Posts Tagged ‘home care’

Meet Deborah Vermillion: Home Care CEO Aims to Keep Seniors at Home as Long as Possible

March 13th, 2015 by Cheryl Miller

Deborah Vermillion, RN, MSHCA, CSA, CDE, President/Owner of ComForcare Homecare, a non-medical home care business.

This month we provide an inside look at a healthcare case manager, the choices she made on the road to success and the challenges ahead.

HIN: Tell us a little about yourself and your credentials.

(Deborah Vermillion) I have been in the healthcare workforce for 36 years. I am a registered nurse. I have a master’s degree in health care administration. I am a certified senior advisor. I am also certified in diabetic education.

What was your first job out of college and how did you get into case management?

My first job out of college was in an intensive care unit (ICU)/coronary care unit (CCU) at Allegheny General Hospital in Pittsburgh as a staff nurse. After four years as a staff nurse and supervisor, I entered medical sales in the home care equipment and infusion industry. During that time it was very important to manage discharge planning as it related to the items we were providing. That was the beginning of my entry into case management.

Has there been a defining moment in your career? Perhaps when you knew you were on the right road?

I always knew that I wanted to be a nurse. My nursing education has led to continued growth and career development, and has been the springboard to all that I have achieved.

In brief, describe your organization.

I own a non-medical home care business. We provide activities of daily living (ADL) and instrumental activities of daily living (IADL) care to seniors in their homes. Our goal is to keep seniors at home for as long as possible. Because I am a nurse we also provide private duty nursing services. We will be expanding this product line through accreditation this year.

What are two or three important concepts or rules that you follow in case management?

  • Follow all cases through to completion.
  • Pay attention to all client details in order to avoid any unforeseen issues.
  • Understand that we are working in their environment, not an institutional environment. Adjust our approach to achieve the best results without being overly invasive.

What is the single most successful thing that your organization is doing now?

Because of our care for each of our clients we have been able to keep readmission rates to a minimum. When we last measured we were at five percent.

Do you see a trend or path that you have to lock onto for 2015?

We need to continue to pay attention to details. We have instituted a more robust quality management program that we hope will bring a stronger platform to our already complete care.

What is the most satisfying thing about being a case manager?

Being able to keep the client at home, aging in place up to their death.

What is the greatest challenge in case management and how are you working to overcome this challenge?

Communication between the various organizations that care for the client in the home. I constantly have to chase the Medicare agencies to ask for cross communication; most of the time they do not call back and obviously do not feel the importance in communicating to support continuity of care.

What is the single most effective workflow, process, tool or form you are using in case management today?

We have a Dementia Wise Training program that certifies our caregivers in dementia care. It is 8.5 hours of training. It has truly raised the bar of care for our clients with dementia, and it makes care much easier for caregivers as well.

Where did you grow up?

Pittsburgh, PA

What college did you attend? Is there a moment from that time that stands out?

University of Pittsburgh. Graduation day stands out. It was a very difficult five-year program and I was extremely proud and happy when I made it through.

Are you married? Do you have children?

I have been happily married for 28 years and I am the proud parent of two great sons — ages 24 and 27.
Yes and yes.

What is your favorite hobby and how did it develop in your life?

Snow skiing. I learned at the age of 22. I have improved every year and have become a relatively good intermediate skiier.

Is there a book you recently read or movie you saw that you would recommend?

American Sniper.

Do you have any additional comments about case management or the industry in general?

I believe that the case management industry needs to employ the very best. They need to be given full knowledge so that they can advise their clients of all their options as accurately as possible.

Infographic: Optimizing the Home Healthcare System

November 7th, 2014 by Melanie Matthews

Optimizing the Home Healthcare SystemWhile today’s hospital CEO is told to fill beds, tomorrow’s will be told to empty them, driving an increase in home healthcare, according to a new infographic by ClickSoftware.

The infographic also looks at how patients can best be served in their home and the typical characteristics of home healthcare patients.

Remote Patient Monitoring for Enhanced Care Coordination: Technology to Manage an Aging Population When integrated with telephonic care management, remote patient monitoring can help avert medical emergencies and preventable hospitalizations among individuals with serious medical and functional challenges.

In Remote Patient Monitoring for Enhanced Care Coordination: Technology to Manage an Aging Population Gail Miller, vice president of telephonic clinical operations in Humana’s care management organization, Humana Cares/SeniorBridge, reviews Humana’s expanded continuum of care aimed at improving health outcomes, increasing satisfaction and reducing overall healthcare costs with a more holistic approach.

Get the latest healthcare infographics delivered to your e-inbox with Eye on Infographics, a bi-weekly, e-newsletter digest of visual healthcare data. Click here to sign up today.

Have an infographic you’d like featured on our site? Click here for submission guidelines.

Infographic: Rethinking Home Healthcare

July 18th, 2014 by Melanie Matthews

With more than 10,000 Americans turning 65 every day and a growing desire from seniors to age in place, there is a growing need for home healthcare services.

A new infographic from Barton Associates shows the growing need for home healthcare, as well as how home care improves the quality of life for seniors.

Rethinking Home Healthcare

Home Health Quickflips© can be used as a reference for documentation, patient eligibility and “how to” instructions for OASIS items which impact reimbursement and quality outcomes. This resource can be a teaching tool for new employees and home health managers.

Get the latest healthcare infographics delivered to your e-inbox with Eye on Infographics, a bi-weekly, e-newsletter digest of visual healthcare data. Click here to sign up today.

Have an infographic you’d like featured on our site? Click here for submission guidelines.

Key Tool for Stratifying Patients for Home Visits

May 29th, 2014 by Cheryl Miller

Tools like the Hospital Admission Risk Monitoring Systems (HARMS) 8 and 11 help to identify patients that would most benefit from a home visit, particularly critical as case loads and time demands grow, says Samantha Valcourt, MS, RN, CNS, clinical nurse specialist for Stanford Coordinated Care, a part of Stanford Hospital and Clinic.

One of the key things to think about when implementing a home visit program is which patients should receive the visits. Who is at risk for having adverse events after hospital discharge, and how do we identify those patients? Just as there are many care transition models, there are many tools that exist to help to risk-stratify those at high risk. Some of them focus on certain conditions, including myocardial infarction (MI), heart failure (HF) and pneumonia (PNA). There are even iPhone apps, into which you can plug certain criteria, like a patient’s age, and whether they have they been to the emergency room (ER). They all try to predict if the patient is at high risk for readmission.

At Stanford Coordinated Care (SCC) we use a tool called the HARMS-11. It’s a modified version of the HARMS-8, a tool created by David Labby and Rebecca Ramsay at Care Oregon. It’s an admission risk monitoring system; it stands for Hospital Admission Risk Monitoring Systems. The numbers 8 and 11 refer to how many questions are on the tool or how many items there are to answer.

We use this tool in two ways: it helps me to identify patients that may need a home visit, and it also helps us to see if a patient is eligible to receive services in our clinic. Besides being a clinic for employees of the hospital and university, we focus on those employees that have chronic or complex health conditions. This tool helps us get a sense of whether they are struggling with many conditions, and what their social support is like. How many medications do they take in a day? Do they ever forget to take them or simply choose not to take them?

The HARMS is written so that the patient can take it as a self-assessment. Positive answers to these questions give us a good indication that this patient may be a good one to see at home after hospitalization. Given that all of our patients have to have multiple conditions, there’s very few that I try not to see after discharge. But as our case load continues to grow and time demands other things, we’re going to make some decisions on who we see. We’re going to go back to this tool to help us do that.

Excerpted from: Home Visits for High-Risk Patients: Tools, Timing and Outcomes.

5 Tips for Seniors to Avoid Hospital Readmissions

June 24th, 2013 by Jessica Fornarotto


Nearly one in five seniors who are hospitalized return to the hospital within 30 days, according to a recent Robert Wood Johnson Foundation report. These readmissions are not only often physically and mentally debilitating to the seniors and their families, but contribute greatly to avoidable and unnecessary expenses on the nation’s healthcare system. To help curb these numbers, SCAN Health Plan recently offered seniors five strategies to lessen the chance of readmission.

  1. Ask questions before discharge. When patients are in the hospital, they’re completely dependent on others for care. But once they’re home, they’re in charge of their own recovery, which makes understanding what to do the key. Patients being discharged from the hospital who ask questions and who have a clear understanding of their after-hospital care instruction are 30 percent less likely to be readmitted or to visit the ED than patients who lack this information, according to a recent study from the AHRQ.
  2. Understand medications. This is particularly important if there have been changes to a medication regimen while in the hospital. Upon discharge, dosages are sometimes changed or a drug is discontinued or added. Patients need to be sure about this and to write it down. They also need to be sure to fill all new prescriptions once they’re home.
  3. Make a plan for follow-up care. Patients need to know when to schedule a follow-up visit to their doctor, and to make sure that they have the transportation to get there. Even if they’re feeling good, they should go anyway. The doctor needs to see a patient in order to track how they’re doing and to gauge whether the treatment plan is working. In addition to doctors, does the patient need to schedule home healthcare with a nurse or therapist, or do they have some new durable medical equipment or home-modification needs?
  4. Communicate with care coordinators. Whether a patient has a professional in-home caregiver, a family member nearby, or resides in an assisted-living community, they need to make sure that their caregiver is up to date on the recent hospitalization and how the patient is feeling. This also goes for the patient communicating with their health plan, as many have programs and professionals in place that can assist with care coordination.
  5. Be aware of “red flags” or complications that should be reported. What is considered “normal” for a patient’s post-hospital condition? What degree of pain or swelling is expected? Patients need to know what to look for, whom to call if they are not feeling well, and to have a clear plan of action in place so they know how to respond to a complication.

Romilla Batra, M.D., vice president and medical director of SCAN, says that readmission rates for seniors can also be reduced by enrolling in a health plan that has a strong emphasis on integrated care and care management. She points to a 2012 study released by Avalere Health that compared 30-day all-cause hospital readmission rates between California dual-eligible (Medicare and Medi-Cal) individuals in traditional Medicare versus those enrolled in SCAN Health Plan. The independent study found that SCAN’s dual-eligible members had a hospital readmission rate that was 25 percent lower than those in fee-for-service.

“Industry-wide efforts are underway to bring down readmission rates including new rules passed as part of the Affordable Care Act that charge additional fees to hospitals with excessive readmissions,” said Dr. Batra. “But ultimately it is still the consumer themselves who can play the biggest role through common sense and following these five easy steps.”

11 Innovations in Healthcare Case Management

July 23rd, 2012 by Jackie Lyons

According to respondents from HIN’s third annual healthcare case management survey, successful case management efforts focus on transition coaching, discharge planning, reward programs and a patient-centered approach to case management.

Despite the challenges of staffing and operating a successful case management company brought on by healthcare reform and the changing industry, respondents contributed innovative interventions that improve health and reduce costs in the populations they serve.

Eleven case management program interventions that proved to be successful are:

1. Working with local community collaboratives for transition coaching. For example, respondents collaborate with a company that performs in-home health assessments on members identified with chronic diseases. The information is sent to them and they use it to direct care for their members.

2. Scheduling home visits by nurse practitioners for selected patients.

3. Redirecting to in-network providers and coordinating services in an efficient manner to prevent delay in discharges.

4. Holding case conference meetings with the treating physicians, case managers, medical directors and other related parties to address issues related to challenging or high-risk patients.

5. Verifying medication and home healthcare strategies to prevent readmission for chronic illness within 24 to 48 hours.

6. Partnering with social workers who will spend time dealing with complex family problems and end-of-life care.

7. Getting high-risk obstetrical clients to assume greater accountability for the outcome of their pregnancies and communicating with providers and educators. Respondents noted a significant decrease in low birth weight infants for RN case-managed programs focused on these objectives.

8. Utilizing diabetes reward programs to keep measures in line.

9. Integrating case management (medical and behavioral health) for a patient-centered approach.

10. Using neutral assessment and family trust to establish realization that case managers can identify affordable and appropriate resources.

11. Attaining the Advanced Achievement in Transplant Management Certification (through Interlink Health Services) so case managers better understand and educate patients about the benefits of using a Transplant Center of Excellence for the best possible clinical and financial outcomes when a transplant is needed. Respondents report successful clinical outcomes and savings range in the 40-50 percent range.