Renee Kinder

Hello, loyal readers! I am indeed still around. 

I have heard from many of you over the past couple of weeks, asking if I would still be writing. The answer is: of course I am!

Same blog, same love of writing and same passion for post-acute care. I’m simply in the beginning of a career change. 

“Simply” would not have been the term I used initially.

My career move is the right decision. It is allowing me to explore new opportunities with fresh eyes, be creative in different ways, and challenge myself to continuously improve.

The move, however, also meant that I left an organization that had supported me for 15 years … the only organization I have ever worked for since I began my career as a new grad speech language pathologist working in long-term care.

I left friends; an amazing team of smart, talented and fierce clinical women; and family (quite literally). 

We have all heard “change is hard.” But I am here to tell you that with some purposeful planning, it doesn’t have to be. 

Consider, to that end, what we as caregivers in the post-acute care spectrum can do to ease the potential difficulty that comes with 1) changes in care settings, during admission and discharge and 2) overall clinical changes that those we care for experience as the result of new onsets or exacerbations.

Admission Procedures — everything here is new

To begin, admission procedures should include the key assessment of clinical condition, and functional abilities in comparison to impairments/potential risks. Of equal importance, we should also consider environmental set-up and when possible simulate the natural environments that were our patient’s norm prior to their admission to the SNF.

The little things matter here. 

If Mr. Jones always had his dresser organized with socks, undergarments and pants in that order for 40 years, then don’t place everything in the closet.

When Mrs. Smith tells us she only prefers a cup of tea and dry toast for breakfast, then we shouldn’t be surprised if she passes on the bacon and eggs. 

When Mr. Adams states you he can’t start his day without two cups of coffee and a scan of the morning paper, then get the gentleman his paper! Otherwise, he might show up to his morning therapy session unable to focus and concerned about the weather report and the local sports wrap-up, which includes highlights from his grandson’s football team. 

Healthcare Literacy — can someone explain to me why?

Next, when we consider the reason many individuals come to skilled nursing facilities for continued recovery after a hospital stay, I often hear caregivers discuss the persistent impacts of clinical complexities. 

Mr. Jones for example, is here secondary to a hip fracture. However even with the functional gains he has achieved, we must get his COPD and diabetes under control before he can go home!

Under control?

How exactly care teams proceed next is key.

Does Mr. Jones truly understand how to manage these conditions outside of medication and oxygen use? 

What can we do to improve his understanding and prevent rehospitalization?

This is where healthcare literacy reigns supreme. You notice I didn’t say education. I said literacy and, yes, there is a difference. 

Literacy means that we hold ourselves accountable for training to the level of true understanding and return demonstration. 

Healthcare literacy is also a focus in the eyes of the Centers for Medicare & Medicaid Services, as noted in forthcoming October 2020 MDS updates aimed at achieving SPADE (standardized patient assessment data elements) to meet IMPACT Act requirements for Quality Reporting Programs.

We have for example, new items at B1300 (admission) and B1320 (discharge) to help determine the individual’s health literacy measured via the following question: How often do you need to have someone help you when you read instructions, pamphlets or other written material from your doctor or pharmacy?

Discharge Procedures — help me transition safely, and stay there!

Finally, we need to move our mindset from “discharge” to “transitions in care,” with the exception of when we have a discharge to an acute-care setting. 

Why the difference?

As a matter of semantics, a discharge comes with the mindset that someone is leaving our care entirely due to condition or new onset out of the realm of our clinical ability to manage care.

A transition in care, however, creates a dichotomy that we as caregivers across the spectrum are to be engaged with one another and fully support transitioning from one setting to another. 

I’m talking IMPACT Act-worthy spectrum of care engagement.

Some simple tips?

  • Start transition planning on day one of the stay.
  • Understand fully the layout and community supports that will be available in desired transition setting.
  • Make HOME EVALUATIONS a standard of care. 
  • Train caregivers and patients alike to a level of return demonstration: Watch Me, Follow Me, Show Me!
  • Communicate functional status, abilities, and residual impairments with care teams in the next level, AND make this process easy, not cumbersome, for therapists at the next level of care to contact you.

In closing, remember change, while not easy, doesn’t have to be hard. 

Hope all of you are enjoying the new year — there’s much more excitement to come. 

We thought 2019 was ripe with change?  With SNF PDPM, similar modeling to home health’s PDGM, SPADEs, QRP updates and more, I have a feeling 2020 may be even more exhilarating.

Hold on tight everyone, change is in the air, and the IMPACT is sure to be a thrill. 

Renee Kinder, MS, CCC-SLP, RAC-CT, is Vice President of Clinical Services for Broad River Rehab and a 2019 APEX Award of Excellence winner in the Writing–Regular Departments & Columns category. Additionally, she serves as Gerontology Professional Development Manager for the American Speech Language Hearing Association’s (ASHA) gerontology special interest group, is a member of the University of Kentucky College of Medicine community faculty, and is an advisor to the American Medical Association’s Relative Value Update Committee (RUC) Health Care Professionals Advisory Committee (HCPAC).