Posted February 27, 2012

by Becky Lerner

 

Forgetting where you put your keys or why you came into a room is nothing compared to what Alzheimer’s and Dementia patients experience on a day-to-day, nay, hour-to-hour, or minute-by-minute basis. With what is arguably one of the most difficult (and possibly engrossing) set of circumstances, our Dementia and Alzheimer’s professionals go through those days with their patients: learning their patterns, living their experiences, and caring for them. It’s a tough job, but TCG employees Karen Howard, OTR/L, and Jennifer Wagner, PT, both out of Bethlehem Woods Nursing & Rehabilitation, speak with us about the rewards and challenges of their respective jobs.

“A big piece of being a caregiver is to know enough about a person—if there’s a time of day when they’re at their best, or what triggers certain behavior,” says Howard. Much of the time, she continues, Alzheimer’s and Dementia patients don’t have the words to communicate if they’re uncomfortable, so it’s the caregiver’s job to learn the patterns, learn their communication forms, and control what they can within the environment. “Familiarity, routine, and repetition are important,” she says.

“Just like you wouldn’t argue a reason with a 3-year-old, they don’t understand reasoning,” says Wagner. “They don’t understand why you need to exercise for the sake of exercise. You need to be where they are, and it’s a comfort to them to have someone with them in that moment.”

So how do the professionals, constantly adapting to their patients, keep themselves healthy, happy, and able to do their job? Balance.

Especially if family members are caring for a Dementia or Alzheimer’s patient, it’s important to set boundaries and find some separation whether that means taking some personal time or utilizing a facility like Bethlehem Woods.

“Coming into a place like this, they have a little peace,” says Wagner. “Family members can still call and come hang out whenever they want, but it’s relieving that they don’t have to worry about caring for someone who needs their full attention all the time.”

As for those who work that the facilities, Howard says that music, yoga, spending time with family and friends, and, of course, lots of laughter help her re-energize and refocus.

Wagner finds her inspiration in the small successes. “Tie a string to balloon, step aside, and let patient punch it. First their hesitant and by the end, they’re whacking the balloon and laughing,” she says. “It’s little successes that make you go back to the books and the websites and figure how you’re going to make this person’s life better. Of course you want long-term goals, but you want short-term, attainable goals. And you should want that for yourself, too.”

“Even though you might not change the condition of a person’s life, know that you have an impact. When the patient knows that you’re there and that you care about them, it really doesn’t matter whether they’re in the mildest or most advanced stages. They know. They can feel it, and they can tell,” says Howard.

As the end of February marks the end of Alzheimer’s and Dementia Awareness Month, TCG wants to take a moment to recognize those professionals who make patients’ and their families’ lives better. Thank you for all your hard work, dedication, innovation, and care!

Posted February 17, 2012

This is a great article from the NASAL about the significant changes pending on the therapy cap exceptions process.

 

Today, conferees are signing the conference agreement that includes an extension of the therapy cap exceptions process through December 31, 2012.  We expect the House and Senate to vote on the agreement either today or tomorrow.

At this point, we have a summary of the “Health-Related Provisions in the Middle Class Tax Relief and Job Creation Act of 2012″ (Conference Agreement) prepared by health committee staff and its details on the extension are vague.  The summary language is similar to the House-passed version from December in some respects.  When actual bill text is released, we will see more detail as to how the reformed exceptions process will be structured.  Also, the original House language saved money over 10 years due to extending the therapy cap to the hospital outpatient setting.  This summary does not indicate any savings, instead it indicates a cost, so it is possible that there have been some tweaks to that specific provision.

Other provisions of interest to NASL members:

• Physician Payment Rates-freezes payment rates at their current level through December 31, 2012;
• Physician Work Geographic Adjustment – extends the floor on the adjustment to the work portion of payments for physician services that account for the geographic area where a physician practices;
• Bad Debt-phases down SNF’s ability to get bad debt reimbursed;
• Resets Clinical Lab Payment Rates-reduces payment rates for clinical lab services by 2% in 2013.

As soon as we have more information, we will send it to NASL members.  Below is the exact section from the Agreement on the exceptions process.  To view entire summary, [Click Here].

Section 3005 – Outpatient Therapy Caps – This provision extends the therapy caps exceptions process through December 31, 2012, with modifications that will require that the physician reviewing the therapy plan of care be detailed on the claim, reject all claims above the spending cap that do not include the proper billing modifier, and provide for a manual review of all claims for high cost beneficiaries to ensure that only medically necessary services are being provided.  Furthermore, the spending caps ($1,880 in 2012), which have been in effect since 2006, would be extended to the hospital outpatient department setting to prevent a shift in the site of service to higher cost settings once enforcement of the current exceptions process begins.  Exempting these services in the HOPD setting made sense when the hard therapy cap was in place, but it no longer makes sense with the exceptions process.  Additionally, HHS is required to collect data to assist in reforming the payment system for therapy services.  MedPAC is required to recommend improvements to the outpatient therapy benefit to reflect the individual needs of patients.  CBO estimates this provision would increase spending by $700 million from 2012 through 2022.