Focus on Safety at Home and Getting to That

More Primary Care and Preventative Care Model

TINA MARRELLI, MSN, MA, RN, FAAN

T he issue of safety and its relationship to quality is finally getting the recognition
it deserves. Safety is the theme of this October issue of Home Healthcare Nurse.
Falls are an ongoing concern for older adults, and a CE article entitled “Falls Risk
Assessment Begins With Hello: Lessons Learned From the Use of One Home Health
Agency’s Fall Risk Tool” authored by Patricia J. Flemming and Katherine Ramsay
discusses a tool to help assess falls and lower their occurrence. Orthostatic hy-
potension has been associated with falls for some people and Diane
Mager addresses this complex topic in an article titled “Orthostatic
Hypotension: Pathophysiology, Problems, and Prevention.”
A home care specialty area that demands a grounded knowledge
of technology, medications, and specific standards is home infusion.
In “Infusion Therapy in the Home Care Setting: A Clinical Competency
Program at Work,” Denise Martel presents one model of collabora-
tion among six community-based nonprofit agencies in two states to
share best practices and maintain staff competence. This program
has been in existence for 12 years and may have lessons for others
seeking to collaborate with peers to offer and support education in
numerous specialty areas. Mellisa Hall addresses another potential
safety issue in her article “Alcoholism and Depression.” The Research
Briefs column by Xiomara M. Dorrejo and Paula Wilson is titled “Research on Cul-
turally Tailored Interventions Aimed at Improving Chronic Disease Risk Factors and
Management.”
In the first part of a two-part series on constipation, “Evidence about the
Prevention and Management of Constipation: Implications for Comfort,” Deborah
Fritz and Matthew Pitlick discuss evidence-based nonpharmacological interven-
tions for constipation. This constipation article is the Hospice and Palliative Care
feature and the second CE for this month.
“Geriatric Care Management: Role, Need, and Benefits” by Marilyn Wideman
explains this holistic care model that supports older adults across time and care
settings—while advocating for their care needs. Wideman explains this role and
why the need will grow.
In an interesting new book, authored by Rosemary Gibson and Janardan Prasad
Sing, “The Battle Over Health Care: What Obama’s Reform Means for America’s

vol. 30 • no. 9 • October 2012 Home Healthcare Nurse 501

Copyright © 2012 Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited.
 Future,” the authors address what the healthcare reform law did and did not do—and
takes some lessons from the banking and financial system debacle. Written for
consumers and those interested in healthcare reform and its implications, they
present exemplars as well as areas in healthcare that need major improvement related
to safety and quality.
Discussions of the aviation world where safety is “in the DNA” of progress is
where healthcare needs to go. This is the time perhaps to think of being/staying
a nurse but perhaps acquiring another degree—in engineering. We need this kind of
information to improve safety and efficiencies. And I think we all know that some-
times specialization is needed, but to care for patients holistically we need more
primary care clinicians and fundamental prevention-focused interventions.
The changes continue and this is a good thing–especially for our older adult
patients with comorbidities, on numerous medications, and other complexities.
One person coordinating care is important to having one’s wishes heard, as well
as for safety reasons. In July 2012, “the Centers for Medicare & Medicaid Services
(CMS) ... issued a proposed rule that would increase payments to family physi-
cians by approximately 7 percent and other practitioners providing primary care
services between 3 and 5 percent” (CMS, 2012). For fiscal year 2013, the CMS is
proposing for the first time to explicitly pay for the care required to help a patient
transition back to the community following a discharge from a hospital or a skilled
nursing facility stay. Other parts of the proposed rule include a proposal to include
additional Medicare-covered preventative services on the list of services that can
be provided via an interactive telecommunications system; a proposal to imple-
ment a durable medical equipment (DME) face-to-face requirement as a condition
of payment for certain high-cost Medicare DME items; a proposal to collect data
on patient function to improve how Medicare pays for physical and occupational
therapy, and speech language pathology services; and others. For the full final
rule, visit http://www.ofr.gov/(X(1)S(m5ipgircoqautlgeimkp3zr0))/inspection.aspx
?AspxAutoDetectCookieSupport=1.
Either way, we have a long way to go. October is also National Sudden Cardiac
Awareness Month (see http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5938a5
.htm)—we have so many specialty healthcare problems and “months” in 1 year!
Interestingly, I saw President Bill Clinton being interviewed on television about his
changed eating habits and lifestyle, related to his heart disease. Because of this, I
also became interested in Caldwell B. Esselstyn Jr., MD, a surgeon at the Cleveland
Clinic, and I got online and found out about his book, Prevent and Reverse Heart
Disease: The Revolutionary, Scientifically Proven, Nutrition-Based Cure. I read this
book, and for those of you who might have seen the movie Forks Over Knives, the
premise is the same: heart disease can be prevented through the adoption of a
lifestyle that excludes meat and dairy products. I even signed up and, with my hus-
band, went to Cleveland and attended a full-day session presented by Dr. Esselsteyn
at the Wellness Institute. They are so busy that I made my reservations last fall for a
summer session. Besides patients, who were “too sick” to have heart interventional
surgeries, there were many doctors in the session who were there to learn so they
can teach this lifestyle and diet to their patients. Some doctors that we met and
spoke to were from Canada and other countries. It is hard to believe there could be a
way to prevent so much of the pain and costs related to heart disease—and the diet
and lifestyle are not for the faint of heart (excuse the pun). Simply put, it is “nothing
with eyes or a mother”!
I tell you this because I think none of the current, proposed “fixes” for improved
health seem to get us there, and I believe we must have “skin in the game” to get to

502 Home Healthcare Nurse www.homehealthcarenurseonline.com

Copyright © 2012 Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited.
 where we need to be. With so much money, with change being so hard, and with our
healthcare systems so entrenched in “more is better” (even though we know that is
not true) there will be lots of intellectual violence going on to rework and reset
healthcare to support real health (i.e., preventative and primary health). Together
we can work on these efforts, and, as always, I love to hear from readers and your
thoughts!

The author declares no conflicts of interest.

DOI:10.1097/NHH.0b013e31826bd0c4

REFERENCE
Centers for Medicare & Medicaid Services. (2012). CMS proposed rule would increase payment
to family physicians by 7 percent. Retrieved from https://www.cms.gov/apps/media/press/
release.asp?Counter=4398&intNumPerPage=10&checkDate=&checkKey=&srchType=1&n
umDays=3500&srchOpt=0&srchData=&keywordType=All&chkNewsType=1%2C+2%2C+3
%2C+4%2C+5&intPage=&showAll=&pYear=&year=&desc=&cboOrder=date
Esselstyn, C. B. (2008). Prevent and reverse heart disease: The revolutionary, scientifically
proven, nutrition-based cure. New York, NY: Penguin.

New Community-Based Care Transitions

Program Sites Announced
The Centers for Medicare & Medicaid Services (CMS) announced 17
sites selected to participate in the Community-based Care Transitions
Program (CCTP). Together with the first 30 participants, the CCTP now
includes 200 acute care hospitals partnering with community-based
organizations across 47 sites to provide care transitions services for an
estimated nearly 185,800 Medicare beneficiaries annually residing in
21 states.
The CCTP is a 5-year program created by the Affordable Care Act.
Participants sign 2-year program agreements with CMS, with the option
to renew each year for the remainder of the program, based on their
success. As of the date of this announcement, CMS continues to accept
applications and approve participants on a rolling basis as long as funds
remain available. Future panels may be announced as funding permits.

vol. 30 • no. 9 • October 2012 Home Healthcare Nurse 503

Copyright © 2012 Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited.