Category: SOS Blog

Caregiving and Caregivers

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I have recently been struck by the number of people in my immediate circle who are primary caregivers for someone other than their children. I am not sure how I had not noticed this earlier in my life. I have always had friends older, younger and the same age as me, so I thought I had a wide spectrum of life experiences on my radar. Not so at all. Only in the last several years as I have focused on my own needs as a caregiver have I really started to notice just how common this state of life is.

According to Medicare.gov, nearly 66 million Americans are caring for an elderly, seriously ill or disabled friend or family member. Within our organization, 1/5 of us work full-time and are also primary caregivers. I was surprised to learn that we are exactly representative of the rest of the U.S. The 66 million indicated above is about 21% of the approximately 315 million people living in this country. Just look around you. If you are not the one-in-five yourself, one of the four people who sits near you at work is likely to be.

Medicare is concerned enough about this state of affairs that it has dedicated a section of its website to providing information and resources for caregivers. This includes documents and videos as well as links. If you are caring for someone who is on Medicare, knowing what services Medicare covers can be most helpful, and having access to additional resources can be a lifesaver!

One of the links on the Medicare.gov site takes you to a Department of Health and Human Services Eldercare locator. This is aimed at helping you find specific kinds of services near to your home when the person you care for is elderly. Many caregivers never look for assistance because they assume none is available. That is not necessarily the case. Learning to reach out and ask for help is an essential survival skill.

Those of us who currently work in the behavioral health field or have done so in the past are always attuned to mental health issues in our clients. Unfortunately, we often overlook those same issues in our own family members, friends and co-workers. According to the National Family Caregivers Association, family caregivers often experience major depression.

Family caregivers suffer from major depression much more frequently than the rest of the population. That’s a fact. When a family caregiver suffers from depression, there are two people at risk – the family caregiver and the family member or friend for whom she or he cares.

Learning to identify depression and deciding to seek assistance is essential to self-care. Just as you would assure that a client is getting appropriate services to treat depression, it is important that you reach out to the caregivers in your life who may be in need of support and similar services.

As baby-boomers become ‘senior’ citizens, the numbers of those needing assistance and of caregivers providing that help will increase dramatically. Now may be the time to learn about available resources and to provide them to those caregivers you know.

Please share your experience. Just enter your comments below.

Thanksgivings: First and Current

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Our book club is reading 1491: New Revelations of the Americas before Columbus by Charles C. Mann. While the book is a fascinating account of relatively new research on the state of the Americas before Columbus and the meeting of Americans and Europeans, I was also struck by Mann’s description of what that harvest celebration we think of as ‘The First Thanksgiving’ between the Pilgrims and the local Indians likely actually included. It was certainly nothing like what we celebrate!

We have created all sorts of traditions that are based more on the ideas of Sarah Josepha Hale, the 19th century editor of Godey’s Lady’s Book and a well known trend setter. According to Elizabeth Armstrong’s article in the Christian Science Monitor in November 2002, the three day harvest festival that occurred in the fall of 1621 included 52 English colonists and 90 Wampanoag Indians. According to Mann’s account, the Indians and their leader Massasoit were likely present to enlist the support of the colonists against a neighboring competing tribe.

A 1999 version of the web site of Plimoth Plantation included in a K-12 curriculum of the state of Wyoming shares details and hypotheses about the development of the Thanksgiving holiday Americans celebrate. A visit to the current web site of Plimoth Plantation reveals significantly more information and tracks the development of the holiday over time. President Abraham Lincoln declared the fourth Thursday in November to be a national day of thanksgiving.

As a behavioral health specialist, holidays and how we handle them have always been interesting to me. How they came to be, which aspects of the celebrations we have adopted, and how we incorporate holiday traditions into our own lives speak volumes about us as a culture and as individuals.

In this year when many are beginning to experience recovery from a very difficult economic time, we hope that a community-wide expression of gratitude for the many privileges we share will help us all move past a bitter and hard-fought election cycle.

We are grateful for our new and our long-time customers. We are indebted to our readers who come back regularly and share their experiences with us and with one another. We appreciate your feedback and your encouragement. Thank you for sharing your journey as behavioral health providers with us.

Happy Thanksgiving!

Resources on Post-Storm Trauma, CPT Codes, Veterans’ Services and More

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If you read this blog often, you will notice that I regularly link to articles and other resources posted by The National Council. While we have exhibited at their conference, our organization has never been a member of The National Council. We have, however, been a grateful promoter of the resources that this organization shares freely with the behavioral health community. If you have never gone to their website or attended a webinar, you should take the opportunity to do so. They provide outstanding information in a timely manner. In spite of not being members, we have never been prevented from attending webinars or sharing in their well-researched and well-documented information.

I wanted to point you to some of the current information being provided by The National Council.

  1. Last week I talked about the need to have your own emergency contingency plans in case of storms and other natural and unnatural disasters. Since most of you are providers of behavioral health services, you will also find yourselves dealing with clients who have experienced the same trauma you have gone through. Just this afternoon, a webinar entitled Mitigating Disaster Trauma: Lessons from Sandy was presented by The National Council. While the webinar is over, The National Council routinely records webinar presentations for later viewing. You should be able to view this one within 48 hours.
  2. On November 9, Manon and I attended the Council’s webinar on CPT Code changes for 2013. Both the recording of the webinar and the slide deck from the presentation are available. In addition, a December 3 webinar has been scheduled to provide additional information about the new Evaluation and Management CPT Codes and how to use them. Registration is still open for that event.
  3. A new report announced by The Council reveals the incredible costs of the unmet mental health needs of returning U.S. Veterans. Having just passed Veterans Day, this is a sad reality we all need to be educated about. Those of you who provide services to Veterans will find the report of interest.

Please be sure to reference these resources properly if you refer to them in any of your own newsletters and announcements. The National Council does outstanding work in educating the behavioral health community and deserves credit for all the work they do!

Please share other resources that you find useful in your work. We love to be able to let our readers know about the wonderful materials that are available to them to enhance the outstanding work you all do in providing mental health services to all who need them.

 

Will Your Organization Weather a Storm…or Other Catastrophe?

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Superstorm Sandy has had major impact on the lives of large numbers of our fellow Americans and colleagues who live in the Northeast U.S. The loss of life, property, and access to conveniences like electricity, warm showers, and transportation has made clear how vulnerable we are to the impacts of catastrophic events.

Sandy has also given us the unfortunate opportunity to evaluate the policies and procedures we have in place for dealing with physical catastrophes.

The Health Insurance Portability and Accountability Act (HIPAA) requires that organizations have in place a Contingency Plan (STANDARD § 164.308(a)(7) Contingency Plan, see page 19):

The Contingency Plan standard requires that covered entities:

“Establish (and implement as needed) policies and procedures for
responding to an emergency or other occurrence (for example, fire,
vandalism, system failure, and natural disaster) that damages systems that
contain electronic protected health information.”

This requirement is not aimed at giving you one more thing to do. The purpose is to protect the health information of your patients and to make sure that they have access to continuing care. Hurricane Andrew in 1992 and Hurricane Katrina in 2005 demonstrated how poorly prepared we have been to maintain continuity of care for our patients. The requirements of HIPAA are designed to prevent such huge failures as happened previously.

FiercePracticeManagement newsletter suggests three key steps.

  1. Know how your remote data is stored and can be accessed. This assumes that you have your data stored offsite, as it should be. Knowing just where it is and how to access it so you can get your system back up and running without delay is crucial. 
  2. Duplicate needed paper and have it with you. Make sure you have a copy of your schedule with you. Assure that you have with you ways to contact your patients so you can let them know your alternative arrangements for meeting with them.
  3. Plan where you will relocate physical data. Know where that alternative location will be so you can get access to your data again quickly.

 

In HealthCare IT News, Benjamin Harris covers some of the same ground. He also suggests three basic processes, but starts at a more basic level.

  1. On-site safety. How is your hardware and software and record systems protected at your site? Is your server located in the building basement along with the generator? As demonstrated by Sandy, the basement is not the best location for such equipment or records in the case of flooding . . . something that had previously been an issue in hurricanes Andrew and Katrina.
  2. Off-site data. If you are relying on a remote (cloud) storage facility or you need to access your data by means of the Internet, what do you do if your ISP (internet service provider) is down? And if your EHR is an online product, what do you do if those remote computers are underwater and without electricity? Having your schedules for the next week and treatment summaries for each of those patients printed out gives you a week of buffer time to give your vendors a chance to get back up and running.
  3. Accessibility. If you are using such remote storage or providers and they are not in the affected area or can implement access to backups quickly, having the capability of connecting to them becomes your responsibility. You can tether your laptop to your cell phone to reach your service or data in an emergency, as long as you have prepared in advance.

 

Madeline Hyden of the Medical Group Management Association (MGMA) suggests a slightly different but very practical list of steps.

  1. Secure your electronic information.
  2. Get the support of your professional colleagues.
  3. Immediately start securing new office space.
  4. Establish authority: Make sure someone in your organization is responsible to and has the authority to activate your contingency plan.
  5. Communicate with your vendors (hardware, software, backup services, electrical company, landlord, billing service, answering service).
  6. Develop a notification protocol: decide who to contact and how and who does the contacting. Determine just what they will be told.
  7. Communicate honestly with your patients.
  8. Protect your records so you are sure you can have access even if your main system is not accessible.
  9. Practice your emergency plan. If you have not done so, it is possible you will be too traumatized to carry it out.

If you are not sure how to go about establishing a contingency plan, AHIMA has some suggestions for you. This does not need to be a complicated process, but it is a process you need to address if you have not already done so. After all, the U.S. northeast coast did not think they were susceptible to a hurricane-like storm that could cause such disruption.

Whether it is hurricanes, snowstorms, tornadoes, earthquakes, or fires, our electrical systems and business facilities are not impervious to disasters. We must be prepared so our patients can rely upon continued care.  Behavioral health clients are especially susceptible to negative consequences from disruptive events. After all, they are likely to have just experienced the same trauma you did.

We hope all our SOS customers and their patients are safe and recovering in the aftermath of Sandy. We hope any of you, our readers will share your experiences and how you have assured the security of your data.

 

PHI Thieves Are Usually After Financial Information

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Now that many physicians and other healthcare organizations are purchasing and utilizing EMRs, they seem to be focused on safeguarding the clinical Protected Health Information (PHI) of their patients. In the process, some are forgetting to protect patient financial information even though it is also PHI.

The FierceHealthIT newsletter of October 24, 2012 indicates that healthcare system data thieves are usually after financial information.

Despite reports of efforts to blackmail patients and the possibility of hacking pacemakers, healthcare data breaches in the end are similar to other cyber crimes, according to a new report from Verizon. In an examination of approximately 60 confirmed data breaches over the past two years, the report concludes that those who attack healthcare systems primarily look for information from which they can make a profit.

According to this Verizon report, point-of-sale systems (credit card machines) and desktop and laptop computers are the most common points of breach. Thieves attack the weakest links in the payment chain. Rather than going after your server, they hack into peripheral equipment that can get them access to this financial information.

Here at SOS, we harp on the need to secure the data in your billing and clinical record software. We have been amazed at the lack of awareness of even our largest customers. Every week, we receive emails that contain PHI or a direct way to get to PHI. Employees of behavioral health organizations often do not realize that sending an email with PHI in it is like sending a postcard with the same information. Anyone who sees that postcard and who knows how to read can take a look at your message. The same is true with insecure, unencrypted email. Anyone who knows how to do so and who has any interest can take a look at your email.

This study indicated that, among the breaches they studied, most of the incidents occurred at businesses that had from one to one hundred employees.

The simple solution….encrypt all PHI while it is resting on your system and while it is in transit from one place to another. If you don’t know how to do that, learn how, now!

Please share your experiences, direct or indirect, with safeguarding PHI. Do you encrypt? What procedures has your organization developed to assure that all of the PHI in your possession is as safe as possible from thieves?