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The Rewards of Providing Superior Post Acute Care

Times are changing and our skilled nursing facilities are expected to now proficiently provide high acuity care to recently hospitalized patients. As I read the latest article in the New England Journal of Medicines, Post-Acute Care –The Next Frontier for Controlling Medicare Spending, I see an opportunity for skilled nursing facilities, home health care agencies, and other post acute care providers.

Typically, after a hospitalization Medicare pays for post-acute care whether this is short term skilled nursing and rehabilitation, skilled nursing facilities, inpatient rehab hospitals or long term care hospitals.  Acute care hospitals are now being penalized for preventable re-admissions. With this increase in penalties, they are now looking for partners that can reliably care for their discharged patients and assist them in decreasing these admissions, as it is in their best financial interest to do so.  Medicare has also introduced bundled payments and shared-savings programs that provide even stronger incentives to integrate acute and post-acute care.

These acute care hospitals and health systems will pursue preferred relationships with nursing homes that are dedicated to post-acute care with distinct short stay units, 24/7 onsite skilled nursing staff, and 24 hour coverage with physicians or advanced practitioners with specialties in geriatrics.  These preferred SNF partners will need to develop the capacity to treat acute exacerbations of common conditions such as cellulitis and congestive heart failure on site, rather than sending these patients to the emergency department for treatment.

Communication between the acute care and post-acute care entities has traditionally always been lacking. This new model of partnership must include willingness from both parties to actively communicate and collaborate on care coordination.    Hospital providers must take responsibility in providing complete clinical information to the post-acute care facility.  Traditionally hospital providers have not considered the patient care that must occur after discharge or the detailed medical history that these post-acute care providers will need to efficiently and effectively transition these admissions into the new setting.  The post-acute care provider must also be willing to collaborate on length of stays with the ultimate goal of safe and quick discharges to manage post-acute care costs.  Both parties should have established clinical liaisons to facilitate a rapid response to unexpected changes in patient status and care coordination. 

Hospitals that are participating in the bundled payment program must establish strong partnerships with all types of post-acute care providers and will be focusing on three basic characteristics when considering discharge to post-acute care partners:
  1. The facility or agency must have the capacity to effectively care for patients with complex needs.
  2. The facility or agency must have the ability to provide high quality care efficiently.
  3. The facility or agency must have the willingness to actively collaborate on care coordination.

To gain preferred partner status post-acute care providers need to make a compelling case of the value they bring to the table.  Historically the post-acute care clinicians may not be prepared to handle the high acuity patient that now sits before them.  It is the forward thinking providers that have prepared, or that are willing to prepare, their clinical staff that will excel in this area. 

All levels of care providers should be equipped to skillfully manage these high level patients from housekeeping, to nursing assistants, to licensed nurses. The days of providing boring repetitive inservices to any staff member should be over. We should ask ourselves, are the types of inservices provided enabling our staff to elevate their standards of care and increasing knowledge levels?  Our maintenance workers should be familiar with fire and life safety and how to address potential hazards of our physical building.    Housekeeping is an integral part of our infection prevention plan. It is time to elevate their level of knowledge to integrate them into care team as infection prevention partners.  Our nurse aides spend the most time with our residents and clients and as such are a reliable source to identify changes in condition, medication side effects, or any new onset symptoms. Our nurse assistants are more important than ever before and should be educated on what should be reported to licensed personnel.  These nurse assistants are now faced with caring for residents and clients with central lines, tracheostomies, mechanical ventilation, and compression therapies.  The nurse assistant is not responsible for these treatments or therapies, but should be knowledgeable enough spot conditions or changes in a patient that should immediately be reported. Our licensed nurses should be provided the education to care for these high acuity residents and clients, as they are being exposed to new treatments, new equipment, and new therapies that have never traditionally been performed in these settings. 

All care providers require a higher level of education than has ever been provided in the past. It is the facilities that recognize this and prepare for it that will be rewarded with the “preferred provider” status.


Pedagogy Memberships
Pedagogy Memberships are the most economical way to provide your staff education in topics that effect post-acute care providers.  Memberships open our entire catalog of online education to your staff. Our robust Learning Management System allows you to set education plans most suited to your facility, as all facility learning needs vary.  Pedagogy is committed to helping you raise the knowledge level of your staff, but understands economics are a consideration of all corporations and facilities. We pledge to meet or beat any verified education plan pricing offer. 

With a catalog of courses designed to impart a higher level of education to your staff our memberships allow you to take advantage of unique course topics:

• IV Therapy and Infusion Education
This category of education provides basic peripheral and central line education as well as meeting many states requirements for LVN/LPN "IV Certification".  Developing a “clysis” program allows nurses to rehydrate using a simple subcutaneous method also called hypodermoclysis. Pedagogy education also offers higher level infusion education such as IgG, blood products, TPN, IV Push Medications, inotropic therapies, and insulin pump training to elevate your nurses’ knowledge and skill in the infusion arena.  All IV courses contain skill competency checklists to allow employers to easily complete the documentation of infusion skills - a necessary component of infusion education.

• Respiratory Care
Respiratory care such as tracheostomies, heat and moisture exchangers and even online CPR certification are available.

• Infection Control and Prevention
Preventing and controlling the spread of infection is a high level priority within the long term care and skilled nursing facility. All care staff and support staff should be educated on infection prevention. Our list of courses include: Handwashing Responsibilities in Healthcare, Bloodborne Pathogens, Blood and Body Fluid Spill Management, C. Difficile prevention and management, and Norovirus prevention and management.  These courses impart the knowledge to your staff to effectively prevent the spread of disease within a difficult to manage healthcare environment.

• General Knowledge Courses
Our extensive catalog of fall prevention, dementia care, pain management, wound care, disease state management, massage and compassionate touch classes provide your staff with solid basic education for post acute care. With attention to proper assessment, communication, and reporting to prevent hospitalizations and courses that prepare your staff to provide the highest levels of care. The Critical Thinking Series of courses assist your nurses in developing the crucial skills in critical thinking and problem solving.  Leadership, hospice, and cultural diversity training rounds out the topics of education in this category.

• Inservices
Interactive online inservices are designed for certified nurse assistants, home healthcare aides and caregivers. We offer an Inservice Membership allows you to engage staff and boost learning and retention of subject matter with our interactive, interesting course presentations. Our Inservice Membership opens up our Inservice Class Catalog to your staff.

• Administrators
We offer a variety of our courses with accreditation specifically for Facility Administrators as well.

• Entire Course Catalog
To view the entire course catalog click here.

To learn more about Pedagogy Memberships click here.

Contact Us
Ready to get started? We can have your learning system up in a matter of days – not weeks. Give us a call and let’s find the best plans and options for your facility learning and education needs.
Call @ 903-871-2150 or email capra.dalton@pedagogy-inc.com

Pedagogy blog written by Capra Dalton, RN,CEO. 

Capra has more than 28 years of experience in infusion therapy and the instruction of licensed nurses in infusion therapy continuing education. Her experience comes from multiple infusion settings: acute care, ambulatory infusion centers, home infusion, long term care continuing education provider, and long term care pharmacy quality assurance consultant.
Posted: 4/29/2014 7:34:20 PM
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