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Referral!Guide!
Guide to Senior Care Options & Patient Care Assisted / Alzheimer’s – Home Healthcare – Hospice – Home Care Private Duty Nursing - Skilled Nursing & Rehabilitation – Rehabilitation Hospital! MOBILE'AND'DIGITAL'AVALIABLE''
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Educate your patients ! ! and their loved ones on the benefits of!!
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Residential*Care*Homes.! Residential Care Homes are dedicated to promote excellent quality living environment for senior adults. Each residential care home provides an enhanced lifestyle to meet the daily needs of each resident from healthcare to personal care. Families (Caregivers) need to have assurance and feel safe knowing their loved one is receiving the highest level of enriched living services and activities based on their condition and individual circumstances. Residential Care Homes understand emotional and physical need of each resident. Staff members can both care for them and appreciate and respond to their needs as elder adults.
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Caregivers)may)call)today)for)a)tour)or)one)of)our)friendly)staff) members)would)be)more)than)happy)to)visit)the)family)or)senior)adult) at)the)hospital)or)skilled)nursing)facility.))
Loyds%of%Dallas! 214.924.5446! www.loydsofdallas.com!
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Groom%Senior%Living! 214.383.9077! www.groomseniorliving.com!
Hillcrest%House! 214.213.3062! www.thehillcresthouse.com! 3!! CASEMANAGEMENTSOCIALWORK.COM! !
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CONTENTS !
DALLAS-COLLIN-DENTON Vol 4 Issue 2
In !January 2011, surgeon Atul Gawande wrote an !article in The New Yorker magazine that helped change the way many of us look at the quality and cost of health care delivery.
How Good Data Can Help LowLevels of Care ALZHEIMER’SElderly 6 ncome Programs and assistance designed with those with loss; some Age inmemory Community communities will provide specially trained security measures to prevent residents from wandering.
Gawande's article, called "The Hot 7 HOME HEALTHCARE Spotters," that we might be Allowingsuggested patients to remain at home bleeliminating to lower travel medical costs "byalternative giving for treatment; to hospital stay or a skilled nursing he neediest patients better care." facility. HOME CARE
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Change "patients" to "residents" Allowing a non-medical home careand Gawande's article holds a valuable assistant (caregiver) provide esson for those of us who careneeds. about transportation, meals, and daily he health and wellbeing of lowHOSPICE ncome older adults living in publically12 In home facility end of life care for the ubsidized ofhousing.
terminally ill with pain management, comfort, and emotional support being the Gawande theforstory of a young primary tells mission the family.
octor in Camden, NJ, who hampioned a "Compstat approach" o evaluating how his city handled its ealth care delivery. Using a facebook/casemgmt! atabase he created, Dr. Jeffrey Brenner literally mapped the City of Š 2014 CMSW ! Camden to find out which blocks ! enerated the highest health care
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PRIVATE DUTY NURSING 13 Working one-on-one with individuals involve pediatric to geriatric patients on Supplemental Security Income (SSI) that have long term illnesses such as Cerebral Palsy (CP)and Traumatic Brain Injuries (TBI). Many of the patients have Together, two(G-Tube), buildings sent 900 Gastrostomythe Tube people to the Care hospital overortwo years Tracheostomy (Trach), Ventilator -(Vent). all to The the tune of about $200 million. private duty nurse are in many cases Registered Nurses (RN) or Licensed Vocationalover Nurses Pouring his (LVN) data, Brenner came
to a startling conclusion. Only 1 REHABILITIONAL HOSPITAL 14 percent of the people using Camden's Providing various neurological, musculomedical facilities accounted for 30 skeletal, orthoped\ic and other medical percent of health care costs conditions following stabilization in of those their facilities. He used acute medical issues.that knowledge to develop a highly coordinated care SKILLEDmodel NURSING & REHAB 17 delivery to serve a targeted Licensed and equipped to provide group of health care "super-utilizers." healthcare which he meets the needs of more In the process, helped reduce extensive physical issues, and assist hospitalizations by 40 percent and residents to regain mobility. hospital bills by 56 percent for his first group of 36 patients. And to think it all started with data. 5!! CASEMANAGEMENTSOCIALWORK.COM! ! Hot Spotting HUD-Assisted
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HOME HEALTHCARE !
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Coverage Map If you have a patient who is out of our coverage area, we would be happy to help you find an agency that can accommodate your patients.
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HOME HEALTHCARE !
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Services Provided:
Lab Work Enterostomal Care Pulmonary Care Anodyne Therapy Fall Prevention
Wound Care Diabetic Care Nutritional Education Rehabilitation
Staff Includes: Speech Therapist Social Workers Home Health Aids
Registered Nurses Physical Therapist Occupational Therapist
Call us! 972.412.1540 Fax 972-475-4443
5001 Rowlett Rd., Ste 300 - Rowlett, TX 75088 info@healthquestoftexas.com Licensed & Certified Home Health Agency Serving Dallas / Ft. Worth Area Since 2003
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We Are Ready to Care for Your Patients
Great Care From Great People Veritas Home Health is different than all other Home Health agencies, as it was designed and engineered around the core values of: Integrity, Honesty, Quality and Truth.
We work with several insurance companies ! Medicare ! Medicaid / STAR+PLUS ! United Healthcare ! SecureHorizons
! Experienced in-home Registered Nurses: with minimal clinician turnover to assure quality ! Dedicated team of Therapists: are in-house and lead by a Physical Therapist Skilled Therapy services include: Physical Therapy, Occupational Therapy, Speech Therapy ! Registered Nurse Clinical Supervisors: review every case each step of the way to assure top line results ! Specialized In-Take Coordinators: help to qualify clients and to coordinate immediate clinical results
AARP MedicareComplete HealthSpring Humana Most Fee for Service Plans
Medicare pays 100% for covered Home Health Care services. We work with doctors, social workers, hospital discharge planners to arrange for Medicare-covered home health care.
Call Us Today to Assist You With Your Patients.
Thank you again for your consideration and care during my mother’s illness. You and your staff were wonderful with her and tremendous support to me and the rest of the family. Please extend my thanks to all. — Susan B.- Dallas
Veritas Home Health, LLC 2825 Regal Rd. Suite 105 Plano, TX 75075 Phone: 972-519-0308
Veritas Home Health is always willing to go the extra mile for the residents. They handle referrals in a timely manner and give excellent feedback after discharging patients. I have never received a complaint from a resident regarding the care that they received from Veritas Home Health.
www.veritashh.com
— Assisted Living Facility - Plano
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HOME CARE !
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HOSPICE !
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REHABILITATION HOSPITAL !
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REAL PATIENTS. REAL STORIES.
Baylor “helped me pickup the pieces.
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Patti Foster was on her way to a Bible study, when a semi-truck driver rear-ended the vehicle she was riding in at full speed. “The impact ejected me out of the side of the SUV,” she says. “And from there, life changed.” Patti sustained multiple traumatic injuries, including a traumatic brain injury. She spent five weeks in a coma in ICU and then moved to Baylor. “Baylor taught me how to live again. I was like a 34-year-old infant. I had to relearn everything.” Today, Patti is an inspirational speaker and does voiceovers for radio and TV. She also volunteers at Baylor. “I want to tell other patients not to give up. Because I’m a walking miracle.” Baylor Institute for Rehabilitation is one of only 16 facilities throughout the nation to be designated as a model system of care for patients with traumatic brain injury by the National Institute on Disability and Rehabilitation Research. To make a referral, or for more information, call 1.877.7BAYLOR or visit us online at BaylorHealth.com/BIR. DALLAS t NORTHWEST DALLAS t FORT WORTH t FRISCO t GARLAND t IRVING Baylor Institute for Rehabilitation is part of a comprehensive inpatient and outpatient rehabilitation network formed through a partnership between Baylor Institute for Rehabilitation and Select Medical. Physicians are members of the medical staff at Baylor Institute for Rehabilitation and are neither employees nor agents of Baylor Institute for Rehabilitation, Baylor Health Care System, Select Medical or any of their subsidiaries or affiliates. ©2013 Baylor Health Care System BIR_271 CE 02.13
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Introducing Rehabilitation and Wellness Centre of Dallas, where we specialize in providing Transitional Care and Post-Acute Services. Management Team Our management team has over 60 years of combined experience in providing top quality nursing care with a enhanced focus on Customer Service. Location We are conveniently located just blocks from Baylor University, Medical Center, Baylor Specialty Hospital and Baylor Institute for Rehabilitation. Our Community Leaders CEO/Executive Dir. John Berg Dir. of Business Development, Penni Smith Dir. of Clinical Services, Romona S. Few, BSN RN Dining Services Executive Chef, Arturo Liberuto Physicians Partnerships Dr. Ankit Punatar Medical Director of Post-Acute Services Dr. Susan Kohl Medical Director of Quality Assurance Dr. Neeta Nayak Attending Physician Dr. Andrew Applewhite Wound Care Dr. Susan Warden Physical Medicine and Rehab !
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Where Your Health & Wellness is our top Priority! 4200 Live Oak St. Dallas, TX 75204 (214) 821-0050
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www.rehabandwellnessofdallas.com
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SKILLED NURSING & REHAB !
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Bridging the Gap From Hospital to Home
Whether you are on a FAST TRACK to recovery or need a place you can call home, we have a place for you. Featuring Physical Therapy • Occupational Therapy • Speech Therapy • IV Therapy Orthopedic Rehabilitation-Hip/Knee Fractures and Replacements Stroke Rehabilitation • Wound Management Pain Management • Comprehensive Discharge Planning
Arlington • 817-274-5571
Ennis • 972-875-9051
Hurst • 817-282-6777 Lancaster • 972-227-6066 Desoto • 972-223-3944
Cleburne • 817-558-8999 Keller • 817-577-9999
Fort Worth • 817-626-5454
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Grapevine • 817-488-8585
Richland Hills • 817-589-1734
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SKILLED NURSING & REHAB
A name you can trust for rehabilitation and health care. !
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Post-Surgical, Short-Term Rehab Heartland - Austin Heartland - Bedford ManorCare - Dallas Heartland - Fort Worth Heartland - North Richland Hills Heartland - San Antonio Heartland - San Antonio North ManorCare - Sharpview ManorCare - Webster ManorCare - West Houston ManorCare - Willowbrook
800.736.4427 www.hcr-manorcare.com
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CASEMANAGEMENT SOCIALWORK.”
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We Are Ready to Care for Your Patients
Great Care From Great People Veritas Home Health is different than all other Home Health agencies, as it was designed and engineered around the core values of: Integrity, Honesty, Quality and Truth. ! Experienced in-home Registered Nurses: with minimal clinician turnover to assure quality ! Dedicated team of Therapists: are in-house and lead by a Physical Therapist Skilled Therapy services include: Physical Therapy, Occupational Therapy, Speech Therapy ! Registered Nurse Clinical Supervisors: review every case each step of the way to assure top line results ! Specialized In-Take Coordinators: help to qualify clients and to coordinate immediate clinical results Thank you again for your consideration and care during my mother’s illness. You and your staff were wonderful with her and tremendous support to me and the rest of the family. Please extend my thanks to all. — Susan B.- Dallas Veritas Home Health is always willing to go the extra mile for the residents. They handle referrals in a timely manner and give excellent feedback after discharging patients. I have never received a complaint from a resident regarding the care that they received from Veritas Home Health. — Assisted Living Facility - Plano
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We work with several insurance companies ! Medicare ! Medicaid / STAR+PLUS ! United Healthcare ! SecureHorizons
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AARP MedicareComplete HealthSpring Humana Most Fee for Service Plans
Medicare pays 100% for covered Home Health Care services. We work with doctors, social workers, hospital discharge planners to arrange for Medicare-covered home health care.
Call Us Today to Assist You With Your Patients. Veritas Home Health, LLC 2825 Regal Rd. Suite 105 Plano, TX 75075 Phone: 972-519-0308
www.veritashh.com CASEMANAGEMENTSOCIALWORK.COM!
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In !January 2011, surgeon Atul Gawande wrote an !article in The New Yorker magazine that helped change the way many of us look at the quality and cost of health care delivery.
How Good Data Can Help LowIncome Elderly Age in Community Gawande's article, called "The Hot Spotters," suggested that we might be able to lower medical costs "by giving the neediest patients better care." Change "patients" to "residents" and Gawande's article holds a valuable lesson for those of us who care about the health and wellbeing of lowincome older adults living in publically subsidized housing. Gawande tells the story of a young doctor in Camden, NJ, who championed a "Compstat approach" to evaluating how his city handled its health care delivery. Using a database he created, Dr. Jeffrey Brenner literally mapped the City of Camden to find out which blocks generated the highest health care costs. Two blocks stood out. A nursing home was on one block. An affordable housing property stood on the other. PLEASE SAY “I FOUND YOU IN
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Together, the two buildings sent 900 people to the hospital over two years - all to the tune of about $200 million. Pouring over his data, Brenner came to a startling conclusion. Only 1 percent of the people using Camden's medical facilities accounted for 30 percent of health care costs in those facilities. He used that knowledge to develop a highly coordinated care delivery model to serve a targeted group of health care "super-utilizers." In the process, he helped reduce hospitalizations by 40 percent and hospital bills by 56 percent for his first group of 36 patients. And to think it all started with data. Hot Spotting HUD-Assisted Housing Properties The LeadingAge Center for Applied Research has been involved in analyzing similarly exciting data over
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assistance. Have higher health care costs than the average older personand even higher costs than community-dwelling elders not receiving HUD assistance who are also eligible for both Medicare and Medicaid.
the past few years. We did this while working !as a subcontractor to the ! Group on a study funded by Lewin the U.S. Departments of Health and Human Services (HHS) and Housing and Urban Development (HUD). The researchers who collaborated on this study were able, for the first time, to successfully link administrative data from HUD and HHS. The new, merged data provide important insights into the health and health care utilization of low-income older residents of HUD-subsidized housing in 12 geographic areas.
The Message Behind the Data You could view our analysis as a depressing statement on the challenges facing low-income older people in this country. But, influenced by Jeffrey Brenner's experience, I choose to see a much more hopeful message here. It's a message about the dramatic difference that affordable senior housing properties could make in the lives of low-income older adults.
An initial analysis of this data has led us to many of the same general conclusions that Jeffrey Brenner reached after mapping Camden's health care data. Like Brenner, we found evidence that subsidized housing properties are the "hotspots" of health care need.
Imagine the good work we could do if we used those housing properties as platforms for delivering health and social services that would help lowincome residents manage their health and improve their functional status--all while saving health care dollars.
Our report, Picture of Housing and Health: Medicare and Medicaid Use Among Older Adults in HUD-Assisted Housing, affirms that older people living in subsidized housing:
At the Center for Applied Research, we have recognized this potential for many years. That's why we established the Center for Housing Plus Services and why we facilitate a Housing Plus Services Learning Collaborative to help affordable senior housing providers develop and test models for bringing health and supportive services into their housing properties.
Have more chronic conditions than their peers in the community who do not receive HUD assistance. Are highly likely to be eligible for Medicaid, in addition to Medicare. Run a higher risk of being hospitalized or using the emergency department than their peers in the community who do not receive HUD
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Next Steps for Housing Providers The merged HUD-HHS data make it hard to ignore the great need that exists in publically! subsidized housing properties and the great potential that those ! properties hold for filling that need. These data give advocates for low-income older adults some great information about how we can intervene to improve health among low-income seniors and where we should target our resources for the greatest return. They also give housing providers the evidence they need to expand their role in meeting the needs of the "super-utilizers" of health care -- and in garnering the support they need to be successful. Becoming a platform to alleviate our health care hotspots means nothing less than reinventing affordable senior housing. We can no longer be the kind of housing providers who collect the rent and leave residents to fend for themselves. Instead, we need to envision a new kind of housing provider that recognizes how prevalent aging in community is becoming, understands the challenges facing low-income older adults, and wants to be part of the solution. Robyn Stone, Leading Age
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Introducing Rehabilitation and Wellness Centre of Dallas, where we specialize in providing Transitional Care and Post-Acute Services. Management Team Our management team has over 60 years of combined experience in providing top quality nursing care with a enhanced focus on Customer Service. Location We are conveniently located just blocks from Baylor University, Medical Center, Baylor Specialty Hospital and Baylor Institute for Rehabilitation. Our Community Leaders CEO/Executive Dir. John Berg Dir. of Business Development, Penni Smith Dir. of Clinical Services, Romona S. Few, BSN RN Dining Services Executive Chef, Arturo Liberuto Physicians Partnerships Dr. Ankit Punatar Medical Director of Post-Acute Services Dr. Susan Kohl Medical Director of Quality Assurance Dr. Neeta Nayak Attending Physician Dr. Andrew Applewhite Wound Care Dr. Susan Warden ! Physical Medicine and Rehab
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Where Your Health & Wellness is our top Priority! 4200 Live Oak St. Dallas, TX 75204 (214) 821-0050
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www.rehabandwellnessofdallas.com CASEMANAGEMENTSOCIALWORK .COM!
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Bridging the Gap From Hospital to Home !
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Whether you are on a FAST TRACK to recovery or need a place you can call home, we have a place for you. Featuring Physical Therapy • Occupational Therapy • Speech Therapy • IV Therapy Orthopedic Rehabilitation-Hip/Knee Fractures and Replacements Stroke Rehabilitation • Wound Management Pain Management • Comprehensive Discharge Planning
Arlington • 817-274-5571
Ennis • 972-875-9051
Hurst • 817-282-6777 Lancaster • 972-227-6066
Desoto • 972-223-3944
Cleburne • 817-558-8999 Keller • 817-577-9999
! PLEASE SAY “I FOUND YOU IN Fort Worth • 817-626-5454 !
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Grapevine • 817-488-858
CASEMANAGEMENT SOCIALWORK.”
Richland Hills • 817-589-1734