Preventing Re-hospitalizations
PAIN
Safety and Falls
Medicare Reasonable and Necessary
SDoH
100

Primary goal for patients and home care staff

What is Preventing Re-hospitalizations?

100

An unpleasant sensory and emotional experience associated with, or resembling that associated with , actual or potential tissue damage.

What is Pain?

100

Every time you enter the patient's home



When do you assess patient's safety?

100

Homebound, under the care of a physician/allowed practitioner, and be in need of skilled care

What are conditions patients must meet for Home Health Services?

100

Conditions in which people are born, grow, live, work and age, not something an individual can have or not have, not positive or negative, differ from social needs, may represent social risk factors.

What are Social Determinates of Health (SDoH)?

200

Unrelieved chest pain, uncontrolled bleeding, unrelieved shortness of breath

What is when to call 911?

200

Psychological, Biological and Social

What are the 3 components of Pain Management?

200

Shower Chair/Bench

What DME equipment is required for patient to shower?

200

Personal care, part time and intermittent, can assist with activities to directly support skilled therapy, may provide incidental services if the above criteria is met.

What are Certified Home Health Aides Services?

200

Within the past 12 months, have you been worried that your food would run out before you could get more?, If you need help with day to day activities such as bathing, preparing meals, shopping, managing finances, etc, do you get the help you need?

What are the OASIS E SDoH Assessment Items?

300

Leaking catheter, medication questions, s/s of wound infection

What is when to call Nurse?

300

Pain that last 3 months or less, related to an injury or specific event, localized to the injured area, accompanied by swelling, warmth and redness in the injured area.



What are signs and symptoms of Acute Pain?

300

Unintentional change in position

What is the definition of a fall?

300

Skill provided, homebound status and education provided.

What is required to be documented in Clinical Notes?

300

Access to care, environment, identity, education/literacy, economic stability and neighborhood.

What are Social Determinate of Health (SDoH)contributing factors?

400

A VNAHG Intranet Resource for evaluating symptoms

What is the  Clinician Triage Guide?

400

Somatic, Visceral and neuropathic



What are the 3 Types of Pain?

400

Have you fallen in the last year?

Do you feel unsteady when standing or walking?

Do you worry about falling?

What are the STEADI Fall Risk Tool questions?

400

Health care team

OASIS Reviewers

Managers

Insurance companies

Medicare auditors

State/CHAP surveyors

What is who reads the Medical Record?

500

Mobile x-ray, lab draw, med change , antibiotics.

What are alternative recommendations to Emergency Room?

500

Patients should be asked to describe their pain in terms of the following characteristics.

What is location, radiation, mode of onset, character, intensity and exacerbating and relieving factors?

500

^FallReporting (NJ Employees)

^OhioFallReporting

Florida

Brian.Pescatore@ccflvn.org (Therapy)

Maureen.McGowan@vnahg.org (Nursing)


Who do you contact with questions regarding Fall Occurrence reporting?


500

Information reflected in the Home Health Plan of Care, OASIS, documentation in clinical record, objective clinical evidence and the patients individual needs and the skilled care may be necessary to improve patient's condition, maintain patient's condition, prevent or slow further deterioration.

What determines reasonable and necessary?