoid any discrepancies.  If suppliers are participating suppliers, they must accept the assignment.  If suppliers are enrolled in Medicare but are not “participating,” they have the choice whether or not to accept the assignment.  If DME suppliers do not accept your assignment, there is no limit on the amount they can charge you.  It is important to you as a client to be well informed of your benefits and who is participating and who is not before you make your choice.  You do not want to pay a drastic amount out of pocket if you can avoid it.

You may also have other insurance besides Medicare.  If that is the case and your other insurance pays before Medicare, it may require you to use a supplier that is not a contract supplier. Medicare may make a secondary payment to that supplier.  The supplier must meet Medicare enrollment standards and be eligible to get secondary payments.  As always, for more information review your benefits with all coverage you have. 

With Total Home Health we have all the information that can be made available for you regarding coordination with DME services so that you have all the necessary equipment in your home to use to reach your treatment goals.

Care Plan Oversight

Care plan oversight can be rather confusing to the general public.  Our goal at Total Home Health is to provide you with the information you need to understand how CPO may affect your experience with the home health services we provide.  Care plan oversight (CPO) refers to the physician supervision of patients under either the home health or hospice benefit where the patient requires complex or multi-disciplinary care requiring ongoing physician involvement.  Medicare does not pay for care plan oversight services for nursing facility or skilled nursing facility patients.

You may wonder if the services you are planning on receiving will be covered under your current benefit package.  The following are requirements to determine whether or not you will qualify related to the services provided to you:

ü  The client (beneficiary) must require complex or multi-disciplinary care modalities that require ongoing physician involvement in your unique plan of care.

ü  Beneficiary must be receiving Medicare covered home health or hospice services during the period in which the care plan oversight services are furnished.

ü  The physician who bills CPO for your services must be the same physician who signed your home health plan of care.

ü  Your physician must furnish at least 30 minutes of CPO within the calendar month for which payment is claimed from you, and it must be determined that no other physician has been paid for CPO within that same calendar month for your services.

ü  Your physician must have provided a physician service to you that required a face-to-face encounter within 6 months immediately preceding the provision of the first CPO service.

ü  The CPO that is billed must not be routine post-operative care that was provided to you.

ü  The CPO services must be personally furnished by the physician who bills them; Services provided “incident to” a physician’s service do not qualify as CPO and do not count toward the 30 minute requirement.

ü  If End-Stage Renal Disease is a condition you are burdened with, your physician may not bill CPO during the same calendar month in which he or she bills the ESRD for the same client. 

Listed above are the requirements that will determine whether or not your benefits allow you to qualify for CPO services.  Now that you know what is required you may wonder, “Which services qualify and which services do not qualify for CPO?”

Services that do qualify for CPO benefits include, but are not limited to:

·      Review of charts, reports, treatment plans, lab results, and any other tests results that were not ordered during the face-to-face encounter that qualified you for CPO.

·      Calls to other health care professionals involved in care of the patient outside of the office.

·      Team conferences regarding your treatment plan.

·      Telephone calls/discussions with the pharmacist about medication therapies.

·      Medical decision making.

Services that do NOT qualify for CPO benefits include, but are not limited to:

·      Calling Home Health Agencies or patients/families.

·      If your provider calls you or your family to do something such as medication or treatment.

·      Time your physician takes to call in prescriptions to pharmacy.

·      Travel time should not be included.

·      Time that is spent on the day of hospital discharge to manage the discharge plan.

The professional staff the make up the Total Home Health team abides by the criteria mentioned above to incorporate CPO into our home health programs for Medicare reimbursement according to your benefits and qualifications.  Review your benefits today and feel free to discuss this with our team at your discretion so that we can answer any unanswered questions for you!

Draining Wounds

Depending upon your health condition you or your loved ones may be faced with a wound during the course of your illness.  The treatment for your wound(s) will be specific to you and what other medical condition(s) you are experiencing.  It is important that you have a basic idea of what to look for in a wound if were to begin producing drainage.  With this knowledge base you will be able to decide if it is something that is a normal part of the healing process or if it is something that should be reported right away to your provider. 

You may wonder, “Well what exactly should I be looking for when I see drainage coming from my wound?”  Drainage is a liquid produced by the body in response to tissue damage.  As healthcare professionals, we want to educate our patient’s that we like their wounds to be moist, but not too moist.  The type of wound drainage you have can tell the story of what is most likely going on in your wound.  Drainage can be classified in the following different ways:

Ø  Sanguineous Drainage

o   This may appear to you as blood that drains from a recent wound. It is characterized by a bright red color.  Generally, it is seen in partial thickness and full thickness wounds.  Sanguineous drainage is not common in wounds after a few hours or days, and if you experience this later it may be indicative of trauma to the wound site. 

Ø  Serous Drainage

o   If you are experiencing drainage that appears thin, clear and slightly thicker than water, it is known as serous drainage.  This drainage is present during the wound healing process.  Most types of wounds excrete some amount of serous drainage, usually making it something you should not have to worry about.  However, if you notice that the there continues to be more and more serous drainage, or it comes at a rate that seems to regularly soak through your bandages, it may indicate a larger issue.  Remember, you should not hesitate to have the wound examined by your provider if this type of drainage seems to be excessive.

Ø  Serosanguineous Drainage

o   This may be observed as watery, thin drainage.  It will appear pale red to pink in color.  The visible pink tinge comes from red blood cells, which means that there was damage done to the capillaries when your bandages were changed.  It is important to avoid damaging these capillaries because they are responsible for the adequate perfusion to the wound area to allow the area to resolve more quickly.  Once again, if you notice an excess of this drainage do not hesitate to contact your provider.

Ø  Seropurulent Drainage

o   This type of drainage is similar to serous drainage in its thickness (slightly thicker than water).  Seropurulent drainage is cloudier in its transparency and can be slightly yellow or tan in appearance.  There could be an odor.  Drainage of this sort usually indicates that the wound has become infected, and it is at this point that you should immediately seek further treatment.  You want to seek treatment as soon as possible to avoid infection that could cause problems in multiple areas of your body.

Ø  Purulent Drainage

o   Patients will describe this drainage as being “milky” in appearance.  Purulent drainage is almost always a sure sign that an infection has developed.  This type of drainage can be green, yellow, brown or white in color with a thick consistency.  Odor may also be noted.  In this case you should seek treatment immediately because most likely an infection has already started and has possibly spread, which could make your treatment that much more complicated.

With this simple background related to types of wound drainage, you should now be able to better distinguish between the types of drainage that are expelled from yours.  If ever you have an inclination that the drainage you see from your wound just isn’t right, you should seek further treatment immediately.  Never hesitate to contact your provider.  Total Home Health has a program that is right for you and the wound treatment that is specific to your personal needs. 

Medication Management

Typically at some point in our lives we are given some form of medication that we must take in order to resolve whatever condition that is compromising our health. It is important to strictly adhere to the medication regimen in order to gain the full therapeutic effects. Medication is involved greatly when treating an individual’s condition(s) and will have an impact on their life. Following a daily medication regimen can prove to cause a burden in someone’s life; from the strict directions, to remembering to take your medication each day. This is where Total Home Health will step in. Our skilled and passionate professionals will provide you with resources and tips to improve your quality of life while managing your medication.

Commonly you will find that when patients are required to follow a strict medication routine that they will require additional drug therapy at some point for their condition, whether it be for prevention, synergistic (working together), or palliative (comfort) care. Plus, with some medications such as Coumadin, the dosage will need to be titrated frequently in order to maintain a safe therapeutic level to reach its intended goal. When medications require titration, this requires tasks such as frequent lab draws in order to maintain the drug at the correct dosage. With Total Home Health you can sit back and enjoy the convenience we have to offer you. Our skilled professionals can perform your blood draws in the comfort of your home so you do not have to frequently travel, which could prove to impose extra danger and costs to you.

Polypharmacy is a word that you most likely do not hear much. This term refers to the use of four or more medications by a patient; this is generally found in patients over 65 years old. Therefore, polypharmacy is most common in the elderly which encompasses almost half of older adults that live in their own home. This issue makes it more difficult to manage medication, even more so in the home environment.

Keeping track of your medications is very important. Making sure they are properly stored and have not passed their expiration dates are crucial points to take into consideration. If a medication is not properly stored or expired, this could result in it not exerting the fullest therapeutic effects, or it could even pose adverse reactions. Plus, it can be hard for an individual to remember what each drug is for, when it should be taken, and how it should be taken; this becomes at an increased risk for those with memory problems. Total Home Health will lead you onto the right path with some simple strategies that you can implement to help you or your loved one to manage your medications.

• Keep a list. Try to keep a list of all the medications you take. Include in this list what the medication is, when it should be taken, and how it should be taken (some medications do better with food, juice, etc.)
• Review Your Record. During your doctor visit at regular intervals, you should review your current medication list with your provider. This will allow you to make sure your list is up to date, and it will provide them with the opportunity to let you in on any new information or instructions about any of the medications.
• Medication Advice. Always keep your medication in its original container. Never put more than one type of medication in the same container. A good piece of advice is to use a weekly medication organizer so you can place pills in the correct spot according to the day and time that they are to be taken.
• Medication Storage. Always make sure to ask your provider or pharmacist where the best place to store your medication is. Plus, read the label because it will usually provide you with this information too. Remember that the bathroom cabinet may not be the best place to store medication after all, because of the frequent warm and moist conditions.
• Do Not Abruptly Stop. You should never just immediately stop taking a medication. Always check with your provider beforehand because this could pose serious health risks. Remember that you should always take the full course of antibiotic therapy to gain the full therapeutic effect, just because you feel better does not mean that you should quit taking the antibiotic.
• Refill Accordingly. Remember to frequently check expiration dates and do not allow yourself to run out of medications. Keep in mind how many pills that remain in your bottles so that you can reorder them in enough time so that you do not run out.
• Keep in a Safe Place. Always keep medications out of the sight and reach of children and away from pets. Remember that children do climb, so place your medication strategically. Have the poison control center number available just in case.

Keep in mind that along with the advice mentioned above that your pharmacist is a great resource to turn to if you ever have any questions at all regarding your medications. Your pharmacist will keep records of all the medications you get filled at their store, so it is a good idea to always refill at the same place if at all possible.

Ultimately, managing your medications can prove to be very stressful and even dangerous to your health if not done correctly. Allow Total Home Health to assist you in making this process as easy as we possibly can. Our main focus is you and your well-being. We are eager to begin this journey with you!

Medicare Home Health

First of all you or your loved one may be new to the world of Medicare, so what is it? Medicare is the federal health insurance program for people who are 65 years or older, certain younger people with disabilities, and people with End-Stage Renal Disease (ESRD – permanent kidney failure requiring dialysis or a transplant). There are four different parts of Medicare: Part A, Part B, Part C, and Part D. The different parts of Medicare help to cover specific services.

• Medicare Part A (Hospital Insurance)
  • This part will cover inpatient hospital stays, care in a skilled nursing facility, hospice care, and some home health care.
• Medicare Part B (Medical Insurance)
  • This part covers certain doctors’ services, outpatient care, medical supplies, and preventive services.

• Medicare Part C (Medicare Advantage Plans)
  • This part is a type of health plan that is offered by a private company that contracts with Medicare to provide you with all your Part A and Part B benefits. These plans include Health Maintenance Organizations (HMOs), Preferred Provider Organizations (PPOs), Private Fee-for-Service Plans, Special Needs Plans, and Medicare Medical Savings Account Plans. Most of these plans offer prescription drug coverage.
• Medicare Part D (Prescription Drug Coverage)
  • This part adds prescription drug coverage to Original Medicare, some Medicare Cost Plans, some Medicare Private-Fee-for-Service Plans, and Medicare Medical Savings Account Plans. These plans are offered by insurance companies and other private companies approved by Medicare.

There are 4 criteria an individual must meet in order for Medicare to help cover costs of your home care services:

1. You must be considered homebound. This means that you either require the assistance of another person or device (walker) to leave your home, your provider believes that if you leave your home it would be harmful to your health, and it is difficult for you to leave your home and you generally are not able to do so.
2. You require skilled care.
3. Your doctor signs a home health certification stating that you qualify for Medicare home care due to being homebound and in need of intermittent skilled care. The certification must also say that a plan of care has been made for you, and that a doctor regularly will review and evaluate it.
4. You receive your care from a Medicare-certified home health agency (HHA).

Following the brief explanation of Medicare above, you or your loved one should now have a better understanding of how it works and what services are covered. As far as home health services go, Medicare will cover specific types of care. The programs offered by Total Home Health will be specific to you not only regarding your situation, but also your Medicare benefits. If you qualify for the home health benefit, you will find that Medicare covers the following types of care:

• Skilled nursing services and home health services provided up to 7 days a week for up to 8 hours per day or up to 28 hours per week. In the event of an unusual case, Medicare can cover up to 35 hours (an unusual case will be determined by other rules and regulations).

• Medicare will pay in full for skilled nursing care. This includes services and care that can only be performed safely and effectively by a licensed nurse. Such as injections, tube feedings, catheter changes, observation and assessment of a patient’s condition, management and evaluation of a patient’s care plan, and wound care.

• Medicare will pay in full for a home health aide if you require skilled services. This aide will provide personal care services including help with bathing, using the bathroom, and dressing. If you only require this type of personal care, you indeed do not qualify for the Medicare home care benefits.

• Skilled therapy services. Physical therapy (PT), speech therapy (ST) and occupational therapy (OT) services that can only be performed safely by or under the supervision of a licensed therapist, and that are reasonable and necessary for treating your illness or injury. PT includes gait training and supervision of and training for exercises to regain movement and strength to a body area(s). ST services include exercises to regain and strengthen speech and language skills. OT helps you regain the ability to do usual daily activities by yourself, such as eating and dressing yourself. Medicare should pay for therapy services to maintain your condition and prevent you from worsening as long as these services require the skill or supervision of a licensed therapist, regardless of your potential to improve. *There may be additional stipulations if you only require OT, Medicare benefits will be determined based on your specific condition.

• More skilled therapy services such as medical social services. Medicare will pay in full for services ordered by your provider to reach out and help you with any social and emotional concerns that you may have related to your illness. This could include counseling or help with finding resources within your community.

• Medical supplies. Medicare will pay in full for certain medical supplies provided by the Medicare-certified home health agency. This could include things such as wound dressings and catheters that may be needed for your care.

• Durable medical equipment. Medicare pays 80 percent of its approved amount for certain pieces of medical equipment, such as a walker or wheelchair.

Get busy! Do some research to see what your benefits qualify you for and enroll in Total Home Health today! Our professionals are eager to come to you and become involved in your treatment to maintain your optimal health status.