The Dentists of Feet: How Colorado VNA is Keeping Feet Healthy

Wanda Wofford, RN at the Glenarm Foot Care Clinic

Wanda Wofford, RN at the Glenarm Foot Care Clinic

Over the last two decades, we’ve come to understand that oral health means much more than healthy teeth. As the American Dental Association states “Your mouth is a window into the health of your body” and regular visits to a dentist allow for a view into general health and wellness. Similarly, foot care is about so much more than simply clipping toe nails, especially for older adults and those with diabetes. Our feet often reveal signs of disease such as nerve disorders, gout, arthritis, melanoma, and heart disease. Feet can tell us about the state of our circulation and the condition of our thyroid. Our feet falter when our shoes are too tight, our toenails too long, we don’t moisturize our skin, and problems such as ulcerations and infections go unnoticed and untreated.

This is why for over 30 years Colorado VNA registered nurses have been providing foot care, and why we believe foot care should be an integral part of preventive care for older adults and those with diabetes.

The highest risk group of patients for foot maladies is diabetic patients. The CDC has reported that over 29.1 million people, or 9.3% of the US population, have diabetes. In Colorado, more than 19,000 adults were diagnosed with diabetes in 2012 and there is belief that as many as 100,000 or more Coloradans could be unaware that they have diabetes. Further, nearly 33% of adults age 65+ have diabetes. According to the Indian Health Service ~40% of people with diabetes will develop nerve damage in their feet, ~20% will have an acute foot problem, ~15% will develop a serious wound (costing about $13,000-$30,000 to treat), and 5-10% of people with diabetes will progress to amputation (at a cost of about $50,000). Indeed, the most common cause of hospitalizations among persons with diabetes is diabetic foot problems, including ulcerations, infections, and gangrene.

Almost all of the above conditions can be prevented or diagnosed early with primary care and the care that Colorado VNA provides at its 150+ foot care clinics across the Front Range. While clients attend clinics for various reasons – difficulty bending over for self-care, trouble finding a family member or friend to assist, limited hand strength due to arthritis, etc. – all receive the same high-quality and comprehensive RN visit that entails:

  • medication reconciliation;
  • blood pressure monitoring;
  • a foot exam for inspection for any discoloration, swelling, corns, calluses, or other changes of the foot, ankle, and leg below the knee including identifying cancers of the nails and skin;
  • trimming, cutting, clipping, and debridement of nails;
  • minor buffing of corns or calluses (if applicable); and
  • hygienic and preventive maintenance care such as cleaning the feet and testing for neuropathy (nerve damage).

Further, our nurses have repeated contact with their clients over long periods of time, sometimes years, and are in a good position to note health changes that may go unnoticed during routine medical visits, such as darkened nail beds that could be early signs of melanoma.

To continue the dental care analogy, Colorado VNA’s nurses provide both the routine care AND assessment for the need for more specialized care provided by podiatrists, surgeons, cardiologists, and other medical specialists. Colorado VNA’s nurses are also an extension of these specialists as they assist with administering care plans in an effort to keep patients healthy and on their feet. Colorado VNA has also started offering more complex foot care services, such as the use of dremels, which are provided by nurses certified by the Wound, Ostomy and Continence Nursing Certification Board. And, just in the last year, Colorado VNA has begun providing foot care in the home when patients are home bound and meet appropriate Medicare guidelines.

Routine foot care is a little understood and often undervalued part of the healthcare system.  Too many older adults turn to nail salons where they run the risk of being exposed to improperly cleaned tools and technicians that are not trained to look for ingrown, overgrown, and thickened toenails as well as fungal infections. Over the next year Colorado VNA will be gathering more clinical data in an effort to demonstrate improved health outcomes such as decreased falls, fewer serious wounds, decreased hospitalizations and/or surgeries resulting in amputations, and better compliance with care plans, as well as higher patient satisfaction. Each month, Colorado VNA cares for more than 1,000 clients, which allows us to generate an incredible wealth of data to share. We are confident that our foot care service is keeping individuals healthier and independent longer. Stay tuned for further updates on our foot care services in the coming months!

For more information about our foot care clinics or to schedule a visit, please call 303-698-6496 or visit http://vnacolorado.org/medical-foot-care-program/.

CAPABLE, a low-cost program to improve senior independence?

The population in Colorado is aging quickly, more quickly than most other states. Related to our aging population, is the rising cost in healthcare, much of it fueled by chronic disease management which affects about 80% of older adults in our country.

And yet, despite the additional medical oversight required when living with chronic disease, the vast majority of older adults want to remain in their homes. According to a study by AARP (Page 2, Housing Preferences) “73 percent [of older adults] strongly agreed that they would like to stay in their current residences as long as possible, while 67 percent strongly agreed that they would like to remain in their communities as long as possible”.

The challenge of aging in place is complicated. Medicare is not intended to provide support for long-term care.   Medicaid does support long-term care but only for those people who qualify per Medicaid income guidelines. Yet, it is unclear what the future of Medicaid is, including programs like Medicaid HCBS which I recently wrote about here. As a result, there is a pressing need for cost-effective programs support aging in place. One such program is CAPABLE, an acronym for Community Aging in Place—Advancing Better Living for Elders. Colorado VNA is pleased to be partnered with CAPABLE’s founder Dr. Sarah Szanton and Habitat for Humanity of Metro Denver to bring CAPABLE to Colorado.

Launched as a research project in Baltimore by Sarah L. Szanton, PhD, ANP, FAAN, of the Johns Hopkins School of Nursing, and expanded to 12 cities in five states, CAPABLE is a five month, home-based intervention for low-income older adults with functional limitations. It entails ten, 60- to 90-minute home visits with an occupational therapist, a registered nurse, and a handyman who work together with elderly individuals to identify mobility and self-care issues in their homes and fix or modify them.

Preliminary data from the Centers for Medicare and Medicaid Services (CMS) Innovation Center, which has funded CAPABLE, is promising:

  • 79% improved their self-care over the course of five months.
  • The average participant improved by cutting disability in half (i.e., the number of self-care tasks that are difficult for the participant were halved).
  • Participants experienced a decrease in depressive symptoms similar to that of taking an antidepressant medicine.

Further, CAPABLE is beginning to yield evidence of cost-savings via delaying nursing home admittance and proper utilization of primary care rather than emergency care. The leading health policy journal, Health Affairsrecently published results showing that the program, which costs less than $3,000, saves more than $10,000 to Medicare in decreased outpatient and hospital costs, including observation stays and hospital readmissions. Additionally, CAPABLE builds on model intervention strategies such as patient-centered care and motivational interviewing.

Colorado VNA clinicians know from their own patient experiences that a safe home environment is critical to the ability to function, yet the home setting is often overlooked by care models because they take place in a clinical setting. Thus, Colorado VNA was awarded a major grant from the Colorado Health Foundation, along with additional support from the Comprecare Fund at the Denver Foundation and an anonymous donor, to implement CAPABLE in Colorado with its  own clinicians and with home alteration support from Habitat for Humanity of Metro Denver. The grant will allow us to provide CAPABLE to 60 patients over 18 months split into three groups of 20 patients. After we care for these 60 patients we will work with Dr. Szanton to study the results and to assess whether our version of CAPABLE yielded similar or better results compared to the original study.

Colorado VNA is thrilled that CAPABLE is now underway and that we are seeing our first patients. We are closely monitoring clients’ progress against our goals of improved health outcomes and decreased healthcare costs, and actively looking for additional philanthropic investments to support the ongoing implementation, monitoring, and evaluation costs.

If you know of an older adult who

  • is having trouble remaining independent (difficulty with eating, bathing, housekeeping) or feels unsafe (at risk of fall) in their home,
  • owns their own home,
  • is on Medicaid or eligible for Medicaid, and
  • lives in the Denver Metro area,

please call me at 303-698-6306 so that we can evaluate the person for our CAPABLE program.

 

What To Ask To Find The Right Home Health Care Provider For You

At Colorado Visiting Nurse Association (VNA) we know that inviting someone into your home to care for you or your loved one is an incredibly important and personal choice. Having the right person can make the experience more pleasant, ensure the appropriate services and in many cases even reduce the likelihood of hospital re-admission. Whether you’re looking for home health care or non-medical support knowing what questions to ask can help ensure that you receive quality assistance.

What To Ask To Find The Right
Home Health Care Provider For You

If you’re recovering from surgery or need long-term care for a chronic illness — or you have a loved one facing a similar situation — you might be interested in home care services. Home care services range from skilled care provided by nurses or therapists to household support, such as cleaning, cooking and running errands. If you’re considering home care services, ask these questions to choose the best provider for your needs.

Qualifications

If you’re considering a home care services agency:

  • Is the agency licensed by the state? Most states — but not all — require agencies to be licensed and reviewed regularly. Reviews might be available through your state health department.
  • How long has the agency been in business?  Experience is one way to measure reliability.
  • Is the agency certified by Medicare to meet federal requirements for health and safety? If not, ask why.
  • What type of employee screening is done? Background and drug testing may go a long way toward your piece of mind.
  • Can the agency provide references? Ask for a list of doctors, hospital discharge planners or other professionals who have experience with the agency.

If you’re considering a home health aide:

  • What are the aide’s credentials? If he or she claims to be licensed, check with the licensing body.
  • Can the aide provide references from at least two employers? Check them thoroughly.

Be sure to ask your or loved one’s doctor, family and friends for recommendations.

Quality of care

If you’re considering a home care services agency:

  • How does the agency train, supervise and monitor caregivers? Does the agency provide continuing education?
  • Are the caregivers licensed and insured?
  • Do the agency’s employees seem friendly and helpful?

If you’re considering a home health aide:

  • Does the home health aide have a positive attitude?
  • Are you and your loved one comfortable with the home health aide?

Costs

If you’re considering a home care services agency:

  • How does the agency handle expenses and billing? Ask for literature explaining all services and fees, as well as detailed explanations of all costs associated with home care.
  • Will agency fees be covered by health insurance or Medicare? Check to see what kind of coverage your health insurance offers.
  • What resources does the agency provide for financial assistance, if needed? For instance, is a payment plan available?

If you’re considering a home health aide:

  • How much does the aide charge for home health services? Make sure you’re comfortable with the fees and the included services.
  • Does the aide require payment for sick days, vacation days or holidays? If so, clarify how many sick and vacation days are allowed, as well as which days are considered holidays.

Understanding services

Whether you’re considering a home care services agency or a home health aide, you might ask these questions about services:

  • Will you receive a written care plan before service begins? The care plan should include details about medical equipment and specific care needs, contain input from the doctor, and be updated frequently.
  • Will you receive a list of the rights and responsibilities of all parties involved? This is sometimes known as a patient’s bill of rights.
  • Will you or your loved one be referred to dietitians, counselors, therapists or other specialists, if needed?
  • Will the agency work directly with you or your loved one, family members and health care providers?
  • Must you identify a primary family caregiver? If so, what’s required of that person?
  • When will service be provided? Is care available round-the-clock, if necessary?
  • What procedures are in place for emergencies? Ask how the agency or home health aide will deliver services in the event of a power failure or natural disaster.
  • How are problems addressed and resolved? Whom can you or another family member contact with requests, questions or complaints?
  • When can services begin?

Monitor your home care services

After you’ve found a home care services provider, monitor the situation. If you’re concerned about the care or services provided, discuss it promptly with the agency or home health aide. If necessary, involve your doctor or your loved one’s doctor as well.

Post updated from article by Mayo Clinic.

Founded in 1889, Colorado VNA is Colorado’s first nonprofit home health care agency and provides expert care throughout the care continuum: wellness, home care and hospice services. For the past three years Colorado VNA has been awarded Home Care Elite Status by the National Research Corporation for placing in the top 25% of home care agencies based on health performance measures.

Colorado VNA earned a four star rating from the Centers for Medicare and Medicaid (CMS) for quality patient care, and is licensed by the State of Colorado to provide home health care. Colorado Visiting Nurse Association is accredited by the Community Health Accreditation Program (CHAP), a national, independent, nonprofit accrediting body for community-based healthcare entities.

Colorado VNA’s Role In Colorado’s Growing Senior Population

By Chris Lee, President and CEO

The State of Colorado is grappling with one of the fastest growing older adult populations in the country. The Colorado State Demography Office estimates [that the] “aging of the younger population, especially the ’Baby Boomers’ …, is forecast to increase the population over 65 by 150% between 2010 and 2030.”[1] The numbers will grow from 550,000 people over 65 in 2010 to 1.2 million in 2030.

Healthy-Aging-in-Colorado-Infographic-high-resolution2

Fortunately, Colorado is not leaving future administrations to deal with the challenges. Our State has created the Strategic Action Group on Aging, in addition to other initiatives, to get out in front of aging-related challenges. The Group’s initial ideas on how to address the challenges associated with a rapidly aging population are detailed in the Colorado Aging Framework, which includes 10 distinct goals that the State aims to achieve. Colorado VNA is a leading partner in the efforts to support the needs of older adults. We are evolving existing services and creating deep partnerships with a variety of stakeholders to position ourselves as a critical provider of older adult services.

In particular, three of the Aging Framework goals directly relate to our work:

  • Goal 3: Strengthen support systems and environments that enable individuals to remain in their homes and communities as they age.
  • Goal 5: Support health care programs and services that provide a continuum of care to Colorado citizens as they age to give individuals the right services at the right time.
  • Goal 7: Promote support for caregivers, including family caregivers, to support citizens as they age

Goal 3 articulates several strategies that are focused on strengthened supportive services for older adults so that they can remain in their homes and communities, one of which “make home-maker services available to support individuals’ ability to remain in their homes as long as possible” is superbly aligned with our current work. Just this past week, I traveled with one of our Certified Nursing Assistant (CNA), Dennis, to visit two of our veterans in their homes. Dennis visits each of these patients several times a week to help with bathing, ensuring that the care plan is implemented, and providing patient and family support. In addition to Dennis, Colorado VNA provides homemakers for these two patients as well. Our homemakers help the patients and families keep their homes clean and safe while also helping with laundry and other household tasks, activities that many of us take for granted even as our ability to conduct them declines with age. Goal 3 seeks to implement similar support functions for those individuals that may not have the resources to pay for private-pay homemakers and/or CNA services. The Denver Regional Council of Governments (DRCOG) has long funded Colorado VNA to provide homemaker services to low-income and vulnerable adults, and Goal 3 seeks to provide even more support to DRCOG and ultimately Colorado VNA.

Senior Living Conditions in Colorado

Goal 5 takes Goal 3 further by identifying strategies to more closely connect homemaker services that are supported by DRCOG to primary care providers. Both of the patients I visited are veterans, and the VA has long understood the importance of connecting skilled nursing and therapy care with paraprofessional care while under physician supervision. Goal 5 seeks to create the same connections between the primary care community and the long-term services and supports (LTSS) community. Additionally, Goal 5 provides direction to study the connection between LTSS and decreasing overall healthcare cost. In summary, the State hopes to answer the question: Do the homemaker services Colorado VNA provides decrease overall healthcare spending, and if so, by how much? To this end, I have been appointed to a guiding committee that will help implement the study that will answer this question.

Healthy-Aging-in-Colorado-Infographic-high-resolution4 smallaAnd finally, Goal 7 seeks to provide more financial support and training for family caregivers as well as other non-family caregivers. Those of you who have cared for an elderly parent know just how difficult, time-consuming, and stressful it is to provide the necessary care to keep your loved one in the home, especially if you must also work outside the home to earn a living.  Goal 7 seeks to find ways to provide more support and guidance for family and friend caregiving. Though not an area we are currently operating within, Colorado VNA has the capabilities to train caregivers, as well as the necessary clinical oversight, to be a viable part of the solution for an expanded family- and friend-based caregiving network. In addition to supporting family caregivers, Goal 7 also acknowledges the need for more expansive wellness services for the elderly, services like our Senior Medical Foot Care run by our Wellness Division.

 

As you can see, there is much change in the aging landscape in Colorado. Thanks to the innovative and compassionate care of our staff, Colorado VNA is well positioned to be a part of an expanded Colorado strategy to respond to a dramatically growing elderly population.

 

 

 

[1] Department of Local Affairs, State Demography Office, July 2012, page 1

 

 

 

Colorado VNA Speaker Series 2016

Colorado VNA’s Speakers Series is designed to offer information and education to help a variety of individuals including seniors, caregivers, and health and wellness professionals navigate the changing landscape of healthcare and foster older adult independence. Admission to all events is free, but space is limited so please RSVP by visiting http://bit.ly/2cCuSmu, emailing hurdl@vnacolorado.org, or calling 303-698-6308.

Donations and sponsorships are gladly welcome. For more information, contact Jodie Deshmukh, Development Manager, at deshmukhj@vnacolorad.org or 303-698-6308.

UPCOMING SESSIONS


aging-in-placeAging and Dying In Place,
A Community Panel Conversation

6:00PM at Anschutz Medical Campus
Fulginiti Pavilion for Bioethics and Humanities, Gossard Forum
13080 E 19th Ave, Aurora, CO 80045

Click on the flyer on the right for more information or RSVP at http://bit.ly/2cCuSmu.

PAST SESSIONS

Thursday, July 21st – Autism to Alzheimer’s
6:00 PM at Anschutz Medical Campus

Thursday, May 12thAdvance Directives: Know Your Rights, Share Your Wishes
5:30 PM at Colorado VNA (390 Grant St. Denver)

Moving from home care to home-based services

Photo courtesy of Gretta Blankenship

Photo courtesy of Gretta Blankenship

It’s time to change what we call ourselves…move from thinking of the Colorado Visiting Nurse Association (VNA) as a “non-profit home health care agency” to a “non-profit organization that provides home-based services”. This may seem like a small distinction, but it there are three reasons we should make this change:
1) “Home health care” agencies are defined by outdated Medicare regulations specifically focused on controlling home care as a way to decrease fraud and abuse within a fee-for-service payment environment.
2) Second, there is very little government and/or insurance company reimbursement for para-based services focused on helping patients remain independent in the home.
3) Further, there is very little coordination of care across our various divisions because of the differing ways we are paid for care that we provide.

The Colorado Visiting Nurse Association has begun to think differently about the care we provide as healthcare transitions from a fee-for-service (FFS) payment system to one where healthcare organizations are paid for overall care and health outcomes.
Currently there are many differences between the care provided by each of our home-focused divisions; home health, paraprofessional home services and hospice/palliative. Care provided by our home health professionals is mostly regulated by Medicare and requires patients to be “home-bound” and have a documented needed for care provided by an RN, PT, LPN, etc.

By definition, paraprofessionals are workers who are not qualified or licensed to serve in particular professions but who handle tasks in support of qualified professionals in those fields. Paraprofessionals often work alongside fully qualified professionals, but they also sometimes work more independently, such as in the case of the health care paraprofessionals who provide home visits to the disabled, ill or elderly.

Care provide by paraprofessionals is more proactive in nature and is provided to help patients remain independent in the home, e.g., bathing, shopping, house-keeping, getting in and out of bed, etc. Hospice visits for appropriate patients are similar to home health visits in that hospice patients have to meet strict criteria for admission, i.e. patients must have a terminal diagnosis and patients must have a prognosis of having less than six months to live.

As one can see, there is a big barrier between the care provided by paraprofessionals and home health and hospice; the barrier has to do with the strict Medicare definitions put in place to help decrease overuse and abuse of skilled home health. Bottom line: the way home health services are reimbursed in our country is too focused on decreasing costs and abuse, rather than on improving care for patients.

The good news is that the old ways of paying for the care we provide are beginning to change as Medicare begins to move to paying for the value provided in the home, rather than just for an episode of care. Here is an excerpt taken from the recent U.S. Department of Health and Human Services Report to Congress: Plan to Implement a Medicare Home Health Agency Value-Based Purchasing Program. The report details a summary of Medicare’s view of the problem of fraud, as well as the limited connection between payments and quality of care.

“…the Medicare Payment Advisory Commission (MedPAC), the Office of the Inspector General, the General Accounting Office (GAO), and other stakeholders have raised significant concerns with fraud and abuse in the Medicare home health benefit. While the benefit is designed to encourage teams of skilled professionals to provide patient-focused care to homebound beneficiaries, there is growing concern that the existing payment system does not provide the necessary incentives to provide such high quality patient focused care.”

There is a lot that is changing in healthcare. Care provided in the home is fast becoming of vital importance to improving the health of populations of patients.

– Christopher Lee, Colorado VNA President & CEO, July 13, 2015

Celebrate Men’s Health in June

MHM-no-date-dark-red-0415-135x150

Each year in the days leading up to Father’s Day, we celebrate Men’s Health as a country. June is national Men’s Health Month. The goal of Men’s Health Month is to raise awareness on how to prevent health problems among men. It is the perfect time to encourage senior men to obtain regular medical checkups, focus on illness prevention and embrace self-care activities such as regular exercise and even trying new past times such as yoga or swimming. At Colorado Visiting Nurse Association, we support our community in encouraging health senior living and applauding men for taking charge of their health and fitness, as they go through life.

In the spirit of supporting Men’s Health and healthier senior living, we hope you will click here to read some great nutrition tips for older men, courtesy of EatRight.org

To learn more about the Senior Wellness Medical Foot Care Clinics offered by Colorado Visiting Nurse Association throughout metro Denver and in Colorado Springs, call our hotline Monday – Friday 8:00 a.m. to 5:00 p.m. at 303-698-6496. We have many foot care clinics, all staffed by Registered Nurses, that are Open to the Public so call for your appointment today.

Happy National Senior Health and Fitness Day

National Senior Health and Fitness Day 2015
“If You Keep Moving…You’ll Keep Improving!”

More than 100,000 older adults will participate in activities at more than 1,000 locations throughout the U.S. on Wednesday, May 27, 2015 as we celebrate the 22nd annual National Senior Health & Fitness Day. The common goal for this day: to help keep older Americans healthy and fit. Always set for the last Wednesday in May, National Senior Health & Fitness Day is the nation’s largest annual health promotion event for older adults.

Did you know?  Colorado boasts more than 60 Senior Recreation Centers across the Front Range. Follow the link to find an Active Adult or Senior Recreation Center near you!

http://www.seniorsresourceguide.com/directories/Denver/search.php?region=CO04&topic=608

 

 

Celebrate National Senior Health and Fitness Day

Parker Senior Stroll

May 27, 2015, 10 a.m., O’Brien Park

Community celebrates National Senior Health and Fitness Day

Community celebrates National Senior Health and Fitness Day at Parker Senior Stroll  Photo courtesy of Parker Parks & Recreation

Among fun local activities open to the public around town tomorrow at 10 a.m. is the annual Senior Stroll in Parker.

Put on your walking shoes and join Parker Recreation for the wonderful Senior Stroll at O’Brien Park, 10795 Victorian Dr.

http://www.ourparkercolorado.com/senior-stroll-in-parker-colorado/

To celebrate National Senior Health & Fitness Day, Parker Parks and Recreation will once again host the annual Senior Stroll. More than 100 active aging adults are expected to enjoy a one-mile fun walk, followed by a tasty breakfast, socializing with friends and local organizations and exciting prize giveaways.

This free event will consist of a one-mile fun walk on a paved trail, a delicious breakfast, senior fitness assessments, blood pressure screenings and additional demonstrations, along with great giveaways!

For more information, contact Hillary Roemersberger of Parker Parks and Rec at 303-805-3278.

To learn more about the year-round Senior Wellness Foot Care clinics of the Colorado VNA that are open to the public, click here.  For example, we are at the Parker Senior Center every 1st and 3rd Friday of the month from 9:00 a.m. to 3:00 p.m. Please call our Colorado VNA Foot Care hotline for appointment info. at 303-698-6496.