Creating Your Seat at the Table for Chronic Disease Management

The Kansas Home Care Association is pleased to bring you this educational program through an agreement with the Association for Home & Hospice Care of North Carolina…

Creating Your Seat at the Table for Chronic Disease Management

With an emphasis in inpatient care on care transitions, ACOs, value based purchasing and other quality cost saving measures being implemented at the federal and state level, are you aware of how to be a part of the care continuum for care transitions and chronic disease management? Do you have the resources ready to go beyond providing a task oriented service to a service model that is part of a larger team for meeting mutual goals for patient centered care and chronic disease management? In order to create your seat at the table with post-acute referral sources you need to understand the concepts in care transitions and identify the top chronic diseases and explore how your Home Care agency can be a partner in care transitions and chronic disease management. This workshop is designed to help agencies understand concepts associated with care transitions, state and national efforts around care transitions and hospital penalties for readmissions. Come explore the home care agency role in falls prevention, medication management, and nutrition as well as the in-home aides’ role in observing, recording and reporting observations related to chronic disease management.

Looking at the case study examples below, which agency do you think a referral source who is interested in chronic disease management would want to consider? In this teleconference, we will explore some tools to help you with your In-home education related to chronic disease management and how to explain to referral sources how you are positioned to assist in chronic disease management.

Mrs. Sanders is an 82 year old client who is widowed and lives alone. She has CHF and COPD.  Mrs. Sanders’ conditions cause shortness of breath and she needs to monitor her vital signs due to her irregular heart rate and fluctuations in her blood pressure.  Mrs. Sanders’ medications can cause side effects such as dizziness. Mrs. Sanders is at risk of falls due to a fall history along with her medical conditions that cause weakness and at times dizziness. The In-home aide working with Mrs. Sanders has been instructed to assist her with her bath, getting dressed, and preparing a meal.

Mrs. Sanders is an 82 year old client who is widowed and lives alone. She has CHF and COPD. Mrs. Sanders’ conditions cause shortness of breath and she needs to monitor her vital signs due to her irregular heart rate and fluctuations in her blood pressure. Mrs. Sanders is at risk of falls due to a fall history along with her medical conditions that cause weakness and at times dizziness. The In-home aide working with Mrs. Sanders has been instructed to assist her with her bath, getting dressed and preparing a meal. The In-home aide has been further instructed regarding the chronic diseases of CHF and COPD and what could signs to be alerted to that Mrs. Sanders could be having a decline in her chronic disease. Knowing that Mrs. Sanders is weak and dizzy at times due to her condition and medications, the In-home aide is aware of falls risk and understands the need to be aware of falls prevention measures. The In-home aide has been instructed in preparing therapeutic diets such as a low sodium diet in order to provide appropriate nutritional services with meal preparation.

Presenter: The instructor for the class is Kathie Smith, RN. Ms. Smith has extensive experience in Medicare and Medicaid home health compliance and regulatory requirements and is a state and national speaker. Mrs. Smith is certified in integrated chronic disease management, is a master training in Coaching Supervision and serves on the North Carolina management team for the Personal and Home Care Aide State Training (PHCAST) grant which has developed Home Care Specialty training for NC aides. Ms. Smith is the VP of State Relations, Home and Community Based Care for AHHC of NC.

KHCA Members:  $99 per line
Non-Members:  $198 per line

Convenience: Enjoy the convenience and cost-efficiency of a telephone workshop. There is no travel time involved and no limit to the number of attendees from your agency who may participate at your site through one phone line. All you need to participate is a speaker telephone and a room large enough for your staff. It is a controlled, radio-like environment where you will gather your staff, dial an 800 number, state your verbal password, and you’re connected. You will also be able to participate in a Q&A portion. Due to the expense of using the hook-up, registrations may not be shared between agencies – the agency’s registration covers the access of only one line into the webinar. The handout will be emailed to you one week prior to the class to the email address you provide.

The Association for Home & Hospice Care of North Carolina is an approved provider of continuing nursing education by the by the North Carolina Nurses Association, an accredited approver by the American Nurses Credentialing Center’s Commission on Accreditation.