Tag Archives: communication

THE CHANGING FACE OF RETAIL

Ever since the first enclosed shopping mall opened outside Minneapolis in 1956, shopping malls have dominated retail. The mix of anchor stores including Sears, JC Penney, Macy’s and hundreds of smaller shops proved a winning combination. Serious shoppers could purchase clothing, jewelry, toys, books, Halloween costumes, and even major appliances from a variety of stores. Teenagers could go to the mall to “hang out.” Mall walkers could use the indoor walkways as exercise areas. The mall was the place to be.

These new shopping malls ranged from the humongous Mall of America in Minneapolis to the upscale Watertower Place on Michigan Avenue in Chicago to the local malls outside large cities across America. At its peak, there were more than 3,000 malls in the United States. Only 1,100 currently exist.

Anchor stores such as Sears. JC Penney, Carson’s, and Macy’s were critical to the success of the malls. They drew a large number of customers within the malls. The smaller shops benefited from the increased foot traffic past their stores. In addition, retailers often signed co-tenancy agreements in their leases with malls. These agreements allowed them to reduce their rent or get out of a lease if a big store closed.

Major department stores such as Sears, JC Penney, Carson’s, and Macy’s are struggling to stay alive. According to an article “America’s Malls Are Rotting Away” published December 12, 2017, “Sears, which had operated nearly 3,800 stores as recently as a decade ago, is now down to 1,104 stores. Macy’s closed 68 stores this year, and JCPenney was set to shutter 128.” Carson’s has recently announced it is going out of business.

What caused these anchor stores to fail? A number of factors contributed to the failures. Too rapid expansion. Changing habits of shoppers. Online shopping. Competition from Amazon.

Each story is different. For example, consider the story of Sears. This company had started out in 1888 as a mail order business. Using its famous Sears Catalog, it was able to reach potential customers in big cities, in small towns, and on farms across the United States. Sears sold everything from clothing to musical instruments to houses. Sears opened stores in large cities. By the turn of the century, it was the nation’s largest employer.

In the 21st century, things changed. Sears faced increased competition from companies such as Walmart and Home Depot. To raise capital, it sold off its Craftsman tool line, DieHard batteries, and Kenmore appliances brands. It sold off real estate of underperforming stores. According to http://money.cnn.com/2017/11/30/news/companies/sears-losses/index.html, “Sears, which had operated nearly 3,800 stores as recently as a decade ago is now down to 1,104 stores.”

To see a video about the changing face of shopping malls, go to “American shopping malls struggle to survive You Tube.”

—By Karen Centowski

AT HOME WITH MOM

 

Mom always had a huge garden on the farm. She grew potatoes, tomatoes, lettuce, peas, onions, green beans, sweet corn, pickles, cucumbers, strawberries, gooseberries, raspberries, and blackberries. There was a bed of asparagus along the fence, and rhubarb plants in another area. A peach tree and an apricot tree grew along the path to the chicken house. We used to say that if we couldn’t grow it, we didn’t eat it.

When Dad retired from farming in 1968, he and Mom moved to a house in Decatur. The house was on a quiet street, not far from a small shopping center. The property backed up to the baseball fields of a high school. The backyard was perfect for a garden. Dad trucked in a load of good, black dirt.

Mom and Dad lived in that house for many years. Then Mom’s mind began to fail. It was as if a computer in her brain had a short in it. Once she tried defrosting a frozen chicken by putting it in the bedroom closet instead of in the refrigerator. She was storing the object in an inappropriate place, an early sign of Alzheimer’s disease.

Another time, Dad had driven Mom to the beauty shop just a few blocks away. He told her to call him when she was finished at the beauty shop, and he would pick her up. He was sitting in his big Lazy Boy chair next to the front window when he saw Mom walking past on the sidewalk. By the time he got up to go outside to get her, she had disappeared. Vanished. Dad called the police, and they came to help search for Mom. They found her around the corner about half a block. She was sitting in a Burger King! Getting lost in familiar places is another early sign of Alzheimer’s disease.

Sometimes when they left the house to visit relatives, she would become frantic at dusk. She thought they needed to get home to put the screen in the door of the chicken house so the foxes would not eat the chickens. That was the routine we had when we lived on the farm, but that was years ago. This was another sign of Alzheimer’s disease.

Mom could still dress herself. She could still cook. Since Dad was in good health and living in the house with her, Mom was able to continue living in their house. Without Dad, she would have needed in-home care or an assisted living facility. She died suddenly at age eighty-one.

If you have a family member who needs in-home services, call American Home Health at (630) 236-3501. The agency can provide round-the clock nursing care by Registered Nurses (RNs), Licensed Practical Nurses (LPNs), and Certified Nursing Assistants (CNAs). Our service area covers fifteen counties in Northern Illinois including Cook, Lake, McHenry, Boone, Winnebago, Ogle, Lee, DeKalb, DuPage, Kane, Kendall, LaSalle, Grundy, Will, and Kankakee. American Home Health is licensed by the State of Illinois and accredited by the Joint Commission.

For further information, go to www.ahhc-1.com, or call (630) 236-3501.

—By Karen Centowski

HOW TO PREVENT DRIVING-RELATED INJURIES

One of the hazards of providing home healthcare is the daily challenge of driving to and from the client’s home. In Winter, the streets may be snow-packed or icy. In Spring, roads may be flooded. Even under ideal conditions, driving can be challenging.

OSHA, the Occupational Safety and Health Administration, has published an overview of hazards in home healthcare at https://www.osha.gov. The article states that home healthcare workers “have little control over their work environment which may contain a number of safety hazards. These hazards include bloodborne pathogens and biological hazards, latex sensitivity, ergonomic hazards from patient lifting, violence, hostile animals and unhygienic and dangerous conditions. In addition, if their daily work schedule requires them to provide care for multiple patients, they face hazards on the road as they drive from home to home.”

The National Institute for Occupational Safety and Health has published six Fact Sheets to assist in reducing home healthcare workers’ risk for injury and illness. Publication Number 2012-122 focuses on preventing or reducing driving related injuries. The Fact Sheet addresses behaviors and conditions which contribute to car accidents. These include distracted driving, aggressive driving, failure to use a seatbelt, driving while tired or under the influence of drugs or alcohol, poor weather conditions, and poorly maintained vehicles.

What can you do to protect yourself? The OSHA Fact Sheet lists the following things employees should do to prevent driving-related injuries:

  • Use seatbelts.
  • Stop the vehicle before using a cell phone.
  • Avoid distracting activities such as eating, drinking, and adjusting radio and other controls while driving.
  • Avoid driving when over-tired.
  • Use detailed maps to determine your route before you leave, or use a GPS.
  • Have the vehicle checked and serviced regularly.
  • Keep the gas tank at least a quarter full.
  • Carry an emergency kit containing a flashlight, extra batteries, flares, a blanket, and bottled water.

—By Karen Centowski


To see a video about distracted driving, go to Distracted Driving Presentation at https://www.youtube.com/watch?v=zfknB9CZiA8.

CHOOSING A HOME HEALTHCARE PROVIDER

In an article called “Top 5 Reasons Why Clients Choose A Home Care Provider,” Home Care Pulse described the results of a 2016 Home Care Benchmarking Study. According to an article at https://www.homecarepulse.com/, each month the company conducted thousands of interviews with home care clients across the country. During these interviews, Home Care Pulse associates asked clients why they selected their provider over others. Their answers to the questions were recorded and analyzed and published as the 2016 Home Care Benchmarking Study.

Below are the results of the survey:

  1. Recommended by family and friends (34.3%)
  2. Reputation of company (25.4%)
  3. Recommended by referral source (22%)
  4. Consumer marketing of company (14.5%)
  5. Selected by case manager (government programs, hospital, etc.) (3.9%)

A report published on http://www.nielsen.com/ confirms that recommendations from family and friends remain the most important form of advertising. The report, RECOMMENDATIONS FROM FRIENDS REMAIN THE MOST CREDIBLE FORM OF ADVERTISING; BRANDED WEBSITES ARE THE SECOND-HIGHEST-RATED FORM, states that “eighty-three percent of online respondents in 60 countries say they trust the recommendations of friends and family.”

Twenty-five per cent of respondents said the reputation of the company was important. How can a person find out about the reputation of a company? Do some checking. Is the agency licensed by the State of Illinois? Is it approved for Medicare patients? Does it have contracts with the State of Illinois? Is it accredited by the Joint Commission? How long has it been in business?

Twenty-two percent of respondents said a referral source had recommended a home health provider. Referral sources include hospital discharge planners, doctors, nurses, and case managers. These individuals determine the level of care the patient will need after discharge and recommend agencies which provide these services.

Fourteen and one-half percent of the respondents said that they had selected a company because of consumer marketing. This includes ads in magazines, newspaper ads, TV ads, billboards, and the company’s website. Some consumers become aware of a company because of its participation at health fairs. Some respondents had heard a representative of a company speak at a senior citizen center,

Almost four percent of the respondents said that a case manager (government programs, hospital, etc.) had selected the home health provider.

If you or a friend or relative in the Chicago area is needing home health services, consider American Home Health. The agency is over twenty-five years old and has hundreds of employees. It is licensed by the State of Illinois and accredited by the Joint Commission. For more information about American Home Health, go to www.ahhc-1.com.

—By Karen Centowski

FASTER THAN THE LAW ALLOWS

Nursing Talk

Dear Cassandra,

Last Tuesday I was driving fast because I was trying to get to work on time. A cop stopped me and gave me a ticket for speeding. He said I was driving twenty miles an hour over the speed limit. When I got to the client’s house, I couldn’t find a place to park so I parked in a restricted area. I came out of the house at the end of the day, and I discovered a $50 parking ticket on my windshield. How can I get reimbursed for these work related expenses?

—Having a Bad Day in Chicago
Dear Having a Bad Day,

Driving fast is nothing new. The Romans had chariot races over two thousand years ago in the Circus Maximus in Rome. Teams of drivers, dressed in colored tunics covered by corsets of leather bands, drove their chariots around the track.

Americans have always had this fascination with vehicles and speed. Thomas Nelson, Jr., a signer of the Declaration of Independence, was thirty-six when in 1774 he took delivery of a sporty, two-seater, horse drawn carriage called a phaeton. The term “phaeton” is derived from Phaethon, son of the sun god Helios in Greek mythology. Phaethon drove the sun chariot so recklessly across the sky that Zeus brought him down with a thunderbolt. Nelson’s phaeton was quite a contrast with the ox carts, sturdy wagons, and stately carriages of the day. It gave the appearance of being fast and dangerous.

Henry Ford’s invention of the assembly line produced Model T brought gasoline powered cars to the masses. These cars replaced horses and ushered in a series of vehicles which captivated the public. Speed and power were the common themes of the muscle cars, race cars, drag racing, Indianapolis 500, and NASCAR.

Sometimes the appearance of the vehicle is more important than its speed. The current trend of “pimping the ride” is an example. Young men buy old cars, do extensive body work on them, give them new paint jobs, add expensive low-profile tires, chrome rims, and ear-shattering sound systems.

What excuse did you give the police officer when he stopped you? Maybe you said, “I was going downhill, and my car picked up speed.” I hope you didn’t say, “No way I was going any faster than 80.” Maybe you blamed your vehicle by saying, “My speedometer wasn’t working.” Maybe you blamed the highway by saying, “I wasn’t familiar with the road.” Maybe you actually told the truth and admitted you were speeding because you were going to be late for work.

The police officer who stopped you for speeding was obviously not impressed by your excuse. He gave you a ticket.

The company is not responsible for your having a lead foot. The company will not pay for your speeding ticket. Likewise, the company will not pay for your parking ticket. It is your responsibility to find a legal parking space.

Try leaving the house twenty minutes early to allow for unexpected delays. You will arrive on time feeling fresh, not frazzled. Leave the speed to the professional race car drivers.

—Cassandra

Note: First published on American Home Health's news, February2012

MY DOG ATE MY HOMEWORK

Nursing Talk

Dear Cassandra,

Why is American Home Health so hung up on little things like clinical notes? Almost every week someone from the office contacts me about my clinical notes. I go to work and take care of my client. Sometimes I don’t have time to write the nursing notes. Sometimes the supervisor says she can’t read them. Once I spilled coffee on the clinical notes. Once the client’s dog ate them. What am I supposed to do?

Perplexed in Palos Hills

Dear Perplexed:

What are you supposed to do? What kind of question is that? You know that you are supposed to write clear, legible nursing notes every two hours. You know the times and dates on the nursing notes have to match the times and dates you Clock In/Clock Out. You know that the nurse working the last shift of the week is to mail the nursing notes to the office. You know one week’s worth of notes is to remain in the home for reference.

Frankly, I’m surprised you haven’t been fired by now. Your excuses sound like the excuses of a high school student. The dog ate the nursing notes. Please! Every teacher has heard that excuse. So you spilled coffee on the notes. Well, rewrite them. So you have poor handwriting. Well, print.

Maybe you think good handwriting is not important. A man recently tried to rob a bank. His handwriting was so poor that the teller could not read the note. She asked him to write the note over again. Instead, he fled. The teller, of course, had activated the silent alarm. The robber was arrested by police waiting outside the bank.

Why is it critical to send the notes to the office in a timely manner? In some cases, American Home Health cannot bill for services without a copy of the clinical notes to accompany the invoice. In addition, in the event of an audit by the Department of Specialized Care for Children (DSCC) or the Illinois Department of Public Health (IDPH), the auditors review the clinical notes to determine the quality of care. The auditors also compare the times recorded on the notes to time billed. Discrepancies can mean paybacks to the funding body. If nursing care is not documented, it is as if it did not happen. That brings questions of possible fraud. Do you want to be accused of fraud? If, God forbid, a child should die under unusual circumstances, the nursing notes would be reviewed by the authorities.

Always proofread your clinical notes. If you work for multiple clients, check to be sure you wrote the correct client’s name on the clinical notes. Did you sign and date the notes? Did you sign the notes using the name which appears on your license even if you have a different legal name?

Do your clinical notes contain medical bloopers? Below are actual statements found in clinical notes of other medical providers:

“Patient was unresponsive and in no distress.”

“Patient is non-verbal, non-communicative, and offers no complaints.”

“Patient was apprehended and guarded.”

Do your notes contain a malapropism? That is an unintentionally humorous misuse or distortion of a word or phrase especially the use of a word sounding somewhat like the one intended. Did you write, “We had to use the fire distinguisher.” Did you say, “The client had an expensive pendulum around his neck, and it got caught in the Hoyer lift.”

What else can you do to correct the situation? Get a Palmer method handwriting manual and start practicing to improve your handwriting. Talk with your supervisor about time management skills. Keep liquids away from the clinical notes. Keep the notes in a safe place so dogs and children can’t get them. If you are responsible for sending in the notes, be sure you send the whole weeks worth of notes and that no pages are missing. Don’t wait until the end of your shift to document the events of the entire shift. Above all, change your attitude about the importance of clinical notes. Your job depends on it.

—Cassandra

Note: First published on American Home Health's news, January 2012.

Documentation Made Easy

Charting

The Basics

Right Chart: Check that you have the correct chart before writing.

Penmanship: All your documentation is to be legible so anyone can read it. If you have poor penmanship, begin to print. Your printing will make it easier to read your notes. Now that your nursing notes are legible, let’s talk about the basics. Use permanent black ink pen. Other colors do not copy well.

Date and Time: Date and time every entry. The date should include the year; the time should indicate am or pm or be in military time. Don’t chart in blocks of time such as 0700 to 1500. This makes it hard to determine when specific events occurred.

Client’s history (including unhealthy conditions or risky heath habits such as scalp lice, smoking, failure to take prescribed medication, specific non-compliance issues and events, etc.) A client’s history is usually reflective of trends and may offer valuable hints about what to expect in the future.

Subjective Information: It is important that you chart any subjective information. Document what you hear, what the client says, what the caregivers say, comments to you about how they feel, feelings of anxiety or depression, etc. Use direct quotes and place quotation marks around the quote. Chart a client’s refusal to allow a treatment or take a medication. Be sure to report this to your immediate supervisor and the client’s physician and document your calls.

Objective Information: Chart your observations, what do you see, vital signs, hard data such as any and all assessment information. It is especially important to document changes in health status such as the emergence of a productive cough, difficulty in breathing or changes in vital signs from their baseline. Did you address: mental status, functional status, mobility, cognitive ability, speech? Oftentimes when you are in the home every day you forget that the people reading your notes do not know the client so you need to show them on paper.

Interventions: Document any actions that you did in response to any of your observations and the client’s response to your actions. These responses to your interventions are commonly called client outcomes. Chart the time you gave a medication, the route you gave it and the client’s response. If a medication is a PRN, chart the reason it was given and the client’s response to the medication (did it give the desired effect). Chart precautions, preventive measures used as well as any safety measures enacted, such as bed rails.

Client outcomes: Chart the client’s response to your interventions, including those that are deviations from what you expected. For example: if a client is in pain, observe and document how that pain is experienced both objectively (what you see) and subjectively (what you hear). Record where the pain is and the level of intensity or severity (use a pain scale to do that). Record the medication and the backrub you give to relieve the pain and whether or not those actions were effective, i.e., did the pain persist, recur, or go away?

Document the client, family member or significant other’s actual response (verbal or non-verbal) to any aspect of care provided even if you were not the one providing it. Doing so indicates that you have evaluated the results of care. It is perfectly acceptable to chart the client’s verbal responses in the record as long as you use quotation (“) marks. Non-verbal responses should be described in as much detail as possible.

Make sure your documentation reflects the nursing process and your professional capabilities. Chart completely, concisely and accurately (“Tell it like it is.”). Write clear sentences that get right to the point. Use simple, precise words. Don’t be afraid to use the word “I.”

Be sure to record your full name, credentials and job title in the required section on documentation forms. Some forms will ask you to record your initials as well. Your signature must be in cursive writing so a word of final caution: do take the time to sign your name legibly.

Beyond The Basics

Client Education and Instruction: Other information that needs to be recorded in the medical record includes any education or instructions you give to the client, his family or significant other. Anytime there is a new medication or treatment the client, family member and other personnel must be educated and informed. Documentation of these actions is required. Include the fact that you informed the client/caregiver of the new order; chart the education of dosage, actions, side effects and schedule; chart that you made changes on the medication administration record or task sheets (if applicable); chart how you were able to communicate the new orders to other nursing personnel responsible for the client’s care, document your communications regarding the new orders to the office.

Check Off Sheets: In some instances a preprinted, standardized check off form may be used where all you have to do is check off or initial what you have done. The only time you may have to write any notes is when something is specific or unique to this particular client, something that can’t be included on a standardized check off form. Remember: if you do not check off items, it means that legally the care was not done.

Phone Calls: We don’t often think about phone calls, but they can contain certain information for which we have obligations such as advice that we may give to a client or a phone order that we may take from a doctor. To protect yourself in these kinds of phone conversations, a detailed summary of your conversations is charted in the client record.

Details of each call should include:

  1.  Date and time of the call
  2. Caller’s name, position or credentials, call back phone number and address
  3. Reason for the call, request, complaint
  4. Your response to the call, advice you gave, protocol you followed (if applicable)
  5. Others that you notified as a result of the call
  6. Your name and credentials
  7. If taking doctor’s orders, transcription of the orders word for word and documentation that you read the orders back for verification.

More Do’s to Make Charting Successful

  • Chart as soon as possible after giving care; don’t wait to chart until the end of your work day. Chart often enough to tell the whole story.
  • If you remember an important point after you’ve completed your documentation, chart the information with a notation that it’s a “late entry.” Include the date and time of the late entry.
  • Chart all of the details relating to visits by physicians or other members of the health care team such as the teacher, therapist, case worker, dietician, social worker, etc. Describe the purpose of the visit, the name of the visitor, the time spent with the client and the outcome of the visit.
  • If you don’t give a medication, circle the time and document the reason for the omission.
  • If information on a form such as a flow sheet doesn’t apply to your client, write NA (not applicable) in the space provided.
  • Use only commonly used or approved abbreviations and symbols. Refer to the procedure manual for a list of approved abbreviations. When in doubt spell out the words. Remember many medications have similar names but very different actions.
  • When documentation continues from one page to the next, sign the bottom of the first page. At the top of the next page, write the date, time and “continued from previous page.” Make sure each page contains the client’s identifying information, date and year.
  • Re-read your documentation. You need to paint a picture of the client. Pretend you know nothing about the client. Then read your notes and see if your notes are capable of making you see the client as he/she really is.

-By Janet Fulfs, President

Note: First published on American Home Health's news, October 2011.