Use adult day care facilities to full advantage
Consider the medical oversight potential
How much interaction do you and your patients have with adult day care facilities? Chances are good that it will be on the rise.
With so much of the care for heart failure focusing on watching symptoms and following a daily medication regime, caregivers at home may need help when they have to work five days out of the week. Dropping off a loved one at a daytime facility may one day be as common as driving the kids to school.
"It’s a huge, growing area," says Elinor Ginzler, senior programs specialist for the American Association for Retired Persons in Washington, DC. "It will only continue to grow."
Special care for heart failure patients
But for specialized customers — such as those with heart failure — Ginzler says adult day care can be a way to help patients and their caregivers keep on top of managing their conditions, possibly putting off more costly options such as long-term nursing home care.
"Truly, as an option, it’s one designed to provide medical oversight," she says. In order for a facility to be licensed, it must have on-site medical staff, such as a full-time nurse. Members of this staff often are skilled in taking care of patients with chronic disease and can supervise medication, weighing, and daily symptom assessment.
As these centers become more popular, Ginzler and others note that physicians can help make this option feasible for their patients if they keep a few points in mind:
• Give specific instructions all around.
This goes for your patient and his or her family, the facility, and your office staff. Everyone must know how to handle problems before they happen.
Where is the facility housed?
Ginzler notes it helps to understand the structure of the particular centers your patients will use. Some facilities are housed in medical complexes. Others are physically on the grounds of nursing homes, assisted living centers, or medical clinics. Still others may be independent of these other care settings. In case staff are not available to handle emergencies themselves, give specific instructions about critical situations and how they should respond.
A facility’s staff should know, for example, when to call the physician for instructions or when they need to get the patient over to you and how — whether to call a family member or an ambulance. If the facility keeps files on day care patients, your instructions could be included for quick access.
Instruct your telephone staff that a patient with heart failure may not be able to wait for the next available appointment. Callers may need your quick instructions on how to deal with the changing symptoms of heart failure.
"Some office staff are wonderful," says Lisa Delvasto, LVN, at the Casa Colina Centers for Rehabilitation Adult Day Health Care program in Pomona, CA. "But some are real bulldogs to get past in order to get a message to the doctor," she says. "They don’t understand the importance of letting the doctor know what is going on with the patient."
When those calls are made to the patient’s doctor, the staff there should be able to take the right message to the physician and get the right response if the doctor is not available to talk directly, says the facility’s staff nurse, Ervin Vergara, RN.
He says that staff may notice common symptoms that show CHF may be developing or getting worse. Some of the common signs include:
1. sweating in the lower extremities;
2. shortness of breath;
3. edema;
4. coughing.
Vergara recalls a 66-year-old man with Down syndrome in the weekly care of the facility. The man had been diagnosed with CHF 20 years earlier and was stable with the disease for 15 years. Then he started to show worsening symptoms and complained of chest pain.
The patient went on to develop pneumonia and needed to see his physician quickly.
• Teach families how to make smooth shift changes — especially on Friday night.
Vergara says when families come to pick up their patients at the end of the day, the caregiver may need to pay extra attention to symptoms that could be getting worse. (It’s a good idea for them to ask the facility staff if there have been any changes in the condition.)
And remember, a center that is not open on Saturday and Sunday puts the family on duty all weekend long.
Unless the family members can contact the physician or a partner on call, or can follow predetermined instructions, they probably will wind up taking the patient to the emergency department or urgent care center. This step can add expense and complications to managing the disease.
(For information about choosing a facility, The Aging Parent Handbook by Virginia Schomp may be helpful.)
A note about generic medications
Choosing the generic brand of a drug you prescribe is a good way to control costs, says Daniel C. Malone, PhD, an assistant professor of pharmacy practice at the University of Colorado in Denver. But you should know the specifics about how a generic could affect your patient.
An example is Lanoxin. Levels of the drug may vary greatly according to who makes it. You may want to determine which version is right for your patient and request that each time the pharmacist dispenses the drug it’s made by the same manufacturer, he says.
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