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How To Talk With Your Mom About Long-Term Care: Top Six Tips

Posted 5/10/2013 Categories: independence at home, home health

The best Mother’s Day gift an adult child can give Mom may be simply to show you love her. But nothing shows you love her more than for you and she to have what is sometimes called "The Talk".

The topic here will be long-term care. As in: does she need it, and if so, what kind would be best – at home or in an assisted-living facility or nursing home – and when should it start.

This conversation may be the most important you ever have with your mother, and – be warned – the most difficult, too. Long-term care is a subject fraught with sensitivities. Your mom may find the whole idea embarrassing and, unwilling to feel like a burden, be reluctant to discuss it. You may feel the same. But at some point it’s a conversation that has to happen.

Two-thirds of adult children have never had this conversation with their parents, an AARP survey found. Yet with Americans now living longer, and with demand for long-term care correspondingly growing, these conversations are needed significantly more than ever. An estimated 70% of people over age 65 will require some kind of long-term care.

Women are more likely to need long-term care than men. They outlive men by an average of five years and may live alone later in life. About 80% of women over age 65 need such care, compared to only 60% of men. Women also need such care for longer periods – an average of 3.7 years, contrasted with 2.2 years for men.

Make no mistake: Your mom may be going strong right now. She's probably still doing most everything she's always done. But you have to think ahead, because someday she may need help with the most basic everyday activities.

How can you carry on this conversation? Here’s my advice:

  1. Start early. By nature, we’re often tempted to wait until a crisis hits But the best time to plan for long-term care is well before anyone needs it, while your mother is still healthy. Several conversations may be required to figure out the best approach.
  2. Find the right icebreaker. Your mother may give you the perfect opportunity, mentioning, for example, her recent challenges driving or bathing or dressing herself. You can then ask her if she could use some help with her personal care.
  3. Take into account her wishes and goals. The best conversation will be a truly two-way street.
  4. Do your homework. If you research long-term care, it could inspire her confidence and win her support. You can also provide her with brochures from AARP and other reliable sources.
  5. Be a partner throughout the process. Make clear to your mother that nobody expects her to go any of this alone, and that you’ll be on hand to help, with advice and paperwork and logistics, from first to last.
  6. Involve others. Your mother may hesitate to discuss long-term care with you because after all, she’s the parent and you the child. If need be, bring in other trusted contacts, whether family, friends, a physician, an attorney or clergy.

Have that talk sooner rather than later, and maybe even today. Ultimately, the timing might be perfect for both of you. It could make this the best Mother's Day ever.

About the Author

Kate Jones, RN, is a former home health nurse and currently serves as chief clinical officer at Amedisys. She was the president and founder of Caring Strategies, a geriatric care management firm that coordinated care for seniors on behalf of their families.

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CMS to Require PECOS Registration Starting May 1

Posted 3/22/2013 Categories: healthcare reform, home health, CMS, PECOS, care plan oversight

Update November 20, 2013: Back in May, CMS delayed enforcement of the PECOS registration requirement described in this article. CMS is still requiring all physicians to register in PECOS, and they've issued a new date to begin denying claims: January 6, 2014.

Beginning May 1, 2013, CMS will begin denying claims for Medicare home health services or supplies from all physicians not registered in PECOS. Access to home health care services is vitally important for many Medicare patients, so physicians who care for Medicare patients should enroll in PECOS by May 1 so their patients can continue to receive the care they need.

Amedisys has developed a one-page guide, 5 Steps to PECOS Enrollment, to help physicians complete PECOS registration quickly and easily.

The new regulation, which is a result of the Patient Protection and Affordable Care Act, was announced last May. This CMS regulation requires all physicians who order or refer home health services or supplies to be enrolled in Medicare – or have officially opted out – and registered in PECOS.

Guide to PECOS EnrollmentDownload 5 Steps to PECOS Enrollment

To help you navigate this CMS requirement, we've created 5 Steps to PECOS Enrollment, a one-page guide to help physicians know what to expect. It includes:

  • the steps to enrolling
  • information to gather before enrolling
  • where to contact for help with PECOS or Medicare enrollment

Common Questions

What is PECOS?

PECOS stands for Provider, Enrollment, Chain and Ownership System. It is a database for physicians who have registered with CMS.

What if I don’t bill for Medicare? Do I still need to enroll in PECOS?

In some circumstances, a physician may order and refer home health services, but not bill for Medicare. These physicians are still required to be enrolled in PECOS.

CMS has identified several unique enrollment issues for certain physicians and has abbreviated their enrollment process. Physicians that fall under one of the following categories can either enroll in PECOS online or fill out and submit the form CMS-855-O:

  • Physicians employed by the Department of Veterans Affairs
  • Physicians employed by the Public Health Service (including Indian Health Services)
  • Physicians employed by the Department of Defense Tricare program
  • Physicians employed by Federally Qualified Health Centers (FQHCs), Rural Health Clinics (RHCs) or Critical Access Hospitals(CAHs)
  • Physicians in a Fellowship
  • Dentists, including oral surgeons
What if I don’t want to be enrolled in Medicare?

In PECOS, you have the option to opt out of Medicare. This way, you will be able to continue ordering home health services for your Medicare patients.

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Why Health Care at Home? - Free Webinar

Posted 3/18/2013 Categories: home health, readmission rates, homebound, webinar, chronic care

Home health care is often misunderstood. Adult day programs and sitter services can muddle even a nurse’s or physician’s understanding of the benefits home health care provides. That’s why Amedisys and Antidote Education Company have teamed up to present “Health Care at Home” – a webinar that provides insights on the benefits of home health care and the eligibility requirements for a patient to receive clinical services in the comfort of home.

Home health care has been proven to prevent hospitalizations, reduce health care spending and improve patient outcomes. But, it’s up to nurses, physicians, and social workers to recognize patients who may benefit from receiving health care at home and refer them to an appropriate provider. Understanding the eligibility requirements and the impact home health care can have on patients is key to building the kind of collaboration that’s been proven to work in study after study.

For example, a recent case study discussed in the webinar illustrates how Monongahela Valley Hospital used collaboration with home health care to reduce their heart failure readmission rate by 13% in one year. And, a home based primary care program introduced by the Veteran’s Administration more than 30 years ago has reduced hospital stays by 62 percent and led to a 24 percent drop in overall medical costs. The home health care industry is poised to produce better patient outcomes if more people are more informed about health care at home options.

If you’d like more information about how home health care can help patients or are interested in learning more about eligibility requirements, watch the webinar at http://www.antidotecme.com/homehealth. Physicians, nurses, and social workers can receive ACCME AMA PRA Category 1 Credits for completing the course.

Webinar Screenshot
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New Mt. Sinai Research on Hospice Care Benefits

Posted 3/15/2013 Categories: hospice, research, chronic care

The March 2013 issue of Health Affairs features new empirical research on hospice care from Mt. Sinai. The article, "Hospice Enrollment Saves Money For Medicare And Improves Care Quality Across A Number Of Different Lengths-Of-Stay," validates the integration of hospice care for delivering three main benefits:

  • Improved quality of care
  • Medicare cost savings
  • Reduced use of hospital-based services

Click here to read the full article
Amy S. Kelley, Partha Deb, Qingling Du, Melissa D. Aldridge Carlson and R. Sean Morrison. Hospice Enrollment Saves Money For Medicare And Improves Care Quality Across A Number Of Different Lengths-Of-Stay. Health Affairs, 32, no.3 (2013):552-561

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The Overlooked Importance of Heart Health for Women

Posted 2/14/2013 Categories: heart health, home health, chronic care

During my 34 years as a nurse, the majority of those in cardiology, I’ve seen many advances in the prevention, diagnosis and treatment of cardiovascular conditions. Traditionally, most of the attention on heart education was focused on men. It hasn’t been until recent years that we’ve seen an emphasis on cardiovascular disease and women, which is so important given the fact that cardiovascular disease is the number one killer of women.

According to the American Heart Association, cardiovascular disease is deadlier for women than all forms of cancer combined. Cardiovascular disease causes 1 in 3 deaths each year – that is approximately one woman every minute. And women comprise only 24 percent of participants in all heart-related studies.

Unfortunately, even with statistics like these, there are still a lot of misconceptions about women and cardiovascular disease. Until we can educate all of our mothers, sisters, grandmothers, daughters and friends on cardiovascular disease risks, prevention and the warning signs of a heart attack and stroke – which can differ greatly between women and men – we’ve still got some work to do.

During February’s Heart Health Month, arm yourself with knowledge. You need to know the facts: that cardiovascular disease doesn’t just affect men and the elderly; that factors like elevated cholesterol can offset a healthy lifestyle (and what to do about it); and even if heart disease does run in your family, there is still plenty you can do to dramatically reduce your risks of heart disease by as much as 80 percent.1

You also need to know the symptoms of a heart attack, because it is critical that you get medical help as quickly as possible. According to the American Heart Association, symptoms of a heart attack include:

  • Uncomfortable pressure, squeezing, fullness or pain in the center of your chest that lasts more than a few minutes, or goes away and comes back.
  • Pain or discomfort in one or both arms, the back, neck, jaw or stomach.
  • Shortness of breath, with or without chest discomfort.
  • Other signs such as breaking out in a cold sweat, nausea or lightheadedness.
  • The most common heart attack symptom in women is chest pain or discomfort, but it is often described as feeling milder. It’s important to note that women are more likely to experience the other common symptoms, particularly shortness of breath, nausea/vomiting and back (shoulder) or jaw pain.

To all my fellow women out there (and the men who love them) – take charge of your heart. Talk with your doctor about cardiovascular disease and visit the American Heart Association's web site (www.heart.org), or click here for heart health tips for women – and men.


  1. Go Red for Women

About the Author

Michelle Farrar, BSN, RN, CCP, is the Chronic Care Program Manager for Cardiovascular at Amedisys, Inc., a leading provider of health care at home.
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