Renee Kinder

Nothing makes me much more nervous than making deviled eggs.

I know it sounds ridiculous, but the level of precision needed in each step of the process can send me into downright panic. 

A simple Google search will reveal people’s most common, and need I say rational, fears. 

Public speaking? Please, it’s like breathing.

Flying… so relaxing I am sound asleep as soon as I take my window seat.

Spiders? Yes, but who isn’t afraid of spiders?

Making deviled eggs, however, is not on any list that I have been able to locate. 

The process begins with boiling, of course, which should be easy, but requires a level of scientific precision and key ingredients, including a touch of salt and apple cider vinegar, I have learned. Also, start with water at room temperature, then 10 minutes at a rolling boil, followed by immediate immersion into cold water. 

Miss any of these steps and then the next phase could be… well, pure misery. 

The peeling. It’s painful. So much room for error. Personally, when I complete this step no one can be in the kitchen or anywhere near me. The gentle tap, tap, tap… peel comes with such pressure. Will the shell break away with ease revealing a glossy white treasure? There really is no better feeling when that happens. 

Or will there be chips in the surface, sharp breaks of shell and imperfections in the texture, which could only be evidence of a broken process and poor planning?

The peeling process is much like the layers of patient complexity rehab professionals must strip away daily, essential for providing the highest level of quality patient care and supporting a health literate culture. 

Let’s begin with a definition of health literacy.

The U.S. Department of Health and Human Services defines health literacy as “the degree to which individuals have the capacity to obtain, process, and understand basic health information needed to make appropriate health decisions.”

Health literacy challenges may impact older adults more than other age groups. On average, adults aged 65+ have lower health literacy than adults under 65. Low health literacy among older adults is associated with increased reports of poor physical functioning, pain, limitations of daily activities and poor mental health status.

Do you see what I mean about the layers here? Missing a step in understanding here and there is adding significant risk for chips in the process. 

Supporting the health literacy of those we serve goes way beyond simply sharing the information. We must ensure that our patients are able to first obtain, then process, and finally understand the information. 

The devil here, of course, is in the details. 

Our patients are not simple. Supporting full health literacy means we fill them with knowledge of their primary diagnosis and all their associated medical complexities.

Oh the pressure… similar to the balance of making the perfect filling for those darn deviled eggs. Yolks mixed with filling tasty yet fine enough to be fed through a piping bag and light enough to not weigh down your precious whites. Topped with the textbook amount of paprika and kept safely packaged for your guests prior to consumption.

So many steps needed for excellence. Each as important as the one before and all collectively essential for the final product.

We see the same dichotomy in supporting literacy of the primary diagnosis, which as we all know, is really just cracking the surface, and the development of functional plans of care supporting the full complexity of patients. 

Take, for instance, the statistics surrounding the Medicare population and multiple chronic conditions (aka MCCs).

 In 2010, approximately 21.4 million Medicare beneficiaries had at least two chronic conditions and accounted for the bulk of healthcare services provided under Medicare

  • MCCs are associated with approximately 66% of the total healthcare spending in the United States
  • As many as three out of four Americans aged 65 or older have MCC and approximately two out of three Medicare beneficiaries have MCC
  • Approximately one in four Americans in any age group has MCC, including one in 15 children
  • People with MCCs are also at increased risk for mortality and poorer day-to-day functioning

If we aim to achieve real breakthroughs during care, it is obvious the devil is in these details. 

Understanding their impact on function ourselves, helping our patients and their loved ones to crack the surface beyond primary diagnoses alone, and filling them all with the delicate balance of knowledge and understanding. 

Time to tap, tap, tap into our evidence base integrating all complexities.

Who knows what treasures you will find!

Renee Kinder, MS, CCC-SLP, RAC-CT, is Executive 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 Current Procedural Terminology CPT® Editorial Panel. She can be reached at [email protected]

The opinions expressed in McKnight’s Long-Term Care News guest submissions are the author’s and are not necessarily those of McKnight’s Long-Term Care News or its editors.