National Rehab and Fall Awareness Month

September is National Rehab Awareness Month and National Fall Awareness Month! What a great combination! Who better to prevent falls in the elderly than our Home Health Rehab Teams and our nurses?

Here are some statistics from the CDC on falls:

  • One out of three adults age 65 and older falls each year, but less than half talk to their healthcare providers about it.
  • In older adults (65+), falls are the leading cause of injury-related death, and the most common cause of nonfatal injuries and hospital admissions for trauma.
  • In 2010, 2.3 million nonfatal fall injuries among older adults were treated in E.R.s and more than 662,000 of these patients were hospitalized.
  • In 2010, the direct medical costs of falls, adjusted for inflation, was $30.0 billion.
  • Falls are the most common cause of traumatic brain injuries (TBI). In 2000, TBI accounted for 46% of fatal falls among older adults. 
  • Most fractures among the elderly are due to falls.  The most common are fractures of the spine, hip, forearm, leg, ankle, pelvis, upper arm, and hand.
  • Many people who fall, even if they are not injured, develop a fear of falling. This fear may cause them to limit their activities, which leads to reduced mobility and loss of physical fitness, and in turn increases their actual risk of falling.
  • People age 75 and older who fall are 4 to 5 times more likely than those age 65 to 74 to be admitted to a long-term care facility for a year or longer.
  • Over 95% of hip fractures are caused by falls.


HOW CAN WE HELP?                                                                                          

  • Identify our patients who are at risk of falling!
  • Request physician’s orders for therapy–PT, OT and SLPs can make a difference!
  • Implement treatment plans that include a focus on increasing strength and improving balance.
  • Review their medicines—both prescription and over-the counter—to identify medicines that may cause side effects or interactions such as dizziness or drowsiness.
  • Make their homes safer by reducing tripping hazards, and making recommendations for adding grab bars inside and outside the tub or shower and next to the toilet, adding railings on both sides of stairways and improving the lighting in their homes.  Again, your therapists can do Home Safety Evaluations!
  • Recommend they have their eyes checked by an eye doctor at least once a year and update their eyeglasses to maximize their vision.  Your OTs can work on Low Vision issues!

Let’s keep our patients safe!
Submitted by Tricia Fox, VP Rehab Services


Director’s Meeting

September 11 and 12 we celebrated our Home Health Division leadership team at the annual Directors Meeting in Austin, Texas. Special recognition for our key metrics in volume, quality, operations, and finance were given and we learned about healthcare reform changes, OASIS accuracy, survey preparedness, and trust building. Check out and join us in congratulating our leaders and their offices with the following awards:

Some of our winners… Who will be celebrating next?

Cindy Rasnick, Austin TX – LEAN Queen, C3 Flagship: $572k ahead for the unit ($364k ahead for the Austin branch!)
Rosa Cervantez, Eastland TX – Captain Consistency: 31% BCM
Crystal Kelley, Tennessee – Most GREEN Combined: 18 squares on the SMART board, 17 are bright green! ($300k ahead!)
Hui Fang, Asian American – Largest Budget Surplus: $700k and growing!
Rena Kendricks, Temple TX – BCM Tops Award: All 5 offices YTD BCM margin over 35%! (5 of Top 13 Performers!)
Melinda Hoffman, Lake Ozark MO – ALL GREEN Award: 7.25RN, 7.96 Therapy, 6.25% LUPA, $131 Cost, Ahead of Plan, 24.2% BCM!
Tammy Thompson, West Virginia – Greatest 2013 Performance Improvement: 15% in Q1, 19% in Q2, 34% in July!
Jodi Wittwer, Montrose/Grand Junction CO – Colorado HERO Award!
Dorothy Trammel, Brownwood TX – Consistently at the TOP!
Shirley Irvin, Corsicana TX – #1 on the Leaderboard: 42% BCM
Tanga Thompson, West Plains MO – Best Consistent Margin: 38%+ (behind a tough budget!)
Renee Hinze, Schulenburg TX – Movin’ On Up
Melody Platson, Chicago IL – GREEN with Quality (Therapy metrics and outcomes) and Satisfaction!
Tammy Hain, Clearwater FL – Homecare ELITE Award: Best Combo of Finance and Quality!
Julie Norrod, Wichita KS – Quality Outcomes: Green across all OASIS questions!
Terry Greene, Clinical Resources – “Step Up” Award: 100% of our patients recommend and 7.4% rehospitalization in July!
Rosa Murillo, Billing/AR/Finance – AR Improvement, Eligibility improvement, Financial statements by the 8th of the month!

The lovely Eastland Directors: Mary Hearrell, Rosa Cervantez, Audra Moss, and Dorothy Trammell

Terry Greene, Director of Home Health Quality speaking



Article submitted by: Julie Vandre, VP of Quality for Home Health and Hospice

Official Direction from the Center for Medicare and Medicaid Services

Home Health & Hospice Aides plan of care cannot use PRN or per patient choice for any task whether personal care or non-personal care. It is out of the scope of practice for the aide to determine what tasks need to be done and when. The qualified professional must develop the plan of care; indicate what task to be done and the frequency of these tasks. If the patient and/or caregiver are cognitively able to make a choice, then the RN must indicate this on the plan of care plus that the patient is functionally able to perform the task. The qualified professional, based on the needs of the patient, also selects non-personal tasks that need to be specific for frequency. Again, if the patient/caregiver is cognitively and functionally able to make a choice, the professional must indicate this on the plan of care.

The Centers for Medicare and Medicaid Services (CMS) recently stated that the Home Health & Hospice Aide plan of care CANNOT use “PRN” or “per patient choice” for ANY task, whether they are personal care or non-personal care

  • Use of “PRN” or “per patient request” in a patient record must be cited as a deficiency during an on-site survey.
  • Multiple types of care, such as the choice between a shower or sponge bath, can only be used when it has been documented by the nurse that the patient/caregiver has the ability to functionally and cognitively make a choice between the types of care that have been ordered.
  • The Aide Plan of Care must be individualized and refrain from using blanket statements like “patient is cognitively and functionally able to make the choice” for all patients and tasks.
  • If patients are requesting a specific type of care as a result of changes in their condition, Aides must still contact their supervisor prior to administering care.


1. Tub bath or shower per patient request.  1. Tub bath or shower 3 times a week. Patient is functionally and cognitively able to make the choice.
2. May use walker or cane for ambulation per patient request. 2. May use walker or cane for ambulation. Patient is functionally and cognitively able to make the choice.
3. Change bed linens PRN. 3. Change bed linens weekly and anytime they are soiled.

Please contact Home Health Quality with questions. 1-800-447-5464

Article submitted by: Terry Greene, Director of Home Health Quality

Updates from IT

Summer is winding down and we are headed into Fall. Although in Texas, it’ll be HOT for another few months! Here is what is on the HORIZON for the rest of the year.

12.3.8 Horizon Fall Regulatory Update: This release became available from McKesson on September 13th and is currently being tested for new features/functionality. We plan to load it to Production on Thursday, September 26th. Keep a look out for training materials and more information for next week’s Q&A calls.

PPS Rate Update for 2014: Coming towards the end of October/beginning of November, there will be another release loaded for the PPS Rate Updates for 2014. This update generally only affects the Billing Department but will first be tested before being loaded to Productino. Expect to see a notice for this update to be loaded during a Thursday night maintenance window at the end of October/beginning of November.

12.3.9 Horizon Winter Regulatory Update: Every December, Medicare puts out new regulatory requirements that take effect on January 1st. In order to be in compliance with those regulations, McKesson will release a Winter Regulatory Update. This release will first be tested in our TEST environment before being loaded to Production during a Thursday night maintenance window towards the end of the month of December.

Article submitted by: Jessica Rhodes, IT Project Manager

G 121: Compliance with Accepted Professional Standards

If you think this sounds like a very general category, you’re right! This tag can be used to cite many different types of deficient practices. One way to focus your attention would be to ask yourself: “What would any prudent nurse or therapist do in this situation?”

The surveyors can use this tag to cite failure to follow policies and procedures, insufficient or lack of drug regimen review, inappropriate delegation of tasks, failure to track/trend complaints, and poor or incomplete physical assessments. These are just a few of the ways in which this tag has been cited for our company in 2013. Each of these can, and often are, cited in other tags as well.

The surveyor will look for evidence of poor infection control, poor wound care procedures, and not following physician orders. If the patient is hospitalized, the surveyor will look at clinical documentation to see if we failed to notice signs of an impending problem. The surveyor will also compare the care observed during home visits and the clinical documentation to state practice acts as well as policies, procedures and physician orders.

Article submitted by: Lori Velko, Director of Compliance

September 2013 Service Anniversaries

Congratulations to the following people that are celebrating their service anniversary with the company.

  • Donna Smith – 10 years
    General Clerk – Temple, TX
  • Maureen Stokes – 10 years
    Regional Sales Manager – HHRC
  • Lisa Pope – 5 years
    Administrator – Beaumont, TX
  • Sheila Nichols – 5 years
    Community Educator – Austin, TX
  • James Hebert – 5 years
    RN Field Case Manager – Beaumont, TX

Article submitted by: Christi Ferina, Executive Assistant

August 2013 HEART Winners

This program has been put in place to recognize our fellow team members for the Terrific work they do each and every day. I would like to thank everyone who sent in a note to show your support in recognizing the great people you work with. The following names are the Terrific people who were nominated in August 2013 for their great work:

Andi Martin – Chicago, IL
Gwendolyn Black – Houston, TX
Tiffany Edwards – Lubbock, TX
Christi Binckley – Sevierville, TN
Joe Williams – Sevierville, TN
Carol Tarlton – Oklahoma City, OK
Russell McKeever – Abilene, TX
Britt Chambliss – Humble, TX
Tamar Huffman – San Diego, CA
Gladys Johnson – Tampa, FL
Lyndsey Flores – Lubbock, TX
Sheryl Angerer – Lubbock, TX
Janice Foran – Oklahoma City, OK
Sherri Fox – Knoxville, TN
Sylvia Boston – Houston, TX
Lauren Rock – Dallas, TX
Sean Kenyon – Clearwater, FL
Nefretria Martin – Oklahoma City, OK
Lori Hobbs – Sevierville, TN
Lynn Cross – Sevierville, TN
Mandi Lee – Eastland, TX
Elaine Wright – Chicago, IL
Ursula Cisneros – Dallas, TX
Kakki Dobbs – Eastland, TX
Ontwaneece Freeman – Oklahoma City, OK

Misty Nicholl – Burnet, TX
Katharine Allgood – Burnet, TX
Melissa La Farga – Tampa, FL
Emily Turnbull – Abilene, TX
Shaunnah Moreno – Burnet, TX
Crystal Jackson – Oklahoma City, OK
Sonia McConnell – Dallas, TX
Valerie Sutton – Dallas, TX
Sandra Murray – Dallas, TX
Lisa Esposito – Chicago, IL
Sheri Scherpf – Tampa, FL
Rose De Mello – Tampa, FL
Terrance Wilder – Tampa, FL
Andrew Shippey – Humble, TX
Jennifer Sarcinelli – Chicago, IL
Olubukola Cole – Chicago, IL
Darlene Johnson – Tampa, FL
Laura Leigh Kniech – Durango, CO
Stephanie Brown – Corsicana, TX
Ronnie Sterling – Corsicana, TX
Shirley Irvin – Corsicana, TX
Alisha Dodd – Oklahoma City, OK
Tracy Fisher – Burnet, TX
Gloria Ng – Oakland, CA
Mary Ajzenman – Dallas, TX

Congratulations to everyone, especially our winners (the names in red) of the $25 gift cards for a job well done. Keep up the excellent work.

Don’t forget to nominate your fellow team members for the great work they do.
The next drawing of 25 winners will be held on October 9, 2013.

Article submitted by: Julia Widener, HEART Rewards Program Coordinator, HHQ