SOC BOOK SD

There is no place like home. This is especially true when convalescing from illness or injury. Lorian Health provides an alternative for those who are well enough to go home, but are still in need of medical care.

Lorian Health delivers a full range of quality home health services for those who need assistance at home, whatever the need, age, illness, disability, or ability to pay.

Our interdisciplinary team of professionals is committed to enhancing the quality of each patient’s life by promoting health, hope, and self-reliance.

Lorian Health combines the warmth and comfort of one’s own home with the best health care that can be provided outside an institutional setting.

Special Advantages

The advantages of receiving care from Lorian Health are significant and include:

• Initial skilled nursing assessment provided without charge in the home, hospital, skilled nursing facility or physician’s office.

• Comprehensive, cost-effective, interdisciplinary care.

• Services available 24 hours a day, seven days a week, including holidays.

• Sufficient staffing to ensure the continuity and quality of care.

• Direct billing for private insurance.

• Assistance with discharge planning and home medical equipment needs.

Professional Staff

We provide medically directed and licensed staff to work with the patient, family, and the patient’s personal physician to ensure an effective plan of care.

All members of the care team are experienced and knowledgeable in how best to provide quality care. From patient education to home infusions, our professionals are constantly staying abreast of the newest technologies. In the comfort of the patient’s home we offer:

• Skilled nursing services that combine the science of nursing with the art of caring.

• Home health aide services that are available to help with the patient’s personal care and hygiene needs and to provide light homemaking services.

• Social service workers to help patients and their families to cope with the personal and emotional impact of illness or disability and to locate financial resources and community assistance.

• Dietary counseling services to teach and assist patients to meet their individualized nutritional needs.

Therapy Services

Special therapy services are available for patients requiring rehabilitative care and include:

• Physical Therapists who provide physician prescribed treatment aimed at development and restoration of muscles and joint function.

• Occupational Therapists who help patients regain the skills necessary for self-care and activities of daily living.

• Speech Language Pathologists who assist patients with impaired communication skills to regain those skills or to learn alternative ways to express their needs and feelings.

PATIENT RIGHTS AND RESPONSIBILITIES

These rights will be respected by all of Lorian Health’s (Lorian) personnel and integrated into all Home Health programs. A copy of these rights shall be given upon the commencement of services to the patient or to the patient’s family, guardian, or authorized representative when the patient has been judged to be incompetent.

1. The patient has the right to be informed of his or her rights and responsibilities and has the right to appropriate and professional care related to physicians/MD orders. Lorian will alternately protect and promote these rights and responsibilities.

2. The patient has the right of choice of care providers and the right to communicate with the providers. The patient has the right to choose the home health agency that will provide his or her care.

3. Lorian will provide the patient with a written notice of the patient’s rights in advance of furnishing care to the patient or during the initial evaluation visit before initiating treatment and will maintain record showing that Lorian has complied with the requirements of informing the patient of his or her rights and responsibilities.

4. The patient has the right to exercise his or her rights as a patient of Lorian. If the patient lacks the ability to understand these rights and the nature and consequences of proposed treatment, the patient’s representative shall have the rights specified as listed in this document to the extent that these rights and responsibilities can devolve to another, unless the representative’s authority is otherwise limited. The patient’s incapacity shall be determined by the court in patient’s physician unless the physician’s determination is disputed by the patient or the patient’s representative.

5. Prior to receiving care, the patient has the right to be fully informed, orally and in writing, of Lorian’s policies and charges for services, including the patient’s eligibility for third party reimbursement and the extent to which payment may be required from the patient. Lorian will advise the patient orally and in writing, as soon as possible, but no later than 30 calendar days from the date that Lorian becomes aware of a change in cost to patient or payer source.

6. The patient has the right to receive information necessary to give informed consent prior to the start of care and also has the right to refuse treatment within the confines of the law and to be informed of the consequences of his/her action.

7. Lorian maintains specific policies and procedures regarding Advance Directives. The patient has the right to be provided in advance with written documentation concerning such policies, to formulate Advance Directives, and to have Lorian comply with the directives unless Lorian notifies the patient of its inability to do so.

8. The patient has the right to privacy and confidentiality concerning his or her clinical records, communications, and personal information and may review all health records pertaining to them. The patient also has the right to request information about his or her diagnosis, prognosis, and treatment, including alternatives to care and risks involved in terms that the patient and his or her family or designee can readily understand so they can give their informed consent. Lorian will advise patient and his or her designee of Lorian’s policies and procedures concerning disclosure of clinical records.

9. The patient has the right to prevent Lorian staff from using, removing, altering or consuming any personal item without expressed consent, and also the right to have any of his or her property treated with respect. The patient has the right to voice grievances to Lorian regarding violation or misuse of his or her property by Lorian staff without fear of reprisal or retribution. Lorian will fully investigate and document such grievances and their resolution.

10. Patient has the right to participate in the planning and revising of his or her care, the right to appropriate instruction and education regarding the plan of care, and to be advised in advance of any changes in the plan of care and/or frequency in care before the change is made. Lorian will advise the patient, in advance, of the disciplines that will furnish care and the frequency of the visits proposed.

11. The patient has the right to voice complaints/grievances regarding his or her plan of care and suggest changes thereto without fear of reprisal or discrimination. Such complaints and their resolution will be fully investigated and documented by Lorian. The patient or his or her designee will be informed of the outcome/resolution of the complaint/grievance.

12. The patient has the right to call the Bureau of Health Care Quality & Compliance. Most field offices are available 24 hours per day. See section “Procedure for Requests and Complaints” in this book to find the local field office address and phone number.

13. The patient is responsible for keeping appointments with Lorian staff. If the patient cannot be available, he or she has the responsibility of notifying Lorian well ahead of the scheduled visit time.

14. The patient has the responsibility to report any unexpected changes in his or her condition to the Lorian Case Manager.

15. The patient has the responsibility to provide Lorian staff with truthful, accurate information regarding his or her emotional, mental, and physical condition and to provide a safe environment for the Lorian staff visiting him or her.

16. The patient is responsible to express any concerns about his or her understanding of the course of treatment, to follow instructions of the health care professionals involved in the patient’s treatment

PATIENT RIGHTS AND RESPONSIBILITIES

Additional patient rights and responsibilities

• Be fully informed of your rights and receive this notice before the initiation of care. MCOP 484.10 (a) (1)

• Be treated with dignity, consideration and respect by trained professional staff.

• Exercise your rights or your family or guardian may exercise your rights if you have been judged incompetent. MCOP 484.10 (b) (1) (2)

• Have your person or property treated with respect and privacy. MCOP 484.10 (b) (3)

• Voice grievances regarding care or lack of respect for property without being subject to discrimination or reprisal. Report problems to the nurse or therapist assigned to your case, or call the manager at (877) 567-4265. MCOP 484.10 (e) (2)

• Be informed by a physician of your medical condition and be given an opportunity to participate in designing a care and treatment plan and to update it as your condition changes, as well as to refuse to participate in experimental research. MCOP 484.10 (c) (1) (II) (2) (I)

• Be advised in advance of the discipline of staff who will provide care and the proposed frequency of visits and be assured the personnel who provide the care are qualified through education and experience. MCOP 484.10 (c) (1) (I)

• Be assured of confidential treatment of personal and medical records and to approve or refuse their release to any individual outside the agency, in accordance with regulations regarding disclosure of clinical records. MCOP 484.10 (d)

• Refuse treatment and be told the consequences of your action.

• Be informed within a reasonable time of anticipated termination of service.

• Have your family taught about your illness, so that you can help yourself and your family can understand and help you.

• Receive written information on completing advance directives including a description of the applicable law. MCOP 484.10 (c) (3)

• Be informed that your rights set forth in this section may be denied for good cause only by the attending physician, and that the denial of such rights must be documented by the physician in your medical record.

• Remain under doctor’s care while receiving Agency services.

• Provide the Agency with a complete and accurate health history.

• Provide the Agency all requested insurance and financial records.

• Sign the required consents and releases for insurance billing.

• Participate in developing your plan of care and updating it as your condition changes.

• Accept the consequences for any refusal of treatment or choice of noncompliance.

• Provide a safe home environment in which your care can be given.

• Cooperate with your doctor, Agency staff and other caregivers.

• Treat Agency personnel with respect and consideration.

• Advise the Agency of any problems or dissatisfaction with our care, without being subject to discrimination or reprisal.

• Notify the Agency when unable to keep appointments. This Agency is an affirmative action/equal opportunity employer and does not discriminate on the basis of race, color, national origin, religion, sex, handicap or age.

This notice describes how medical information about you may be used and disclosed and how you can access this information. Please review carefully.

Lorian Health (Agency) may use your health information that constitutes protected health information as defined in the Privacy Rule of Administrative Simplification provisions of the Health Insurance Portability and Accountability Act of 1997 (HIPAA), for purposes of providing you treatment, obtaining payment for your care, and conducting health care operations. The Agency has established policies to guard against unnecessary disclosure of your health information and is committed to protecting the confidentiality of your health information.

For Your Treatment

During the course of treatment, the Agency may use your information to coordinate care within the Agency and with others such as your physician or other health care professionals who have agreed to assist the Agency in caring for your needs. The Agency may also disclose your health care information to individuals outside of the Agency involved in your care such as family members, pharmacists, your physician, medical equipment suppliers, laboratories, and other health care professionals.

For Payment

In order to receive payment or authorization for services provided to you in the home, the Agency may have to release some private health information to your insurance carrier. In order to facilitate payment, information provided to the carrier may include the health problem itself and services being rendered. This will allow the carrier to ensure that you are receiving the care that is needed to improve your overall health and that it is medically necessary.

For Healthcare Operations

The Agency may use your health information to evaluate staff performance, combine your health information with other Agency patients in evaluating how to more effectively serve all Agency patients, disclose your health information to Agency staff and contracted personnel for training purposes, or use your health information to contact you as a reminder regarding a visit or to inform you of alternate treatments.

For Appointment Reminders: The Agency may use and disclose your health information to contact you as a reminder that you have an appointment for a home visit.

For Treatment Alternatives: The Agency may also use your information to tell you about or recommend possible treatment options or alternatives that may be of interest to you.

Continued on next page

NOTICE OF PRIVACY PRACTICES

Special Uses: Your health care information may be used and disclosed in order to facilitate the function of the Agency and, as necessary, to provide quality care to all of the Agency’s patients. The following are examples of such activities:

• Quality assessment and improvement activities.

• Activities designed to improve health or improve health care cost.

• Protocol development, case management, and care coordination.

• Contacting health care providers and patients with information about treatment alternatives and other related functions that do not include treatment.

• Professional review and performance evaluation.

• Training of non-healthcare professionals.

• Compliance, medical, and legal reviews.

• Business planning and development and administrative activities.

Required or Permitted Uses and Disclosures

If you do not verbally object, the Agency may share your health care information with a family member or friend involved in your care. The Agency may use your health care information in an emergency if you are not able to express yourself. Your information may also be disclosed to Federal Agencies or law enforcement to report abuse, neglect, or violence.

Your Right to Revoke Authorization and Your Right to Private Health Care Information

You may revoke, in writing, the authorization you granted us to use your private health care information. However, the Agency can use your information until the time you revoke your consent.

You have the right to inspect your health care information. The Agency may refuse to give you access if it may cause you harm, but the Agency must explain why and provide you with someone to contact for a review of our refusal. You may disagree with our records and you may amend your records with a request in writing. Our representative will contact you with instructions on facilitating your request.

OUTCOME AND ASSESSMENT INFORMATION SET (OASIS) STATEMENT OF PATIENT PRIVACY RIGHTS

As a home health patient, you have the privacy rights listed below.

• You have the right to know why we need to ask you questions. We are required by law to collect information to make sure:

1. you get quality health care, and

2. payment for Medicare and Medicaid patients is correct

• You have the right to have your personal health care information kept confidential. You may be able to tell us information about yourself so that we will know which home health services will be best for you.

We keep anything we learn about you confidential. This means, only those who are legally authorized to know, or have a medical need to know, will see your personal health information.

• You have the right to refuse to answer questions.

We may need your help in collecting your health information. If you choose not to answer, we will fill in the information as best we can. You do not have to answer every question to receive services.

• You have the right to look at your personal health information.

• We know how important it is that the information we collect about you is correct. If you think we made a mistake, ask us to correct it.

• If you are not satisfied with our response, you can ask the Centers for Medicare and Medicaid Services, the federal Medicare and Medicaid agency, to correct your information.

You can ask the Centers for Medicare and Medicaid Services to see, review, copy, or correct your personal health information, which the Federal agency maintains in its HHA OASIS System of Records.

If you want a more detailed description of your privacy rights, see the PRIVACY ACT STATEMENT – HEALTH CARE RECORDS.

This is a Medicare and Medicaid Approved Notice

CENTERS FOR MEDICARE AND MEDICAID SERVICES

PRIVACY ACT STATEMENT - HEALTH CARE RECORDS

This statement gives you advice required by law (The Privacy Act of 1974). This statement is not a consent form. It will not be used to release or to use your health care information.

I. Authority for collection of your information, including your social security number, and whether or not you are required to provide information for this assessment.

Sections 1102(a), 1154, 1861(o), 1861(z), 1864, 1865, 1866, 1871, 1891(b) of Social Security Act. Medicare and Medicaid participating home health agencies must do a complete assessment that accurately reflects your current health and includes information that can be used to show your progress toward your health goals. The home health agency must use the “Outcome and Assessment Information Set” (OASIS) when evaluating your health. To do this, the agency must get information from every patient. This information is used by the Centers for Medicare and Medicaid Services (CMS) to be sure that the home health agency meets quality standards and gives appropriate health care to its patients. You have the right to refuse to provide information for the assessment to the home health agency. If your information is included in an assessment, it is protected under the federal Privacy Act of 1974 and the “Home Health Agency Outcome and Assessment Information Set” (HHA OASIS) System of Records. You have the right to see, copy, review and request correction of your information in the HHA OASIS System of Records.

II. Principle purposes for which your information is intended to be used

The information collected will be entered into the Home Health Agency Outcome and Assessment Information Set (HHA OASIS) System No. 09-70-9002.

Your health care information in the HHA OASIS System Records will be used for the following purposes:

• Support litigation involving CMS

• Support regulatory, reimbursement and policy functions performed within CMS or by contractor or consultant

• Study the effectiveness and quality of care provided by those home health agencies.

• Survey and certification of Medicare and Medicaid home health agencies.

• Provide for development, validation and refinement of a Medicare prospective payment system.

• Enable regulators to provide home health agencies with data for their internal quality improvement activities.

• Support research, evaluation or epidemiological projects related to the prevention of disease or disability, or the restoration or maintenance of health, and for health care payment related projects; and

• Support constituent requests made to a Congressional representative.

III. Routine uses

These “routine uses” specify the circumstances when the CMS may release your information from the HHA OASIS System of Records without your consent. Each prospective recipient must agree in writing

CENTERS FOR MEDICARE AND MEDICAID SERVICES

PRIVACY ACT STATEMENT - HEALTH CARE RECORDS

to ensure the continuing confidentiality and security of your information. Disclosure of the information may be to:

• the Federal Department of Justice for litigation involving CMS.

• contractors or consultants working for CMS to assist in the performance of a service related to this system of records and who need to access these records to perform the activity.

• an agency of a State government for purposes of determining, evaluating and/or assessing cost, effectiveness and/or quality of health care services provided in the State, for developing and operating Medicaid reimbursement systems; or for the administration of Federal/State home health agency programs within the State.

• another Federal or State agency to continue for the accuracy of CMS’s health insurance operations (payment, treatment and coverage) and/or to support State agencies in the evaluation and monitoring of care provided by home health agencies.

• Peer Review Organizations, to perform Title XI or Title XVII functions relating to assessing and improving home health agency quality of care.

• an individual or organization for research, evaluation, or epidemiological project related to the prevention of disease or disability, the restoration or maintenance of health, or payment related projects.

• a congressional office in response to a constituent inquiry made at the written request of the consultant about whom the record is maintained.

IV. Effect on you if you do not provide information

The home health agency needs the information contained in the Outcome and Assessment Information Set in order to give quality care. It is important that the information be correct. Incorrect information could result in payment errors, as well as making it hard to be sure that the agency is giving you quality services. If you choose not to provide information, there is no federal requirement for the home health agency to refuse you services.

NOTE: This statement may be included in the admission packet for all new home health agency admissions. Home health agencies may request you or your representative to sign this statement to document that this statement was given to you. Your signature is NOT required. If you or your representative signs the statement, the signature merely indicates that you received this statement. You or your representative must be supplied with a copy of this statement.

CONTACT INFORMATION

If you want to ask CMS to see, copy or correct your personal health information, which that Federal agency maintains in its HHA OASIS System of Records, Call 1-800-6833, toll free, for assistance in contacting the HHA OASIS System Manager.

OUTCOME AND ASSESSMENT INFORMATION SET (OASIS) NOTICE ABOUT PRIVACY

For Patients Who Do Not Have Medicare or Medicaid Coverage

As a home health patient, there are a few things that you need to know about our collection of your personal health care information.

• Federal and State governments oversee home health care to be sure that we furnish quality home health care services, and that you, in particular, get quality home health care services.

• We need to ask you questions because we are required by law to collect health information to make sure that you get quality health care services.

• We will make your information anonymous. That way, Centers for Medicare and Medicaid Services (CMS), the federal agency that oversees this home health agency, cannot know that the information is about you.

• We keep anything we learn about you confidential.

• If you believe that your health information has been violated, you may file a complaint with Lorian Health or with the Secretary of Health and Human Management Department, Office of Civil Rights at: (877) 696-6775 or write to: Independence Avenue, SE Washington, D.C. 20201.

Effective April 14, 2003, Federal health information privacy rules require us to give you notice of our privacy practices. This document is your notice. We will abide by the practices set forth in this notice. However, we reserve the right to change this notice and our privacy practices when permitted or as required by law.

This is a Medicare and Medicaid Approved Notice

This page explains your rights to make health care decisions, how you can plan for your future, and what should be done when you can’t speak for yourself.

Federal law requires us to give you this information. It will also explain how Lorian Health complies with your wishes. We hope this information will help increase your control over your medical treatment. Who decides about my treatment?

Your doctors will give you information and advice about treatment. You have the right to choose to say “yes” to the treatments you want and “no” to any treatment you don’t want – even if the treatment might keep you alive longer.

How do I know what I want?

Your doctor must tell you about your medical condition and about what different treatments can do for you. Many treatments have side effects. Your doctor must offer you information about serious problems that any medical treatment is likely to cause you.

Often, more than one treatment might help you – and people have different ideas about which is best. Your doctor can tell you which treatments are available to you, but your doctor can’t choose for you. That choice depends on what is important to you.

What if I am too sick to decide?

If you can’t make treatment decisions, your doctor will ask for your closest available relative or friend to help decide what is best for you. Most of the time, that works. But sometimes everyone doesn’t agree about what to do. That’s why it is helpful if you say in advance what you want to happen if you can’t speak for yourself. There are several kinds of Advance Directives that you can use to say what you want and who you want to speak for you.

One kind of Advance Directive under California and Nevada law lets you name someone to make health care decisions when you can’t. This is called a DURABLE POWER OF ATTORNEY FOR HEALTH CARE (DPOAH).

Who can fill out this form?

You can if you are 18 years of age or older and of sound mind. You do not need a lawyer to complete the DPOAH form.

Who can I name to make medical treatment decisions when I’m unable to do so?

You can choose an adult relative or friend you trust as your “agent” to speak for you when you’re too sick to make your own decisions.

How does this person know what I would want?

After you choose someone, talk to that person about what you want. You can also write down in the DPOAH when you would want or wouldn’t want medical treatment. Talk to your doctor about what you want and give him/her a copy of the form. Give another copy to the person named as your agent and take a copy with you when you go into a hospital or other treatment facility. Sometimes treatment decisions are hard to make and it truly helps your family and your doctors if they know what you want. The DPOAH also gives them legal protection when they follow your wishes.

CENTERS FOR MEDICARE AND MEDICAID SERVICES

YOUR RIGHT TO MAKE DECISIONS ABOUT MEDICAL TREATMENT ADVANCE DIRECTIVES

What if I don’t have anyone to make decisions for me?

You can use another kind of advance directive to write your wishes about treatment. This is often called a “living will” because it takes effect in the event that you become unable to speak for yourself but are still alive. The Natural Death Act lets you sign a living will called a DECLARATION. Anyone 18 years or older and of sound mind can sign one. When you sign a DECLARATION, it tells your doctor that you don’t want any treatment that would only prolong your dying. All life-sustaining treatment would be stopped if you were terminally ill and your death was expected, or if you were permanently unconscious. You would still receive treatment to keep you comfortable. However, the doctor must follow your wishes about limiting treatment or, if unable, turn your care over to another doctor who will. Your doctors are also legally protected when they follow your wishes.

Are there other living wills I can use?

Instead of using the DECLARATION in the Natural Death Act, you can use any of the available living will forms. You can use a DPOAH form without naming an agent. Or you can just write your wishes on a piece of paper. Your doctors and family can use what is in writing in deciding about your treatment. However, living wills that don’t meet the requirements of the Natural Death Act don’t give as much legal protection for your doctors if a disagreement arises in regards to following your wishes.

What if I change my mind?

You can change or revoke any of these documents at any time as long as you can communicate your wishes.

Do I have to fill out one of these forms?

No, you don’t have to complete any of these forms. You can just talk with your doctors and ask them to put your wishes in writing in your medical chart. Meanwhile, you can talk with your family about your wishes. People will be clearer about your treatment wishes if they are in writing. Your wishes are more likely to be followed when in writing.

Will I still be treated if I don’t fill out these forms?

Absolutely. You will still get medical treatment. We just want you to know that if you become too sick to make decisions, someone else will have to make them for you. Remember that:

• A DPOAH lets you name someone to make treatment decisions for you. That person can make most medical decisions – not just those life-sustaining treatments – when you can’t speak for yourself. Besides naming an agent, you can also use the form to say when you would or wouldn’t want particular kinds of treatment.

• If you don’t have someone you want to name to make decisions when you can’t, you can sign a NATURAL DEATH ACT DECLARATION. The DECLARATION says that you do not want life prolonging treatment if you are terminally ill or permanently unconscious.

How can you get more information about advance directives?

Ask your doctor, nurse, or social worker to get more information for you.

HOW LORIAN HEALTH COMPLIES WITH YOUR ADVANCE DIRECTIVES

• The admitting nurse/therapist will ask you for a copy of your advanced directives.

• Valid advance directives will be followed to the extent permitted and required by law.

• In the absence of advance directives, Lorian Health will provide appropriate care according to the Plan of Care authorized by the attending physician, dentist, or podiatrist.

• Lorian Health recognizes that all persons have the fundamental right to make decisions about their own medical treatment. This includes the right to accept or refuse medical treatment.

• Lorian Health will request a copy of advance directives to ensure Lorian Health staff understands the patient’s directive.

• Lorian Health will not condition the provision of care or discriminate against the patient based on whether or not advance directives have been established.

• The patient has the right to revoke or change an advance directive at any time. The patient will need to notify Lorian Health of any changes made.

• If Lorian Health cannot, for any reason, carry out the patient’s advance directive, they will notify the patient/caregiver and, if necessary, assist the patient to find an alternative provider.

• Lorian Health will communicate directives to all staff participating in the patient care.

• If the patient’s advance directive does not identify the wish to withhold resuscitation and there is no physician order to do so, Lorian Health staff will initiate CPR in event of Cardio Pulmonary Arrest.

IMPORTANT INFORMATION ON SHARPS WASTE

Home-generated sharps should not be disposed of in bleach bottles, soda containers, or detergent containers. Instead, users should store the sharps waste in red bio-hazardous containers for easy identification.

Bio-hazard containers are available for purchase by consumers. Additionally, some jurisdictions have containers available at no cost. Information can be found at county health websites.

Bio-hazard containers can be disposed of in one of four ways:

• Taken to a local household hazardous waste facility

• Taken to a medical waste generator facility (hospitals, clinics, or doctors’ offices)

• Shipped through a mail-back program

• Taken to an approved home-generated sharps waste collection location

Riverside County / San Bernardino County:

Moreno Valley Corp. Yard HHW Collection Facility (800) 304-2226

Agua Mansa Reg. Permanent HHW Collection Facility (800) 304-2226

Rite Aid Pharmacy Collection Facility (951) 769-7370

Lake Elsinore Reg. Permanent HHW Collection Facility (951) 486-3200

Orange County:

Clean Scene Pick Up Service (877) 246-4292

City of Laguna (Door to Door Pick Up) (800) 449-7587

Huntington Beach Collection Center (714) 834-4176

Buena Park Senior Center (800) 449-7587

San Diego County: Chula Vista Transfer Station (619) 691-5122

Miramar Household Hazardous Waste Facility (858) 694-7000

Ramona Household Hazardous Waste Collection Facility (877) 713-2784

Vista Community Clinic (760) 631-5000

South Bay Regional Household Hazardous call for details (619) 691-5122 (Home Pick Up)

Clark County Nevada: Waste Management Inc. North Las Vegas (702) 642-0362

Paramount Waste Management Inc. North Las Vegas (702) 255-2220

Rhino Dump Las Vegas (702) 877-0139

Republic Services Henderson (702) 399-5501

FALL RISK PREVENTION

Each year, an estimated one third of older adults fall, and the likelihood of falling increases substantially with advancing age according to the CDC.

The effect these injuries have on the quality of life of older adults and on the U.S. Health-care system reinforces the need for broader use of scientifically proven fall-prevention interventions.

The following are some suggestions to prevent falls.

1. Use appropriate size non-slip footwear. For example: wear rubber-soled shoes for traction.

2. Make sure there is always adequate lighting in stairways, bathrooms and walkways.

3. Keep a flashlight with fresh batteries beside your bed.

4. Add grab rails where needed: stairways, hallways, etc. if possible

5. Be aware of medication that might increase risks of fall and monitor for status changes in condition.

6. Make sure wheelchairs and walkers are in good repair.

7. Make sure all equipment (wheelchairs, walkers, beds with wheels) are locked before getting in or out of them.

8. Follow specific instructions about your medical equipment and supplies in order to prevent injury, i.e., cane, walker, etc.

9. Make sure room is free of hazards, i.e., loose rugs, electrical cords around walkway, toys, barriers, clutter, etc.

10. Be sure carpets and area rugs have skid-proof backing or are tacked to the floor.

11. If needed, place a quick release gate at the top/bottom of steps/stairs to prevent accidental falls.

12. Place a rubber bath mat in the tub or shower to prevent falls.

13. Install grab bars on bathroom walls near the tub, shower, and toilet.

14. Place chairs throughout the home to create a rest stop where needed.

15. Make sure all sensory deficits have been addressed and there are appropriate accommodations to prevent injury.

16. Be careful on highly polished floors that become slick and dangerous when wet.

17. If using a step stool for hard-to-reach areas, use a sturdy one with a handrail and wide steps.

18. Consider purchasing a cordless phone so that you don’t have to rush to answer it, or so that you can call for help if you do fall.

OXYGEN SAFETY

What is oxygen?

Oxygen (often called O2) is a colorless, odorless gas that is part of the air we breathe. It is essential for all cells in our body and helps healing. Sometimes, children who have breathing problems need extra oxygen. This makes them feel better because they don’t have to breathe harder or faster to get enough oxygen. Your may have two types of oxygen systems:

• oxygen concentrator, for home use only

• portable oxygen: either an oxygen tank or liquid oxygen

What are the risks of oxygen?

When oxygen is in use, there is an increased risk of fire. Each type of oxygen system has other safety issues as well as the danger of fire. For example, oxygen tanks and liquid oxygen vessels contain oxygen under pressure, which can cause injury if not used correctly. Make sure you understand completely how to use the oxygen equipment. Ask your nurse, doctor, or medical equipment company as many questions as needed.

What should I do?

Think of oxygen as a medicine. Do not change the liter flow (amount of oxygen flowing through the tubing) without talking with your home care nurse, doctor, or respiratory care practitioner. Be sure to have at least a three-day supply of portable oxygen on hand, so that it does not run out. Your respiratory care practitioner or oxygen supplier can help you determine what a three-day supply is for you, and will help you arrange a routine delivery schedule. Keep the oxygen tubing in sight. Do not put the tubing under furniture, bed covers, carpets, clothing, or other items. This could kink the tube and prevent the flow of oxygen through the tubing.

Prevent fires

Do not allow smoking in your home, car, or other places where you are receiving oxygen. Post “No Smoking” and “Oxygen in Use” signs on the entrances to your home. Ask your oxygen supplier to give you these signs.

Do not leave oxygen on when not in use. When the oxygen is on, keep it and your child at least 10 feet away from fireplaces, stoves, or gas appliances (dryer, hot water heater). Do not use electrical equipment in an oxygen-enriched environment. Examples include electric razors, hairdryers, electric blankets, or electric heaters. Electrical equipment may spark and cause a fire. Cell phones are okay. Do not use flammable products such as paint thinner, rubbing alcohol, or oil-based products such as Vaseline® near the oxygen. Use a water-based lubricant such as K-Y jelly to moisten your lips or nose.

Prevent injury

Prevent oxygen tanks or liquid oxygen vessels from falling. A falling tank or vessel is very dangerous. If it falls over or is dropped, it might break, causing the pressurized oxygen to escape rapidly. This pressure can cause the tank or vessel to fly through the air. Always keep oxygen tanks or liquid oxygen vessels upright in a cart, rack, or stable base. Never tip them on their side. Do not use tanks or vessels that have fallen or are damaged. Store out of direct sunlight and in a well aired space. When moving an oxygen tank or vessel, always use a shoulder bag or wheeled cart.

OXYGEN SAFETY

Using an oxygen concentrator

An oxygen concentrator is a device that separates the oxygen out of the air, concentrates it, and stores it in the machine. A nasal cannula (plastic tube) brings the oxygen to your nose.

Store and use the oxygen concentrator correctly

The oxygen concentrator needs electricity to work. Always plug it into a grounded outlet. Do not use an extension cord or power strip. The concentrator produces heat. Keep it in an open area. Never put it in a closet or small, closed-in space. The concentrator is not portable. Long lengths of oxygen tubing are used so the patient can move around. Another type of oxygen system must be used for travel outside your home, or if the power goes out.

Taking care of the equipment

An oxygen concentrator is easy to maintain. Your medical equipment company will give you instructions on care and cleaning. Please check with your medical equipment company to see how often your concentrator needs to be serviced.

Using an oxygen tank

An oxygen tank is a metal container filled with oxygen under high pressure. Oxygen tanks come in different sizes.

Terms:

Cracking the tank: opening the valve just enough to let a small amount of oxygen out, which will clear dirt out of the valve.

Crush gasket: a nylon washer that comes with each new tank of oxygen. When you set up an oxygen tank, take this off and throw it away.

Flow meter: measures the flow of oxygen coming out of the tank in liters per minute (LPM).

Nasal cannula: tubing that is connected to the oxygen tank and brings the flow of oxygen into your nose.

Pressure gauge: measures how much oxygen is in the tank. A full tank has between 1800 and 2200 pounds per square inch (PSI).

Regulator: a device that contains both the flow meter and the pressure gauge. It is attached to the tank, and lets the oxygen out at a safe pressure. Never carry a tank by the regulator. Never use any type of lubricant (oil or grease) on the regulator. This could cause a fire.

Sealing washer: a metal or metal-and rubber washer that is used to provide a tight seal between the oxygen tank and the regulator. The sealing washer helps to prevent oxygen from leaking.

What else do I need to know?

If you think there is a problem with your oxygen system, do not try to fix it. Call your equipment company for help.

HOME MEDICATION SAFETY

The 3 R’s for Medication Safety:

1. All medicines have RISKS as well as benefits. Weigh these risks and benefits carefully for every medicine you take.

2. RESPECT the power of your medicine and the value of medicines properly used.

3. Take RESPONSIBILITY for learning about how to take your medication safely.

Over-The-Counter

Over-the-counter (OTC) are drugs you can buy without a prescription and OTC and prescription medicines have one thing in common: they are serious medicines that need to be taken with care.

Ten Ways to be Medication Wise: (www.bemedwise.org)

1. Always start by reading all the label. Reading the label will help you decide if you have selected the right product for your symptoms, understand the dosing instructions and are aware of any warning that may apply to you.

2. Look for an OTC medicine that will treat only the symptoms you have. The formulation of OTC drugs are very specific and should not be mixed and matched.

3. Know what to avoid while taking an OTC medicine. Like prescription medicines, some OTC drugs can cause side effects or reactions. Read the label to see what to avoid while you are taking the drug.

4. When in doubt, ask before you buy or use an OTC medicine. Taking an OTC medicine safely is too important for guesswork. If you have questions, ask your pharmacist or doctor.

5. Take the medicine EXACTLY as stated on the label. When it comes to OTC medicines, more is not better!! Taking too much of an OTC medicine can be harmful. Only take the recommended amount and at the exact intervals stated on the label.

6. Use extra caution when taking more than one OTC drug product at a time. Many OTC medicines contain the same active ingredients which means you may be getting more than the recommended dose. Always compare active ingredients before taking more than one OTC drug at the same time.

7. Don’t combine prescription medicines and OTC drugs without talking to your doctor first. Sometimes combining drugs can cause adverse reactions or one drug can interfere with another drug’s effectiveness.

8. Make sure that each of your doctors has a list of all the medicines you are taking. This includes not only prescription medicines but also any OTC drugs and dietary supplements that you may be taking.

9. Always give infants and children OTC medicines that are specially formulated for their age and weight. Unless labeled otherwise adult-strength products should not be given to children.

10. Don’t use OTC medicines after their expiration date. Dispose of all medicines promptly after their expiration date and be careful not to throw them away where children or pets may find them.

HOME MEDICATION SAFETY

Prescription Medications

10 tips to help remind you to stay on schedule: (www.mustforseniors.org)

1. Set a daily routine. Try to take your medication at the same time and place every day.

2. Make a list of instructions for all of your medications.

3. Place sticky note reminders to yourself where you will see them.

4. Count your pills. If you know how many pills you have left, it will be easier to figure out if you’ve missed a dose or already taken one.

5. Ask your healthcare professional or pharmacist about using a pill box organizer or other aids.

6. Set an alarm. Set the alarm on your clock radio or cell phone as a reminder.

7. Use technology. Smartphones and other handheld devices can provide texts, emails or other reminders to help you keep track of your medication schedule.

8. Bring another set of ears. Bring a trusted friend, member family member or caregiver along to the doctor or pharmacy if you think you might need help understanding or remembering instructions.

9. Mark it on your calendar. Write the date you are due for your next refill or follow-up appointment on your calendar.

10. Talk to your pharmacist about scheduling medicine refills at the same time if possible. This will reduce the number of trips to the pharmacy.

Take your medications as directed

Not taking them the correct way can:

1. Make you sicker

2. Lead to more hospital visits

3. Increase your medical costs

Juggling Multiple Medications

1. Beware of interactions: Some drugs can interact with other medication, food, alcohol and cause dangerous side effects. (http://healthtools.aarp.org/drug-interactions)

2. Check for red flags yourself. See below the Beers Criteria.

3. Follow instructions. Carefully read the written information that comes with your prescription medications.

4. Pay attention to side effects. If you notice any changes in how you’re feeling, thinking or behaving, tell your doctor or pharmacist right away.

5. Keep things simple. Talk to your doctor or pharmacists about how you could simplify your medication schedule so it will be easy for you to keep track of everything.

6. Make a reminder sheet or calendar. Write down your medication schedule.

7. Ask your healthcare professional about using reminder tools or products.

BEERS LIST

Medications inappropriate for elderly people

The Beers Criteria (or Beers List) is a list of specific medications that are generally considered inappropriate when given to elderly people. For a wide variety of individual reasons, the medications listed tend to cause side effects in the elderly due to the physiologic changes of aging.

alprazolam (Xanax)

amiodarone (Cordarone)

amitriptyline (Elavil)

amphetamines

anorexic agents

barbiturates

belladonna alkaloids (Donnatal)

bisacodyl (Dulcolax)

carisoprodol (Soma)

cascara sagrada

chlordiazepoxide (Librium, Mitran)

chlordiazepoxide-amitriptyline (Limbitrol)

chlorpheniramine (Chlor-Trimeton)

chlorpropamide (Diabinese)

chlorzoxazone (Paraflex)

cimetidine (Tagamet)

clidinium-chlordiazepoxide (Librax)

clonidine (Catapres)

clorazepate (Tranxene)

cyclandelate (Cyclospasmol)

cyclobenzaprine (Flexeril)

cyproheptadine (Periactin)

desiccated thyroid

dexchlorpheniramine (Polaramine)

diazepam (Valium)

dicyclomine (Bentyl)

digoxin (Lanoxin)

diphenhydramine (Benadryl)

dipyridamole (Persantine)

disopyramide (Norpace, Norpace CR)

(http://en.wikipedia.org/wiki/Beers_Criteria)

halazepam (Paxipam)

hydroxyzine (Vistaril, Atarax)

hyoscyamine (Levsin, Levsinex)

indomethacin (Indocin, Indocin SR)

isoxsuprine (Vasodilan)

ketorolac (Toradol)

lorazepam (Ativan)

meperidine (Demerol)

meprobamate (Miltown, Equanil)

mesoridazine (Serintil)

metaxalone (Skelaxin)

methocarbamol (Robaxin)

methyldopa (Aldomet)

methyldopa-hydrochlorothiazide (Aldoril)

methyltestosterone (Android, Testred, Virilon)

mineral oil

naproxen (Naprosyn, Avaprox, Aleve)

Neoloid

nifedipine (Procardia, Adalat)

nitrofurantoin (Microdantin)

orphenadrine (Norflex)

oxaprozin (Daypro)

oxazepam (Serax)

oxybutynin (Ditropan)

pentazocine (Talwin)

perphenazine-amitriptyline (Triavil)

piroxicam (Feldene)

promethazine (Phenergan)

propantheline (Pro-Banthine)

propoxyphene (Darvon) & combination products

doxazosin (Cardura) (Off the market)

doxepin (Sinequan)

ergot mesyloids (Hydergine)

estrogens

ethacrynic acid (Edecrin)

ferrous sulfate (iron)

fluoxetine (Prozac)

flurazepam (Dalmane)

guanadrel (Hylorel)

guanethidine (Ismelin)

quazepam (Doral)

reserpine (Serpalan, Serpasil)

temazepam (Restoril)

thioridazine (Mellaril)

ticlopidine (Ticlid)

triazolam (Halcion)

trimethobenzamide (Tigan)

tripelennamine

ELEVEN TERMS YOU SHOULD KNOW

(www.mustforseniors.org)

1. Side effects: symptoms or feelings you get when you take a drug that are beyond the drug’s intended effects. Side effects are usually bothersome (for example, dizziness, nausea, confusion) and can be mild or serious. You should report any side effects to your healthcare professional.

2. Generics: copies of brand-name drugs that have the same purpose, strength, safety, and other characteristics of brand-name drugs, but are manufactured by a different company. Generics are required by the US Food and Drug Administration (FDA) to meet the same quality standards as brand name drugs and generally cost significantly less money.

3. Drug interactions: when a drug interacts with another drug, condition, food, or alcohol and changes the way the drug acts in the body.

4. Drug-drug interactions: when taking one drug alters the effect of another medication a person is taking. Drug-drug interactions can increase or decrease the effectiveness of a drug, or cause harmful unintended side effects.

5. Drug-condition interactions: when a medical condition you already have affects how your body responds to certain medications.

6. Drug-food interactions: when a drug reacts with foods or drinks you have consumed. Foods can affect the way a drug is absorbed, and drugs can affect the way the body absorbs nutrients from foods.

7. Drug-alcohol interactions: when a medicine reacts with an alcoholic drink you have consumed. Drug-alcohol interactions can increase or decrease the effectiveness of a drug, or cause harmful side effects or increased intoxication. Note: To view the Beers criteria see Beers List: a list of medications that are generally considered inappropriate or unsafe for people over age 65.

8. Formulary: typically, a list of prescription drugs that your drug insurance plan will pay for. Formulary can also refer to a list of drugs in other contexts; for example, a hospital’s formulary is a list of drugs the hospital pharmacy stocks.

9. Non-medical use of prescription drugs: the misuse or abuse of prescription medications for purposes other than medical treatment—for example, to get high. This type of drug abuse is increasing in the United States. Use your prescription medications only as prescribed and keep them out of the hands of friends and family members (especially teenagers and young adults).

10. Medication adherence: faithfully sticking to the medical treatment regime your doctor prescribes, even without that doctor’s close supervision.

11. Polypharmacy: when a person takes multiple prescription and/or over-the-counter (OTC) medicines. Polypharmacy is common among older adults and can lead to problems such as harmful drug interactions, medication confusion and high costs.

EMERGENCY PREPAREDNESS Environmental Hazards Know and Understand Natural Disasters

A natural disaster is when events such as earthquakes, mudslides, floods or wildfires affect people. Despite our inability to control these events, we can plan and prepare for them to minimize damage when they do happen. Below are brief explanations of disasters that are common in California. Follow the links to more information about a specific disaster.

Earthquakes: An earthquake is a sudden shift or movement of the plates in the earth’s crust. On the surface, this moves and shakes the ground and can be very damaging to poorly built structures. The most powerful earthquakes can destroy even the best built structures. They can also cause other disasters, such as tsunamis and volcanic eruptions. Earthquakes occur along fault lines and are unpredictable. California is highly prone to earthquakes because of its many active fault lines.

Floods: A flood is a natural disaster caused by too much rain or water in an area, and could be caused by many different conditions. In California, floods are most often caused by prolonged rainfall from a storm. Flooding is particularly dangerous because it often leads to landslides or mudslides.

Wildfires: A wildfire is a natural disaster that starts in forests, deserts with heavy brush or other vegetated areas. They can be a great danger to people who live in or near such areas. Wildfires can be started by lightning, extremely dry vegetation in warm climates, human carelessness or intentionally. In the wilderness they can quickly burn thousands of square miles. In metropolitan cities such as Los Angeles, they can burn entire neighborhoods. Southern California is very prone to wildfires because of low annual rainfall, warm summers and dry vegetation.

Landslides and Mudslides: A landslide occurs when soil, rocks, trees, parts of houses and other debris is swept downhill. Landslides can be cause by earthquakes, rain or general instability of the land. Mudslides are a special type of landslide, in which heavy rainfall causes loose soil on steep land to collapse and slide down. Mudslides occur with some regularity in parts of California after periods of heavy rain.

Tsunami: A tsunami is a series of waves that happens when water in a lake or sea is quickly displaced on a large scale. Disturbances such as earthquakes, volcanic eruptions, landslides or meteorite impacts can cause tsunamis. Because the most common cause is an undersea earthquake, there is potential for coastal areas in California to be impacted by a tsunami. According to researchers at the University of Southern California, a 7.6 magnitude earthquake under the seafloor near Catalina Island could cause a tsunami to hit the Southern California coast.

Power Outages: A power outage is the loss of electricity to an area. A power outage may be referred to as a blackout if power is lost completely, or as a brownout if some power supply is still present. Blackouts and brownouts are common in California because of extremely dense populations. Though power outages are not necessarily considered natural disasters, they often occur with natural disasters. Power outages are very damaging for hospitals, since many life-supporting medical devices and tasks require power. For this reason, hospitals have emergency power generators which are typically powered by diesel fuel and start automatically when the power goes out.

Extreme Heat: Heat-related illness can be very dangerous and affect anyone when temperatures outside get hot enough. The best defense against heat-related illness is prevention. Drinking more fluids (non-alcoholic and without caffeine or sugar) can help prevent heat-related illness regardless of activity level. Taking cool showers or baths, wearing loose and light-colored clothing and limiting outdoor activity to cooler times of the day can also prevent illness. Infants and young children, people aged 65 and over, mentally ill and physically ill people are at a greater risk for heat-related illness and should be checked on frequently.

Climate Change and Health Equity

For more information please visit the climate change and health equity page at the following link https://www.cdph.ca.gov/Programs/OHE/Pages/CCHEP.aspx

For more information on natural disasters visit the Centers for Disease Control and Prevention at the following link https://www.cdc.gov/disasters/

EMERGENCY PREPAREDNESS

Be Prepared - Emergency Plan Guidelines

Evacuation

Away from your home: Evacuations are more common than you realize. Ask local authorities about emergency evacuation routes for your location.

Check list for evacuation:

• Keep a full tank of gas in your car

• If you don’t own a car, make transportation arrangements with friends or your local government

• Have a battery-powered radio with extra batteries

• Follow recommended evacuation routes. Do not take shortcuts – they may be blocked

• Do not drive into flooded areas

• Stay away from downed power lines

If time permits: gather disaster supply kit, wear sturdy shoes and clothing, secure your home (close and lock doors, unplug electronics), and let others know where you are going.

Escape route out of your home :

Develop an escape route from your home and arrange a meeting place. Make sure everyone living in the home knows the route and the meeting place. Draw a map if needed. If children are involved use a blank sheet of paper for each floor. Mark two escape routes from each room. Post a copy of the drawing at eye level in each child’s room.

Family communications:

• Plan how you will contact one another if not together when disaster strikes.

• Have contact numbers listed by the phone and carry with each family member

Utility Shut-off and Safety

Check with your utility service and modify the following guidelines:

Natural gas: Turn off the gas, using the outside main valve if need be. Make sure you check with the gas company for correct procedure.

Water: Locate the shut-off valve and make sure you can turn the valve off-on. Label with a tag and make sure all household members know where it is and how to use it.

Electricity shut off: Locate circuit box. Teach all household members how to shut off electricity to the entire house.

Vital Records

• Inventory home possessions: photo or video.

• Store important documents in a safe place and make copies for your disaster kit.

• Keep a small amount of cash or traveler’s checks at home with your disaster kit.

Continued on next page

EMERGENCY PREPAREDNESS

Be Prepared - Emergency Plan Guidelines

Special Needs

Hearing impaired: May need to make special arrangements to receive warnings.

Mobility impaired: May need special assistance to get to a shelter.

People with special dietary needs: Take special precautions to have an adequate emergency food supply.

• Register special needs with office of emergency services or the local fire department.

• Create a network of neighbors, relatives, friends, and coworkers to aid you if needed.

• Have extra equipment like wheelchairs, oxygen, catheters, medication, food for service animals, and any other items you might need.

• Keep a list of the type and model numbers of the medical devices you require.

Caring for Animals in a Disaster

• Identify shelter including hotels/motels that allow pets

• Have pet supply disaster kit including copies of veterinarian records, pet carrier and/or leash

• Large animals: Have some form of identification, provide evacuation vehicles/trailers. If evacuation is not possible, owners must decide whether to move large animals to shelter or turn them outside.

Disaster Supply Kit

Since you do not know where you will be when an emergency occurs, prepare supplies for home, work, and vehicles. Kits should contain supplies for at least 3 days or more. Include:

• Battery powered radio or television

• Flashlight and extra batteries

• First aid kit

• Sanitation and hygiene items

• Matches

• Waterproof container

• Whistle

• Extra clothing

• Kitchen utensils for cooking

• Photocopies of important documents

• Cash

• Special needs items

Water: A normally active person needs at least one-half gallon of water daily just for drinking. Commercially prepared water is available and is safe for 5 years. There are kits available also to prepare your own water.

If you choose to use your own water storage containers:

• Choose two-liter plastic soft drink bottles-not plastic jugs or cardboard containers that have had milk or fruit juice in them. Thoroughly clean the bottles with dishwashing soap and water, and rinse completely so there is no soap residue.

• Sanitize the bottles by adding a solution of 1 teaspoon of non-scented liquid household chlorine bleach to a quart of water. Swish the sanitizing solution in the bottle so that it touches all surfaces. After sanitizing the bottle, thoroughly rinse out the sanitizing solution with clean water.

• Fill the bottle to the top with regular tap water. If the tap water has been commercially treated from a water utility with chlorine, you do not need to add anything else to the water to keep it clean. If the water you are using comes from a well or water source that is not treated with chlorine, add two drops of non-scented liquid household chlorine bleach to the water.

EMERGENCY PREPAREDNESS

Be Prepared - Emergency Plan Guidelines

• Tightly close the container using the original cap. Place a date on the outside and store in a cool, dark place. Replace this water every six months.

Food: Have a manual can opener. Avoid foods that will make you thirsty. Use canned foods, dry mixes, and other staples that do not require refrigeration, cooking, water, or special preparation. Include special dietary needs.

Maintaining Disaster Kit:

• Keep in a dry, cool place

• Store in plastic or metal containers to protect

• Throw out any canned goods that become swollen, dented or corroded

• Replace foods when bad

• If indicated change stored food and water supplies every six months,

• Re-think your needs every year and update your kit as your family needs change

• Put your entire disaster supplies kit in one or two easy-to-carry containers

Reference for above information: Riverside Operational Area Multi-Jurisdictional Local Hazard Mitigation Plan: http://www.rctlma.org/genplan/content/gp/chapter06

Fema web site: http://www.fema.gov/pdf/areyouready/areyouready_full.pdf

What to Do if Home Health Services are Disrupted

• Please review emergency preparedness information and be prepared for an emergency.

• If a disaster or emergency occurs Lorian Health will make every effort to contact you and determine your situation. We will provide as much help as the situation will allow, but if you need help right away please call the local emergency responders at 911.

• If there is a communication disruption, please call 911 or go to your nearest emergency room.

Enhancing the Quality of Life at Home

FEDERAL NUMBERS

Lorian Health provides the patient with the names, addresses, and telephone numbers of the following federally-funded and state-funded entities that serve the area where the patient resides:

San Diego

Agency on Aging

Address: 9335 Hazard Way #100, San Diego, CA 92123 Phone: (858) 560-2500

Center for Independent Living

Address: 255 Deep Dell Rd, San Diego, CA 92114 Phone: (619) 804-5699

Protection and Advocacy Agency

Address: 1111 Sixth Ave #200, San Diego, CA 92101 Phone: (619) 239-7861

Aging and Disability Resource Center

Located in: Bond Academic Center

Address: 3900 Lomaland Dr, San Diego, CA 92106 Phone: (619) 849-2486

Quality Improvement Organization (QIO)

Address: 5055 Ruffin Rd, San Diego, CA 92123 Phone: (858) 573-7300

California Public Health

Address: 5202 University Ave, San Diego, CA 92105 Phone: (619) 229-5400

Enhancing the Quality of Life at Home

INFECTION CONTROL

Standard Precautions

Standard precautions require everyone, from daycare workers and teachers to accountants and auto mechanics, to assume that anyone’s blood and body fluids may carry hepatitis viruses, HIV or other bloodborne infections.

No child is too young to learn health safety. The following is an approach you can take with children under five or six. To help kids understand how invisible germs can pass from one person to the next, put glitter on your child’s hands and let him/her go to the bathroom, play with family members and pick up a cracker (without actually eating it). Then, go back to the beginning of the glitter journey and walk around the house following the trail of glitter. This will help demonstrate to your children how they can pass germs to each other without knowing it.

It’s important to teach children never to reach out and touch another person’s blood or body fluid. One way to help them understand is to ask them if they would touch someone else’s poop or nose gunk. Most kids will say an emphatic “no.” Once you get that all-important “no” response, explain that blood is very personal and they should never touch anyone else’s blood. Reference: www.pkids.org

• Standard Precautions carries a blanket assumption that anyone-rich or poor, fat or thin, young or old-may be infected with a virus.

• Standard precautions require you to always have a barrier between any infectious substance and your skin, eyes, gums, or the inside of your nose.

For more information visit: www.cdc.gov

HAND HYGIENE

According to APIC (Association for Professionals in Infection Control and Epidemiology) an estimated 1.2 million infections occur annually in approximately 8 million adult and pediatric home health care patients in the U.S. Lorian has developed a hand hygiene program in order to prevent health care associated infection. We encourage you to follow the hygiene program as well.

Hand hygiene is the single most important strategy to reduce the risk of transmitting organisms from one person to another.

When should you wash your hands?

• Before, during, and after preparing food

• Before eating food

• Before and after caring for someone who is sick

• Before and after treating a cut or wound

• After using the toilet

• After changing diapers or cleaning up a child who has used the toilet

• After blowing your nose, coughing, or sneezing

• After touching an animal or animal waste

• After touching garbage

What is the right way to wash your hands?

• Wet your hands with clean, running water (warm or cold) and apply soap.

• Rub your hands together to make a lather and scrub them well. Be sure to scrub the backs of your hands, between your fingers, and under your nails.

• Continue rubbing your hands for at least 20 seconds. Need a timer? Hum the "Happy Birthday" song from beginning to end twice.

• Rinse your hands well under running water.

• Dry your hands using a clean towel or air dry them.

What if I don’t have soap and clean, running water?

Washing hands with soap and water is the best way to reduce the number of germs on them. If soap and water are not available, use an alcohol-based hand sanitizer that contains at least 60% alcohol. Alcohol-based hand sanitizers can quickly reduce the number of germs on hands in some situations, but sanitizers do not eliminate all types of germs.

Hand sanitizers are not effective when hands are visibly dirty.

How do you use hand sanitizers?

• Apply the product to the palm of one hand.

• Rub your hands together.

• Rub the product over all surfaces of your hands and fingers until your hands are dry.

Reference from CDC: http://www.cdc.gov/handwashing

Enhancing the Quality of Life at Home TM

URINARY TRACT INFECTION

A Urinary Tract Infection (UTI) can occur in the Urinary System (bladder, urethra, ureters, kidneys). Most UTIs occur in the Lower Urinary Tract (bladder, urethra). Severe infections occur when the kidneys are affected.

Causes, Incidence, and Risk Factors

• A Urinary Tract Infection is usually caused when bacteria enters the bladder via the urethra.

• Women are more likely to suffer from a UTI.

• Risk factors include: Being female, sexually active, menopause, urinary tract abnormality/blockage, immunosuppression, and having a urinary catheter.

• Symptoms include: Urge to urinate, burning sensation with urination, frequent small volume urination, cloudy or dark urine, strong-smelling urine, pelvic pain in women, rectal pain in men.

Tests

• Urine sample for urinalysis or culture/sensitivity

• Ultrasound, CT, radiographic contrast studies

• Cyctoscopy

Treatment

• Antibiotic treatment with Bactrim, Septra, Amoxicillin, Nitrofurantoin, Ampicillin, Cipro, Levaquin, etc.

• Analgesics

• Severe infections could require IV anatibiotics and/or hospitalization

Prevention

• Drink plenty of fluids

• Wipe from front to back (females)

• Empty bladder soon after intercourse

• Avoid irritating feminine products

Reference: Mayo Clinic (August 2012)

WOUND HEALING

The skin is a barrier to the outside world protecting the body from infection, radiation, and extremes of temperature. There are many types of wounds that can damage the skin including abrasions, lacerations, rupture injuries, punctures, and penetrating wounds. Many wounds are superficial requiring local first aid including cleansing and dressing. Some wounds are deeper and need medical attention to prevent infection and loss of function, due to damage to underlying structures like bone, muscle, tendon, arteries and nerves. The purpose of medical care for wounds is to prevent complications and preserve function. While important, cosmetic results are not the primary consideration for wound repair. History is important to understand the circumstances of the injury, because mechanism of injury will significantly affect the care provided. An animal bite will require more medical care than one caused by a fall on the playground. It is important to know the circumstances of the injury to decide how dirty the wound might be, and whether there are any potential underlying injuries. Individuals with diabetes, poor circulation, on dialysis, or taking medications that can compromise the immune system are at higher risk of infection. The decision to repair a wound may also be affected by the patient's medical history. The time frame from when the initial injury occurred and when medical care is sought is also a consideration. The longer a wound is left open, the higher the risk of infection if the wound is sutured.

Reference: http://www.emedicinehealth.com/wound_care/article_em.htm

The gold standard for wound treatment

At Lorian Health we encourage the use of moist wound healing which follows the gold standard for wound treatment. It has been demonstrated that a moist wound will heal faster than a dry wound. A moist wound allows the cells to do the work they need to do in order to heal the injury. Another gold standard which assists wound healing is the use of compression garments to manage edema. Again, the compression encourages healing by allowing vital nutrients and oxygen to cross over to the wound from the vessels.

Diet and wound healing

Diet is a key component for wound healing. Your body uses nutrients from a healthy diet to help fight infection and heal wounds. You can eat a healthy diet by eating a variety of foods from each food group every day. Eat regular meals and snacks to help you eat enough servings from each food group. If you have trouble eating 3 meals a day try eating 5-6 small meals throughout the day instead. Include good sources of protein, zinc and vitamin C in your diet each day. Drink plenty of liquids during and between meals unless your doctor has placed you on a fluid restriction, then you need to discuss this with your doctor. Limit foods that are high in fat, sugar, and salt. These foods are unhealthy choices because they are low in healthy nutrients that are important for healing.

The following are good sources of:

C & B

What is Hepatitis C & B?

Hepatitis C & B is inflammation of the liver caused by the Hepatitis C & B virus.

Who gets Hepatitis C or Hepatitis B?

Anyone can get hepatitis C or B but the following are ways people get infected:

• Being born to a mother with hepatitis C or B

• Having sex with an infected person

• Being tattooed or pierced with unsterilized tools that were used on an infected person

• Sharing needles with an infected person

• Sharing personal items like razors or toothbrushes with an infected person

You cannot get Hepatitis C or B from:

• Shaking hands with an infected person

• Hugging an infected person

• Sitting next to an infected person

Symptoms

Hepatitis C Hepatitis B

• Yellowish eyes and skin

• Longer time to stop any bleeding

• Swollen stomach or ankles

• Easy bruising

• Upset stomach

• Loss of appetite

• Diarrhea

• Dark yellow urine

• Tiredness

• Fever

• Light-colored stools

How are Hepatitis C & B diagnosed?

• Feeling very tired

• Mild fever

• Headache

• Not wanting to eat

• Feeling sick to your stomach/vomiting

• Belly pain

• Diarrhea/Constipation

• Muscle aches and joint pain

• Skin rash

• Yellowish eyes and skin

A simple blood test but your doctor might also recommend a liver biopsy if he thinks there is liver damage or possible chronic hepatitis.

How is Hepatitis treated?

Hepatitis C: usually not treated unless it becomes chronic then it is treated with drugs that slow or stop the virus from damaging the liver.

Hepatitis B: Usually it will go away on its own. You can relieve your symptoms at home by resting, eating healthy foods, drinking plenty of water, and avoiding alcohol and drugs.

How Can Hepatitis C & B be prevented?

• Use a condom when you have sex

• Do not share needles

• Wear latex or plastic gloves if you have to touch blood

• Do not share toothbrushes or razors

• Make sure any tattoos or body piercings you get are done with sterile tools

• Do not donate blood or blood products if you have hepatitis

• Hepatitis B vaccine: it is a series of 3-4 shots

Reference: http://digestive.niddk.nih.gov

Enhancing the Quality of Life at Home TM

FIRE SAFETY

Some statistics from the National Fire Protection Association:

• One home structure fire was reported every 87 seconds in 2009.

• On average, seven people died in home fires every day. Adults 65 and over face the highest risk.

• In 2009, U.S. Fire Departments responded to 362,500 home structure fires at a cost of $7.5 billion in direct damages.

In order to provide a safer environment:

• Plan an escape.

• Have working smoke alarms.

• Have home fire sprinklers.

• Cooking – Have functional cooking equipment. Don’t leave cooking food unattended.

• Heating – Have functional heating equipment. Keep equipment clean and keep a safe distance between heater and other household items.

• Electrical – Keep electrical equipment clean and in good order.

• Candles – Keep a safe distance from other items that can burn. Make sure candles are not left burning while sleeping.

How to make a home fire escape plan

• Draw a map of your home. Show all doors and windows.

• Visit each room. Find two ways out.

• All windows and doors should open easily and be able to use to get outside.

• Make sure your home has smoke alarms. Push the test button to make sure smoke alarm works.

• Pick a meeting place outside your home were everyone can meet.

• Make sure your house/building number can be seen from the street.

• Talk about your plan with everyone in your home.

• Learn the emergency phone number for your fire department.

• Practice your home fire escape drill.

DIABETIC FOOT CARE GUIDELINES

Inspect your feet daily

Check for cuts, blisters, redness, swelling or nail problems. Use a magnifying hand mirror to look at the bottom of your feet. If you are not able to look ask family/friends to help.

Wash your feet in lukewarm (not hot) water

Keep your feet clean by washing them daily. Use only lukewarm water – like you would wash a baby in.

Be gentle when bathing your feet

Wash them using a soft washcloth or sponge. Dry by blotting or patting, and carefully dry between the toes.

Moisturize your feet – but not between your toes

Use a moisturizer daily to keep dry skin from itching or cracking.

Cut nails carefully

Cut them straight across and file the edges. Don’t cut nails too short, as this could lead to ingrown toe nails. If you have concerns about your nails, consult your doctor. Medicare benefit allows for a podiatry visit monthly and a pair of new shoes yearly.

Never treat corns or calluses yourself

No “bathroom surgery” or medicated pads. Visit your doctor for appropriate treatment.

Wear socks to bed

If your feet get cold at night, wear socks. Never use a heating pad or hot water bottle.

Shake out your shoes and feel the inside before wearing

Remember your feet may not be able to feel a pebble or other foreign object so always inspect your shoes before putting them on.

Keep your feet warm and dry

Don’t let your feet get wet in snow or rain. Wear warm socks and shoes in the winter.

Never walk barefoot

Not even at home! Always wear shoes or slippers. You could step on something and get a scratch or cut.

Take care of your diabetes

Keep your blood sugar levels under control.

Don’t smoke

Smoking restricts blood flow in your feet.

Get periodic foot exams

Seeing your foot and ankle doctor on a regular basis can help prevent the foot complication of diabetes.

Enhancing the Quality of Life at Home

DIABETES PATIENT SELF-CARE WORKBOOK

Take this booklet with you to your doctor appointment

What does Diabetes mean?

• Diabetes is a disease in which the body does not make or properly use insulin. Insulin is a hormone produced by the pancreas. Insulin is needed to turn sugar, starches, and other food into energy. When you have diabetes, your blood glucose (sugar) level becomes high and must be controlled.

• There are 2 main types of diabetes:

• Type 1 - The body does not make any insulin. Insulin must be taken every day.

• Type 2 - The most common type of diabetes. The body does not make or use insulin well. Insulin or pills are taken to control Type 2 diabetes.

• It is very important to get your diabetes under control.

• Diabetes can lead to many health problems including:

• Heart disease and stroke

• Eye disease that can cause problems with your eyesight

• Kidney problems

• Nerve damage that can cause numbness and tingling in your hands and feet

• Gum disease and loss of teeth

Know the “ABCs” of Diabetes

• “A” is for the A1C test. This is a blood test that shows how well your blood glucose has been controlled over the last 3 months. Your A1C goal should be less than 7%. You should have this test at least 2 times each year.

• “B” is for Blood pressure. High blood pressure makes your heart work too hard and can cause heart disease, stroke, and kidney problems. The blood pressure goal when you have diabetes is 130/80 or less.

• “C” is for Cholesterol. Bad cholesterol (”LDL” level) clogs up your blood vessels and can lead to heart disease and strokes. Your LDL goal should be less than 100.

Diabetes can be managed

This workbook was put together to help you understand your role (”self-care”) in keeping your diabetes under control. Self-care includes: See: http://www.diabeteseducator.org/ (AADE7TM)

1. Healthy Eating: Following your diabetes food plan

2. Being Active Exercising and staying active

3. Monitoring: Checking your blood glucose regularly and knowing when to take action

4. Taking Medications: Taking your medicines correctly as ordered by your doctor

5. Problem Solving: Knowing when to take action if you have a problem (example: Low blood sugar)

6. Reducing Risks: Taking care of and checking your feet every day, not smoking, seeing your doctor regularly, and seeing an ophthalmologist regularly

7. Healthy Coping: Having a support network and ways to manage tough times

DIABETES PATIENT SELF-CARE WORKBOOK

Medication:

• There are several types of medicines that your doctor may prescribe to manage your diabetes.

• You may be on more medicines than these.

• Your doctor, nurse, or pharmacist will give you more specific information about your medicines.

• Always check before taking over-the-counter medicine or herbal supplements. Some of these medicines may interact with your prescribed medicines and cause problems.

• Your home care nurse will work with you to make sure you understand all of your medicines.

• If you often forget to take your medicine, your nurse can show you different ways to help you remember to take your medicine at the right times.

DIABETES MEDICINES:

Oral diabetes medicines

These medicines work in a variety of ways to keep your blood glucose under control. For example, some increase the amount of insulin made by the pancreas and some may decrease absorption of glucose in the intestines.

I am taking:

Insulin

Some persons with Type 2 diabetes will need insulin injections to get the blood glucose under control. Type 1 diabetics must have insulin. Insulin is given one or more times per day. There are several different types of insulin. Some are long acting and may be given once per day. Intermediate acting insulin is ofter given two times per day. Short acting insulin is taken more often, usually based on blood glucose level.

My insulin type(s) and schedule:

High blood pressure medicines

If you have diabetes and high blood pressure, you should be taking a certain type of medicine –either an “ACE Inhibitor” or an “ARB.” These drugs work by opening up your blood vessels.

I am taking:

Cholesterol lowering medicines

If your LDL level is high, you should be taking a medicine to bring your LDL level to less than 100. A common type of cholesterol medicine is called a “statin.”

I am taking:

Enhancing the Quality of Life at Home TM

Blood Glucose Levels:

Your nurse will teach how to check your blood glucose levels using a machine called a “glucometer.” This involves a small prick of your finger to obtain blood. Glucometers and test strips measure glucose using “whole blood” or “plasma.” Find out which type you use. Ask your doctor or nurse about how often you should check your blood glucose levels.

General guidelines for your blood glucose levels are:

Goals for your blood glucose levels:

Talk to your doctor about how often you should check your blood glucose and your expected blood glucose levels.

Before meals: Between and

At bedtime: Less than

Low Blood Glucose (hypoglycemia)

If you have the following symptoms, your blood glucose level may be too low.

• Feeling weak

• Feeling dizzy

• Sweating

• Feeling changes in your heartbeat

• Feeling hungry

Check your blood glucose right away.

If it is less than 70, eat one of the following right away:

• 2 or 3 glucose pills

• ½ cup of fruit juice

• ½ cup of regular, non-diet soda

• 1 cup of milk

• 5-6 pieces of hard candy

Check your blood glucose after 15 minutes. It should return to a healthier level (90-130).

If it as at least 1 hour before your next meal, eat a snack.

Diet:

To keep your blood glucose at a healthy level, you should:

• Eat about the same amount of food each day.

• Eat your meals and snacks at about the same time each day.

• Do not skip meals.

• Take your medicines at the same time each day.

• Exercise at about the same time each day.

You should already have a Diabetes Meal Plan that fits your eating habits, your routine, and your diabetes medicines. If you do not, your home care nurse should refer you to a diabetes educator or dietitian. The diet for a person with diabetes is basically a healthy and balanced diet. You should eat foods that are low in fat and salt to decrease high blood pressure and heart problems.

Your Diabetes Meal Plan is based on:

• your size,

• any need to lose weight, and

• your amount of exercise.

Fill in the amount of servings that your diabetes educator has recommended that you eat from each food group:

Starches

Vegetables

Fruits

Milk and yogurt

Meat or meat substitute

Fats

Foot Care:

• Foot care is very important.

• Nerve damage can cause a lack of feeling (numbness).

• You may not feel the pain of an injury.

• Cuts, blisters, or sores may heal slowly and you are at risk for serious infection.

Things I should do:

• Check my feet every day for sores, red spots, or swelling.

• Wash my feet every day in warm water and dry them well.

• Keep my skin soft and smooth by using lotion over the top and bottom of my feet but not between toes.

• Keep my toenails trimmed.

• Wear well fitting shoes and socks at all times.

• Get rid of poorly fitting shoes.

• Protect feet from hot and cold.

• Ask my nurse or doctor to check my feet with each visit.

DIABETES PATIENT SELF-CARE WORKBOOK

Activity and Exercise:

• Exercise is very important when you have diabetes.

• Exercise keeps you healthy and helps to control your blood glucose.

• It is important to start slowly when you are not used to exercise. A home physical therapist can help you begin your exercise program.

You will be instructed in ways to safely exercise such as:

• Drink water before and after you exercise.

• Warm up and cool down for 5-10 minutes before and after exercising. For example, walk slowly before you start and after you finish your exercise.

• Test your blood glucose before and after exercise. If your blood glucose is less than 100, eat a small snack first. Do not exercise if your blood glucose is over 300.

• Know symptoms of low blood glucose (hypoglycemia) and how to treat it.

• Keep glucose pills or hard candy handy when you exercise in case of a low blood glucose reaction.

• Teach your family and friends about the symptoms of low blood glucose and actions to take.

• Check your feet for redness or sores after exercising.

Telehealth Strategies...

In addition to seeing you in your home, your home care nurse may also suggest or use “telehealth” to monitor your diabetes.

What is telehealth ?

1. Your home care nurse calls you on the phone – simple telephone monitoring. You will be asked questions about your blood glucose levels, or if you are having any symptoms. Your nurse will review information you need to know to better manage your diabetes.

Example Question: “What was your blood glucose level this morning?”

2. Telemonitoring

A monitoring system is placed in your home. This may include a blood pressure cuff, and other devices, such as a glucometer. The monitor may also include questions on a computer that you answer each day. Some systems include computer screens where you and your nurse can see each other while you talk. Your nurse may watch you draw up your insulin. Your nurse will teach you how to use the telemonitoring system. Your information (blood glucose level, blood pressure, etc.) is sent to the home care agency computer, usually over the telephone lines. A nurse at the agency checks your information every day. If there are changes, your nurse will call you or visit you at home.

3. You call the home care agency

Your blood glucose may be up, you may notice a sore on your foot, or you may be having symptoms. You may just want to ask a question.

Example Question: “I have a blister on my toe that I hadn’t noticed before. What should I do?”

The home care nurse may give you advice over the telephone, may want to see you at your home to check your condition, or may tell you to call 911 if your symptoms are severe.

TOLL FREE : 1-877-LORIAN-5 (1-877-567-4265)

DIABETES PATIENT SELF-CARE WORKBOOK

DIABETES CARE RECORD:

Take this record with you to your doctor appointment. Write down and keep track of your results.

A1C (blood glucose)

Date:

My A1C:

Blood Pressure (BP)

Date:

My BP:

Weight

Date:

My Weight:

Dental Exam

Date:

• At least 2 times per year

• Usual goal is < 7%

Do the following at least 1 time per year:

Cholesterol blood test

Usual goal is LDL level <100

Results:

• Each home visit and doctor appointment

• Usual goal is < 130/80

Dilated eye exam

Results:

Complete foot exam

Results:

• Each doctor appointment

Kidney Check (blood work and urine test)

Results:

Flu Shot

• At least 2 times per year

YOUR ACTION PLAN:

Date:

Date:

Date:

Date:

Date:

Do the following at least once:

Date:

Pneumonia Shot

Use this guide to help you report changes in your symptoms to your doctor or home care provider. Reporting symptoms early may keep you out of the hospital.

You are doing WELL when:

• Your A1C level is under 7%

• Your average blood glucose levels are usually less than 150

• Most fasting blood glucose levels are less than 150

Call your home care nurse or doctor when:

• Your A1C is between 7 and 9

• Your average blood glucose levels are between 150 and 210

• Most fasting blood glucose levels are between 150 and 200 You may need to improve your diet, increase activity, or change medicines

Call your doctor RIGHT AWAY when:

• Your A1C is greater than 9

• Your blood glucose levels during the day are over 210

• Most fasting blood glucose levels are over 200 You need to be evaluated by a doctor

Reference: www.improvingchroniccare.org/tools/criticaltools.html

DIABETES PATIENT SELF-CARE WORKBOOK

MY PERSONAL PLAN:

I would like to work on the following areas to manage my diabetes:

Taking My Medicine

Regular Exercise Foot Care

Eating Healthy Other

My GOAL for the next month is:

Possible problems in meeting my goal:

Things that would help me meet my goal:

This material prepared by OASIS Answers, Inc. (www.oasisanswers.com), and is provided by the West Virginia Medical Institute, Inc. the Quality Improvement Organization supporting the Home Health Quality Campaign, under contract with the Centers for Medicare & Medicaid Services (CMS), an agency of the U.S. Department of Health and Human Services. The contents presented do not necessarily reflect CMS policy. Publication number: 9SOW-WV-HH-BBK-012711J App. 01/11.

HEART FAILURE (HF) SELF-CARE WORKBOOK

Take this booklet with you to your doctor appointment

What does Heart Failure mean?

• It means that your heart does not pump enough blood to meet your body’s needs.

• Blood can “back up” in your lungs.

• Too much blood in your lungs causes shortness of breath.

• You may cough more or wake up at night short of breath.

• Blood can also “back up” in other parts of your body.

• You may have swelling in your legs and feet or in your abdomen.

• You may also feel tired and not feel like eating.

Heart failure can be managed

This booklet was put together to help you understand your role (“self-care”) in keeping your heart failure under control.

Self-care includes:

1. Taking your medicines as ordered by your doctor

2. Decreasing the amount of sodium in your diet

3. Avoiding alcohol

4. Exercising and staying active

5. Checking your weight daily and taking action right away when your weight goes up

6. Monitoring yourself for symptoms and taking action right away when they occur

7. Seeing your doctor regularly

Understanding your symptoms

• It is important to understand the symptoms that you have when your heart failure worsens.

• You will tend to have the same symptoms each time your heart failure worsens.

Symptoms I have had are:

HEART FAILURE (HF) SELF-CARE WORKBOOK

Medicines:

• There are 4 types of medicines that are usually used to manage heart failure.

• You may be on more medicines than these.

• Your doctor, nurse, or pharmacist will give you more specific information about your medicine.

• Always check before taking over-the-counter medicine or herbal supplements.

• Some medicine can be harmful for patients with heart failure.

• Your home care nurse will work with you to make sure you understand all of your medicines.

• If you often forget to take your medicine, your nurse can show you different ways to help you remember to take your medicine at the right times.

HEART FAILURE MEDICINES:

Diuretics (“water pills”)

These drugs work in your kidney and help you get rid of extra fluid and sodium through your urine.

I am taking:

Angiotensin converting enzyme (ACE) inhibitor

These drugs work to open up blood vessels. This makes it easier for your heart to pump. Blood pressure is lowered. Use of ACE inhibitors for heart failure contributes to a longer, healthier life. Someone who cannot tolerate an ACE inhibitor may be prescribed an Angiotensin II Receptor Blockers (ARBs) instead.

I am taking:

Beta blockers

These drugs work to improve heart muscle function and block chemicals that can make your heart failure worsen. Blood pressure is lowered. Use of beta blockers in heart failure contributes to a longer, healthier life.

I am taking:

Digoxin

Digoxin makes your heart beat stronger and at a regular rhythm and helps to reduce heart failure symptoms. Your nurse will teach you to check your pulse when you are on Digoxin. Call if your pulse is less than

I am taking:

HEART FAILURE (HF) SELF-CARE WORKBOOK

Diet & Nutrition:

• Sodium makes your body retain fluid.

• Too much fluid makes your heart work harder and can make your heart failure worse.

• Your weight will increase and you may develop symptoms.

• Try to keep your sodium intake about 2000 milligrams (mg) per day or as ordered by your doctor.

• Salt is a major source of sodium. One teaspoon of salt contains 2400 mg of sodium!

• Your nurse or a dietitian will help you look at your own diet, help you read food labels, and can give you lists of foods that are high and low in sodium.

• Avoid alcohol as it can make your heart failure worsen.

• Some patients with heart failure should limit the amount of liquids they drink. Ask your doctor or nurse about this.

I should limit my liquids to:

How can I lower my sodium intake?

Check off the things you think you can do.

� Do not add salt to my foods during cooking.

� Take the salt shaker off of my kitchen table.

� Try other seasonings to add flavor such as lemon juice, onion or garlic powder, or herbs.

� Read food labels to see which foods are high in sodium.

I will avoid high sodium foods such as:

� Canned soups and vegetables

� Hot dogs or packaged lunch meats

� Cheese and cheese spreads

� Deli meats such as ham

� Ketchup, soy sauce, salad dressings, barbeque sauce

� Frozen dinners that are high in sodium

I will eat lower sodium foods more often such as:

� Lean meats

� Low fat milk

� Reduced sodium cheese

� Cereals low in sodium

� Fresh fruits and vegetables

When going out to eat, I will:

� Choose items that are listed as “healthy choice” or “low sodium” on the menu

� Choose broiled or grilled foods instead of fried foods

� Ask for sauces and salad dressings “on the side”

HEART FAILURE (HF) SELF-CARE WORKBOOK

Staying Active and Safe:

• Exercise provides many benefits for you when you have heart failure.

• Activities such as walking, bike riding, or swimming are good exercise options.

• Exercise will:

• Improve your muscle tone

• Strengthen your heart

• Increase your energy

• Make you feel better

• Before starting an exercise program, your heart failure should be stable.

• Your weight should be at baseline and you should not be experiencing symptoms.

• It is important to start slowly when you are not used to exercising.

• A home physical therapist can help you begin your exercise program.

You should monitor yourself for fatigue and shortness of breath when you exercise. Your home care nurse or therapist will teach you how to use the Borg scale so that you can rate your shortness of breath and/or fatigue during activity and exercise.

Modified Borg Scale

0 No breathlessness/fatigue at all

1 Very Slight Breathlessness/Fatigue

2 Slight Breathlessness/Fatigue

3 Moderate Breathlessness/Fatigue

4

Somewhat Severe Breathlessness/Fatigue

HEART FAILURE (HF) SELF-CARE WORKBOOK

Telehealth Strategies...

In addition to seeing you in your home, your home care nurse may also suggest or use “telehealth” to monitor your heart failure.

What is telehealth ?

1. Your home care nurse calls you on the phone – simple telephone monitoring. You will be asked questions about your daily weights or if you are having symptoms. Your nurse will review information you need to know to better manage your heart failure.

Example Question: “Are you having any increased swelling?”

2. Telemonitoring

A monitoring system is placed in your home. This may include a special scale, blood pressure cuff, and other device(s). The monitor may also include questions on a computer that you answer each day. Some systems include computer screens where you and your nurse can see each other while you talk. Your nurse will teach you how to use the telemonitoring system. Your information (weight, blood pressure, etc.) is sent to the home care agency computer, usually over the telephone lines. A nurse at the agency checks your information every day. If there are changes, your nurse will call you or visit you at home.

3. You call the home care agency

Your weight may be up or you are having symptoms. You may just want to ask a question.

Example Question: “I feel out of breath, even when I’m resting! What should I do?”

The home care nurse may give you advice over the telephone, may want to see you at your home to check your condition, or may tell you to call 911 if your symptoms are severe.

MANAGING YOUR CONDITION Sudden weight gain

A sudden increase in weight means that your body is retaining fluid. If your weight goes up, this is the time to TAKE ACTION. Do not wait for other symptoms to occur. An extra diuretic pill for a day or two is usually prescribed until your weight comes back down.

Action taken right away will help keep you out of the hospital.

If you do have a weight gain, think about possible reasons why?

• Did I forget to take my medicine?

• Did I eat high sodium foods in the last few days?

HEART FAILURE (HF) SELF-CARE WORKBOOK

DAILY WEIGHT LOG

Record your weight each day: same scale, same time of day, same type of clothing.

REPORT! Weight gain of or more pounds within a day period

YOUR ACTION PLAN:

Use this guide to help you report changes in your symptoms to your doctor or home care provider. Reporting symptoms early may keep you out of the hospital.

You are doing WELL when:

• Your weight is stable

• You have no trouble breathing

• You can do your normal activities

• You have no changes in your symptoms

Call in the next 24 hours when:

• Your weight goes up pounds in days

• You have new swelling in your feet, ankles, hands, or abdomen

• You have a dry, harsh cough that does not go away

• You use 2 or more pillows or a recliner to breathe better at night if this is different from how you usually sleep

• You feel more tired or have less energy than usual

• You have side effects from your medicines

Call your doctor RIGHT AWAY when:

• You have trouble breathing –

• Call 911 for severe shortness of breath

• You feel dizzy

• You feel very anxious

• Call 911 if you have chest pain that does not go away

HEART FAILURE (HF) SELF-CARE WORKBOOK

I would like to work on the following areas to manage my heart failure:

My GOAL for the next month is:

Possible problems in meeting my goal:

Things that would help me meet my goal:

This material prepared by OASIS Answers, Inc. (www.oasisanswers.com), and is provided by the West Virginia Medical Institute, Inc. the Quality Improvement Organization supporting the Home Health Quality Campaign, under contract with the Centers for Medicare & Medicaid Services (CMS), an agency of the U.S. Department of Health and Human Services. The contents presented do not necessarily reflect CMS policy. Publication number: 9SOW-WV-HH-BBK-012711M App.

HOME ENVIRONMENT SAFETY EVALUATION

Check Yes or No for each of the following items. For all “No” responses, identify in the space provided the item number and the action plan to correct the problem. All 18 items are applicable to every patient and should be answered.

Yes Enhancing the Quality of Life at Home TM TOLL FREE : 1-877-LORIAN-5 (1-877-567-4265) www.lorianhealth.com

1. There is a working telephone and emergency number accessible

2. Electric cords and outlets appear to be in good repair in the patient area

3. There is a functional smoke alarm

4. Fire extinguisher is available and accessible

5. Access to outside exits is free of obstruction

6. Alternative exits are accessible in case of a fire

7. Walking pathways are level, uncluttered, and have non-skid surfaces

8. Stairs are in good repair, well lit, uncluttered, have non-skid surfaces, or there are no stairs

9. Lighting is adequate for safe ambulation and ADL

10. Handrails are present if applicable

11. Temperature/ ventilation is adequate

12. Poisonous/ toxic substances are clearly labeled and placed where client can reach, as needed, but not within reach of children

13. Bathroom is safe for provision of care

14. Oxygen safety

a. Are there smoking materials in the home

b. Are there oxygen alert signs in place

c. Are there potential risks for open flames

d. Are there emergency backup tanks available

15. Overall environment is sanitary for provision of care

16. An emergency preparedness plan is in place and has been discussed

# Action Plan Pt verbalized understanding of corrections suggested

Additional Comments:

A MEDICARE-CERTIFIED HOME HEALTH AGENCY Serving California and Nevada Documents 51

CLARIFICATION OF HOMEBOUND STATUS

For a patient to be eligible to receive covered Home Health services, Medicare requires that a physician certifies in all cases that the patient is homebound, i.e. the patient is confined to his or her home. To be considered homebound, there must be a normal inability to leave the home, or leaving the home would require a considerable and taxing effort on the part of the patient, or would be a risk factor to the patient.

The patient’s absence from home may be considered evidence that the patient is not homebound except under the following circumstances:

Any absence attributable to the need to receive health care treatment, including regular absences for the purpose of participating in therapeutic, psychosocial, or medical treatment in a licensed or certified adult day-care program.

Any absence for the purpose of attending a religious service.

Any other absence that is infrequent or of a relatively short duration.

Your homebound status will be reflected and documented frequently in the medical record.

By signing the Patient Service Agreement on page 53, you are acknowledging your understanding of the Medicare requirements and regulations regarding “homebound status”.

If Medicare is not providing payment for your home health services, then you are not required to meet homebound criteria.

PROCEDURE FOR REQUESTS AND COMPLAINTS

Lorian Health (Lorian) wants to provide you the best possible service. For that reason, in the event that you are unhappy with anything having to do with our delivery of your care, please do not hesitate to notify Lorian directly at (877) 567-4265. We appreciate the opportunity to improve our service, deliver you better care, and resolve any complaints you may have. There will be no ill effects or repercussions to you involving your complaint or request for any change in service provider, or in response to any other reasonable request you may have that would result in your improved satisfaction with our care delivery.

In the event we are unable to satisfy your needs and you feel you would like to file a formal complaint with Lorian’s supervising entity, there is a licensing body available to you 24 hours a day, 7 days a week that you may call toll free to report your complaint. Below is the following information relating to that licensing body:

For Lorian Health San Diego County California Department of Public Health, Licensing and Certification, Northern San Diego District, 7575 Metropolitan Drive, Suite 104, San Diego, CA 92103

Make confidential complaints, including complaints concerning advanced directives, to the California Department of Public Health, Licensing and Certification Division without being subject to discrimination or reprisal. The home health hotline number for registering a complaint is (800) 824-0613, and it may be used 24 hours per day, 7 days a week.

For Lorian Health Orange County and Riverside County

JCAHO: available 8½ hours a day 5 days a week (Central time) that you may call toll free to report your complaint. Office of Quality Monitoring, The Joint Commission One Renaissance Boulevard, Oakbrook Terrace, Illinois 60181 and the e-mail address is complaint@jointcommission.org.

Make confidential complaints, including complaints concerning advanced directives, to the Office of Quality Monitoring, Joint Commission without being subject to discrimination or reprisal. The home health hotline number for registering a complaint is (800) 994-6110, and it may be used from 8:30 am to 5:00 pm Monday through Friday Central time. The fax number is (630) 792-5636.

Riverside County: You may also contact California Department of Public Health 7 days a week/24 hours a day without being subject to discrimination or reprisal. The mailing address is 625 E. Carnegie Dr., Suite 280, San Bernardino, CA 92408 and the home health hotline number for registering a complaint is (888) 354-9203.

Orange County: You may also contact California Department of Public Health from 8:00 am to 5:00 pm Monday through Friday without being subject to discrimination or reprisal. The mailing address is 681 S. Parker Street, Suite 200, Orange, CA 92868 and the home health hotline number for registering a complaint is (800) 228-5234.

For Lorian Health San Bernardino County

California Department of Public Health, Licensing and Certification, 464 West Fourth Street, Suite 529, San Bernardino, CA 92401

Make confidential complaints, including complaints concerning advanced directives, to the California Department of Public Health, Licensing and Certification Division without being subject to discrimination or reprisal. The home health hotline number for registering a complaint is (800) 344-2896.

For Lorian Health Los Angeles County

California Department of Public Health, Licensing and Certification, 12440 E. Imperial Highway, Room 522, Norwalk, CA 90650

Make confidential complaints, including complaints concerning advanced directives, to the California Department of Public Health, Licensing and Certification Division without being subject to discrimination or reprisal. The home health hotline number for registering a complaint is (800) 228-1019.

For Lorian Health Clark County

Department of Health and Human Services, Bureau of Health Care Quality & Compliance, Southern Nevada District Office, 4420 South Maryland Parkway, Suite 810, Las Vegas, Nevada 89119

Make confidential complaints, including complaints concerning advanced directives, to the State Department of Health and Human Services Licensing and Certification Division without being subject to discrimination or reprisal. The home health hotline number for registering a complaint is (800) 225-3414, and it may be used 24 hours per day, 7 days a week.

PHOTO CONSENT FORM

The undersigned does hereby authorize

LORIAN HEALTH

and/or its associates, assistants to photograph

Name (please print):

The undersigned authorizes Lorian Health to permit the use and display of said photographs for the purpose of providing information to physicians, medical institutions and constituent departments.

The undersigned agrees that Lorian Health may use name, likeness or biographical information supplied by the undersigned.

The undersigned releases and forever discharges Lorian Health, its agents, officers and employees from any and all claims and demands arising out of or in connection with the use of said photographs / images, including but not limited to, and claims for invasion of privacy or defamation.

Accepted and Agreed:

Patient Signature Date

PHYSICIAN AUTHORIZATION OF PATIENT TO PARTICIPATE IN LORIAN HEALTH

WIRELESS HOME MONITORING PROGRAM

Dear Physician,

Lorian Health is offering a new benefit to our home health patients. We have implemented a wireless home monitoring program with the primary goal of decreasing morbidity and mortality as well as preventing hospitalizations among homebound patients by detecting early signs of deterioration and intervening quickly before health status worsens.

We believe your patient , DOB: who was referred to us for home health services would be a good candidate for this program. We are writing to obtain your authorization for this patient to participate in our program, as well as to obtain standing orders that will be used in conjunction with our program. We also request that you send us by fax the patient’s most up-to-date health records, including medication lists, problem lists, relevant diagnostic studies and most recent clinic notes pertaining to the patient’s ongoing health conditions as listed below:

I would like to have access to my patient’s telehealth information. Initial:

Thank you for your cooperation, and we look forward to providing excellent care to your patient!

Sincerely,

Lorian Health Staff

Tel: (877) 567-4265

Fax: (619) 280-8150

Authorization

(physician printed name) authorize my patient: (patient’s name) to participate in Lorian Health’s Wireless Home Monitoring Program, which includes the use of standing orders that I have indicated below on the attached forms.

I,

Signature Date

PATIENT SERVICE AGREEMENT / MSP / ACKNOWLEDGEMENT RECEIPT & EXPLANATION

I. Request for Admission & Authorization to Treat & Release of Information

I hereby request admission to Lorian Health (Lorian), and I consent to such care and treatment as is ordered by my physician through the home health program. I authorize release of all medical records necessary for reimbursement, care coordination purpose and for licensing/accreditation bodies.

II. Financial Responsibility Statement

Medical Statement. Assignment of benefits: I hereby request payment and assign any benefit due to me under the terms of any policy or policies and/or Title XVIII of the Social Security Act that may cover my Home Health visits, to be paid directly to Lorian for services rendered, but not to exceed the regular charges, or the maximum amount allowed by Medicare, or Payor for the care given. If a copay is required such charges will be documented on page 69. Further, I understand that if at any point Medicare regulations or specific Payor criteria determine skilled services are no longer covered, I will be immediately informed and will be given the option to discharge services or make other payment arrangement (see page 69). When this occurs the financial data previously given will be canceled and new financial data will be filled out determining the new payment source and amount (see page 69). Medicare/Medi-Cal reimbursement is accepted as full payment; however, I agree to make a good faith effort in notifying Lorian of any change in insurance payor source as soon as possible. Upon admission I am responsible for notifying Lorian or anytime during my service with Lorian if I am to receive, or Have received, any other services outsourced by another provider, i.e. Outpatient Therapy, Medical Supplies Provider, or another Home Health Agency. If I do not inform Lorian that I am receiving outsourced services by another provider, I understand that I may be held responsible for any outstanding payment due to the servicing provider(s). If i have been fully transparent of information that i am aware of and no fault of my own have not informed Lorian, Lorian in return will never pursue me for losses incurred by Lorian for services on my behalf. If the aforesaid agreement is breached and it is found that I have not complied with my obligations, Lorian will hold me responsible at a rate of $347.00 per visit upon the date that I am found negligible of the aforesaid agreement.

III. I hereby acknowledge receipt, explanation, and understanding of the following:

Clinician has reviewed/instructed me on the following checked boxes: ____________ Clinician Initial _________ Patient Initial

□ 24 Hour Home Health Hotline – Inside front cover

□ Patient Rights & Responsibilities – page 1

□ Health Info Portability and Accountability Act (HIPAA) – page 4

□ Advance Directives and Patient Education Packet – page 10

□ Basic Home Safety & Waste Disposal Tips – page 13

□ Home Environment Safety Evaluation – page 51

□ Clarification of Homebound Status – page 53

□ Procedure for Requests and Complaints – page 55

□ Photo Consent Form – page 57

□ Wireless Home Monitoring Program Physician Authorization – page 59

□ Financial Responsibility & Payment Expectation (Section II above & Documents 69).

Patient Name ______________________________________________ Patient ID ____________________________________

I have reviewed and agreed to everything above.

Patient Signature ____________________________________________ Date ________________________________

Witness Name & Title _________________________________________ Date ________________________________

I have reviewed the above information with the patient and confirmed they fully understand everything.

Witness Signature ___________________________________ __________ Title ________________________________

YOUR PLAN FOR HOME HEALTH

What is your goal that home heath can assist you with?

Planned home health team members:

Nurse ___________________________ times per week

Physical Therapist ___________________________ times per week

Occupational Therapist________________________times per week

Speech Therapist ____________________________times per week

Home Health Aide ____________________________times per week

Social worker ____________________________times per week

Treatments to be done by your home health team:

Nurse:__________________________________________________________

Physical Therapist:_________________________________________________

Occupational Therapist:_____________________________________________

Speech Therapist:__________________________________________________

Home Health Aide: ________________________________________________

Social Worker:____________________________________________________

Special instructions you need to know regarding your health or home care:

See attached medication list and instructions.

If you have any questions about your healthcare- we want to know! Please give us a call

Patient Name:

BENEFICIARY ELECTED TRANSFER

Date: Facility:

Address: Tel: RE: Beneficiary Elected Transfer

Patient: HIC#: Effective Date:

To Whom It May Concern:

According to the Regional Home Health Intermediaries (RHHI) inquiry system, patient , HIC no. , has established a plan of home health treatment with your agency. At the request of the beneficiary, services have transferred to our agency (pursuant to section 201.8 of Medicare Home Health Regulations). We wish to inform you of the Beneficiary Elected Transfer (BET). Our agency’s start of care date for services began on the day of .

The beneficiary’s attending physician, has also been informed of the transfer the beneficiary elected to make. Please contact our office should any questions arise regarding this matter.

Sincerely,

Beneficiary Elected Transfer Patient Verification

To Whom It May Concern:

I hereby acknowledge, as of the day of , Lorian Health will be my official provider of home health services rendered to me. No longer should any other agency resume responsibiity or receive compensation for care provided to me.

Patient’s Name (Please print)

Patient’s Signature Date

NOTICE OF MEDICARE PROVIDER NON-COVERAGE

OMB Approval No. 0938-0953

Patient Name: Medicare/Insurance

Number:

The effective date coverage of your current home health services will end:

Your provider had determined that Medicare or current Health Insurance carrier will not pay for your current home health services after the effective date indicated above. You may have to pay for any home health services you receive after the above date.

Your right to appeal this decision

• You have the right to an immediate, independent medical review (appeal), while your services continue, of the decision to end Medicare or current Insurance carrier coverage of these services.

• If you choose to appeal, the independent reviewer will ask for your opinion and you should be available to answer questions or supply information. The reviewer will also look at your medical records and/or other relevant information. You do not have to prepare anything in writing, but you have the right to do so if you wish.

• If you choose to appeal, you and the independent reviewer will each receive a copy of the detailed explanation about why your coverage for services should not continue. You will receive this detailed notice only after you request an appeal.

• If you choose to appeal, and the independent reviewer agrees that services should no longer be covered after the effective date indicated above, Medicare or current Insurance carrier will not pay for these services after that date.

• If you stop services no later than the effective date indicated above, you will avoid financial liability. Should you choose to continue services you will be responsible for the cost of each visit at a rate of $347.00 dollars per visit.

How to ask for an immediate appeal

• You must make your request to your Quality Improvement Organization (also known as a QIO). A QIO is the independent reviewer authorized by Medicare to review the decision to end these services.

• Your request for an immediate appeal should be made as soon as possible, but no later than noon of the day before the effective date indicated above.

• The QIO will notify you of its decision as soon as possible, generally by no later than two days after the effective date of this notice.

• Call your QIO at: Livanta, LLC (877) 588-1123 to appeal, or if you have questions. (NV) Health Insight (702) 385-9933

TOLL FREE : 1-877-LORIAN-5 (1-877-567-4265)

NOTICE OF MEDICARE PROVIDER NON-COVERAGE

Continued on from front

Other appeal rights

• If you miss the deadline for filing an immediate appeal, you may still be able to file an appeal with a QIO, but the QIO will take more time to make its decision.

• Contact 1-800-MEDICARE (1-800-633-4227), or TTY/TDD: 1-877-486-2048 for more information about the appeals process.

Additional information (optional)

Please sign below to indicate that you have received this notice.

I have been notified that coverage of my services will end on the effective date indicated on this notice and that I may appeal this decision by contacting my QIO.

Signature of Patient or Authorized Representative

Form No. CMS-10123

Exp. Date 06/30/2008

According to the Paperwork Reduction Act of 1995, no persons are required to respond to a collection of information unless it displays a valid OMB control number. The valid OMB control number for this information collection is 0938-0953. The time required to prepare and distribute this collection is 5 minutes per notice, including the time to select the preprinted form, complete it and deliver it to the enrollee. If you have comments concerning the accuracy of the time estimates or suggestions for improving this form, please write to CMS, PRA Clearance Officer, 7500 Security Boulevard, Baltimore, Maryland 21244-1850.

C-500 PATIENT TRANSFER/DISCHARGE PROCESS

POLICY

Discharge Planning is initiated for every home health care patient at the time of the patient’s admission for home health care. When the RN/therapist identifies a patient for discharge, the RN/therapist is required to contact the DOPCS and/or Clinical Manager to best determine the appropriateness of the discharge. The final determination to discharge will be per coordination and review between the clinician and the clinical manager. Additionally, RN/therapist will provide advanced notice to patient, family, and physician regarding plans to discharge/change the POC.

PURPOSE

1. To ensure continuity of a patient’s health care needs when the patient is discharged or transferred to another health care provider.

2. To collect data necessary for statistics, audits, and outcome measurement.

SPECIAL INSTRUCTIONS

1. The patient’s discharge potential shall be assessed during the admission visit. The discharge plans shall be discussed with the patient/caregiver as soon as it’s appropriate.

2. The patient’s discharge potential shall be documented on the Plan of Treatment/485.

3. The discharge plan will be discussed with the physician prior to discharge. Ongoing care needs will be identified.

4. The RN/therapist shall meet with other personnel involved in the patient’s care to review the impending discharge, ensuring that the patient meets the discharge criteria.

5. The RN/therapist shall review the electronic clinical record to assure accuracy and completion. A Discharge Plan should be developed which includes written/verbal instruction regarding the patient’s ongoing care needs and available resources.

6. The RN/therapist shall ensure that the treatment goals and patient outcomes have been met or, if unmet needs are present, the appropriate referrals are made to agencies/institutions to meet continuing patient needs.

7. Upon discharge to self-care, the patient will receive verbal/written information regarding community services, medication use, any procedures/treatments to be performed, and follow-up visits for physician care.

8. To avoid charges of “abandonment”, Lorian documentation will include the following:

•Evidence that the decision was not made unilaterally further showing that the patient, family, and physician participated in the decision to discharge patient from Lorian.

•Evidence that the patient no longer qualifies for home health care services.

•If there are unmet needs, and Lorian is no longer able to meet those needs, electronic documentation will demonstrate that appropriate notice was given (verbal and written) and referrals made as indicated.

•Documentation of all communication with the patient, including the rationale for discharge, will be kept in the patient electronic file with copies sent to the primary physician.

Discharge Criteria:

1. Patients shall be discharged from home health services on the basis of reasonable criteria which includes:

A. The patient has reached defined goals and is no longer in need of home health care.

B. The patient’s care has become such that it is unsafe and medically inappropriate to maintain the patient in his or her home.

C. Patient is non-compliant with the established POC.

D. Medical approval or supervision has been terminated.

E. The contracting payer terminates authorization for service.

F. The patient terminates payment for service.

G. The patient chooses to use another home health care company.

H. The patient is hospitalized and the hospitalization period is greater than 14 days or exceeds the current POC certification period.

I. Patient moves out of Lorian’s service area.

J. Lorian does not provide services needed by the patient.

K. No funding is available to provide the care. Patient stays on services until other means of care is found at no cost to the patient.

L. The patient will be transferred to an acute or sub-acute care facility if the patient has demonstrated deterioration, appearance of acute symptoms, adverse effects of medical treatment, or other negative change in status occurs or if there is a threat to patient safety due to unsafe home environment, absence of physician, family, or caregiver involvement. When the patient is transferred to another facility a copy of the discharge summary will be sent to the attending physician upon request and to the facility if known. The summary will include the patient’s medical and health status at transfer or discharge from the agency.

2. The patient and caregiver will be informed of the change in status and be encouraged to provide input to the physician regarding the POC.

3. The physician will order the patient to be hospitalized, as appropriate.

Transfer Criteria:

1. In order to provide continuing care, all patients transferred to a facility will have an episode summary faxed to that facility. If a patient has had an infection during the episode, the infect report will be faxed to the facility as well.

2. The process will include:

a. Identification of the transfer via hospital hold order

b. A Medical Records/Clinical Manager will identify the facility the patient has been transferred to and will fax an HCHB episode summary to that facility

c. The fax cover sheet will include:

i. Patient Name

ii. Date of Birth

3. Evidence of the episode summary having been faxed will be in the HCHB fax status report.

A MEDICARE-CERTIFIED HOME HEALTH AGENCY Serving California and Nevada

YOUR LORIAN TEAM

Name: Phone: Discipline: Name: Phone: Discipline: Name: Phone: Discipline: Name: Phone: Discipline:

CLINICAL SIGN-IN SHEET

A MEDICARE-CERTIFIED HOME HEALTH AGENCY Serving California and Nevada

YOUR LORIAN TEAM

Name: Phone: Discipline: Name: Phone: Discipline: Name: Phone: Discipline: Name: Phone: Discipline:

CLINICAL SIGN-IN SHEET

YOUR LORIAN TEAM

***Abnormal Symptoms & VS: Dizziness,sudden numbness,headache,blurred vision, sudden confusion

1.- Finger Stick is less than 60 or greater than 300

2.- BP is less than 90/50 or greater than 170/90.

3.- Hear Rate less than 50 or greater than 120

4.-Weight gain of 2 lbs in one day or 5 lbs in one week.

5.- Oxigen less than 90%

***Call your doctor or the agency. If Symptoms persist, call 911