Aging, Elderly, Senior Citizens
Colorado's population is aging. In 2010 there were 550,000 Coloradans over the age of 65; by 2030 there will be 1.3 million individuals 65+ with the largest changes along the Front Range. As people live longer, they are more likely to develop chronic conditions such as heart failure, which is the leading cause of hospitalization for those over the age of 65 and represents a significant clinical and economic burden.
CVNA has invested in technology to facilitate home monitoring and remote visits for patients with heart failure as well as other chronic conditions. Most individuals with chronic heart failure are older adults with declines in their functional abilities. For them, leaving the house for a doctor appointment is quite taxing physiologically and psychologically, especially if they rely on others for transportation. Increasingly, telemedicine/tele-monitoring is playing a growing role in the delivery of health care, such as heart failure treatment and management, in a cost-effective, highly accessible manner.
A donation to support tele-monitoring will allow CVNA to provide these services for those people 65 and older that can't afford to pay for the services themselves and/or don't have insurance to pay for tele-monitoring services.
Identified as a priority for healthcare-related outcomes improvement, rehospitalization rates are a primary target of telemonitoring programs. Prior to program initiation, CVNA had a relative rehospitalization rate of 19.69%, encompassing all patients/diagnoses, and all-cause rehospitalizations. A similarly high starting-point rehospitalization rate (19.3%) was reported by a study2 completed by the University of Pennsylvania Health System in 2016, with a study outcome of a remarkable 5.2% reduction in all-cause rehospitalization.
A review of CVNA rehospitalization rates from December 1, 2017 to October 31, 2018 for patients enrolled (75 patients total during the dates reviewed [N=75]) revealed 8 (10.65%; 2 within 30 days, 6 within 60-days) all-cause rehospitalizations (inclusive of heart failure-related rehospitalizations), and 3 (4%; 0 within 30-days, 3 within 60-days) heart failure-related rehospitalizations; an absolute risk reduction of 9 percentage points (a 45.02% reduction), with a Number Needed to Treat (NNT) of 11 (CI 99%, p=0.0200 [2-tailed test]). Non-telemonitored patients of CVNA, during the same period, experienced an all-cause rehospitalization rate of 1,137 (19.99%; involving 829 individual patients [N=5,666]). A review of all-cause rehospitalizations for the same time span of the previous year (December 1, 2016 to October 31, 2017) demonstrated 1334 (19.69%; involving 1036 individual patients) rehospitalizations. This represents a clinical statistically significant improvement in 30 and 60-day all-cause and heart failure-related rehospitalization rates for CVNA.
Aging, Elderly, Senior Citizens
Poor, Economically Disadvantaged, Indigent
Colorado VNA is piloting a program in metro-Denver, the Johns Hopkins intervention CAPABLE, a patient-directed program that combines occupational therapy, nursing, and minor home modifications to improve older adults' functional goals.
The vast majority of older adults wish to age in their homes and communities. Aging-in-place means independence, access to friends and family, familiar routines, possessions and pets, and reduced risk of illness like airborne colds. However, in order to keep older adults in familiar surroundings, the surroundings must be able to support them and the seniors must be able to adequately function in them.
Launched as a research project in Baltimore by Sarah L. Szanton, PhD, ANP, FAAN, of the Johns Hopkins School of Nursing, and since expanded to three Michigan cities, CAPABLE is a five month, home-based intervention for low-income older adults with functional limitations. It entails ten, 60- to 90-minute home visits with an occupational therapist, a registered nurse, and a handyman who work together with elderly individuals to identify mobility and self-care issues in their homes and fix or
Blind & Vision Impaired
Deaf & Hearing Impaired
Disabled, General or Disability unspecified
Colorado VNA assists elders and persons with disabilities with everyday challenges by providing light housework, meal planning, personal care/grooming, laundry, and travel to/from appointments. This critical service helps keep these individuals, especially low-income elders with chronic pain and worsening vision, out of skilled living facilities. These services are provided as part of a physician's care plan and free-of-charge to vulnerable elders who demonstrate need thanks to generous donations and grants.
In its most recent client satisfaction survey, 93% of individuals who responded reported that Colorado VNA's homemaker services are helping them to remain in their homes.
Anecdotally, we know from survey comments that the majority of elders are pleased with their care, and thus, we presume, have an improved emotional state of health, too. Typical comments to the question "If you did not receive homemaker or respite care services, what would you do?" include:
-be very unhappy;
-live in a dirty home;
-do without and suffer; and
-endure more pain doing the things my caretaker does for me.
The Home Care division provides nursing (post hospitalization care, wound care, intravenous (IV) therapy, psychiatric nursing), rehabilitation therapies (physical, occupational, speech), medical social work (psychosocial support, connections to community resources), and in-home services, or paraprofessional assistance (personal care, homemaking) to support people recovering from illness or injury.
Nearly half of the seniors that receive in-home services are low-income and pay nothing for this program. The majority of philanthropic dollars raised annually are allocated to this critical community service.
Colorado VNA uses Strategic Healthcare Partners (SHP) to manage clinical outcomes, financial performance, patient satisfaction, and regulatory compliance in real time. SHP is web-based and tracks scores for Colorado VNA services (e.g., ambulation, dyspnea, wound care, etc.) that are posted on Centers for Medicare and Medicaid Services' (CMS) Home Health Compare report.
The most recent Home Health Compare report indicates that less than 15% of Colorado VNA patients are readmitted to the hospital, putting VNA in the top 10% nationally. (Hospital readmission, especially for Medicare patients, is an indicator of poor care, so Colorado VNA strives to remain below the national average
VNA Hospice & Palliative Care provides a continuum of end-of-life care for clients and their families including advanced chronic care management for those with life-limiting conditions as well as palliative care and pain management for those terminally ill who are estimated to have 6 months or less to live. The hospice team's comprehensive approach focuses on the physical, psychosocial and spiritual needs of each client.
Evidence of Program Success is documented via the numerous thank you notes and positive survey responses received from family members. Additionally, Colorado VNA is pleased to report that its hospice services are equal to or above state and national averages in 10 of 11 domains including Providing Emotional Support, Information Continuity, and Overall Rating of Hospice.
A Senior Wellness and Medical Foot Care visit is a 30-minute session with a nurse that includes a general health assessment, medication review, foot care (neuropathy tests and toenail trimming), and monitoring of chronic diseases such as diabetes. A visit also entails individual health "coaching" which includes reminders about the importance of taking medications as prescribed, as well as physician referrals if any readings are "out of normal" range. Colorado VNA partners with community-based organizations, senior centers, churches and other companies to host community-based foot care clinics for older adults to attend. Over 150 clinics take place monthly through the Front Range.
In addition to medical foot care, Colorado VNA's Wellness Services also include flu immunization clinics and corporate wellness services whereby we partner with businesses to promote healthy lifestyles for employees in and out of the office. Options include immunizations, health risks assessments, biometric screenings, and labs.
Colorado VNA is in the process of refining its patient satisfaction survey for Wellness Services. Anecdotal evidence, such as stories from our nurses and patients, also demonstrate success. By way of example:
Becky is a long-time Colorado VNA Senior Wellness Clinic patient. A couple of years ago, Becky began to experience prolonged fatigue and a rapid pulse. Nurse Debbie noticed other symptoms as well including poor coloring and a sense that "Becky just wasn't herself." Becky had relayed these symptoms to her physician at Nurse Debbie's urging, but they were not deemed urgent enough to warrant a check-up. After six weeks and continued prodding from Nurse Debbie, Becky made her way to a hospital where she was diagnosed with blood clots in her lungs. Nurse Debbie's diligence allayed a potentially dangerous situation. Becky is now on medication and responding well to treatment. And, she has an expert nurse watching over her.
A diabetic client came to a clinic last year with a large, open wound on the bottom of her foot that she was completely unaware of due to peripheral neuropathy. The client was sent to see her PCP for wound care and a possible future amputation was avoided due to this nurse's prompt attention to the client's issue. The wound healed completely and the client was extremely grateful!
One RN detected an irregular heartbeat in a patient. The patient followed up with his PCP, who ended up needing surgery else he may have had a stroke.
Another nurse found a mole on a patient's leg and urged the patient to request a biopsy. The mole ended up being malignant cancer and was subsequently treated.
Colorado VNA nurses also occasionally care for homeless seniors at Wellness Clinics, some of whom are then escorted to emergency rooms for immediate treatment of conditions such as diabetes and high blood pressure.