The January 22, 2013 cover story of the Journal of the American Medical Association focused on the growing problem of unnecessary hospitalization. As our nation’s lawmakers wrangle over the topic of health care reform, this is one thing everyone can agree on: these unnecessary hospital trips cost money, and aren’t good for the health of seniors. Policymakers are looking at ways to protect the well-being of our vulnerable seniors and, in the process, saving money for Medicare and consumers.

For Seniors, Is This (Hospital) Trip Necessary?

Hospital care is expensive. Yet according to a recent report from the Medicare Payment Advisory Commission (MedPAC), 60 percent of all Medicare emergency room visits and 25 percent of hospital admissions are “potentially preventable.”  And this is not just a matter of money. Hospitals, it turns out, are not always the best care setting for seniors. Researchers are looking at ways to keep older adults out of the hospital. This includes:

• Encouraging patients to be treated by their primary physician rather than at the emergency room.
• Better preventive care and management of diabetes, heart failure and other common health problems.
• Helping seniors manage their medications.
• Identifying and treating depression, which increases emergency room use.
• Improved healthcare education and information for consumers.

Avoiding the Hospital Revolving Door

Re-hospitalization is also an expensive and dangerous problem. According to the National Association of Area Agencies on Aging (n4a), nearly 20 percent of Medicare patients discharged from the hospital are readmitted within 30 days, costing over $26 billion every year. Why are seniors readmitted at such a high rate? Sometimes they have nowhere else to go—they can’t get an appointment with their primary care physician or don’t understand their care instructions. Studies show that in other cases, patients are released too soon: almost half of all surgical complications happen after discharge. And often, the reason for readmission is unrelated to the condition for which the patient was hospitalized. (See “Is Post-Hospital Syndrome Real?” below for more about this.)

For hospitals, there is a new emphasis on preventing unneeded readmissions. Medicare penalties are one reason for the concern: beginning in October, Medicare began reducing payments to hospitals which have high rates of preventable readmission.

Of course, not all readmissions can be prevented. But healthcare agencies are taking steps to help seniors, professionals and consumers address the problem. The Agency for Healthcare Research and Quality (AHRQ) calls for improvements in care transitions between the hospital and care facility or home:

• Education for patients about their diagnosis and treatment while they are in the hospital and upon discharge
• Making appointments for needed follow-up care
• Improved instructions on how to take medications
• Following up with patients within a few days of discharge

Improved communication within the system is also important.  Said Dr. Elizabeth Rasch of the National Institutes of Health, “When a person has an emergency department visit, their primary care providers often don’t know or don’t get the results of that visit, and vice versa. The emergency department often doesn’t know about the complex medical history people bring with them. That’s where things tend to break down.”

The AHRQ also recognizes that patients may be unable to remember discharge instructions.  Family caregivers play a valuable role at this time. Hospital discharge planners, geriatric care managers, home care professionals are also often called in to help.

Is “Post-Hospital Syndrome” Real?

Care received in a hospital saves the lives of millions of seniors each year, and helps many enjoy a higher level of independence and quality of life. Yet studies over the past few years have confirmed that a hospital stay can have a negative impact on seniors. In a January 2013 study appearing in the New England Journal of Medicine, Yale University’s Dr. Harlan Krumholz showed that many hospital readmissions are for a medical condition that is different from the initial cause of hospitalization—”post-hospital syndrome,” a 30-day period where patients are at risk.

A stay in the hospital can leave seniors vulnerable to medication problems, urinary tract and other infections, sleeplessness, bedsores, and even falls, which can even lead to a more serious problem than that for which the senior was admitted. Of special concern is hospitalization delirium—a sudden state of confusion that sometimes occurs after surgery or a serious illness. This temporary event is sometimes mistaken for dementia—and delirium has been found to raise the risk of or hasten the course of cognitive decline in some patients.

Hospitals are making changes to support better outcome for elders. Some have opened geriatric emergency departments to meet the special needs of frail older patients, with such features as specially trained personnel, a quieter setting and thicker mattresses for comfort and bedsore prevention. Experts are calling for more geriatric training in medical and nursing schools, as well as policies that make geriatrics a more attractive specialty for med students.

For More Information

The Agency for Healthcare Research and Quality recently released a consumer booklet: “Taking Care of Myself: a Guide for When I Leave the Hospital.”

The Joint Commission healthcare accreditation organization offers the “Speak Up” series of patient education brochures and videos.

The Eldercare Locator website has the online booklet “Hospital to Home: Plan for a Smooth Transition.”

Read more about the post-hospitalization syndrome study in the New England Journal of Medicine

April 15 – 21 is National Volunteer Week

In these tough economic times, the budgets of service organizations must stretch farther than ever. Charitable donations are down, and there is less money in the public coffers for social services and education. So it’s not surprising that social service agencies, community groups, non-profit organizations, schools and cultural organizations all report that they now rely more than ever on volunteers to help their programs succeed.

At the same time, many organizations report that their pool of volunteers is smaller as people are spending more time looking for work, some even taking second jobs to make ends meet.

Seniors Are Stepping Up

The good news is, help is arriving from an increased cadre of senior volunteers, many of them Baby Boomers who are now reaching retirement age. A recent study from SeniorCorps, the national program to match older adults with volunteer opportunities, reports that Boomers who are currently in their 50s volunteer at a higher rate than earlier generations did at that age, and there is no reason to think the trend will change. And though many Boomers are expected to retire at a later age—for personal and financial reasons—they are also likely to change the face of retirement by shifting to work with a smaller financial reward, but with more flexibility, and a greater sense of giving back.

Boomers aren’t the only seniors who are taking on this challenge. Seniors of every age are finding ways to put their talents to good use. No matter what your age, consider the many rewards and benefits of volunteering.

Volunteers know that public service can be an important part of later life, and a major boost to healthy aging in several ways. Serving as a volunteer offers:

Continued Sense of Purpose. Did you know that gerontologists predict that depression is one of the greatest health challenges Boomers will face? While it’s a sure bet that some rest and relaxation are on your retirement “to do” list, many retirees are surprised to discover that leaving work creates a “vocation gap” in later years. “After the initial flurry of golf games and sleeping in,” said one former Air Force colonel, “I realized how much my self-image was tied up with my job.” Volunteer service can produce a profound sense of achievement—often well beyond what our paid work offered.

Enhanced Satisfaction with Our Life’s Legacy. One of our basic emotional “tasks” as we enter our older years is life review—taking stock of what we have accomplished, and seeking reassurance that the path we have taken through our world has made it a better place. No matter what your religious or philosophical beliefs, chances are good that you have gained the perspective to know that our families, communities, nation, human race and planet can only thrive if we work together. By offering a daily reminder that we can make a difference, volunteer service encourages an enhanced sense of satisfaction and well-being.

Healthier Body and Mind. Staying physically active is a major component of healthy aging—and retirement itself can lead to inactivity, offering the temptation to develop “couch potato” habits. The Corporation for National and Community Service recently released a report that examined over 30 different studies, showing that volunteers have greater longevity, higher functional ability, lower rates of depression and less incidence of heart disease. “This is good news for people who volunteer,” said Robert Grimm, Director of the Corporation’s Office of Research and Policy Development. “This research is particularly relevant to Baby Boomers, who are receiving as well as giving when they help others. Just two hours of volunteering a week can bring meaningful benefits to a person’s body and mind.”

Greater Social Connectedness. Growing older can also result in a loss of social context. At our retirement party, many of us say we will get together soon with our work friends—but somehow, we seldom get around to it. And at this stage of life, our children are grown, possibly moved to new communities. Maybe we ourselves have retired to a different state. Many seniors report a feeling of isolation—and did you know that current research demonstrates that spending time with others is as important as physical activity?

Serving as a volunteer helps fill this vital role for many seniors: it provides a context for human contact, for connecting with others in a sense of community and belonging. According to Dr. Stephen Post of Case Western Reserve University, “There is now a convergence of research leading to the conclusion that helping others makes people happier and healthier. So the word is out—it’s good to be good. Science increasingly says so.”

The good news is that many falls can be prevented. Fall prevention programs can start by looking around the patient’s or elderly person’s home. The most important step you can take to prevent falls is to:

1. Maintain as much strength and coordination as possible,

2. By following your doctor’s instructions on taking your medications,

3. Eating properly and exercising.

The next step is to look around your home for hazards that could lead to a fall, and correct them. Here are some suggestions for fall prevention exercises, patient fall prevention, and for creating a safer home environment:

Bathroom

-Grab bars to get into and out of the tub

-Use a bath chair or stool in the shower

-Don’t use throw rugs or wax on the bathroom floor

-Use a raised toilet seat with arm rails

-Buy soap on a rope, or put a bar of soap in a nylon stocking with one end tied to a towel bar

Bedroom

-Never get up in the dark – make sure the room is well lit

-Keep light switch close to bed – Use a Fall Prevention Light-Touch Dimmer

-Avoid slippery socks or slippers

-Consider using a Bed Transfer Handle or Bed Security Rail

-Hide all loose extension cords

-Consider using a Medical Alarm / PERS System

-Use carpets and rugs with skid-proof backing or tacked to the floor

Kitchen

-Use a long-handled sponge/mop to wipe up spills

-Keep your floors smooth but not slippery

-Store your often-used supplies in easy-to-reach cabinets

-Avoid hard-to-reach wall phones; consider a cordless phone that can be carried from room to room, or a counter model

Around the House

-To be safer, consider using a Medical Alarm

-Stairwells should be well lit; consider nightlights for hallways and bathrooms

-Wear low-heeled, comfortable shoes with nonskid soles;

-Don’t walk around in socks, slippers, or stockings on bare floors

-Keep rooms and hallways free of clutter

-Make sure carpets, including those on stairs, have skid-proof backing or are tacked to the floor

Use common sense. If bending throws you off balance, try to avoid picking things up. If you are unsteady outdoors, use a cane to negotiate sidewalk cracks and curbs. If you fall but do not injure yourself, don’t assume that you must restrict your activities. Too little activity can cause you to lose strength and coordination, putting you at greater risk for another fall. Instead, talk to your doctor about these and other steps you can take to reduce your risk of a more serious fall.

FORT MYERS FRANCHISE OWNER RECOGNIZED FOR OUTSTANDING CONTRIBUTIONS TO FRANCHISING 

Franchise Leaders Deliver “Franchising Votes” Message to Congress

WASHINGTON, D.C., Sept. 10 – Assisting Hands franchisee Robert Thomas of Fort Myers, FL was honored today by the International Franchise Association (IFA) with its annual Franchisee of the Year Award.  Franchise owner-operators representing 31 franchise systems were recognized today during the IFA’s 13^th Annual Public Affairs Conference for their outstanding performance and the contributions they have made to enhance the growth and development of franchising.

“The IFA is proud to recognize the outstanding efforts of Robert with the Franchisee of the Year Award,” said IFA Chairman Jon Luther, Chairman, Dunkin’Brands, Chairman, Arby’s Restaurant Group.  “The franchising community is an important component of the U.S. economy due to the hard work of these exemplary individuals who have helped bolster the growth of the industry.”

The Franchisee of the Year Award is a major component of the IFA’s Public Affairs Conference, which brings more than 400 franchise business leaders together in Washington, D.C. to carry the key messages of franchising to lawmakers on Capitol Hill.  During the two-day event, which began today and continues through Sept. 11, franchise industry leaders will meet with over 200 congressional offices about issues important to the future of franchising such as tax certainty, healthcare reform and access to credit.  The Public Affairs Conference is a powerful way to help forward IFA’s advocacy efforts and further increase awareness about how franchising can contribute to economic recovery and job growth. The event is supported by founding sponsor ADP Small Business Services.

IFA members are highlighting the economic impact of franchising.  According to a study conducted for the IFA Educational Foundation by PricewaterhouseCoopers on the economic impact of franchising, there are more than 825,000 franchised businesses in operation across the country which is indirectly responsible for providing 18 million jobs and generating $2.1 trillion in economic output.  “As Washington works to strengthen and renew our economy, lawmakers should remember that franchising counts in local communities all across the country, Luther said.  “With available credit and sound regulatory policies, franchise businesses like will create the jobs necessary for sustained economic recovery and growth.”

1. Memory loss that disrupts daily life – forgetting recently learned information or important dates
2. Trouble in planning or solving problems – difficulty following familiar instructions, recipes, how to pay monthly bills, etc.
3. Difficulty completing familiar tasks – trouble driving to or navigating to familiar places
4. Time and place confusion – losing track of days or seasons
5. Trouble understanding visual images or spatial relationships – difficulty judging distance or determining colors
6. New problems with speaking or writing – repetitive speech, trouble following conversations
7. Misplacing things, inability to retrace steps – putting things in unusual places, may accuse others of stealing
8. Decreased or poor judgment – problems dealing with money, paying less attention to grooming
9. Withdrawal from work or social activities – shying away from social functions or tasks
10. Changes in mood or personality – easily upset, confused, suspicious, fearful, etc.

Assisting Hands Fort Myers, the company’s first independent franchise location, celebrated its fifth birthday by moving offices to 1850 Boy Scout Drive, #A103, Fort Myers, FL 33907 in mid-July this year.  The new location sits on one of the city’s busiest streets and provides the office great exposure to passing traffic.

“We have tripled our space, reflecting our growth and expanded activities,” owner Robert Thomas notes.  “We have the space we’ve needed to expand our “Caregiver Excellence Training Program.”  The program includes special skills including use of a hoyer lift for paraplegics—a caregiver skill that will distinguish Assisting Hands from other agencies in the area.

The new office location is just one of the many enhancements the Fort Myer’s agency has added in 2012.  The Fort Myers location now offers Skilled Nursing, Care Management, and offers new care services tailored to specific client needs.  The office has revamped its policies, redesigned its marketing materials, and many countless improvements, all leading to one goal—to become the undisputed best home care agency in Florida this year.  “We’re absolutely serious about this goal of becoming the best—and having the programs and service level to prove it,” Thomas stated.

Robert I. Thomas, President

Assisting Hands Fort Myers

(239) 337-4263