As a nurse that works in the community I have worked with literally hundreds of families while they are trying to make health care decisions. I personally have had to make health care decisions for myself and my own family. What I have learned is the importance of being a well educated advocate. You are only as helpful as the knowledge you have when it comes to yourself or the person you are making decisions for. When a physician comes in and doesn't give you all of the possible scenarios he isn't helping to make the right decision for you.
In order to better explain I am going to use a couple of personal stories with you. Many physicians have their own preconceived beliefs about things such as culture, aging, quality of life. These pieces play highly for against your decisions. I have been in the room when a doctor told a 91 year old that there was nothing more they could do for her hip fracture because of her age and heart condition. The reality was that physician did not believe that this elderly woman's quality of life would be as good if he operated and so he advised against it.
This woman was alert and oriented and adamantly refused to take no for an answer. She researched and found another surgeon in another state that would take on her case. She received that surgery. She continued to walk 2 miles 2 times a week for 10 more years. Until arthritis made it too painful. At 101 she succumbed to a wheel chair and lived 4 more in that.
In order for her to receive that surgery she had to know that the physician's terms weren't hers. That physician had no idea how active this woman was and didn't ask. She didn't know to tell him. In order for a physician to truly be on your side he has to know where you stand. It is our job to remind him of the facts about us. It is natural for a physician to have their own beliefs and practices. It is our job to assure he knows ours.
That woman I described above was my grandmother, Nina Luckett. She lived to 105. I believe she would have lived longer but they found a skin cancer on her ear and told the family it was inoperable. By the time this nurse granddaughter found out she was a week from dying. She learned to play chess for the first time the week before. She reminds me every day why we need to stand up for those who can't stand up for themselves.
Many who read this will have their own beliefs about my grandmother's quality of life because "she is so old." My grandmother was indeed elderly but old she was not. She believed in learning something new, standing up for the underdog, fighting for the rights of others. She believed that aging was part of the way God made us. She believed that when God said he was finished He would take her home. Her skin cancer may have been inoperable but the choices or options were never even mentioned to the family. In fact they were only told that she had a skin cancer and "we aren't going to treat it because it isn't necessary."
The whole family wept when they discovered the type was not only operable but a simple procedure. They still talk about letting her down. She was content to go at any time so I don't grieve her loss. I only look at her experience to consider how I may better advocate for those around me.
I recommend that you take the time to find out the beliefs of those you care about that are directly around you. Advocate for their needs when necessary and ask questions so you are well informed.
Next week I will share a story about a very young boy that had a similar fate.
To find out more about Lisa Doyle, RN, BSN, CMC contact her at www.caycare.com
She believes in advocating for those around you that need it and using a trained advocate when you feel you don't have enough of the information.
Wednesday, December 19, 2012
Tuesday, October 23, 2012
In Home Care Coordination
Ever wonder what to do next after you decide to return home?
In Home Care Coordination is free assistance to help the family make a care plan before returning home and planning for in home care. It allows the family the chance to talk about who is going to be responsible for all the tasks that involve activities of daily living.
Reasons that In Home Care Coordination can help you:
1. A free advocate can help you voice your needs to the agency involved.
2. We will provide follow up to help should you want to change your plan or need guidance in planning.
3. Helping through the transition from medical facility to home.
4. Help for the spouse or other family member in planning the care when the paid caregivers are not present.
5. This service has been showing good results for helping prevent hospital re-admission after discharging from the hospital which can help decrease overall stress and improve overall well being.
The social security administration reports that there are currently 136,000 people in the over 100 year old club with a projected rate of 600,000 by 2033 having some plans for care for longer is only going to help those future centurions.
www.caycare.com
Paying for Long Term Care
As a nurse that works in the community I find that most people do not understand that care-giving or housing needs are not in fact covered by medical insurance. Families will often call or meet with our liaisons ready to "order" their care or service shell shocked when they discover they will be paying out of pocket. This has made our company very knowledgeable on back up strategies. This is a simple layout of some options. Having a back up plan could have saved hundreds of hours of stress with families in the emergency room. Consider the tips listed at the bottom of the page to help get your family on track.
Medicare covers the skilled nursing home stay when an individual has had a hospital stay that includes 3 midnights and has a skilled reason to be admitted to a rehabilitation center. When an individual has managed care there may be exceptions to the 3 day stay in a hospital. This has been a blessing for individuals who have had a setback with their care but no medical reason to have a hospital stay. With Medicare discouraging hospital admissions for custodial reasons managed care insurance has helped many a family we have worked with in getting some immediate assistance until long term planning can be initiated.
Medicaid is a state program and is great once in place. However many families contact or first see medical personnel once the care is already needed. The process to apply and be approved can be at least a month or two. If families have not planned ahead for this time period then planning with the family becomes our strength. We utilize our Chart Your Own Course programs to help families do some planning with guidance. Often times the family will have to step up and provide the care until Medicaid does begin.
Long Term Care Insurance is a wonderful plan for people wanting to pay for all levels of care. The package and level of coverage varies but many a family has sighed once discovering their loved one has this insurance. It helps families meet wishes for families. Often times Long Term Care insurances will also pay for care coordination (a care manager) without a waiting period allowing you to have some assistance.
Individual entitlements such as Veteran's, L&I, Government Grants are very individualized and there is no immediate assistance with these programs. Though they are excellent ways to fund someone long term some funding will need to be provided up front and possible for as much as a year before they kick in. Rarely do these programs cover the entire amount of care.
Privately paying can be the most challenging for individuals that haven't planned for a medical or physical setback or increase in care needs. Some tips that we can offer:
1. A referral agency can help negotiate a decreased rate with facilities. We aren't just saying this because we are one. It is the agency's job to know who is currently more willing to work with you.
2. A Care Manager can help advocate for care assessment changes when health improvements occur.
3. A Care Manager can evaluate potential entitlements an individual may qualify for.
4. A referral agency will know local deals that are happening offering the most creative plans.
5. Paying for a facility that will work with you finances will make a difference.
6. Other Veteran's benefits besides just a veteran's pension. Aid & Attendants is one but there are others.
7. Beware of just placing at a location that was recommended by someone. This doesn't mean the place they recommend isn't a great facility. It is just is it the right one for your loved one? Many a dollar has been spent only to be spent again elsewhere because a facility wasn't really the right fit for the individual.
Good luck with your search!
www.caycare.com
Lisa Doyle is an registered nurse and a certified care manager and healthcare advocate. She has worked in healthcare since 1995 serving mainly a geriatric population. She has worked with pediatric and young adult cases with chronic disease management or developmentally delayed challenges. She serves on a board for helping serve families with medically intensive infants since 2009. She believes strongly in advocating for the medical services for the healthy senior regardless of the age. Lisa herself had cancer while pregnant in 2002 and two premature children since then. Lisa also lost a son shortly after birth, Djeran Will Doyle. Lisa speaks regularly to small and large groups on many topics including advocacy, hospital care transitions- enabling the client, aging and dealing with death, humor in chronic illness, miracle of life-regardless of the age.
To have Lisa speak at your next engagement email: contact@caycare.com
Medicare covers the skilled nursing home stay when an individual has had a hospital stay that includes 3 midnights and has a skilled reason to be admitted to a rehabilitation center. When an individual has managed care there may be exceptions to the 3 day stay in a hospital. This has been a blessing for individuals who have had a setback with their care but no medical reason to have a hospital stay. With Medicare discouraging hospital admissions for custodial reasons managed care insurance has helped many a family we have worked with in getting some immediate assistance until long term planning can be initiated.
Medicaid is a state program and is great once in place. However many families contact or first see medical personnel once the care is already needed. The process to apply and be approved can be at least a month or two. If families have not planned ahead for this time period then planning with the family becomes our strength. We utilize our Chart Your Own Course programs to help families do some planning with guidance. Often times the family will have to step up and provide the care until Medicaid does begin.
Long Term Care Insurance is a wonderful plan for people wanting to pay for all levels of care. The package and level of coverage varies but many a family has sighed once discovering their loved one has this insurance. It helps families meet wishes for families. Often times Long Term Care insurances will also pay for care coordination (a care manager) without a waiting period allowing you to have some assistance.
Individual entitlements such as Veteran's, L&I, Government Grants are very individualized and there is no immediate assistance with these programs. Though they are excellent ways to fund someone long term some funding will need to be provided up front and possible for as much as a year before they kick in. Rarely do these programs cover the entire amount of care.
Privately paying can be the most challenging for individuals that haven't planned for a medical or physical setback or increase in care needs. Some tips that we can offer:
1. A referral agency can help negotiate a decreased rate with facilities. We aren't just saying this because we are one. It is the agency's job to know who is currently more willing to work with you.
2. A Care Manager can help advocate for care assessment changes when health improvements occur.
3. A Care Manager can evaluate potential entitlements an individual may qualify for.
4. A referral agency will know local deals that are happening offering the most creative plans.
5. Paying for a facility that will work with you finances will make a difference.
6. Other Veteran's benefits besides just a veteran's pension. Aid & Attendants is one but there are others.
7. Beware of just placing at a location that was recommended by someone. This doesn't mean the place they recommend isn't a great facility. It is just is it the right one for your loved one? Many a dollar has been spent only to be spent again elsewhere because a facility wasn't really the right fit for the individual.
Good luck with your search!
www.caycare.com
Lisa Doyle is an registered nurse and a certified care manager and healthcare advocate. She has worked in healthcare since 1995 serving mainly a geriatric population. She has worked with pediatric and young adult cases with chronic disease management or developmentally delayed challenges. She serves on a board for helping serve families with medically intensive infants since 2009. She believes strongly in advocating for the medical services for the healthy senior regardless of the age. Lisa herself had cancer while pregnant in 2002 and two premature children since then. Lisa also lost a son shortly after birth, Djeran Will Doyle. Lisa speaks regularly to small and large groups on many topics including advocacy, hospital care transitions- enabling the client, aging and dealing with death, humor in chronic illness, miracle of life-regardless of the age.
To have Lisa speak at your next engagement email: contact@caycare.com
Wednesday, August 15, 2012
Once "We" Go Home
An elderly client sits in the emergency room of a local hospital. The family is tired, worn out, frustrated. This patient is the mother, grandmother or friend and she is needing more help then she realizes. Who doesn't live in some denial about the help they need. Can't get your settings right on the computer? It takes some time to actually ask IT to walk you through it, doesn't it? Can't get rid of that noise when you put on the brakes? How long did it take before you went in to the shop? Did you know what to tell the technician to get the right results?
I have logged hundreds of hours now in the emergency room with patients and their families. They are tearful, overwhelmed, confused and uncertain. In my 8th year of doing this job now I realized something. I have a unique opportunity to share what I see. How do I share this with you in such a way to make a difference? Why don't you go along for a ride with me for a moment. I will take you through a case that have occurred in the last 90 days. (Note: These stories were changed or combined to protect the patient(s).)
Case Study #1:
The son of a patient contacts me when I am the week end, on call nurse navigator for CayCare, Inc. He tells me that his mom was just sent home from the emergency room after sustaining a non injury fall. She is more confused and doesn't seem able to make a meal before he leaves. He isn't sure if he should make her something and leave or take her back to the emergency room. He calls me because for advice.
After reviewing how mom has been in the last month and what the emergency room checked for it was determined that this was not a brand new problem, just one the son had been unable or afraid to face. Mom needed placement or a caregiver right then. We talked about follow up care and symptoms to watch for. We went over an entire intake process. The son realized he had no idea what his mother had in the way of finances but had no idea had to access them. Mom had most of her information set up through bill pay at some point back and stopped managing anything.
A family care plan was discussed and reviewed and the son felt confident that for the week end they could manage until he could go in with his mom on Monday and find out what her assets were. He called on Sunday to check in and continued to keep mom safe. He reported new information about how she had not been sleeping for what appeared some time in her own bed as the sheets hadn't been changed. She also had no dirty clothes and she was throwing her underwear away.
Monday an MD appt was set. The bank was accessed and the family determined that they would feel better with someone monitoring her more closely. She saw a geriatric specialist to confirm a dementia diagnosis, was later treated for a urinary tract infection and had a family meeting to establish goals. This lovely lady has improved enough to live in a local facility and is very happy there. 6 days after placement this individual became confused and nauseated. She was seen by the physician and treated for another urinary tract infection.
Case Study #2:
This client was brought in to a local emergency room after becoming confused and refusing his medications at home repeatedly. His wife had stopped getting any sleep at home and had fallen. She was suspected to be in this state for 48 hours. They were brought in together. She had sustained an injury that required surgery and would need subsequent skilled rehabilitation at a local nursing home. He was agitated and had no injuries or medical condition that warranted a hospital stay. Now he was in the emergency room scared and confused putting himself and the staff at risk.
Once the family was contacted it was determined that he would require immediate placement. An intake was performed to review options and screen needs. The placement navigator was able to come on site and evaluate his needs and the family's wants. 3 hours later orders were being written for discharge to his new location, a local memory care center.
I share these stories for many reasons. One of them being, plan ahead. The options and the time to review them decrease considerably while sitting in an emergency room. Not to mention the entire family's mental state. CayCare, Inc is the best in the business in my opinion in handling these cases and making them really stick well. However, I can also tell you that if the family could have one do over it would be to have planned ahead.
Talk to your families about discharge plans after the discharge from the skilled nursing home upon admission. There is such a sense of relief when they have the medical support that they just don't realize that time if of the essence. If you or someone you care about lives in an independent living or assisted living find out what they can do for you there and when you may have to consider the next step. No facility every wants to lose their resident and they will bend over backwards to assist you whenever possible. That being said there are regulations they must follow. Assisted livings also have varying levels of what they will do for care. Do not assume you can stay where you are. If you are not sure about the level and feel you aren't getting answers you can call the local ombudsman for answers. www.caycare.com
I have logged hundreds of hours now in the emergency room with patients and their families. They are tearful, overwhelmed, confused and uncertain. In my 8th year of doing this job now I realized something. I have a unique opportunity to share what I see. How do I share this with you in such a way to make a difference? Why don't you go along for a ride with me for a moment. I will take you through a case that have occurred in the last 90 days. (Note: These stories were changed or combined to protect the patient(s).)
Case Study #1:
The son of a patient contacts me when I am the week end, on call nurse navigator for CayCare, Inc. He tells me that his mom was just sent home from the emergency room after sustaining a non injury fall. She is more confused and doesn't seem able to make a meal before he leaves. He isn't sure if he should make her something and leave or take her back to the emergency room. He calls me because for advice.
After reviewing how mom has been in the last month and what the emergency room checked for it was determined that this was not a brand new problem, just one the son had been unable or afraid to face. Mom needed placement or a caregiver right then. We talked about follow up care and symptoms to watch for. We went over an entire intake process. The son realized he had no idea what his mother had in the way of finances but had no idea had to access them. Mom had most of her information set up through bill pay at some point back and stopped managing anything.
A family care plan was discussed and reviewed and the son felt confident that for the week end they could manage until he could go in with his mom on Monday and find out what her assets were. He called on Sunday to check in and continued to keep mom safe. He reported new information about how she had not been sleeping for what appeared some time in her own bed as the sheets hadn't been changed. She also had no dirty clothes and she was throwing her underwear away.
Monday an MD appt was set. The bank was accessed and the family determined that they would feel better with someone monitoring her more closely. She saw a geriatric specialist to confirm a dementia diagnosis, was later treated for a urinary tract infection and had a family meeting to establish goals. This lovely lady has improved enough to live in a local facility and is very happy there. 6 days after placement this individual became confused and nauseated. She was seen by the physician and treated for another urinary tract infection.
Case Study #2:
This client was brought in to a local emergency room after becoming confused and refusing his medications at home repeatedly. His wife had stopped getting any sleep at home and had fallen. She was suspected to be in this state for 48 hours. They were brought in together. She had sustained an injury that required surgery and would need subsequent skilled rehabilitation at a local nursing home. He was agitated and had no injuries or medical condition that warranted a hospital stay. Now he was in the emergency room scared and confused putting himself and the staff at risk.
Once the family was contacted it was determined that he would require immediate placement. An intake was performed to review options and screen needs. The placement navigator was able to come on site and evaluate his needs and the family's wants. 3 hours later orders were being written for discharge to his new location, a local memory care center.
I share these stories for many reasons. One of them being, plan ahead. The options and the time to review them decrease considerably while sitting in an emergency room. Not to mention the entire family's mental state. CayCare, Inc is the best in the business in my opinion in handling these cases and making them really stick well. However, I can also tell you that if the family could have one do over it would be to have planned ahead.
Talk to your families about discharge plans after the discharge from the skilled nursing home upon admission. There is such a sense of relief when they have the medical support that they just don't realize that time if of the essence. If you or someone you care about lives in an independent living or assisted living find out what they can do for you there and when you may have to consider the next step. No facility every wants to lose their resident and they will bend over backwards to assist you whenever possible. That being said there are regulations they must follow. Assisted livings also have varying levels of what they will do for care. Do not assume you can stay where you are. If you are not sure about the level and feel you aren't getting answers you can call the local ombudsman for answers. www.caycare.com
Friday, June 8, 2012
Chart Your Own Course TM
Every day our company is faced with cases where the family, significant other or representative is making a decision that is unpopular to the one needing the care support. There is objection to what needs to happen and guess where every one is certain to want to return? Home. Home is where our heart is and leaving it is a tough decision. As a healthcare provider who worked many years in home health I can tell you many people successfully achieve this goal. However, the reason that home is successful depends on the support and layout of the home.
CayCare, Inc. utilizes an unique approach that allows the individual who's care needs has changed to drive the plan. The Placement Navigator empowers the individual to do the decision making with a very unique program. This program addresses the barriers, the concerns and yet allows the individual to make their very own decision. It is exactly what I would want done for me.
Several care managers were given the Chart Your Own Course TM mini test. Rarely were these experts able to "chart" a safe plan without guidance and barriers acknowledged. Making decisions about your health, your care and keeping them in the budget and care needs that an individual has is TOUGH. The more the individual is on the team for the decision the more likely that same individual will comply. The more compliant we are to our care needs our health is more likely to be better as well. Who wouldn't want to chart the direction you take?
To find out how you can Chart Your Own Course or have this information for a client please contact: Lisa Doyle RN, BSN for a webinar or speaking engagement.
CayCare, Inc. utilizes an unique approach that allows the individual who's care needs has changed to drive the plan. The Placement Navigator empowers the individual to do the decision making with a very unique program. This program addresses the barriers, the concerns and yet allows the individual to make their very own decision. It is exactly what I would want done for me.
Several care managers were given the Chart Your Own Course TM mini test. Rarely were these experts able to "chart" a safe plan without guidance and barriers acknowledged. Making decisions about your health, your care and keeping them in the budget and care needs that an individual has is TOUGH. The more the individual is on the team for the decision the more likely that same individual will comply. The more compliant we are to our care needs our health is more likely to be better as well. Who wouldn't want to chart the direction you take?
To find out how you can Chart Your Own Course or have this information for a client please contact: Lisa Doyle RN, BSN for a webinar or speaking engagement.
Sunday, May 20, 2012
Disjointed Healthcare
As a nurse actively working in the community assisted families on a daily basis you would think that I had seen it all by now. Yet almost every day now a new type of case crosses my path and leaves me questioning how we can better help families deal with the trauma of major healthcare changes happening in places like the emergency room. It is why I have the company that I do. While all the answers may not lie at my feet I honestly know our company is one of if not the only that is the closest to the answer.
Why, you ask? Just this week end I received an emergency room call where a daughter has come into town worrying about her mom who has been living with a room mate and has reportedly not been herself. She is confused and wandering the home she lives in completely lost. The daughter, not sure what to do brings her in to the closest emergency room wondering if they can help her get care.
Why, you ask? Just this week end I received an emergency room call where a daughter has come into town worrying about her mom who has been living with a room mate and has reportedly not been herself. She is confused and wandering the home she lives in completely lost. The daughter, not sure what to do brings her in to the closest emergency room wondering if they can help her get care.
Our company receives the call to help with placement. Questions are going through my nurse brain such as, is this sudden? Have they tested her for an infection and several other clinical concerns. To protect the identity of the case I can't answer those questions here but I will say that after several interviews between case manager, physician and myself with the family it was determined there was more to the story. I jokingly told the social worker that our job is often not that of a clinician but that of a private investigator. Trying to find all the clinical pieces to the puzzle to help this daughter make the next right decision for her mother in a week end trip. NO pressure at all.
Becoming the private investigator that solves the case by fitting the pieces of the puzzle together allowed this daughter some time to process her choices and safely move forward. If we could join together and help the family make a next step decision about care needs and then obtain the knowledge of experts such as our placement navigators then the disjointed would be come the totally together care system.
Find out how CayCare, Inc uniquely joins healthcare together with the Chart Your Course program @ www.caycare.comNinja Xl Blender
Wednesday, May 9, 2012
Placement Navigation
Have you ever wondered how a term or a saying was created? A few years ago I learned that the saying, "Don't throw the baby out with the bathwater." was from the family using the same bath water from oldest until youngest. By the time that the baby was washed it was pretty dirty. We have long since grown out of the saying yet I have heard someone use that saying as recently as yesterday.
Another funny thing that often happens at work is the comment, "That is the way we have always done it." It is true that there are a lot of things that have always been done a certain way and have worked. Thank goodness for things in life that don't change. Unfortunately, healthcare is not one of them.
How often have you wondered how healthcare got in the state it is in? I know I have. Here is a nation that is so advanced in so many areas and yet so far behind in other areas. We still have one of the highest infant mortality rates in the world. Shocking isn't it? We have the highest rate of obesity of any nation. We have very fragmented healthcare.
No one will deny that healthcare is fragmented. Bridging the gap of healthcare has been a high priority and is definitely the key to unlocking poor outcomes if you are asking me. The reason is simple. There was a time, not all that long ago where your physician knew you. He or she knew your healthcare needs, your personal life and when you went to the hospital he was right by your side. That intimate knowledge helped him make detailed decisions about your care. He knew that if he didn't discharge you home in a timely manner there would be problems because you were the only caregiver for you 6 year old child and your invalid spouse. He knew because he interviewed you and had the time in the office to get to know you. He knew because he was there in the hospital after you were admitted deciding if you should have your gallbladder removed and often he removed it.
Hospital Case Managers and Social Workers now have to act as an investigator to clinically extrapilate the facts to get to the same conclusion that your physician would have in the previously discussed model. The hospital case manager and social worker have become the person(s) that analyzes your story and moves you in the right direction.
So what does placement navigation offer to this formula? That is perhaps the greatest piece of all. Placement navigation is triggered based on criteria that these case managers and social workers identify and it allows the client additional help without putting a burden on the healthcare system or costing the client anything. Medicaid has identified this service as being so cost effective that our company is reimbursed to care for these cases when they qualify. It has been reported that our service saves the state $2700 per client.
Remember that saying at the beginning, "Don't throw the baby out with the bathwater?" Well, even though CayCare, Inc is in fact a referral agency we turn the industry on it's side. There is nothing like what we do out there. Nothing even close. Our entire model is outcome driven instead of consumer driven. Every client we follow has a clinical team to help with the results. They receive hands on guidance and literally are empowered to chart their own course. The follow up allows our clients clinical assistance even after a decision has been made. And at least once a week our clinical team helps a family with a clinical challenge. In fact we are so well known for this that we often get calls after other agencies have placed a client in a facility. Currently we receive a call about this type of case at least once a week. The questions or concerns are anything from medication management to wounds they discovered and need guidance on what to do.
Next time you are in the hospital or elsewhere remember one thing, one of our placement navigators is there to assist...
Another funny thing that often happens at work is the comment, "That is the way we have always done it." It is true that there are a lot of things that have always been done a certain way and have worked. Thank goodness for things in life that don't change. Unfortunately, healthcare is not one of them.
How often have you wondered how healthcare got in the state it is in? I know I have. Here is a nation that is so advanced in so many areas and yet so far behind in other areas. We still have one of the highest infant mortality rates in the world. Shocking isn't it? We have the highest rate of obesity of any nation. We have very fragmented healthcare.
No one will deny that healthcare is fragmented. Bridging the gap of healthcare has been a high priority and is definitely the key to unlocking poor outcomes if you are asking me. The reason is simple. There was a time, not all that long ago where your physician knew you. He or she knew your healthcare needs, your personal life and when you went to the hospital he was right by your side. That intimate knowledge helped him make detailed decisions about your care. He knew that if he didn't discharge you home in a timely manner there would be problems because you were the only caregiver for you 6 year old child and your invalid spouse. He knew because he interviewed you and had the time in the office to get to know you. He knew because he was there in the hospital after you were admitted deciding if you should have your gallbladder removed and often he removed it.
Hospital Case Managers and Social Workers now have to act as an investigator to clinically extrapilate the facts to get to the same conclusion that your physician would have in the previously discussed model. The hospital case manager and social worker have become the person(s) that analyzes your story and moves you in the right direction.
So what does placement navigation offer to this formula? That is perhaps the greatest piece of all. Placement navigation is triggered based on criteria that these case managers and social workers identify and it allows the client additional help without putting a burden on the healthcare system or costing the client anything. Medicaid has identified this service as being so cost effective that our company is reimbursed to care for these cases when they qualify. It has been reported that our service saves the state $2700 per client.
Remember that saying at the beginning, "Don't throw the baby out with the bathwater?" Well, even though CayCare, Inc is in fact a referral agency we turn the industry on it's side. There is nothing like what we do out there. Nothing even close. Our entire model is outcome driven instead of consumer driven. Every client we follow has a clinical team to help with the results. They receive hands on guidance and literally are empowered to chart their own course. The follow up allows our clients clinical assistance even after a decision has been made. And at least once a week our clinical team helps a family with a clinical challenge. In fact we are so well known for this that we often get calls after other agencies have placed a client in a facility. Currently we receive a call about this type of case at least once a week. The questions or concerns are anything from medication management to wounds they discovered and need guidance on what to do.
Next time you are in the hospital or elsewhere remember one thing, one of our placement navigators is there to assist...
Thursday, February 23, 2012
CayCare's Mission
Mission Statement:
CayCare, Inc
is a for profit, privately held agency incorporated in 2005 for the purpose of
empowering seniors and their families to make better health care and long term life
decisions. This is at no cost to the client. CayCare, Inc believes that
providing free resources and referrals to seniors enables them to make safe
decisions regarding health care while dealing with complicated and stressful
emergency situations. CayCare, Inc is confident that this patient centered
service allows for access to exceptional health care, improved individual health,
and a reduction of health care costs.
As of February 2012 we own the rights to providing the exclusive service of Placement Navigation. It is a patented and registered trademark. Placement Navigation is a service that provides hands on education and screening to clients as a independent third party. We protect the rights of the client by educating and empowering the client and their family to make the very best decisions in their long and short term care plans. Best of all we are not a burden to the healthcare system as we are currently compensated by the housing and in home care industry, much like a realtor. The service we are providing is helping clients make better, healthier decisions about living situations thus keeping them safer. The safer the client, the less likely they are to end up back in a hospital in less then 30 days. To find out more about Placement Navigation or to offer this service contact Lisa Doyle RN to set up a presentation.
CayCare, Inc is changing the way we view healthcare, one client at a time.
Case Study
Sophie's stories is like many out there that you see. She wanted so badly to return home to her apartment and live out her days independently. She was, after all 89 years old and had been doing well this far without asking for an assistance. Sophie was surviving on the help of her worried neighbors.
They enjoyed being there for Sophie and she had lived by them for over a decade now. Problem is Sophie was falling more and more. At first, Sophie's fall was just tripping on a newspaper she had left in the living room. Then she tripped on the door stop leaving her house. Then one day Sophie tripped on the stairs outside and couldn't get up. Sophie had fractured her hip and arm. ..
Her hospital stay was going smoothly. She had managed to recover quite nicely and her neighbors would be able to care for her. She headed to the local skilled nursing home and therapy helped her get strong enough to maneuver the 3 stairs that had caused her fall. She passed all of her tests and one neighbor said she would be there.
This neighbor came to get Sophie and settle her in. She checked on her later that night. The next day she seemed fine. The day after that Sophie was saying she was a little worn out and wanted to rest. That night the neighbor thought something was wrong and brought her into the emergency room. Sophie's labs were fine. She was just still recovering and needed to take it easy. The neighbor promised to check on her 3 times the next day and they settled Sophie back into bed.
The next morning Sophie called an ambulance to take her into the emergency room. Sophie told the emergency room nurse upon check in, "I think I might need a little more help."
The nurse identified the nearest family member was in Arizona and had called her mother every day. She had indicated all was going well even an hour prior to the call to the hospital. Sophie passed all of her cognitive tests and was alert and comfortable. What was the difference?
Sophie told our placement navigator that was called to the emergency room that she was not able to cook when she arrived and didn't want to burden her neighbors so she hadn't eaten the first day she went home. The next day she was able to eat some leftovers the neighbor brought and snack on some crackers the rest of the day. She was really only feeling up to getting up to toilet and so she was feeling a little more worn out. She was worried she might fall like she had originally so she wasn't going to leave the house unless someone was right with her.
Sophie's choice became simple in that emergency room. She wanted more support. After reviewing with her a family care plan, it was determined that she would like to try in home care. Sophie started with 24 hour care for the first week but is now at 12 hours per day. She has also had CayCare's triage nurse contact her three times and Sophie has benefited from the guidance on her medications and follow up with physician. She had home health check on her the next day after her hospital stay but only qualified as home bound for a week. Sophie's choice has been to stay home with some care. She is more confident now and sure of what to do. She has a plan at home in place that will help Sophie know what to do if there is a next time from a fall. The best part is CayCare was able to donate the time it took to make a detailed care plan that Sophie agreed to. Her daughter in Arizona was sent a copy of the care plan and has all of Sophie's legal information in place and ready should another emergency ever come.
Sophie sent a special thank you to CayCare in a very nice letter.
"I didn't know what I needed until you arrived that day. I was in crisis and felt like they were going to take away my hope. I didn't want to burden my friends and family with my embarrassing falls. When you helped me say what I wanted and help me feel safe again I knew it was going to be okay. I wish I had known about you earlier. Maybe then I wouldn't have had that last fall that broke my hip. Please make sure you tell others what you do so they won't feel hopeless and ready to give up." This case study is for you Sophie.
*Note portions of this case study were altered to fiction to protect the identity of the client. This is including the name.
www.caycareplacement.com A free referral and resource agency that provides placement navigation to clients who are in the healthcare continuum and need assistance with placement or in home care. We specialize in geriatric but can serve all ages. We utilize a unique team approach that prevents re hospitalizations and empowers families to make the best decisions about the long and short term care plan.
www.caycareplacement.com A free referral and resource agency that provides placement navigation to clients who are in the healthcare continuum and need assistance with placement or in home care. We specialize in geriatric but can serve all ages. We utilize a unique team approach that prevents re hospitalizations and empowers families to make the best decisions about the long and short term care plan.
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