Home Health Care Can Help Seniors With Loneliness and Social Isolation

By: Elizabeth Townsend, RN

People are social beings. With COVID-19 introducing social distancing guidelines and restrictions on visitations, social isolation and loneliness are increasing. A report referenced by JAMA discussed the need for solutions for social isolation and loneliness in older adults. There is significant documentation that social isolation and loneliness are related to a higher rate of major mental and physical illnesses, including:

  • Cardiovascular and cerebrovascular risks
  • More depression and anxiety
  • An increased risk of dementia

According to the National Institute on Aging, people who participate in worthwhile activities with others tend to live longer and have a sense of purpose.

Assessing seniors for isolation and loneliness

COVID-19 has made it difficult for seniors to participate in:

  • Social gatherings
  • Communal dining
  • Exercising in groups
  • Social programs at senior centers
  • Volunteering

Home health clinicians assess patients for social isolation and loneliness. Asking patients about their social needs is important to identify who needs assistance, easing isolation and loneliness. The home health agency provides tools or guidelines with questions for the clinicians to ask. Examples of questions to ask:

  1. Do you feel you have no friends or loved ones?
  2. Are you lonely?
  3. How are you staying active?

5 ways to relieve isolation and loneliness

After assessing and finding that your patient is suffering from social isolation, consult with their caregivers and healthcare team —specifically the agency’s social worker—to find ways to relieve their isolation. Daily Caregiving suggests some ways to help:

  1. Encourage a sense of purpose. Suggest activities such as knitting blankets and caps for newborns at a local hospital, making masks for healthcare workers or family members, or writing letters to their grandchildren to encourage them. Allow the patient to have a responsibility, such as taking care of a plant or dog. This would be giving them a meaningful purpose.
  2. Encourage interaction. Encourage interaction with others via phone, computer, or if in person, socially distant, wearing a mask.
  3. Encourage physical activity. Take Into account the patient’s physical ability. They can do gentle exercises such as walking, stair-climbing, yoga, or group exercises via computer. If they cannot get out of bed or are not able to walk, find appropriate activities. Consult with the physical therapy team who can provide resources for exercises for those with limitations.
  4. Assess the food they are eating. Encourage fiber-rich foods like fruit, vegetables, whole grains, and lean proteins. Consult with community services such as food banks, churches, or meal delivery services.
  5. Show them they are loved. Find ways to show that they are loved and needed. Listen to what they have to say. Encourage family members, if they are in the home also, to hug the patient and talk and listen to them.

Social workers can help seniors with social isolation and loneliness

Social workers can ensure that patients have access to available resources. Local churches may have “shut-in” outreach for those unable to leave their homes. They may provide phone calls, run errands, provide food baskets, and communicate by mail with the seniors. Local library programs have online programs and can arrange to have books available for the patient to check out. The social worker can also refer the patient to transportation programs that take seniors to doctor appointments.

Encourage virtual connections for seniors

Advancing States created a resource to help reduce social isolation and loneliness.

  1. If the patient can use a smartphone, show them how to google Earth National Park Tours so they can “visit” the parks and talk about what they saw with others via telephone or with you when you visit.
  2. Patients can meditate through Journey Meditation.
  3. Put the patient in contact with Well Connected by Covia, who will help them participate in virtual classes, conversations, and activities by phone and computer.

There are helplines for mental and emotional support, which include:

  1. Friendship Line by Institute on Aging- 1(800)971-0016
  2. Happy– a free app that provides emotional support 24/7
  3. National Alliance on Mental Illness Helpline- 1(800)950-6264
  4. Substance Abuse and Mental Health Services Administration National Helpline- 1(800)662-4357

Sepsis Awareness Month: Why Our Program Actually Works

By: Portia Wofford

Home health clinicians play an essential role in caring for patients who are:

  1. At risk of developing sepsis
  2. Recovering from sepsis or septic shock

Home health providers are vital in preventing hospital admissions and readmission among sepsis patients. According to the CDC, sepsis is the body’s extreme response to an infection. It is a potentially life-threatening medical emergency.

Many patients receiving home healthcare services have chronic medical conditions and comorbidities that put them at risk for infection, including COVID-19 and sepsis. According to the Global Sepsis Alliance, COVID-19 can cause sepsis. Research suggests that COVID-19 may lead to sepsis due to several reasons, including:

  • Direct viral invasion
  • Presence of a bacterial or viral co-co-infection
  • Age of the patient

According to Homecare Magazine, approximately 80% of people with COVID-19 will have a mild course and recover without hospitalization. The remaining 20% of patients with COVID-19 may develop sepsis and be admitted. Patients with severe illness will need home health care.

A study published in Medical Care by the National Institutes of Health (NIH) suggests that when strategically implemented, home health care can play an essential role in reducing hospital readmissions for patients recovering from sepsis. According to Home Health Care News, the study points out that sepsis survivors who were less likely to return to the hospital if they:

  1. Received a home health visit within 48 hours of hospital discharge
  2. Had at least one additional visit and
  3. Had physician visit within their first week of discharge

According to the findings, these interventions reduced 30-day all-cause readmissions by seven percentage points.

Home health clinicians are trained to monitor patients and identify signs and symptoms of sepsis. Additionally, they can teach patients and their caregivers how to prevent and recognize sepsis. According to research and estimates, rapid diagnosis and treatment could prevent 80% of sepsis deaths.

Home health care can contribute to early detection of sepsis

Early detection is critical. For each hour treatment initiation is delayed after diagnosis, the mortality rate increases 8%. Home health nurses can monitor and educate patients and their caregivers on signs and symptoms to report to include. Additionally, home healthcare agencies can provide screening tools that fill the gaps in identifying at-risk patients during transitions from inpatient to outpatient settings.

Home health provides case management for chronic comorbidities

  1. Some comorbidities like Type 2 Diabetes, chronic heart disease, and dementia were associated with sepsis risk in almost all infection types. Those with other chronic illnesses, cancer, and an impaired immune system are also at increased risk. Monitoring can help reduce risks.
  2. Post-discharge and follow-up visits, including telehealth visits, may provide positive intervention for post sepsis patients.
  3. Nurses can review and coordinate care to adjust medications, evaluate treatments and interventions, and refer for appropriate treatment.

When it comes to serious complications, our sepsis program effectively:

  • Prevents infections that can lead to sepsis
  • Recognizes sepsis symptoms before they become severe
  • Rapidly responds if sepsis symptoms occur by initiating appropriate treatments and referrals
  • Follows-up with care to ensure continued recovery

AT Home Care’s sepsis program promotes quality of care and improves outcomes for those at risk for developing or recovering from sepsis.

COVID-19 & Home Health

Pandemic Relief via legislation, CMS waivers, and enforcement discretion

  • Telehealth
  • Waived requirement to use volunteers
  • Face to Face encounters to establish HH services
  • Non-physician practitioners (NNP) certification authority accelerated

Telehealth and Telephonic Visits

  • CMS permits HHAs to provide all necessary telehealth during the emergency period
  • Must be physician-ordered and on the plan of care
  • Does not replace in-person visits (telehealth or telephonic visits are not billable visits)
  • Allows for HHA to supplement in person visits for patients who might refuse more frequent visits or senior living or other congregate living facilities that might be restricting access to HHA personnel.
  • The Home Health Face to Face visit may also be provided by telehealth but must be performed utilizing 2-way audio and visual programs.

In an effort to protect patients, some SNF, LTC, hospice, and other facilities are limiting the number of visits that Abode Healthcare staff may make to patients in their care. Some patients are even requesting fewer in-person visits to reduce their exposure to the outside world.

Abode Healthcare understands and joins in these protection measures by offering telehealth visits. In some cases where access has been limited or is desired, Abode staff are utilizing telehealth on a weekly or bi-weekly basis in order to maintain contact with high-risk patients.

In all cases, telehealth visits are meant to be supplementary to in-person patient visits. Telehealth visits should not replace in-person visits altogether.

Telehealth Tools

Our commitment, as always, is to serve our patients as best we can. Our clinical team has been trained in effective ways to utilize telehealth systems to streamline patient care through our own remote access system using the following tools:

  • Phone: Abode Healthcare staff may conduct remote visits with patients through phone calls.
  • Video: Abode Healthcare staff may conduct remote visits with patients through Doxy.me. (All F2F between NPs or MDs, DOs must be done through a 2-way type of technology. This is for both HH and Hospice)
  • me can be utilized via tablets or phone and has been selected by Abode due to the ease of use for both the clinician and the patient/family/caregiver as well as its ability to capture/validate that the tele visit occurred, and its security features.

Though telehealth is never our first choice, it is the right choice during this time. Abode Healthcare continues to partner with providers to preserve the health and wellbeing of all of our patients.

Though telehealth is never our first choice, it is the right choice during this time. Abode Healthcare continues to partner with providers to preserve the health and wellbeing of all of our patients.

CMS clarification on homebound status for COVID-19 patients and those at high risk of contracting:

Non-Physician Home Health Certification Authority

  • Allows patient to be under the care of an NPP to the extent permitted under state law
  • NPP= Nurse Practitioner (NP, ARNP), Physician Assistant (PA) and Clinical Nurse Specialist (CNS)
  • Authorities
  • Order Home Health Services
  • Establish and review POC (Plan of Care)
  • Certify and recertify eligibility
  • CMS utilizing discretionary authority not to enforce rules
  • Must also check state HHA licensure for any barriers to implement
  • CARES Act makes this relief permanent, but CMS needs to implement

For more information, contact Jon Wilder.

Life-Limiting Illnesses – When to Call Hospice

A life-limiting illness is an incurable chronic disease or condition that no longer respond to curative treatments.

Examples of a life-limiting illness include:

  • Alzheimer’s Disease or Dementia
  • Stroke
  • ALS
  • Parkinson’s Disease
  • Heart Disease
  • Pulmonary Disease
  • Liver Disease
  • End-stage Renal Disease
  • AIDS
  • Cancer

A life limiting illness, coupled with symptoms below, could be indicators of decline and hospice eligibility:

  • Frequent hospitalizations, ER visits, or visits to the physician within the last six months
  • Progressive weight loss (with consideration to weight gain factors such as edema, when applicable)
  • Decreasing appetite
  • Dysphagia or difficulty swallowing
  • Increased weakness or fatigue
  • Decline in cognitive status or functional abilities
  • Increasing assistance needed with Activities of Daily Living (ADLs)
  • Increasing pain or increasing difficulty in controlling pain
  • Increasing dyspnea or shortness of breath
  • Oxygen dependency
  • Reoccurring infections
  • Ascites
  • Increased nausea and/or vomiting that is difficult to control
  • A desire to forgo future hospitalizations
  • A request to discontinue treatment
  • Recurrent or frequent infections
  • Skin breakdown
  • A specific decline in condition

If you or a loved one has a life-limiting illness and are experiencing any of the above symptoms, consider speaking to your physician about hospice services. You can also call At Home Care & Hospice, and one of our team members can help guide you through the process of requesting hospice through your physician.

The Value of Companionship on a Senior’s Mental Health

As a person ages, he or she may begin to lose their ability to live independently due to a variety of physical conditions. These include limited mobility, chronic pain and frailty, as well as typical everyday activities that may become stressors, such as maintaining a household and caring for themselves. Mental health problems may also arise as people grow older. Depression and anxiety are two of the most common mental health conditions.

Health conditions and lifestyle adjustments are inevitable. However, an elderly person does not need to feel alone in dealing with such changes. Whether a loved one needs full-time or part-time in-home care, or just a friendly face to stop in for a visit, in-home care offers a great deal of value that offsets the isolation, depression and anxiety an elderly person sometimes experiences.

Most seniors enjoy the company of family, friends, caretakers and new companions. In-home companionship has a huge impact on the mental health of the elderly. Not only do companionship services provide the senior with much needed interaction, they relieve some of the stress and worry from family caregivers. This allows time spent with family to be more fun and carefree, and less of a stressor.

In-home companionship care includes activities such as:

  • Playing games, telling stories and help with reading
  • Crafts, like scrapbooking and collages
  • Maintaining calendars and organizing social engagements
  • Planning trips outside of the home
  • Assisting with personal tasks
  • Engaging in meaningful conversation

A helpful and friendly companion has a unique influence on a senior’s quality of life. In many cases, after a few visits from a companion, the senior is much more willing to initiate activities and accomplish tasks independently. This sense of self-worth has a significant impact on mental health. For more information on senior companion services, contact AT Home Care today.

Is My Loved One Ready for Home Health Care?

Assisted living, nursing homes and home health care are issues most elderly persons and their loved ones will be faced with at some point. Whether the person struggles with mental disabilities, physical incapacities or chronic illnesses, most times care outside of what family and friends can provide is necessary. When the time comes to think about options, the process of researching and deciding on an approach can be particularly stressful. Some elderly people may be resistant to change, and would prefer to keep present arrangements because they are comfortable and familiar.

Factors to Consider

Home health care is an excellent way to receive specialized medical care in the comfort and familiarity of the patient’s home. However, before determining if this is the right option for you or your loved one, there are several factors to consider.

  • Does the person have an accessible, nearby network of loved ones and friends?This is critical because home health care involves the participation and companionship of those close to the patient. When receiving home health care it’s easy for the person to feel alienated, especially if they live alone, and a familiar support system is very important to a successful in home health care plan.
  • Is the person’s home easily maintained and modified?When an elderly person has medical needs and conditions, it’s important that their living environment is safe. Many times home health care professionals, like nurses and therapists, will recommend some home modifications be made to create a more safe, stable environment for the patient.
  • Is the person comfortable with having unfamiliar faces in their home?This question might seem obvious, but many times it isn’t until a home health aide, nurse or therapist makes their first visit that the patient feels uncomfortable with the arrangement. Make sure you or your loved one understands who is visiting and why. It’s important to work with the home health agency to ensure there is a good match between the medical professional and the patient.

There are many other key points to consider that are unique to each person. Talk to your family and loved one about the available options of care and try to get feedback in all areas. Together you can decide if this is the right time for in home health care.

How In-Home Care Promotes Independence in the Elderly

Independence is an important part of life, but daily human interaction and regular activities are important to a senior’s health and happiness. There is no denying that keeping seniors physically, mentally and socially active can result in overall better health and the ability to live independently longer. Having the right person step in and offer a helping hand is just what most seniors need to achieve their highest level of independence.

A nurse or caregiver can provide an interactive approach to in-home care that stimulates a senior’s natural ability to perform. At a very basic level, in-home caretaking is health care combined with task-oriented activities to encourage a senior’s independence. Overall health and independence is promoted when engaging activities are the focus. There are four main areas of concentration for an interactive approach to in-home care.

  1. Physical Activity
    Once physical activity is approved by a doctor, it’s important to remain as active as possible. Sometimes all it takes is a companion to make being physically active more enjoyable. Dancing, stretching, walking, gardening and housekeeping are all suitable forms of physical activity that will improve one’s physical and emotional well-being.
  2. Socialization
    Being around others is critical to a high quality of life. As people age, life changes occur that sometimes result in feelings of isolation. By meeting up with friends and loved ones outside of the home, or attending parties and other events, a senior may regain confidence. Additionally, research shows that socializing slows the development of memory problems.
  3. Mental Stimulation
    Regularly participating in mind-engaging activities is important for a seniors brain function. Activities such as card games, crossword puzzles, computer activities, arts and crafts and storytelling are all fun and accessible ways to stimulate the brain. These games and activities keep the mind active, and promote healthy mental growth.
  4. Emotional Well-Being
    Feeling connected and involved are significant factors that contribute to emotional health. This can include simple things like staying in touch with family and friends, being involved in the community or learning a new hobby. Unlike those included in the socialization category, these are things the senior can do alone, or with friends and loved ones.

Tips for Finding the Right Home Health Care Agency

An Aging Population And Other Outside Factors Means More People Are Turning To In Home Health Care in Virginia

As the population ages, and hospitals cut back on their stays, more and more people will be looking to home health care as an alternative. Did you know that home care is approximately two-thirds less expensive than hospital or nursing home care? Knowing the options for the continuum of care can help alleviate some of the anxiety that occurs when a loved one leaves the hospital or has increasing medical needs.

The pace and unfamiliar surroundings of a hospital or nursing home can be confusing. Not only is the financial burden of a hospital stay alleviated with home care, studies show that patients with home care often enjoy a faster rate of recovery and the chance of further hospitalization is minimized. The decision to choose a home care giver can seem overwhelming, but the points outlined below should direct you to resources that will make the process much easier. Not only do you want to ensure that the care you will be receiving is of the highest quality, but, also, that the caregiver will respect your lifestyle as well as your home.

Finding Qualified Agencies

Some of the first things to consider when choosing a home health agency are:

  1. Type of care or services that will be needed,
  2. The care giver’s level of training, and
  3. The financial coverage provided by your insurance or Medicare.

You will want an agency licensed by the Center for Medicare/Medicaid. A physician or an Area Office on Aging can help you evaluate your needs and provide you with a list of licensed agencies. In addition, Medicare ranks all the agencies that they certify and conducts performance surveys of each on specific categories of patient care. There are several professional organizations that have established stringent standards to define quality in home care services that go beyond the minimum state and national requirements. Two of the most respected are: The Joint Commission on Accreditation of Healthcare Organizations (JCAHO) and Community Health Accreditation Program (CHAPS). Agencies that have attained one of these certifications are the most respected in the home care industry.

Questions To Ask a Home Health Care Agency

Once you have a list of potential agencies, it is time to ask about specific care services, as well as the personal standards demanded of the clinicians.

  • What type of license does your agency have?
  • How soon after discharge from the hospital will your plan of care begin?
  • What is the evaluation process for developing a care plan for the patient and assigning care givers?
  • Does a nurse or therapist consult the patients’ family and physicians?
  • How frequently will there be feedback and updates regarding the patient’s progress?
  • How detailed is that patient’s course of treatment?
  • How often does the care giver update the family members and doctor?
  • What procedures does this provider have in place to handle emergencies?
  • Are its caregivers available 24 hours a day, seven days a week?

Additional Considerations

    • References should be availableThe area on Aging that covers the Richmond area is Senior Connections
    • Eligibility for MedicareUS citizens, age 65 years or older, who have contributed to Social security, are eligible for Medicare benefits. Medicare will pay for an unlimited number of visits provided the criteria listed below are met on a continuous basis.  Medicaid is for the poorer population and eligibility in Virginia needs to be checked as legislation is currently being altered.
    • Home Health Care Eligibility under Medicare
      1. Must be homebound.  This term means confined primarily to the home as a result of medical reasons.
      2. Intermittent need for temporary nursing care or physical therapy.  Examples of this are when a patient suffers from Congestive Heart Failure after a hospitalization; or the need for physical therapy after a joint replacement.
      3. A physician’s order and plan of care need to be coordinated with your doctor and a home health agency.
  • Private Insurance Usually follows Medicare criteria, although each insurance policy may have different coverage benefits and different co-pay amounts.  Call your insurance company and ask for specific benefits and service.
  • The Types of Services found at Home Care Providers
    • Nurses (Registered Nurses and Licensed Practical Nurses)
    • Certified Nursing Assistants
    • Physical Therapists
    • Home Health Aides
    • Speech Language Pathologists (speech therapists)
    • Occupational Therapists
    • Medical Social Workers
    • Companions (sitters) –Personal Care & Private Duty

    Taking time to ask a few important questions will go a long way in finding the most compatible home health agency.  For a complimentary home health evaluation after discharge from a hospital please call 804 359-3400, and ask for Barbara Wilson, RN Clinical Director for AT Home Care.

Home Health Agency Services

A home health agency is a great resource if you or a loved one is in need of personalized home health care services. Home health agencies are growing in popularity as a great alternative to traditional medical care. These agencies provide the same type of care and services, but medical professionals visit the patient in their own home. For the elderly community, or those that are ailing or disabled, home health care offers great advantages over outpatient care. In home health care provides the comfort, security and convenience most elderly persons desire.

Patients look to home health care for a variety of medical reasons. Some are preparing for, or recovering from surgery. Others need assistance with ADLs. Many people are going through the stages of dementia and need extra help inside and outside of their home. Maybe an elderly person’s loved ones need assistance, or are seeking alternatives for a transition into a nursing home or assisted living facility. All of these needs can easily be met through a home health care agency. Most agencies provide customized care plans to meet you or your loved one’s medical needs through a comprehensive in home approach.

Home Health Agency Services

In home health care services typically include:

  • Personal Home Health CareCertified nursing assistants and home health aides help patients with a number of needs like assistance with ADLs, personal hygiene, light housework, meal preparation, medical condition(s) tracking and record keeping.
  • Skilled NursingRegistered nurse (RN) or licensed practical nurse (LPN) coordinates a health care plan with the patient’s physician and oversees most in home care services. Skilled nursing includes chronic disease management.
  • Therapy and RehabilitationPhysical, speech and occupational therapists focus on core areas of therapy and develop personalized rehabilitation plans for patients. Specialized services also include amputee rehabilitation and orthopedic/joint replacement programs.
  • Medical Social WorkSocial workers are oftentimes the connection between the patient and their family, friends and community. They provide support to the patient, but also serve as a guide for loved ones and friends who are unsure as to how to best offer support and companionship.
  • Hospice CarePalliative hospice care helps patients and their loved ones during the most difficult times. This type of hospice care focuses not on treating the disease, but relieving pain, stress and other symptoms that patients with terminal illnesses often experience.

Home Care Resources in Virginia

As the baby boomer generation grows older, the demand for information regarding senior home health care rapidly increases. There are many care options available to seniors that need specialized medical services. However, sometimes it’s difficult for the person and their family to make the best decision for where to seek medical care when faced with various options and choices. Home health care is a preferred alternative to traditional inpatient care because it allows the family to take regular part in their loved one’s care while acting as a full-time support system. Home senior health care is beneficial to elderly persons struggling with a variety of illness, disabilities and physical limitations. Before making a decision, it’s important to be educated on what home senior care entails.

The Virginia Department for the Aging

The Virginia Department for the Aging (VDA) provides assistance and resources to older Virginians and their families. The organization helps educate seniors and their loved ones on how to live as comfortably and independently as possible as they grow older. The VDA has provided a great deal of resources on home care, how to select a provider, how to handle in-home health care problems and what to expect when receiving home health care.