Kaleida Health SPHM Programs

1. Kaleida Health SPHM Programs Safe Patient Handling for All Healthcare Workers, Understanding the Risk Associated with Working in the Home Care Industry. Paula Pless-Director SPHM Kaleida Health ppless@kaleidahealth.org

2. Kaleida Health SPHM Programs What impacts Home Care? What can be done to improve safety for the ; • Home Health Care Workers • Care providers who are Family or Friends • Patient Safety, Client Safety or Resident Safety

3. Kaleida Health SPHMPrograms What did Homecare look like on that first visit? • Nurses wore heels, caps, capes and white • They carried 1 little doctor bag-no pager, no cell, no IV’s, no equipment, no treatment bags, no pepper spray, mace, stun gun. • The patient was sitting in a chair fully dressed waiting for the visit with a snack ready to share, eager to have a visitor, or someone to take their temperature, cook a hot meal do some light housework.

4. THENDress, one bag and heels

5. NOW 4 bags on her body, 1 bag pulled, cell phone and pager.

6. Kaleida Health SPHMPrograms • An estimated 12 % of nurses leave the profession annually. • An estimated 52% of nurses complain of chronic back pain. Home Health Care Workers face-violence, abuse, MVA’s, Slips & trips, MSD’s, CTD’s, GET LOST!, are alone

7. Kaleida Health SPHMPrograms Did you know that • In 1997 LOS was 7.1 days v.s. LOS in 2003 5.7 days • 5 Million Americans are over 85 • 49 Million Americans are over 60 • First wave of baby boomers are about to become 60. Who is going to take care of them, who is going to take care of us?

8. Kaleida Health SPHMPrograms What are some of the Impacts? • Shorter hospital stays • Sicker patients leaving hospitals • Sub-acute care taking place in the home. • Insurance coverage has changed • No OT services in most hospitals • Poorly staffed S.W dept • Disconnect between D/C planners and Home Care Agencies

9. Visiting Nursing Association of WNY, Inc.VNA Home Care Services-est.1885 Orleans County Niagara County      Services cover : 8 Counties Certified  Licensed Pediatrics/Maternal-Infant Number of clients treated in 2006- approximately 25,000 Number of referrals in 2006 - 16,280 Genesee County    Erie County Wyoming County      Allegany County Cattaraugus County Chautauqua County        

10. Kaleida VNA Services CHHA Nursing Home Health Aide Occupational Therapy Nutritional Medical Social Services Speech/Language Pathology Physical Therapy SPPCHHA (Services to Women & Children - Prenatal & Postnatal) Nursing Home Health Aides Respiratory Therapy & Supplies Medical Social Services Occupational Therapy Physical Therapy Speech/Language Pathology LSHHCA Nursing Nutrition Breast pumps & Accessories Respiratory Therapy & Supplies Home Health Aide Personal Care Physical Therapy Occupational Therapy Speech/Language Pathology

11. Kaleida Health SPHMPrograms • Adult Children don’t live in the area. • Elderly live alone. • Adult children are working, caring for their own children and their parents. • Frail elderly care for frail elderly.

12. Kaleida Health SPHMPrograms Who supports/assists the healthcare workers efforts in the home environment? “I need an arm in Room 222” “Hello anyone out there?” “No you sit down before you fall” “I will take care of your Husband” “Which one is the patient?” “I want to do his/her treatment so please leave him/her in bed”

13. Kaleida Health SPHMPrograms Home environments are used to care for dependent, critically ill patients. “No equipment,this is my home” {pts.say} “it is their home” {workers say} “Never not in their home” {children say} “I am a visitor in their home” {staff say}

14. Can you say vaccination time? Do you think anyone said no to her?

15. Kaleida Health SPHMPrograms Did you know that SW’s, OT’s, D/C Planners & Liaison positions have been cut? • Patients leave the hospital before they have even gotten out of bed or used a toilet! • D/C Planners sometimes don’t see the patient, ask about the home environment, or speak to the people that the patient tells them will be assisting with their care in the home! “OH Yeah my neighbor will change my dressing” “He can flush my PIC line too” • No Equipment is discussed or ordered prior to D/C.

16. Kaleida Health SPHMPrograms So with all those impacts how do we keep everyone safe? Everything in Homecare has changed but the way we deliver care has remained the same. In the words of Dr. Phil- ”how's that working for you?”

17. Look at that stride!

18. Kaleida Health SPHMPrograms Quote from a 1898 Nursing text book “Occasionally the complaint is made that a nurse has injured her back or strained herself in some way in moving a patient. This will generally be because she failed to do the lifting properly” (Hampton, 1898, p.102).

19. Kaleida Health SPHMPrograms When is it easier to get the King of the Castle to agree to allowing the necessary equipment in to the home? • When they are vulnerable in a hospital bed wanting to go home at any cost wearing a gown that exposes their backside? OR • You open the case they are in their castle sitting on their thrown, with a cigarette in their mouth,their dog growling at you and their King size bed on the second floor?

20. Kaleida Health SPHMPrograms • Communicate-who are all the Stakeholders? • Assess-who is qualified and invested to provide an appropriate assessment? • Have the tools necessary to do the job-Hospital bed, lift, Non-Friction Sheets, caregiver support,3-Position Lift Chair • Use an Admission Agreement-smoking, pets, equipment brought in to the home. • Develop a Plan of Care-include safety, communicate to the next person

21. Kaleida Health SPHMPrograms • When don’t you open a case? Does your agency say no to a case? • Do you expect the support person to be present when you open the case? • Do PT and NSG open the case together • HHA in the Home when PT or NSG is there • Equipment is preordered to be delivered prior to D/C or on the day of D/C. • Your agency is a SPHM care provider, it is in your admission agreement.

22. Kaleida Health SPHMPrograms What is hurting us? • Stand Pivots #1 transfer used-need equipment • Manual lifts-need equipment • Treatments/wound care-need equipment-LE’s done with patients OOB • Incontinent care-need equipment • Carrying numerous heavy bags in to the home-need equipment on wheels, supplies left in homes • Driving-need safe driving course, maps, agency rules about returning calls and pages while in car

23. Kaleida Health SPHMPrograms Kaleida’s VNA has implemented a SPHM Policy & Program with Leadership “Buy In”. • Formed an Ergo Committee • Conducted a SWOT analysis • Began to write a SPHM Policy • Purchased equipment • Began training, “Buy In” and problem solving • Break the Myth-Educate

24. The National Nursing Shortage is Expected to Increase by 30% by the Year 2020. Will We Still be Caregivers?

25. Kaleida Health SPHMPrograms-WNY VNA 120 Years of Service