Providence Care Launches New Website

Providence Care is happy to announce the recent launch of their new website. The new site offers many benefits to our patients, including comprehensive information, ease of use and the ability for the patient and their family to communicate with us online. This, combined with a modern design interface, makes our website more user-friendly and easier to navigate.

Our new website will provide our patients and their families with easier access to information about the services we provide, ways we help our community, how you can assist us in our endeavors, and comprehensive employment information. We hope this makes our site a simple way to access Providence Care and makes interacting with us easier than ever before.

The new Providence Care website was conceptualized and designed by MPW Marketing, a New York advertising firm specializing in the health care industry. “We’ve designed a patient-focused website for Providence Care,” said MPW Marketing Online Director Matt Wilson. “We sought to create a warm, friendly look for this company that combined ease of navigation and relevant content. We think that will provide Providence Care’s patients and families with the best experience possible while visiting this website.”

All of us at Providence Care invite you to review our new site and learn all about the many services we provide – whether you need help from us for yourself or a family member, we believe you’ll be satisfied with the updates to our site and how simple it is to use.

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House Calls Filling Unmet Need for Homebound

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Rosemary Donnelly rests in her power recliner tucked beneath a soft blue blanket. Her eyes are closed, her muscles atrophied. And dementia has robbed the 85-year-old of the ability to speak. For the past 15 years, her daughter, Diana Fabiano, has lovingly cared for her. “My goal is to keep her at home as long as possible, because at home she is taken care of better,” she told The Greenville News. “It’s one-on-one.”

But her mother is so frail and debilitated that getting her to the doctor for the necessary visits or to the lab for tests is an ordeal. So Fabiano retained a service that brings the doctor to her. “It would be a hardship to try to get her back and forth. It’s a two-man job to transfer her,” she said. “It’s easier for someone to come check her out here at home.”

Making house calls

Dr. Romin Shah arrives at Fabiano’s Greenville home carrying Donnelly’s chart and a backpack filled with his stethoscope, blood pressure cuff and other medical equipment. He holds out a hand to Fabiano, then turns his attention to her mother. Shah was working as a hospice physician four years ago when he realized that some patients were being turned away because they weren’t terminally ill. Yet they were so fragile and sick, they needed home care.

“There is a large population of frail, elderly, debilitated patients who are homebound and it requires a taxing effort to get out to a physician,” he said. “And if they don’t get access to care, we will see them fall through the cracks, rehospitalized, going back to the ER.” Shah, a geriatrician, and his business partner, Johnnie Garmon, decided to fill the void by launching Providence Care, a medical practice that offers physician and nurse practitioner house calls to homebound patients.

“So many people who are elderly struggle to get in and out of the home,” said Magen Fowler, chief development officer for the company. “And the average geriatric patient sees five to seven physicians.” Around the country, practices like these are beginning to sprout up as the population ages. It’s “a small but growing trend that may pick up speed as we move away from fee-for-service,” said Alwyn Cassil, an independent health policy consultant with Policy Translation in Silver Spring, Maryland.

A need for care

The Center for Medicare and Medicaid Services has a demonstration project in 14 states – though not South Carolina – to gauge the effectiveness and cost of providing care at home for up to 10,000 Medicare beneficiaries with chronic conditions. “Home-based primary care allows health care providers to spend more time with their patients, perform assessments in a patient’s home environment, and assume greater accountability for all aspects of the patient’s care,” CMS said in its description of the project.

“This focus on timely and appropriate care is designed to improve overall quality of care and quality of life for patients served, while lowering health care costs by forestalling the need for care in institutional settings,” it says. Elderly patients in their declining years consume the highest share of health care spending, according to a Brookings Instution report, which notes the fastest-growing portion of the Medicare population is people with five or more chronic conditions.

While CMS won’t provide an estimate of projected savings, one statistic cited in the Brookings report suggested that a 5 percent reduction in end-of-life costs would save Medicare $90 billion over a decade. The number of Americans 65 and older is expected to grow from 40.2 million in 2010 to 54.8 million in 2020, according to the U.S. Census Bureau. And research shows they want to grow old in their own homes.

“Everybody wants to age in place … and most people can’t afford a nursing home,” Fowler said. “Families don’t know what to do. We are trying to meet this huge wave of elderly people where they are.” Columbia health care consultant Lynn Bailey said making house calls is “a desperately needed service.” Getting a homebound patient to the doctor requires an ambulance, which costs $300 to $700 depending on the distance traveled, she said. And most physician’s offices don’t have a place to hold someone who’s on a stretcher.

“It is very patient-friendly to be able to have a nurse practitioner, physician assistant or physician come and see you in your home,” she said. “It’s a terribly needed service.” While nine of 10 Providence Care patients are seniors, there are younger patients as well. They may have dementia, like Fabiano’s mother, Shah said. Or they have ALS, congestive heart failure, Parkinson’s disease, chronic obstructive pulmonary disease, HIV, end-stage renal disease or other conditions that leave them homebound.

Thief of personalities

Shah listens to Donnelly’s heart and takes a blood pressure reading. He examines her skin for pressure sores and finding none, asks Fabiano whether her mother seems weaker than usual. Rosemary Donnelly was a vivacious auburn-haired stunner in her younger days, her daughter says. She worked as a respiratory therapist at the VA in Cleveland before moving to her daughter’s home in Buffalo, New York, after she was diagnosed with dementia. A sparkling conversationalist and avid reader, she loved spending time listening to her vast music collection. She was a gourmet cook who prepared Beef Wellington and other memorable meals for her husband and four children. And at Christmas, the family looked forward to her beautifully decorated cookies with eager anticipation.

“She was very pretty and nice, and she was always kind to people. She always looked for the good in somebody,” her daughter said, smiling at her mother in a way that reveals she still sees her like that. “This is a terrible disease,” she adds. “It really robs a person of their personality.”

Now, Donnelly’s gray hair is neatly pleated into a braid. Each morning, Fabiano, a retired teacher who moved to Greenville last year to be closer to her daughters, rises and prepares her mother’s medications, then gets her cleaned and dressed.

Tragic changes

One of Fabiano’s daughters helps get Donnelly into a wheelchair with a Hoyer lift – a device that uses hydraulic power to move people – and they roll her into the living room, where the lift is again used to transfer her to the recliner. Fabiano fixes her mother’s hair, gives her her breakfast and medications, and turns on the TV or music. “She’s happy and comfortable there,” she said. “It doesn’t seem like she’s actively watching, but I think she’s listening.”

After lunch, the routine is reversed so Donnelly can take a nap. Then she’s brought back out for dinner and her evening meds. It wasn’t always like this. In the beginning, Donnelly was just forgetful. She couldn’t remember what happened the day before and kept asking the same question over and over. But by 2000, Fabiano realized her mother couldn’t live alone any more. So she turned her first-floor family room into a bedroom for her.

She’s been unable to speak or move for several years now. She has trouble swallowing, making aspiration pneumonia a constant threat. Her bones are so brittle that Fabiano always fears she’ll cause a break just moving her from one room to the other.

Quality of life

Each day, Shah sees five to six patients. During his house calls, which can last up to an hour, in addition to the medical exam he reviews lifestyle issues such as diet to make sure too much salt, for instance, isn’t aggravating a patient’s condition. He talks to the family about what to expect, such as worsening agitation with dementia. And a major focus is on reviewing prescriptions for drug-drug interactions. Fowler said the average patient is on 10 to 15 medications. That can cause problems from altered mental states to falls, Shah said.

“We act as a safety net to help prevent this constant cycle of patients who need small tweaks in medications or adjustments in care to prevent them from going back to the hospital,” he said. “A couple day’s hospitalization will set them back weeks or months,” he added. “And that would break up their whole quality of life.”

After looking over her medications, Shah takes Donnelly off an Alzheimer’s drug, which he says has only been shown to be of modest benefit in the first six months of dementia. Like most patients with chronic illnesses, Donnelly is seen every 5-8 weeks, more often if they’re having problems, Fowler said. Providence also partners with a company that provides home laboratory and X-ray services and with home health, therapy and social work services so patients don’t have to leave for those supports either.

Growing business

With three offices in South Carolina, including one in the Upstate, Providence Care, which has a sister company that offers hospice services, now has between 1,500 and 2,500 patients statewide, Fowler said. Often, patients are referred by other doctors because they’ve missed appointments with them, she said. While Shah was the only one making house calls at first, the business soon grew so much that three nurse practitioners and another physician were added to the mix.

It’s hard to recruit doctors who want to work in the home environment, Fowler said, but she’s trying. House calls are covered by Medicare and Medicaid, which reimburse at the same rate as a doctor visit. The company also has a nonprofit foundation funded by donations that covers uninsured patients, she said. Though caring for her mother is sometimes a challenge, Fabiano says she doesn’t mind. She wants her to have the best life she can. “She’s aware on levels that people don’t realize,” she said. “When she’s in an unusual situation, she’s frightened. She’d rather be here at home.” It’s common for patients with dementia to be upset when they’re taken out of their routines, Shah said. And that can lead to a vicious cycle of worsening symptoms, more medications and sometimes delerium. “The most effective thing for her and her quality of life is to be home with her loved ones,” he said. “We need to respect those wishes at this point.”

Source with Video: http://www.greenvilleonline.com/story/health/2015/03/05/house-calls-filling-unmet-need-homebound/24315423/

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Health Care Agency Offers Old-Fashioned House Calls

Reprinted from the Lake Wylie Pilot | By Jennifer Becknell

–YORK —

Providence Care, a private health care agency that offers old-fashioned house calls for geriatric patients and other services including hospice care, has opened a new office in York.

The agency, which has been serving upstate South Carolina counties since 2010 with offices in Greenville and Summerville, recently began serving York County, said CEO Johnnie Garmon.

The York office, at 1736 Old York Road, will serve patients in a 45-mile radius, Garmon said, which includes Lake Wylie, Rock Hill, Fort Mill and parts of Chester and Lancaster counties.

“We currently are serving about 35 patients in this area, and we have only been open for about six weeks,” Garmon said last week. “We serve over 600 patients in the upstate.”

Dr. Ramin Shah, a geriatrician who earned his medical degree at St. George University School of Medicine in the West Indies, says house call care can benefit patients.

“With modern technology, house call visits can produce better clinical outcomes than other outpatient settings,” Shah said. “Lab work, blood draws and even complicated X-ray procedures can be done in the home setting.”

Shah said the agency saw a need in the York County area for physicians to make house calls to shut-in and homebound patients.

“Our goal is to improve the patient’s quality of life and reduce emergency room visits and hospitalizations that result with the patient being able to live at home longer,” he said. “This can be done with seeing the patient and home and spending more time with the patient.”

Garmon said Shah is being joined by Dr. Bob Randall, who will serve as medical director of the hospice program and also helps with house calls. Randall, a surgeon now doing family medicine, earned his medical degree at Bowman Gray School of Medicine at Wake Forest University.

Garmon said Providence Care offers three levels of service. They include primary house calls for geriatric care; in-home palliative care to manage pain and provide services to patients with chronic illnesses; and hospice care, for patients who have terminal illnesses.

“We’re the only ones in the state that have a continuum of geriatric care,” Garmon said. “We call it a geriatric wellness system.”

Garmon noted that with health care reimbursements being cut, many doctors are forced to see up to 30 patients a day. “We’re able to go into the home and actually see what they are eating, spend more time with the patient.”

He said a new admission visit may last an hour; routine visits may last 30 to 45 minutes. The frequency depends on the patient’s needs, he said. The agency’s staff also includes nurse practitioners.

He said the service is funded with Medicare reimbursements from hospice patients and private health insurance. He also said they are starting a nonprofit arm to raise money to support the services.

“We don’t waste our money,” Garmon said, referring to the agency’s ability to be profitable by keeping operating costs low. “We’re just a bunch of providers. I don’t have this huge bureaucratic overhead.”

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Palliative Care Prolongs Life

Palliative care prolongs life, reduces suffering
By Liz Szabo,, USA TODAY
Updated Feb 22, 2011 8:50 PM By Judy S. Reich for USA TODAY

Dr. Gail Austin Cooney visits hospice patient Beverly Vivona.

There are no secret passwords in medicine, no mysterious handshakes or signals to use when seeking the best care for a serious illness.

But experts say two words come close: palliative care.

Many people have never heard of palliative care, a comprehensive service that aims to relieve suffering in people with serious illnesses, such as cancer, lung disease or kidney failure.

Some patients — and even many doctors — confuse palliative medicine with hospice, a form of palliative care for people in the last six months of life. Other patients mistakenly worry that doctors won’t work as hard to cure them if they ask for palliative care, says Gail Cooney, former president of the American Academy of Hospice and Palliative Medicine.

Those notions could change in light of recent research.

A study of 151 patients published last summer in The New England Journal of Medicine showed that getting early palliative care — in addition to regular medical treatment — helpedpeople with lung cancer live three months longer, compared with those given standard care.

In comparison, chemo can give newly diagnosed lung cancer patients an extra two to three months of life, says study co-author Thomas Lynch, director of the Yale Cancer Center.

“If this was a drug, this would be on the front page of every paper in the country, talking about ‘New advance in lung cancer,’ ” Lynch says.

But palliative care patients didn’t just live longer. They also lived better, with less depression and a higher quality of life, he says.

Tailored to the patient

It’s never too early to ask about the service, doctors say.

People can begin palliative care as soon as they’re diagnosed with a serious illness, even if they still hope to be cured, says Thomas Smith, medical director of palliative care at Virginia Commonwealth University’s Massey Cancer Center in Richmond.

Teams that provide palliative care focus on talking to patients, trying to understand people’s values and tailor care to the patients’ goals, Cooney says.

These teams — which often include psychologists, social workers, pharmacists, nutritionists and chaplains — also coordinate treatment, which can be especially important if people are being seen at more than one center, says Ira Byock, director of palliative medicine at Dartmouth-Hitchcock Medical Center in Lebanon, N.H.

The teams also support caregivers, who have a critical role in patients’ health.

Palliative care benefits

Patients whose doctors focused on relieving suffering, rather than extending life, actually lived longer and felt better, one study of 151 people finds:

Median survival:

Palliative care patients: 11.6 months

Standard care patients: 8.9 months

Percentage depressed:

Palliative care patients: 16%

Standard care patients: 38%

Source: The New England Journal of Medicine

‘People need to ask for it’

Because of her work, Cooney knew to ask for palliative care when she was diagnosed with advanced ovarian cancer nearly three years ago.

“I wanted it all,” says Cooney, 58, who’s also the assistant medical director of Hospice of Palm Beach County in Florida. “I received very aggressive chemo. But I used a program of palliative care to control my symptoms and allow me to tolerate the chemo.”

In addition to undergoing surgery and chemo at a hospital, Cooney sought palliative care through an outpatient center, the Sari Asher Center for Integrative Cancer Care in Palm Beach.

Though about 80% of large hospitals offer some kind of palliative care, there are fewer ways for patients to get support outside the hospital, where cancer patients today receive much of their care, Cooney says.

She used both acupuncture and conventional drugs to avoid nausea and felt well enough to indulge in milkshakes to keep up her strength and weight.

Palliative care helped with many aspects of cancer therapy, which put her in remission for two years, Cooney says.

She joined an ovarian cancer support group, received one-on-one counseling with an oncology social worker and met with a nurse educator to better understand the many drugs she was taking.

After her cancer began growing again last fall, Cooney resumed intravenous chemo and hopes for a good response.

Cooney says she wishes that more patients and their caregivers knew to ask for palliative care. “People think, ‘My doctor will ask if I need it,’ ” Cooney says. “But people need to ask for it. It can be tough to challenge a doctor. But if people begin asking and advocate for themselves, generally doctors will say OK.”

Saving money

Palliative care also could help cut spiraling medical costs, Smith says. Studies show it can save hundreds of dollars a day, keeping patients out of the hospital or expensive intensive-care units.

Kaiser Permanante, an integrated system in which the same company operates hospitals and insurance plans, found that people cared for by a palliative team live just as long as or longer than others and had fewer symptoms.

Their caregivers also experience a lighter burden because the programs address their needs as well, Smith says.

“No death panels here — exactly the opposite,” he says.

In spite of these benefits, palliative programs struggle to reach everyone who might need them, Smith says. That’s because few health systems are as coordinated as Kaiser, he says.

The bottom line

In most cases, the cost savings from palliative care are spread throughout the system — saving money for Medicare, for example — instead of returning money to individual hospitals or programs, Smith says. So in the short term, individual hospitals may lose money, even if the country overall saves money.

“It would be terrific to have more family support, more chaplain support,” he says. “Most programs don’t have any way to pay for that.”

The Massey Cancer Center pays for a psychologist partly by reducing physician salaries, Smith says. His team also does fundraising to pay for a chaplain, who he says “is critical to help people come to terms with their illness and often the end of life.”

Without enough resources for everyone, palliative care programs often give first priority to people with advanced or fast-moving cancers, such as pancreatic tumors, Byock says.

“Even the most robust palliative care programs have limited resources,” he says. “If someone has a serious diagnosis and they have only the ‘ordinary’ level of stress, we’d likely not see them.”

But patients shouldn’t give up.

“It really does take one-on-one advocacy,” Byock says. “You have to be savvy enough to ask for it. Just say, ‘We want the best care for our loved one.’ ”

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Patients Live Longer With Hospice Care

New Research Finds Patients Do Live Longer Under Hospice Care

Hospice Patients Lived an Average 29 Days Longer Reports NHPCO

(Alexandria, Va) – A new study published in the March 2007 issue of the Journal of Pain and Symptom Management reports that hospice care may prolong the lives of some terminally ill patients.

Among the patient populations studied, the mean survival was 29 days longer for hospice patients than for non-hospice patients. In other words, patients who chose hospice care lived an average of one month longer than similar patients who did not choose hospice care.

Sponsored by the National Hospice and Palliative Care Organization, the study was conducted by NHPCO researchers in collaboration with the highly regarded consulting and actuarial firm, Milliman, Inc.

Researchers selected 4,493 terminally ill patients with either congestive heart failure (CHF) or cancer of the breast, colon, lung, pancreas, or prostate. They then analyzed the difference in survival periods between those who received hospice care and those who did not. Data came from the Centers for Medicare and Medicaid Services and represented a statistically valid five percent sampling from 1998-2002.

Longer lengths of survival were found in four of the six disease categories studied. The largest difference in survival between the hospice and non-hospice cohorts was observed in CHF patients where the mean survival period jumped from 321 days to 402 days. The mean survival period also was significantly longer for the hospice patients with lung cancer (39 days) and pancreatic cancer (21 days), while marginally significant for colon cancer (33 days).

“There’s an inaccurate perception among the American public that hospice means you’ve given up,” said J. Donald Schumacher, NHPCO president and CEO. “Those of us who have worked in the field have seen firsthand how hospice can improve the quality of and indeed prolong the lives of people receiving care. Benefits of hospice have been reinforced by positive stories like that of Art Buchwald who seemed to thrive under the care of hospice.”

Researchers cited several factors that may have contributed to longer life among patients who chose hospice. First, patients who are already in a weakened condition avoid the risks of over-treatment when they make the decision to receive hospice care. Second, hospice care may improve the monitoring and treatment patients receive. Additionally, hospice provides in-home care from an interdisciplinary team focused on the emotional needs, spiritual well-being, and physical health of the patient. Support and training for family caregivers is provided as well. This may increase the patient’s desire to continue living and may make them feel less of a burden to family members.

“There is a perception among some healthcare providers that symptom relief in hospice, especially the use of opioids and sedatives, could cause patients to die sooner than they would otherwise. This study provides important information to suggest that hospice is related to the longer, not shorter length of survival – by days or months – in many patients,” said Dr. Stephen Connor, NHPCO’s vice president of research and international development, and lead author of the study. “This additional time may be valuable to patients and families to give more time for resolution and closure.”

Co-author Bruce Pyenson, an actuary at Milliman in New York, added, “We believe this study helps support the growing quality movement within healthcare. For some patients, hospice care is not a choice about cure, it is a choice for the best care.”

Contact us today to see how we can make a difference in your loved one’s life.

864-295-8714 (upstate office) or 843-851-3126 (low country office).

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House Calls to the Elderly!

Dr.Shah_.Article-4.4The Greer Citizen, a local publication in the up-state of South Carolina, featured Providence Care and our Chief Medical Director Dr. Roman Shah in the Living Here Section.  Click the Photo to view the complete article.

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