Perspective - Huntington Hospital

Issue 1 / 2012
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Reduced Public Services Leave Frail Seniors Vulnerable
Healthcare and an Aging Population: An Interview with Cathi Chadwell
Preparing for the Unexpected: Helping Clients Stay Safe in an Emergency
Severe Windstorm Tests Emergency Management Plan
Huntington Hospital Senior Care Network
Perspective
A newsletter on aging and services
for older adults
Reduced Public Services
Leave Frail Seniors Vulnerable
Visits by HSCN
care coordinators
help clients stay
independent and
able to live safely
at home.
How vital can it be to have fewer hours of weekly personal care assistance, no
care for ill-fitting dentures or no prescriptive shoes if you’re diabetic? Does participation in adult day care really matter?
For frail adults dependent on public services and unpaid help for their safety, the
loss of these and other supports can matter a lot. State budget cuts over the past several years have already put the independence of many at risk and possibilities for more
reductions loom in the future.
A recent policy brief from the UCLA Center for Health Policy Research, Independence at Risk: Older Californians with Disabilities Struggle to Remain at Home as Public
>
Supports Shrink (December 2011) underscores the impact. Presenting find-
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Perspective
“I have been
taking care of my
mom for 12 years.
I just don’t know
how I would have
gotten through it
all without Senior
Care Network
and (our care
coordinator).”
~ A HSCN client’s
daughter
ings from a yearlong study, the brief concludes that “declines in health status and other
personal circumstances among aging Californians have been exacerbated by recent
reductions in public support, and will be made even worse by significant additional cuts
that are pending.”
“It makes our continued ability to help people with alternatives difficult,” says
Eileen Koons, MSW, ACSW, director of Huntington Hospital Senior Care Network
(HSCN). “We rely on family caregivers to do more and it exhausts them.”
Typically living on fixed incomes and coping with multiple health problems, clients
are delaying needed care or doing without. Declining health is a predictable outcome.
Chewing difficulties due to infected teeth and gums lead to nutritional problems and
weight loss. Impaired vision results in more falls. Untreated foot lesions in clients
with diabetes worsen. Less attention to personal hygiene increases the chances of
medical complications.
In response, HSCN care coordinators have redoubled their efforts to educate
clients and their families about risks to their health and the dangers of inaction. As
community resources and other funding options also shrink, the search for solutions
demands more time and energy. “We’ve had to become more creative than ever,” says a
care coordinator.
Some families are able to step up their involvement, but others are not. Waiting lists
for services have ballooned. The upshot is that when clients and others become unsafe
in their homes, the likely alternative is relocation to a nursing home, a costly solution
that reduces the quality of life for many.
Uncertainty about the future adds another layer of anxiety. “It’s been very hard for
families to know what’s going to happen and how to plan,” says HSCN clinical supervisor Charleen Crean, LCSW. “They think they have it figured out and then it changes. No
one can count on what is staying. We try to calm the waters and help them advocate for
themselves — to find another path when the road they’re on is crumbling.”
Looking down that road of potentially more reductions, Koons believes flexibility is
the best response. “We need to remember we’re here for older people who need assistance,” she says. “We need to continue to advocate.
“Yes, the sands are going to shift, but whatever direction we end up as a state, we’ve
got to ensure strong consumer protections. These are clients who have no advocate and
no individual should end up with unintended consequences thrust upon them. It isn’t
the end of the conversation, it’s the beginning.” ‡
Back to page one 
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Perspective
Healthcare and an Aging Population:
An Interview with Cathi Chadwell
Cathi Chadwell, executive
director, public affairs,
oversees a number of
Huntington Memorial Hospital
departments that interact
with the community, including
Huntington Hospital Senior
Care Network (HSCN). Involved
in fundraising since she
came to the hospital 20 years
ago, she continues to work in
philanthropy, public relations
and community outreach, in
addition to HSCN. Over the
years she has worked with
HSCN to raise money and
facilitate strategic planning.
Perspective: Why
does the hospital have
a special interest
in seniors?
Cathi Chadwell: Seniors
are a huge portion of our
patient population. Looking down the road, that
population is growing.
Given our mission and
the expected mandates
of healthcare reform, the
hospital will be held even
more accountable for our
community’s health and
well-being, which makes
it our business to focus on
the needs of seniors.
What is the role of
a community-based
program like HSCN?
With its emphasis on
keeping people healthy,
independent and out of
institutions, it’s a model
that came before its time.
The rest of healthcare is
now catching up. HSCN
has more than 25 years of
experience with managing care before people
are in the hospital. It’s a
model we all should be
embracing to make better
use of resources.
How does HSCN’s
chronic care focus fit
with the traditional
hospital emphasis on
acute care?
The hospital is evolving. In my mind, we’re
at a wonderful juncture
shifting away from acute,
episodic care to looking
at the whole continuum.
HSCN has beautifully
built that bridge between
community and hospital,
and we need to leverage
those strengths. If you
approach chronic disease
with a care management
>
model, you’re
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Perspective
keeping people in a place
where they are less likely
to have acute care episodes that put them in the
hospital — and, we hope,
improving their quality of
life as well.
“HSCN has beautifully built that
bridge between
community and
hospital, and we
need to leverage
those strengths.”
Are there ways HSCN
can make this process
more effective?
One way is to embrace
electronic-based
technology that is
integrated with the
hospital and, down the
road, other community
providers. It’s a culture
shift that, for example,
means taking notes
electronically instead
of manually. Another
way is for HSCN staff to
reach out and become
involved in hospital
projects and initiatives,
raising awareness of
HSCN’s services. I want
every employee and the
community to understand
and appreciate that
HSCN is integral to the
hospital’s future.
As healthcare continues
to change, name one
key challenge.
A challenge is how to
structure ourselves to
serve the population
of the future within
our resources and
competencies. There
will always be more need
than resources available.
This is where chronic
care management comes
into play. Last year
we added two HSCN
health navigators whose
expertise helps patients
make a safe transition
from hospital to home
and avoid unnecessary
re-hospitalization. I
believe that model will
prove successful.
Where do you see HSCN
headed in the future?
We’re doing good work
today, but we don’t want
to rest on our laurels. This
year we are undertaking a strategic planning
process for HSCN. Ideally,
we’ll come away with a
roadmap for the future.
Obviously there are things
out of our control, such
as healthcare reform and
the state budget, but there
are a lot of opportunities
as well. With an older
population that wants to
age gracefully and with
vitality, for example, we
should increase HSCN’s
visibility with our donor
population and engage
their support for our efforts, rather than always
having to rely on government funding. There are
so many possibilities; it’s
an exciting time! ‡
Back to page one 
5
Perspective
HSCN client
Louis Feng has
emergency
supplies on
hand in a kit
put together by
his daughter,
Hani Feng.
Preparing for the Unexpected:
Helping Clients Stay Safe in an Emergency
T
hink natural disaster in
Southern California and
earthquakes head the
list. But in recent years
frail, elderly Huntington
Hospital Senior Care Network (HSCN)
clients have faced hardship and
evacuation from their homes due to
wildfires, floods, mudslides and dayslong storm-induced power outages.
Frequent summer heat waves also put
the many clients who lack central air
conditioning in danger of heat stroke.
Care coordinators routinely educate
clients about emergency preparedness,
but the recurring threats to the safety
of such a vulnerable population called
for a closer look at emergency management policies and procedures. The effort,
headed by HSCN clinical supervisor Pat
Trollman, LCSW, zeroed in on defin>
ing the risk level of each client,
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Perspective
“As larger
disasters such as
Hurricane Katrina
and recent
earthquakes in
Haiti and Japan
have shown,
you may be on
your own for a
minimum of two
weeks before
assistance arrives.”
identifying and confirming resources that
would be available to help, and clarifying
the care coordinators’ role to help clients
and families be prepared and to assist
them in an emergency.
The first clients to be contacted
in an emergency are those deemed at
greatest risk, Code 1 of four codes. They
usually live alone with limited support;
may depend on company-provided
medical equipment; need others to help
with their personal care; and may have a
communication barrier. Reaching these
and other clients during an emergency,
however, can be the first hurdle care
coordinators face.
“Communication may be a big challenge for us in emergencies,” Trollman
acknowledges. “Phone systems may not
be working. That’s why it’s so incumbent
upon clients and their families to be
prepared. Many haven’t given it much
thought until we intervene and work with
them to take it seriously that they may
need to sustain themselves for a while.”
Daniel Holden, the hospital’s emergency management coordinator who
worked with HSCN to hone the plan,
advises that plans should use a common terminology, which will facilitate
communication during an emergency
and avoid confusion. When reviewing
statements made in emergency response
plans, he says, he asks questions such
as, “How do you know this response will
happen? Do you have the resources to
support your response procedures? How
do you know your plan will work? Has it
been tested?”
Holden stresses the importance of redundancy in emergency plans, so “you’re
not putting all your eggs in one basket.”
Care coordinators, for example, maintain
a current, easily accessible list of several
people to contact when a client needs
assistance or can’t be reached by phone.
HSCN also has agreements with local
contacts and vendors to meet clients’
emergency needs.
Yet clients and their families may
have to manage on their own for more
than a day or two. “It’s a false sense of
security to say 72 or 96 hours of supplies is enough,” says Holden. “As larger
disasters such as Hurricane Katrina and
recent earthquakes in Haiti and Japan
have shown, you may be on your own for
a minimum of two weeks before assistance arrives.”
To help clients and their families face
this reality, care coordinators work with
them to develop a personal emergency
plan and assemble an emergency supply
kit. In the future, a computerized tracking system may be able to meld predictive
information about occurring disasters
with clients’ locations to better assess the
need for assistance.
Less than three months after the
revised emergency management plan was
in place, a violent windstorm left local
areas without electrical power for days
(see story, page 7). Put to the test, the plan
“worked quite well,” Trollman reports.
“We found some resources needed updating, but we easily identified who to contact first and helped clients problem solve
to obtain what they needed.” ‡
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Perspective
Severe Windstorm Tests
Emergency Management Plan
Uprooted trees
and downed
power lines
caused days‑long
power outages
for many
HSCN clients.
Konstantin Sutyagin / Shutterstock.com
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The week following last Thanksgiving, hurricane-force winds ripped
through areas served by Huntington Hospital Senior Care Network (HSCN) for up to
five hours during the night. Come morning, uprooted trees and downed electrical wires
clogged streets and power was out in much of the region, with no indication of when it
would return.
As part of HSCN’s emergency management plan (see story, page 5), HSCN care
coordinators contacted clients to assess their safety and work with them and their
families to obtain needed resources. For several clients, the HSCN intervention made a
crucial difference in their well-being.
Mrs. M, 75, lives alone. She has several health issues and was recuperating from recent back surgery. When a care coordinator reached her by phone, she was very anxious
and reported that she had no electricity or heat. She said it was very cold and there was
no one she could stay with. The surrounding area was also without electricity.
The care coordinator couldn’t locate any battery-operated heaters at local stores or
learn when power would be restored. Mrs. M’s phone service was intermittent, but the
building manager was reachable as a backup. Mrs. M said she was using her emergency
flashlight and was greatly relieved to know there was someone to help her manage
the situation.
Determining that her safety was threatened, the care coordinator arranged to trans>
port and place Mrs. M in a hotel, accompanied by a friend who could stay with
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Perspective
Working
from HSCN’s
emergency plan,
HSCN staff were
able to respond
effectively to
further maintain
the safety of
clients in need.
her and help with limited personal care. Three days later she was able to move back
home after power was restored.
Mrs. S, 75, is bed-bound and has severe cognitive impairment. She is totally dependent for care on her 94-year-old mother and a paid caregiver who comes for eight
hours a day. She has a feeding tube run by electric pump. A small generator can supply
power for a limited time. When the electricity went out, the resourceful mother enacted
the family emergency plan, notifying the city and local fire department, who said they
would come to check. But overwhelmed with calls and hampered by considerable debris
in the streets, they were unable to respond.
Reaching the mother by phone, the care coordinator learned they had no heat or hot
water. In addition, lack of electricity meant the head of Mrs. S’s electric bed couldn’t be
raised or lowered and her air mattress, which uses an electric pump, had deflated. Without prompt intervention, an existing pressure sore would likely worsen.
Certain that power would resume soon, the stoic mother felt they could manage
and was reluctant to consider moving her daughter to a skilled nursing facility for the
interim. Finding that nursing facility beds were filling up fast due to the emergency, the
care coordinator emphasized that it was unsafe for the daughter to stay at home and
finally convinced the mother. While her daughter was cared for during the five days of
power loss, she was able to go stay with her son for much-needed rest. Clients and families like Mrs. M and Mrs. S’s mother had been helped by care
coordinators to be prepared as much as possible for an emergency situation. Working
from HSCN’s emergency plan, HSCN staff were able to respond effectively to further
maintain the safety of clients in need. “Many clients we contacted expressed gratitude
that they were better prepared as a result of the care coordinators’ prevention efforts,”
says clinical supervisor Pat Trollman, LCSW, “and this event has motivated them to
do more.” ‡
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Perspective is published two times a year by Huntington Hospital Senior Care Network, Pasadena, California.
Eileen Koons, MSW, ACSW
Director
Gladys Gundrum, MA
Writer/Editor
Huntington Hospital Senior Care Network provides access to a complete
range of medical, social and personal services for adults, older adults with
disabilities and their families. For more information, call (626) 397-3110 or
(800) 664-4664 or visit our website at www.huntingtonhospital.com/SCN.