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New Jersey Home Care Standards & Accreditation Explained

Monday , September 23 , 2019

New Jersey Home Care Standards & Accreditation Explained

As a licensed agency providing care for seniors and the disabled in their homes, my agency has a lot of “masters.” Foremost among them are our clients. We respond to their needs in all that we do, and we answer to them for the quality of our services. That much is straightforward.

What is less obvious to most people is that we also answer to the NJ Division of Consumer Affairs (who grants us our license), the NJ Board of Nursing (who writes detailed best practices governing our standards and day-to-day practices), and an accrediting agency approved by the state to inspect and review every aspect of our business.

As of 2019, accreditation is now a requirement for any home care agency in the state, and the Division of Consumer Affairs has committed to shutting down those agencies who don’t comply.

Certification in New Jersey

New Jersey has some of the most stringent regulations in the nation governing the provision of care services to seniors in their homes.

On March 18, 2019, Governor Murphy signed and enacted Senate Bill Number 2773, which clarifies the definitions of Health Care Service Firms and Homemaker/Home Health Aides. The bill ensures that “all firms acting as health care agencies for our elderly, including the ones using the Internet to arrange and provide companies or health care services, are properly registered.”

While most other states do not require that an employee who provides personal care be certified or show proof of any training. In New Jersey, any aide who touches a client, whether it is to help them into a wheelchair or to give them a sponge bath, must be “certified.”

To receive certification, the aide must successfully complete a training course approved by the Board of Nursing. Once they have passed, they may call themselves a CHHA (a Certified Homemaker Home Health Aide.)

And that’s only the first step!

CHHAs must renew their licenses every two years, and the state will not grant that renewal unless the aide can prove that he or she is working under the supervision of a registered nurse. In other words, they must work for a licensed agency like ComForCare who employs RNs to assess patients, write detailed care plans, and supervise the home care aides.

Home Care Best Practices – It’s the Law!

Clients are sometimes surprised (and sometimes annoyed!) at how in-depth our initial assessments and bi-monthly reassessments are. It generally takes our nurses at least two hours in the home every 60 days to review and document according to state regulations and our accreditation standards. This thoroughness can seem excessive to clients, but the NJ best practices were written to safeguard the health and safety of home care clients.

Our nurses can (and do) catch problems that doctors and families are unaware of—everything from flagging fall risks in the home to addressing the potential for skin breakdown that can lead to life-threatening pressure ulcers. They connect clients who have balance and strength problems to physical therapy, catch medication errors such as duplicate prescriptions under different medication names, and flag cognitive decline that would indicate a need for more safety supervision.

In addition, the RNs are regularly supervising and evaluating our HHAs to make sure they adhere to nursing standards and understand what is required under the patient’s plan of care.

Final Thoughts

Over the past couple of decades, the home care industry was wide open to just about anyone who wanted to set up shop. Some agencies followed best practices in hiring and supervising aides, but others simply operated as “matchmakers,” much as current online registries operate.

When it comes to providing care for vulnerable seniors in private homes, choosing an accredited agency is the safest way of ensuring quality of care and accountability.

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Adaptive Homes Allow Seniors to Age in Place

Tuesday , September 17 , 2019

Adaptive Homes Allow Seniors to Age in Place

If you ask an older adult what they fear most about aging, it’s often the loss of independence. Given the choice, most Americans would stay in their own homes for the duration of their lives, rather than move to alternative retirement accommodations.

Most houses, however, are not built with seniors in mind. Staying in the “standard” American home can be risky for an older adult as their physical and mental abilities change.  In fact, more than 95% of US homes lack aging-in-place features to make them safe and accessible for wheelchair users and seniors with other mobility challenges.

According to the Centers for Disease Control (CDC), environmental factors, such as tripping hazards and poor lighting, lead to about half of all injuries that occur at home. In addition, a lack of modifications, such as stair railings and ramps, can create further in-home danger.

Luckily, older adults have options, from adapting their existing home to finding a new standalone home that meets their needs.

Adapting your existing home

Adapting your home can be as easy as removing throw rugs and installing grab bars in the bathroom, or as costly as an entire remodel including wheelchair ramps and wider doorways. To ensure best results and protect your home’s value, it’s a good idea to work with a Certified Aging-in-Place Specialist affiliated with the National Association of Home Builders.

Some commonly recommended modifications include:

Bathroom:

  • Replace the standard tub with a walk-in shower or tub
  • Install grab bars for toilets and tubs
  • Replace your standard toilet seat with an elevated model (with armrests, if you have problems getting up)
  • Consider open shelves to keep essentials easily accessible
  • Replace ceramic tile floors with hardwood or vinyl for safe standing (this applies to other rooms as well!)

Kitchen:

  • Replace the cabinets with drawers and pull-out shelves
  • Move commonly used items to lower areas to avoid the need for a step stool
  • If possible, lower counter and sink heights
  • Install an elevated dishwasher or one with drawers for easy access
  • Replace old stoves with induction cooktops to help prevent burns
  • Consider adding seated workspaces to avoid a lot of standing

Bedroom:

  • Install bed rails to make getting into and out of bed easier
  • Consider an adjustable bed that can be raised and lowered at the head and foot for the most comfortable sleep position
  • Make sure the bed is not too high
  • Have a sturdy chair handy for sitting while dressing

Living room:

  • Remove unnecessary throw rugs and fasten down rugs or floor runners to prevent slipping
  • Move furniture to create clear walking paths
  • Replace your recliner with a lift chair, which will enable you to sit down or stand up with ease

General spaces:

  • Consider a lightweight aluminum walker to make getting around the house easier (choose one that folds vertically for easy storage)
  • Keep objects off the floor and coil or secure cords to the wall to prevent tripping
  • Replace doorknobs with lever door handles
  • Apply non-slip tape on uncarpeted indoor and outdoor steps
  • Replace standard light switches with rocker-style switches
  • Increase the width of doorways and hallways to accommodate wheelchairs
  • Repair or replace loose handrails and install adequate lighting in stairways
  • Install threshold ramps when you can no longer walk safely up or down the steps
  • Provide proper lighting (seniors need two to three times more lighting than younger adults!)

Financing your remodel with Medicare

Medicare will provide coverage for a lot of upgrades and equipment – but not everything. Here’s what’s covered and what’s not.

According to PHC Online, Medicare will cover:

  • Manual wheelchairs (capped rental)
  • Power wheelchairs
  • Some positioning devices
  • Walkers
  • Scooters
  • Seat-lift mechanisms for lift-chairs
  • Mattress over-lays (capped rental)
  • Hospital beds, semi-electric type only (capped rental)
  • Patient lifts (capped rental)
  • Oxygen equipment (capped rental)
  • Durable medical equipment, such as wheelchairs, if it has been prescribed by a doctor and the coverage criteria is met

Medicare will NOT cover adaptive daily living aids, such as:

  • Ramps
  • Reachers
  • Sock-aids
  • Utensils
  • Transfer benches
  • Shower chairs
  • Raised toilet seats
  • Grab bars

 

Other finance options

Caregiver Homes lists several other finance options on their website, such as:

  • PACE (Program for All-Inclusive Care for the Elderly): “An innovative Medicare program that provides frail individuals age 55 and older comprehensive medical and social services coordinated and provided by an interdisciplinary team of professionals in a community-based center and in their homes, helping program participants delay or avoid long-term nursing home care.”

  • Reverse mortgage: A loan that allows qualified homeowners aged 62 plus to take part of their home’s equity as cash, either as a line of credit, a monthly or lump sum payment, or a combo line of credit and payments.

  • SHA Grants: Veterans with certain service-connected disabilities can use a SHA grant to adapt of purchase a home to accommodate the disability.

  • A 203K loan: If you don’t have enough equity in your home to borrow against, you may qualify for a 203K loan. A borrower with good credit and a stable mortgage payment history can apply for the loan when certain requirements are met.

  • Charitable organizations: “Many organizations organize repair projects for elderly persons or persons with disabilities. Organizations may include your neighborhood association or community groups, churches, synagogues, Lutheran Social Services, Catholic Charities, Little Brothers of the Poor, Jaycees, Agency on Aging, senior centers, building trade unions, Boy Scouts of America, Girl Scouts of America, Kiwanis Clubs, sororities, fraternities, high school volunteerism, YMCA, Knights of Columbus, Rotary Clubs, Lion’s Clubs, B’nai B’rith, Masons, or 4H Clubs. Inquire about interest in a community project or see if you can propose one.”

Nothing is more important to successful aging than preventing unnecessary injury. And few things are more important to happiness and quality of life than having an environment that supports the activities you enjoy.

Fortunately, for a relatively modest invest, the safety of most homes can be significantly improved to provide the best of all possible worlds: a safe, comfortable environment for aging that feels just like home because it is home.

Posted in: Aging, Home Care

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Deaths caused by falls are rising among older adults: Here’s what you need to know

Monday , July 22 , 2019

Deaths caused by falls are rising among older adults: Here’s what you need to know

As adults age, the constant, terrifying threat of falls looms over them: Everyone knows that once you reach old age, a broken hip or head injury can spell certain disaster.

Now, there is even more reason to worry. Surprising new research from the CDC shows that among Americans aged 65 plus, fall-related deaths have tripled in the last ten years. That adds up to more than 25,000 deaths a year.

The rise in fall-related deaths

The research, recently published in the Journal of the American Medical Association, shows that almost 25,000 people aged 75 and older died as a result of falls in 2016 – 31% more than in 2000. The study tracked both men and women and found that the increase in fall related deaths was about the same for each group. In addition, both groups were more likely to experience death as a result of falls as the median age increased.

For example, the death rate due to falls among 75- to 79-year olds was 42 per 100,000 people. Among those aged 95 and old, the rate was 591 per 100,000.

Lead researcher Elizabeth Burns said, “If deaths from falls continue to increase at the same rate, the U.S. can expect 59,000 older adults will die because of a fall in 2030.”

Risk factors for falling

Exactly why the rates of fall-related deaths is increasing isn’t entirely clear, researchers said. One obvious explanation is that people today are living longer than ever before – and many of them live on their own without help or experience chronic conditions which leave them predisposed to falling.

According to Dr. Burns, “The chance of falling increases with age, and risk is higher with certain chronic diseases, such as a history of stroke, arthritis, diabetes, dementia and Parkinson’s disease.”

In addition, many medications common to older adults (such as blood pressure meds), make them prone to fall. Other risk factors include a sedentary lifestyle, chronic diseases, neurologic issues, and incontinence.

Fall-related injury

One in three adults over 65 takes a serious tumble every year – and even though most of those falls don’t result in death, the risk is always there. More often, however, a fall will result in a serious injury or permanent disability. According to Aging.com:

  •  When an elderly person falls, their hospital stays are almost two times longer than those of elderly patients who are admitted for any other reason
  • Every 11 seconds, an older adult is treated in the emergency room for fall-related injuries
  • Two-thirds of those who fall will do so again within six months
  • One in ten falls resulting in serious injuries such as hip fracture, other fractures, subdural hematoma, or traumatic brain injury
  • The most profound effect of falling is the loss of functioning associated with independent living

How to reduce the risk of falls

The important thing to remember is that falls can be avoided.

Another study in the Journal of the American Medical Association tested a home-based exercise program aimed at helping seniors prevent falls. Researchers found that a home-based strength and balance exercise program reduced falls in older adults by 36% in just 12 months.

A few of the exercises that can help reduce risk include:

  • Walking (both forward and backward!)
  • Balance exercises such as Tai Chi or squats
  • Resistance exercises with light weights or bands

Those who need extra help should consider home visits by a physical therapist, or asking a care giver or family member for assistance if that’s not an option. In addition, it’s also important to take steps to prevent and treat osteoporosis to help avoid future complications.

For those whose fear of falling affects their daily life, the State of New Jersey, Department of Human Services, Division of Aging Services run a fabulous program called A Matter of Balance: Managing Concerns About Falls.

The program is designed to reduce the fear of falling and increase the activity levels of older adults who have this concern. The class utilizes a variety of activities to address physical, social, and cognitive factors affecting fear of falling and to learn fall prevention strategies. For more information: http://bit.ly/2W3lTEB

Posted in: Aging, Health, Home Care

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