Home care dietitians improve tube feeding patient outcomes

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Coram’s research highlights the critical role home care dietitians play in decreasing tube feeding intolerance and improving nutrition outcomes

Home-based health care continues to gain traction as an option for people living with a variety of chronic conditions. In fact, home infusion care can be a safe and cost-effective treatment alternative when compared to the same care provided in an in-patient or hospital setting. Coram CVS Specialty Infusion Services (Coram) is leading the way in home infusion care and parenteral (intravenous) and enteral (tube feeding) nutrition with a team of skilled home care Registered Dietitians, who can address nutrition intolerance, assess adequacy of hydration in feeding regimens, and address associated patient questions.

To advance the knowledge of health care practitioners and improve care for patients, Coram is actively involved in home nutrition care research. This research includes evaluating the impact of transitioning nutrition care from the hospital to the home and the benefits of home-based parenteral and enteral nutrition in certain populations.

Coram dietitians Nicki Bray, MS, RD, LDN; Sarah Allen MS, RD, LDN; and Caitlin Wendecker, RD, CNSC, recently conducted research to evaluate the efficacy of home care dietitian recommendations in addressing reported enteral nutrition intolerances, and the critical role home care dietitians play in creating interventions to improve nutrition outcomes. They shared their findings in their abstract, Home Care Dietitian Intervention Effectiveness to Reported Intolerance.

When patients are sent home from the hospital with little additional support and potentially poor tolerance to tube feedings, their outlook and compliance with their home tube feeding regimen may be impacted. Identifying and effectively addressing intolerance will increase a patient’s compliance and improve nutrition outcomes.

Coram conducted a retrospective review of adult patient records that reported intolerance within 48 hours of start of care. This retrospective review supported the important role of home care dietitians in evaluating and managing tube feeding intolerance, with dietitian interventions effective for 72% of patients by day 30 and 91% of patients by day 60. Without appropriate intervention by a dietitian, patients may be at risk for poor nutrition outcomes such as gastrointestinal distress, malnutrition, weight loss or underfeeding.

Home enteral nutrition patients are also at increased risk for dehydration due to inadequate fluid administration, and Coram dietitians explored this in an additional abstract, Adequacy of Flushing Orders in Home Enteral Nutrition Patients, by Katrina Sesler, MS, RD, CNSC; Rebecca Caldwell, MS, RD, LDN; and Laura Kashtan, RD, which reviewed patients’ water flushing orders at discharge from facility to home care. From a retrospective chart review of adult patients, Coram dietitians noted that discharge flush orders are missing or are inadequate for a considerable number of home enteral nutrition patients. Individualized recommendations and early patient contact by a dietitian may be important to prevent dehydration in these patients.

Early intervention by home care dietitians can help patients address tube feeding intolerance, assess hydration levels, improve therapy compliance and address patient questions and concerns. This support can help improve patient outcomes, potentially preventing hospital readmission at a time when hospital resources are stretched due to the increasing rate of COVID-19 admissions. Measures to help patients remain home and avoid hospital readmission are always valuable, but today they are critical.

A practitioner, using a tablet computer, assists a patient with tube feeding therapy.
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Quarantined seniors face unseen dangers

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With an increased risk of severe illness from COVID-19, the Centers for Disease Control and Prevention (CDC) advises that adults 60 and older "stay at home as much as possible." But, studies show that isolation and loneliness can cause seniors physical and mental harm. In fact, it can be more harmful to a person’s well-being than obesity or smoking 15 cigarettes a day.

Why loneliness is lethal

The first step in finding solutions is to understand that loneliness and social isolation are related, but different problems, says Dr. Christopher Lim, M.D., Senior Clinical Advisor, Aetna Medicare. Isolation is objective and can be measured by factors like the size of a person’s social network. In contrast: Loneliness is a subjective and personal feeling. Both are common among older adults.

A 2020 study found that nearly a quarter of Americans aged 65 and older are socially isolated, and some 43% of adults aged 60 or older report feeling lonely. Add on the isolation felt with the pandemic, and these people face increased risk for heart attack, stroke, or even reduced antiviral protections that are so important right now.

“Loneliness is not a normal state of being for a human,” says Lim. “Biologically, we depend on others to survive in the world.”

Making connections

Fortunately, there are ways we can all help older adults stay connected while respecting social distancing:

  • Resources For Living consultants call at-risk seniors identified by the Social Isolation Index to offer customized local solutions, such as food delivery.

  • SilverSneakers, now offers members age-appropriate online video workouts from home.

  • Papa, Inc. program connects college students and seniors through “Assistance from a Distance” to encourage positive thinking, help with ordering groceries and medicines and explaining telehealth tools.

  • Through an Aetna Foundation grant, the Meals on Wheels program is developing a training curriculum to teach seniors how to use technology to make online connections.

Dr. Robert Mirsky, Chief Medical Officer, Aetna, talking with an older woman outdoors.
Dr. Robert Mirsky, Chief Medical Officer of Aetna.

“We are continuing to look holistically at our social connectedness offerings to build out a variety of approaches to identify and support our members who are lonely or isolated,” says Dr. Robert Mirsky, Chief Medical Officer for Aetna Medicare.

You can help, too. Consider adding your neighbor’s shopping list to your own. Call your elderly relatives to remind them they aren’t alone. Schedule a virtual visit between your children and parents. The connections you make during this time could be lifesaving.

Help older adults stay connected

  • Make a plan how to social distance and sanitize their home. Update phone numbers for pharmacy and other home deliveries.

  • Schedule regular phone calls and video chats.

  • Organize a virtual game night using online board games or set up identical game boards and use a speaker phone. 

  • Create a virtual book club or have grandparents read bedtime stories.

  • Host a long-distance dinner party with meal delivery and phone or video conversation.

A photo of an older woman gazing out of a window with natural filtered light.
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Addressing social isolation among seniors

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With studies showing social isolation can be as damaging to your health as smoking a pack of cigarettes a day, loneliness can be just as dangerous as high blood pressure and high cholesterol.

That's why addressing social isolation is a major focus for Aetna’s Medicare business and care managers, who are taking a more holistic view of senior health to help get them on a path to better health.

With studies showing social isolation can be as damaging to your health as smoking a pack of cigarettes a day, loneliness can be just as dangerous as high blood pressure and high cholesterol.
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“The most common challenge with our senior patients, honestly, is that so many of them have no one,” says Aetna Field Case Manager Sarah Fischer, RN. “So many of them don’t have families. One lady said to me, ‘I’m the only one left.’"

Watch the video to see how case managers are introducing seniors to benefits such as the SilverSneakers fitness program, community volunteering and other opportunities for social connection.

“We get them involved, get the area office on aging involved. There are senior newspapers, things like that,” says Sarah. “We just bring these benefits to the member and say, ‘Let’s get you involved in something.’”

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Aetna’s Compassionate Care Program Lends a Hand During Difficult Times

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Life is unpredictable, and the end of it can be even more so. Advanced age and/or serious illness can feel like it arises suddenly, leaving patients and their families unprepared and in crisis. That’s why Aetna has worked for over a decade to find empathetic and supportive ways to help people make difficult choices about end-of-life care.

“Nothing is more personal than how we want to face the end of our lives,” said Alena Baquet-Simpson, M.D., Senior Director of Medical Health Services for the Aetna Medicare team. “We are committed to ensuring that individuals receive the kind of timely and compassionate care that they wish for and deserve.”

Aetna’s Compassionate Care program provides not only help with coordinating needed services, but also the empathy members and their families need during these trying times. The program offers members and families comprehensive care management and caregiver support that allows the critically ill member to face end of life on their own terms–without unnecessary stress or discomfort.

Importantly, the Compassionate Care program expands the window for many members in Commercial lines of business to receive hospice care from the typical six months to a full year. It also allows these members to receive medical treatment such as chemotherapy along with palliative care or hospice services.

The Importance of Knowing Your Options

According to Baquet-Simpson, patients or loved ones often only learn about their hospice options after a medical crisis or hospitalization. In fact, according to recent research,https://www.healthaffairs.org/doi/abs/10.1377/hlthaff.2017.0175 only 1 in 3 adults has done any advanced planning to cope with end-of-life matters.

Aetna hopes to change that dynamic by using sophisticated predictive modeling to identify patients who may be at risk for advanced illness and are candidates for advanced care planning. Highly trained professionals at Aetna then reach out to those members or their families to start a conversation about available options, information and support. Nurse case managers then work closely with members to help them understand their care options, the philosophy behind and services offered under hospice and how everything may fit with their end-of-life wishes.

For example, one member was returned home after hospitalization and a lengthy skilled nursing facility stay. The Aetna nurse case manager educated the member and his family about covered services, including home health care to help with changing wound dressings. She also ensured his questions concerning copays and network providers were answered in a timely way and engaged an Aetna social worker to identify additional community resources.1

After much discussion, the member and his family came to realize that the care he required exceeded the family members’ abilities, and he was subsequently placed in an assisted living facility. At that point, he began considering hospice. After the member passed away peacefully under hospice care, his daughter reached out to the Aetna nurse to share the family’s gratitude.

“When you are making these huge life choices, you want emotional and medical support to allow you to get your affairs in order,” said Nancy Snyder, Aetna Case Manager RN. “If things turn bad, not only do you have time to prepare, but to make sure your wishes are met. Aetna has a very forward-thinking attitude that has helped many families deal with one of life’s hardest periods.”

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Help Your Loved Ones Learn About Their Medicare Options

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Heath care is deeply personal. And when it comes to making health decisions, consumers often seek the counsel of those who know them best – family and friends.

Aetna is committed to helping you and your loved ones better understand their Medicare options. Get information on how plans can support total health and wellness and learn the role of a Medicare Advantage plan.

For this Annual Enrollment Period (October 15 through December 7), Aetna created a new video series called Kitchen Table Talk. It explores common health and Medicare-related topics typically discussed within the comfort and privacy of your home.

You can watch the three-part video series on the new Aetna Medicare Solutions website:

“We’re providing resources to help Medicare beneficiaries discuss their health goals and identify what’s most important to them,” said Christopher Ciano, who was appointed head of Aetna Medicare earlier this year. “Based on personal experiences with my own parents, I know these are the types of conversations actually taking place between Medicare beneficiaries and their family members. We hope this video series helps make those conversations easier for everyone involved, so that people can choose the plan that best fits their needs.”

The Aetna Medicare Solutions website also features engaging educational information to help Medicare beneficiaries make decisions that empower them to achieve their unique health goals.

Aetna Medicare is a PDP, HMO, PPO plan with a Medicare contract. Our SNPs also have contracts with State Medicaid programs. Enrollment in our plans depends on contract renewal. See Evidence of Coverage for a complete description of plan benefits, exclusions, limitations and conditions of coverage. Plan features and availability may vary by service area.

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Improving Alzheimer’s Awareness for those with the Disease & Providers

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Alzheimer’s disease has a significant impact on the more than 5 million Americans living with the disease and their 16 million caregivers across the country. Currently, 5.5 million Americans aged 65 and older are living with Alzheimer’s and that number is expected to rise to 7.1 million in 2025 as the population continues to age. “2017 Alzheimer’s Disease Facts and Figures.” Alzheimer’s Association. 2017. https://www.alz.org To ensure access to care for these individuals, the CVS Health Foundation has partnered with the Alzheimer’s Association to support the Diagnose, Disclose, and Direct Connect program.

Since entering the partnership in 2016, the CVS Health Foundation has committed $1.1 million to six local chapters of the Alzheimer’s Association to expand efforts to educate providers on Alzheimer’s, deliver resources to individuals and families, and develop best practices for Alzheimer’s care delivery.

Educating Providers

Since launching the Diagnose, Disclose, and Direct Connect program, the Alzheimer’s Association has educated more than 7,000 health care professionals, virtually and in-person. Local chapters are hosting continuing medical education (CME) events, developing video and online CME material, building email lists, and conducting in-person outreach.

Delivering Resources to Patients

The Alzheimer’s Association provides people living with Alzheimer’s and their caregivers access to a variety of supportive and educational resources. These are primarily to help educate families about the disease and its management, as well as to jumpstart a discussion about long-term planning and advanced directives before further progression of Alzheimer’s.

To expand access to these resources, the Alzheimer’s Association has established a direct referral program with providers and health care systems. Local chapters of the Alzheimer’s Association have continued working in their local communities to implement the direct referral program at additional provider locations. 

Developing Best Practices

At the local chapter level, Alzheimer’s Association employees and volunteers have explored a wide range of strategies to connect people with the disease and providers. As the Alzheimer’s Association implements and revises processes and procedures, lessons learned from ongoing efforts will be applied to maximize reach.

A diagnosis of Alzheimer’s is a life-changing event. However, by ensuring providers receive up-to-date information on Alzheimer’s and giving patients tools to make informed decisions, diagnosed individuals and their caregivers can be well positioned to live their best possible lives with the disease.

04.10.18

Alzheimer’s patient and caregiver
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