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
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:
- Do you feel you have no friends or loved ones?
- Are you lonely?
- 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:
- 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.
- Encourage interaction. Encourage interaction with others via phone, computer, or if in person, socially distant, wearing a mask.
- 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.
- 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.
- 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.
- 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.
- Patients can meditate through Journey Meditation.
- 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:
- Friendship Line by Institute on Aging- 1(800)971-0016
- Happy– a free app that provides emotional support 24/7
- National Alliance on Mental Illness Helpline- 1(800)950-6264
- Substance Abuse and Mental Health Services Administration National Helpline- 1(800)662-4357
By: Portia Wofford
Home health clinicians play an essential role in caring for patients who are:
- At risk of developing sepsis
- 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:
- Received a home health visit within 48 hours of hospital discharge
- Had at least one additional visit and
- 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
- 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.
- Post-discharge and follow-up visits, including telehealth visits, may provide positive intervention for post sepsis patients.
- 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
Abode’s sepsis program promotes quality of care and improves outcomes for those at risk for developing or recovering from sepsis.
Pandemic Relief via legislation, CMS waivers, and enforcement discretion
- 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.
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.
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)
- 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.
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
- Parkinson’s Disease
- Heart Disease
- Pulmonary Disease
- Liver Disease
- End-stage Renal Disease
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
- 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 Abode Hospice & Home Health, and one of our team members can help guide you through the process of requesting hospice through your physician.
Promoting Independence in Senior with In-Home Health Care
Independence is an important aspect in helping a person determining their self-worth. As people, we start off as children who need help just getting from place to place, then teenagers who just need financial aid to support them, and then eventually into full-fledged adults that function for the most part on their own. But as people reach their later stage of adulthood, it becomes apparent that it’s harder for them to maintain this level of independence. Seniors often feel like having in-home care is the end of their independence, but this is far from the case.
While it’s not always easy to admit, sometimes it’s necessary to recognize that as a senior, some extra care and attention might need to be administered by someone else. But just acknowledging this fact is a sign that you’re aware that such care can actually enhance your independence as you age. These in-home care professionals can provide interactions with their patients and give them the help that they need to stay healthy and stimulated. In addition to this, there are few things to remember that will prolong the independent stage of a senior’s life.
- Stay physically active
- Doing small tasks around the house or community like gardening, walking, stretching, and housekeeping are all ways to keep the body stimulated and prevent it from aging prematurely. Always make sure to listen to your doctor and your body though when doing physical activities to ensure that you don’t strain yourself unnecessarily.
- Socialize often
- So many changes often occur at the senior stage of life, so it’s important for them to have some sort of routine. A fun way to do this is to have a scheduled time to hang out with friends and family to ensure that love and laughter continue in a consistent manner while things around them begin to change.
- Stay mentally stimulated
- A lack of activity and stimulation of the brain is often what drives most seniors into being more forgetful people. Just something as simple as crosswords and Sudoku puzzles can be enough to give the brain a metaphorical jog to keep it in shape and keep the person on the right track to longevity.
These are just simple aspects that can help individuals maintain that individuality on their own. However, in addition to these practices, in-home healthcare like that which is provided by Abode Hospice and Home Health can almost guarantee a stronger and more independent individual as they experience this new phase of their life.