From the CEO: Update on Swine Flu

Carol Wood, R.N., CEO

CDC Swine Flu website last updated April 27, 2009 1:00 PM ET

Human cases of swine influenza A (H1N1) virus infection have been identified in the United States. Human cases of swine influenza A (H1N1) virus infection also have been identified internationally. The current U.S. case count is provided below.

U.S. Human Cases of Swine Flu Infection (As of April 27, 2009 1:00 PM ET)
State	# of laboratory confirmed cases
California	7 cases
Kansas	2 cases
New York City	28 cases
Ohio	1 case
Texas	2 cases
TOTAL COUNT	40
International Human Cases of Swine Flu Infection See:  World Health Organization

An investigation and response effort surrounding the outbreak of swine flu is ongoing. 

CDC is working very closely with officials in states where human cases of swine influenza A (H1N1) have been identified, as well as with health officials in Mexico, Canada and the World Health Organization. This includes deploying staff domestically and internationally to provide guidance and technical support.

CDC activated its Emergency Operations Center to coordinate the agency's response to this emerging health threat and yesterday the Secretary of the Department Homeland Security, Janet Napolitano, declared a public health emergency in the United States. This will allow funds to be released to support the public health response. CDC's goals during this public health emergency are to reduce transmission and illness severity, and provide information to assist health care providers, public health officials and the public in addressing the challenges posed by this newly identified influenza virus. 

To this end, CDC has issued a number of interim guidance documents in the past 24 hours. In addition, CDC's Division of the Strategic National Stockpile (SNS) is releasing one-quarter of its antiviral drugs, personal protective equipment, and respiratory protection devices to help states respond to the outbreak. Laboratory testing has found the swine influenza A (H1N1) virus susceptible to the prescription antiviral drugs oseltamivir and zanamivir. This is a rapidly evolving situation and CDC will provide updated guidance and new information as it becomes available.

What You Can Do to Stay Healthy

There are everyday actions people can take to stay healthy.

Cover your nose and mouth with a tissue when you cough or sneeze. Throw the tissue in the trash after you use it. 

Wash your hands often with soap and water, especially after you cough or sneeze. Alcohol-based hands cleaners are also effective. 

Avoid touching your eyes, nose or mouth. Germs spread that way. 

Try to avoid close contact with sick people.

Influenza is thought to spread mainly person-to-person through coughing or sneezing of infected people. 

If you get sick, CDC recommends that you stay home from work or school and limit contact with others to keep from infecting them.

The CDC will continue to update its Website:  www.cdc.gov/flu/swine and is answering questions via telephone at 800-CDC-INFO.

* The above was taken from the CDC website for your information. 

Nursing Home Abuse & The Ombudsman

George F. Dickerman, Elder Law Attorney

A nursing home ombudsman is a person who is trained to respond to
complaints of elder abuse and neglect that occur in a nursing home.
Ombudsmen are either paid for their services or volunteer their
time for this important task.

The ombudsman's assistance is critical as an impartial
investigator. Their task is not to advocate for the patient;
rather, it is to investigate the complaint to determine whether
abuse or neglect has occurred and then report the incident if
warranted. However, many patients have no family members who visit with any regularity, and no other interested person to assist when abuse or neglect is committed against this "forgotten population".

Typically, the ombudsman's office will receive a complaint from a
family member who reports that their elderly loved one is being
abused or neglected as a nursing home patient. The type of abuse or
neglect may arise from a variety of ways.

Often, the complaint is that the patient is suffering from
decubitis ulcers, or bed sores, that occur when a non-ambulatory
patient is not turned in their bed at regular intervals. This
condition can develop within weeks and may result in a deep wound
that extends down to the bone.

Other complaints may involve improper feeding. Some patients have
hands and arms that are too weak or shaky to allow them to use a
fork or spoon. It's not that they aren't hungry; rather, their
physical limitations simply prevent them from performing the
otherwise simple task of eating. Neglectful nursing home personnel
bring the patient their food, but leave it entirely to the patient
to eat. When the employee comes back to retrieve the food tray,
they simply note the patient's chart as "not hungry".

When an ombudsman receives a complaint, they then make an
unannounced inspection to investigate. During the investigation,
they will speak with the nursing home personnel - including the
director of nursing and the particular employees responsible for
the daily care of the patient. The ombudsman will also review the
patient's medical records to determine whether any notations are
made that support or refute the allegations of abuse or neglect.

If the ombudsman finds fault against the nursing home, then a
report can be made to the local county or state authorities who
monitor and also respond to such cases.

In California, the law requires that all 58 counties provide these
ombudsman services. Unfortunately, the state's budget crisis has
forced this program to be severely slashed - reducing state funding
by $3.8 million (2008). As a result, ombudsman programs are laying
off full-time employees or reducing hours to part-time, and relying
more than ever on volunteers.

The Riverside County, California program recently was forced to lay
off its three full-time employees, reduce a full-time employee to
part-time, and eliminate mileage reimbursement for 20 volunteers.

The bottom line: many complaints against nursing home abuse and
neglect will not be investigated and the "forgotten population" of
elderly patients will suffer without representation. However, the
ombudsman's role continues to be a valuable tool in combating elder
abuse and neglect.

George F. Dickerman, Esq.
3879 Brockton Avenue, Riverside, CA 92501

(951) 788-2156

www.Elder-Law-Advocate.com

A Note From The RVNA & Hospice CEO

Carol Wood, R.N., CEO
As the only Not-for-Profit home health and hospice agency located in the Hemet-San Jacinto Valley, Ramona VNA & Hospice is committed to providing quality care to the patients we serve. One of the best indicators for someone evaluating a home health or hospice agency is whether or not the agency has achieved accreditation.

The Community Health Accreditation Program, Inc. (CHAP) is an independent, non-profit accrediting body.  It was the first accrediting body for community-based health care organizations in the United States and was created in 1965 as a joint venture between the American Public Health Association (APHA) and the National League for Nursing (NLN).  These organizations brought to fruition the futuristic view that accreditation was the needed mechanism for recognizing excellence in community health practice. In 1988, CHAP became a separately incorporated, non-profit subsidiary of the NLN under the CHAP name.  In 2001, it was spun-off by the NLN and became an independent, non-profit corporation.
CHAP was granted “deeming authority” by the Centers for Medicare and Medicaid Services (CMS) in 1992 for home health and in 1999, for hospice. This means that instead of state surveys, CHAP has regulatory authorization to survey agencies providing home health and hospice services, to determine whether they meet the Medicare Conditions of Participation (CoPs). In 2006, CMS granted CHAP full deeming authority for Home Medical Equipment (HME). Recently RVNA & Hospice received CHAP Accreditation following a very comprehensive review of the Agency, which objectively validates the excellence of community health care practice through a consistent measurement of the delivery of quality services.

As discussed in our Podcast with a CHAP surveyor following the survey process, few agencies in the country meet the National Standards as identified in the CHAP guidelines (Listen to the Podcast interview HERE). She commented that most people look for good quality of care but don’t know how to evaluate it. She said people should look for CHAP designation when selecting an agency; because CHAP accreditation means the agency provides high quality of care and meets National Standards. She further commented that many start up companies, new to communities, don’t provide good quality, which is bad for the community.

Comments during the survey by members of the survey team included… that our (Agency) was, “in the top 5% of Agencies I have surveyed in the country”; that “if I lived in this area I would want to work here”; and finally after evaluating our quality improvement process stated, “your patients and their families are very pleased about your agency and the quality you provide”.

Our agency success is directly related to the efforts of the entire staff. Leadership directs the orchestra, but it is the entire team that makes the music. Please join me in congratulating the staff and leadership for their excellence, and Ramona VNA & Hospice on their receipt of CHAP Accreditation.

ASK THE DOCTOR - Free Medication Samples?

Question: “My doctor gave me free samples of a new medicine to take for my blood pressure; how can the drug companies afford to give away free samples?”

Answer: While necessity is the mother of invention; the price tag for “invention” of new drugs would not be a very nice Mother’s Day gift. The estimated cost of bringing a new drug to market is greater than $500 million dollars. Once the new drug is approved by the FDA, the manufacturer holds exclusive rights on the brand name drug for 5 to 7 years. During this time no generic products are allowed to compete against the brand name. This allows the drug company to set the price at a level to recoup their investment and hopefully make a profit.

Have you ever wondered why a brand name drug which costs $130.00/ month later sells for $4.00/month once it is available as a generic? The majority of the $500 million to develop a new drug is related to research and development expenses. The actual cost to manufacture a pill is only pennies per dose. Thus, it is cost-effective for the drug company to offer “free” samples of medicine to patients who they hope will continue using the new medication.

The development of new drugs is essential if we are to continue making progress against diseases such as diabetes, heart disease, and cancer. Newer is not always better however. When given a prescription by your physician you should always ask the doctor to explain what the medication is for and how it works, including the benefits and side effects. Because the newer medications are very expensive, I also suggest asking your physician if there are less expensive generic alternatives that might be equally effective. When a newer medication is indicated, using a free sample is a good way to try the new medicine and determine how well it works before buying it. Remember: Caveat emptor - "Let the buyer beware".

If you would like to submit a question please contact Jennifer Trebler at jtrebler@ramonavna.org.