Health Care Observation

With the observations, the goal was to become aware of what is in store for the future both within school and after graduation. First person observed was Sharon, a dental hygiene student at PIMA, in her 5th semester. To begin her visit, Sharon ensured she had all the necessary paperwork and materials needed for the visit prior to procuring her patient from the lobby. After sitting the patient down, she reviewed his medical history with him and took his vitals, she then turned her light on for an instructor. Once the instructor arrived, she presented the patient and had the instructor sign off on the paperwork. After the instructor left, Sharon quickly began to continue with an oral cancer screening (OCS), noting any findings. From there, she took periodontal probing depths (PPD), gingival margin to cementoenamel junction readings (GM to CEJ), clinical attachment loss (CAL), and periodontal description. Immediately after writing all her notes she turned her light on for an instructor to come evaluate her findings, which is called check in. When the instructor came into the room he sat down and had Sharon read off her findings to him while he did his own exam on the patient. From there, Dr. Burnett came to evaluate the patient. Unfortunately, the 3 hours had pasted by the time all this was done, so the patient was scheduled at a later date for his prophy.

Service Coordinator (SC), Jennifer Stoker met personal staff, Aiesha Crayton at the home of consumer Jonathan .SC asked was Jonathan meet his outcome would like is medical expenses to cover. Aiesha noted he has Medicare and Medicaid which cover all his medical expenses. SC asked if money covering his want and needs. Aiesha noted yes. He wants and needs are being meet. Jonathan wants his cell to be paid every month. Aiesha noted he cell is being paid every month. SC asked is Jonathan maintain good health. Aiesha noted he when to his PCP on June the 1st. She noted he is health and there was no change in medication.

Worker observed one year old Vincent, he just had a birthday on February 15th. He was observed to be wearing a onsie and was sitting on a high chair. Vincent was eating gold fish crackers. He appeared to be healthy with no visible marks or bruises. Worker was informed that he received four vaccinations and those were his one year old vaccinations. He had his first birthday celebration at his daycare facility. It was a Mickey Mouse theme. Present at the party was his PGM, MGM his father Weylin, mother Katherine as well as the rest of the children in the daycare facility.

SC received VM form Tanya, ERS provider via Active Aid Solution. Tanya reported that they received a monthly maintenance service order for ERS but did not get one for the installation and requested that SC put it in ASAP. SC created service order in Oracle and completed service order in SAMS. SC reviewed Pa care plan and everything else looks good. SC placed phone call the Penn Asian Senior Services enhanced day care provider. SC call was transferred to Soon Pack Pa’s social worker at the center. When Soon got on the phone SC introduce self and stated reason for calling (was to visit Pa at the day center) Soon stated that, that would be ok because SC must be there before Pa’s leaves at 1:45 PM. SC asked why Pa leaves so early and Soon reported that, that’s

SC completed monitoring telephone with Pa’s informal Tressa on 1/28/2016. No new health problem was reported. However Pa’s treatment regimen has change to include radiation therapy due no change in the tumor. No ER visit, hospitalization, or falls were reported by CG. A temporary increase in PAS services was requested due to new medical treatment. Pa's informal, stated Pa is requesting a temporary increase in Pa's aide services so that she can safely remain in her home with assistance. Pa is being treated for cancer and need a more aggressive treatment which includes chemo and radiation 5 days a week. Pa currently gets 6 hours of PAS per week, 4 hours on Wednesday and 3 Saturday agency model PAS via Prestige Home Car. Pa anticipates that

SC completed monitoring telephone call with Pa on 1/20/2016. SC called Pa. Pa reported that ding “good”. Pa reported no new health problems, no medications, no falls, and no hospitalizations. Pa reported no outstanding doctor’s visits. Pa reported that’s he saw her PCP on 1/19/2016. SC reviewed Pa's ISP. Pa confirms that she is receiving services in the following type, scope, amount, frequency and duration of services specified in the ISP agency model aide via Total Home Health Care from 10-2PM, Monday through Sunday. Pa's aide provides assists her with the completion of ADLs, IALDs and supervision as needed. Pa has PERS system which gives her access to emergency medical service. Pa also, receives HMD from PCA weekly. She reported being satisfied

Pa confirmed that there is no duplication of services. Waiver is the payer of last resort for services. Pa reported that his back-up plan that the agency will send a replacement aide if needed has not been utilized, Pa reports that is services are not available, his son, Ralph, will come to assist him, these back up plans remain effective and has never been used per Pa. SC called the Dynamic Home Health Care PAS provider agency and reported that the aide has not shown up for the day and she would the Pa to call out leaving him without proper coverages. The receptionist took SC information and stated that the director of the Waiver service was not in as yet and will have all SC. The called meal site and spoke with Lavern, who resumed Pa’s HMD and set it up for Friday delivery. SC called Theresa the nutritionist at DaVita Dialysis and informed her that the Pa HDM will begin starting 5/13/2016. SC called back Dynamic Home Health Care and spoke with the director of Waiver services. The SC informed her of the Pa’s claims about the aide calling him when she will not be at work instead of the agency so that they can send

SC complete monitoring phone call on 01/20/2016 with Pa's PAS (Cheryl). Pa reports receiving all services as outlined in ISP. He remains satisfied with services and feels that they meet his current needs. No falls, hospitalization, changes in health status or medication reported by Pa. No outstanding follow up needs identified. The day before SC received a phone call from Cheryl reporting that Pa’s is running low on heating oil and has exhausted all other option and would like PCA emergency fund to supple Pa with heating oil. SC completed the paperwork and gave to SDCS to review and submit. At the time of this call retreated that the paperwork has been submitted and Pa will receive the heating oil as long as he is qualified and has not use

Pa stated that she don’t trust her family anymore because her grandchildren are crazy and no good. SC redirected Pa numerous times, but it was difficult for Pa to stay focused. Pa reported some anxiety and agreed to follow up with her physician regarding this (Pa stop taking Zoloft because she didn’t feel taking it anymore). Pa confirmed that she is received her services as specified in the ISP in the following type, scope, amount, frequency and duration: PAS Agency Model aide care for 2 hours on Monday, Tuesday, Wednesday, Thursday, and Saturday from 9am-11am and 3 hours on Sunday from 9:30am-12:30pm. Agency aide will supervise and assist with Pa with bathing ADL and IADLs of meal preparation, shopping, light housework and weekly errands. Pa receives an emergency response system which she uses as needed for emergencies. Pa receives 7 frozen Home delivered meals weekly from PCA which she heats in the microwave for

SSA placed phone call to Kim Budke-Provider. We discussed that the nurse care manager went ahead and met with John this morning with Kim being able to attend. She shared that John’s case manager with Lifepointe was going to attend but did not make the meeting. She shared that Jean is the nurse case manager with Cincinnati Home Care and they discussed finding John an activity to engage in during the daytime hours. She shared they discussed ADS programs in Williamsburg and John expressed interest in Cane Run Farm. She shared that they also discussed increasing John’s in home nursing services up to 14 hours per week to address his high blood sugar levels. We discussed that if John attends CRF, provider hours will have to be reduced to cover the

Patient is a 76 y/o male that lives with family members and his wife who has Alzheimer’s disease. They live in a single family home with 1 step to enter. Pt has 2 daughters and 1 son who live locally and assist him and his wife with driving to the grocery store. The reason that the patient was referred to Occupational Therapy is because of his decline in strength, decrease in functional mobility, and decrease in transfers along with his reduced participation in his activities of daily living. Pt’s prior level of function was moderate independent with the assist of adaptive equipment such as a rolling walker. His prior level of function doing his ADL’s was moderate independent in hygiene, grooming, bathing, toileting, UB &

SC spoke with Pa and CG on 09/30/2015. No falls, hospitalization, changes in health status or medications were reported by Pa or CG. Pa reported that both she and spouse (Travers Russell was not present when SC called; Pa stated he went to the senior center and he’s doing well no unmet needs) are receiving services as outlined in the ISP. Pa’s goals remain unchanged both her and spouse remain satisfied with services and feel that they meeting their current needs. Pa reported that all services are received in the correct type, scope, amount, duration, and frequency as specified in the ISP. Pa self-directed model PAS provide hands on assistance and supervision with bathing, dressing, grooming, toileting, light home support and meal prep; daily

Developing educational goals that can improved patient centered care after being discharged from the hospital is challenging. Our curriculum has to be designed from an understanding of adult learning needs. It has to be based on their cultural background and languages barriers. The medical staffs, who will be working in the simulation center, have to be properly train to deliver the course.

SP discussed future care with client daughter and advise Cindy that client needs to follow up with doctors as recommended immediately after she is discharged. Cindy also discussed with SP that Mrs. Figueroa may be discharged into the NF for short-term rehab and she wanted to know if this would interfere with her CO waiver or MA. SP explained that no interference would occur with CO waiver and MA if client remains in the NF for less than 30 days. After 30 days, Mrs. Figueroa MA will change from STC to LTC. SP is in the process of requesting additional hours from DHMH since client health is significantly declining, SP is waiting to obtain client discharged summary as medical documentation to support the request for 63 hours of personal assistance

Our discoveries revealed some delays in dental care services. There was up to 3-4 month wait time for inmates to be seen by the dentist for follow up care after the triage of sick call was completed. The audit team found 110 inmates on the wait list for follow up services. It is the team’s assumption that the dentist was not as familiar with the dental standards and procedures outlined in the ACA performance-based standards 4-ALDF-4C-20.