What is a care plan? In health and social care, a care plan is a document that outlines your assessed health and care needs to ensure you or a loved one receive the right level of care at home. It details your care requirements, the type of care you need, how and when care is provided and your personal wishes. A person centred care plan is essential to providing first class care.?At Koi Homecare,?we ensure the person is at the heart of everything and an effective care and support plan will ensure you live as independently as possible in the comfort of your own home, enabling you to have more control over your life. Benefits of a person centred care plan -It empowers the individual – encourages independence and dignity -Collaborative working – easier to involve other family and friends in the management of care -Transparency – enables individuals to raise concerns about the level of care being provided -Improved health outcomes What does a person centred care plan include? Care plans are completely unique and vary differently from person to person. If you are unable to make decisions about your care, your nominated individual will be fully involved in the support plan process to make your wishes known and the outcome you want to achieve. Care plans are flexible and the plan will be reviewed and adjusted accordingly when needs or requirements change. Your care plan will include the following information: ~Personal details: Including information and contact details for next of kin, their doctor and any other health care professionals involved ~A list of medical conditions ~Medication requirements including medication required, who administers and frequency ~What your assessed care needs are and the type of support you need ~How many visits are required or if 24/7 care is needed ~Allergies ~Personal care – what support is needed ~Mobility requirements including whether any equipment or home adaptions are required ~Nutrition and dietary requirements including peg feeding ~About me – your likes/dislikes, hobbies, interests. It could also include visits to day centres or other things you may find enjoyable. ~The cost of care ~Consent forms ~Risk Assessment How often are care and support plans reviewed? We aim to review care and support plans on a regular basis especially where someone’s condition is changing rapidly. Any changes to your care and support plan will be updated and a new care plan will be created. Everyone involved will be advised of any changes to your medication, health and personal requirements.
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A recent study published in JAMA demonstrated that physicians who are more actively engaged in addressing the Health Related Social Needs (HRSN), aka Social Determinants of Health, are more likely to experience burn out. This should not come as a surprise. We have long understood that health outcomes are impacted less by direct clinical care and more by our environment, community and personal behaviors. Yet, in the US health system, physicians have been held responsible for the outcomes of health with very little offered in the way of support or tools to address the factors impacting 80% of outcomes. This is a distorted Pareto principle. For example, primary care physicians are now required by some payers to screen for SDOH. Yet our health system does not incentivize or make ready a support system for these patients that adequately addresses their concerns. Physicians are at risk of moral injury when we are asked to screen and identify causes of poor health without resources to address what is found. The problem lies in the disjointed system of healthcare in the US, which is not a system of care at all. Primary Care alone is not and cannot be responsible for SDOH. Payers have long recognized the increased cost of unaddressed SDOH and have attempted to address these through care management and social workers who are largely estranged from the primary care team and patient relationship. It is not shocking that this is ineffective. So the payers try to incentive physicians to be engaged in the process through compensation mechanisms without adequately funding the wrap around services needed to actually impact outcomes. These services require an integrated system of care with collaboration among social services, mental health and addiction services, public health, the education system, justice system and the politicians. Screening through primary care has helped identify and highlight the problem. The solutions lie in developing a collaborative system to address the interventions that can have impact. Some medical clinics with business models funded by Medicare Advantage plans have created microsystems that create the full continuum of care services, albeit limited to their attributed population. When I practiced as family physician, I didn’t realize how fortunate my patients were to have access to the Muskegon Health Project. Thirty years ago, this community collaborative evolved to fill the gaps in wellness care and serve as the glue for community care to address SDOH. This was a lifeline for me as a family physician pressed by the social needs of my patients. Most communities are not so fortunate to have this level of collaborative support. Perhaps this example along with the Medicare Advantage primary care business model can serve as a foundation for reimagining a health system in the US. If we can imagine it, we can achieve it. #healthcare #SDOH #medicareadvantage #leadingwithtrust
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Transforming Health Care to improve Health, Hope and Healing for each and for all ?|| Strategy Design & Deployment || Performance Improvement?? || Population Health?? || High-Value Care Innovation || Change Champion??
100% agree Dr. Woods that holding physicians - mostly trained to address acute and emergent needs are disproportionately penalized for the health of others without commensurate influence. Teachers too have an unrealisic burden to ensure students learn without adequate resources, Science is clear regarding the importance for brain development of quality sleep, movement, nutrition, stable environment, emotional nurture and the list goes on. When will we as a collective nation set health as the new MARS. Not a moonshot for the few but a stellar reality for the many? When will we vote - with economic dollars as well as elections for the persistent promotion of wellbeing? In our communities, schools, corporations, society? Those of us fortunate enough to be trained in whole person and high-value care and facilitate the outcomes-based payment models payors continue to iterate are all too familiar with the discouragement and potential liability of identifying needs through screening in a system not YET designed to assist individuals and families in addressing the health influencing needs. A quick glance at the television gives the impression that most ads promote, low nutrient 'fast' food, alcohol, and prescription drugs. How might the health of millions improve if healthy lifestyle options received similar airtime or substances proven to erode health were consistently treated like tobacco and taken off the air? Please share what you think Americans can do - in small and big ways to become the healthiest, happiest nation in the world? It starts with an idea. Imagine what is possible! Make health the mars shot? #choosehealth #bettertogether
A recent study published in JAMA demonstrated that physicians who are more actively engaged in addressing the Health Related Social Needs (HRSN), aka Social Determinants of Health, are more likely to experience burn out. This should not come as a surprise. We have long understood that health outcomes are impacted less by direct clinical care and more by our environment, community and personal behaviors. Yet, in the US health system, physicians have been held responsible for the outcomes of health with very little offered in the way of support or tools to address the factors impacting 80% of outcomes. This is a distorted Pareto principle. For example, primary care physicians are now required by some payers to screen for SDOH. Yet our health system does not incentivize or make ready a support system for these patients that adequately addresses their concerns. Physicians are at risk of moral injury when we are asked to screen and identify causes of poor health without resources to address what is found. The problem lies in the disjointed system of healthcare in the US, which is not a system of care at all. Primary Care alone is not and cannot be responsible for SDOH. Payers have long recognized the increased cost of unaddressed SDOH and have attempted to address these through care management and social workers who are largely estranged from the primary care team and patient relationship. It is not shocking that this is ineffective. So the payers try to incentive physicians to be engaged in the process through compensation mechanisms without adequately funding the wrap around services needed to actually impact outcomes. These services require an integrated system of care with collaboration among social services, mental health and addiction services, public health, the education system, justice system and the politicians. Screening through primary care has helped identify and highlight the problem. The solutions lie in developing a collaborative system to address the interventions that can have impact. Some medical clinics with business models funded by Medicare Advantage plans have created microsystems that create the full continuum of care services, albeit limited to their attributed population. When I practiced as family physician, I didn’t realize how fortunate my patients were to have access to the Muskegon Health Project. Thirty years ago, this community collaborative evolved to fill the gaps in wellness care and serve as the glue for community care to address SDOH. This was a lifeline for me as a family physician pressed by the social needs of my patients. Most communities are not so fortunate to have this level of collaborative support. Perhaps this example along with the Medicare Advantage primary care business model can serve as a foundation for reimagining a health system in the US. If we can imagine it, we can achieve it. #healthcare #SDOH #medicareadvantage #leadingwithtrust
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President and CEO Southlake Health; Primary Care Systems Expert and Health System Value Gap Solutions Architect
This isn’t yet another post about US healthcare and its well-documented challenges. This is about here in Canada, the True North Strong and Free where Universal Healthcare is a foundational pillar of our society. But in her phenomenal post Kristen highlights the disconnects in the US healthcare mechanism (US healthcare is not a “system” by any definition of the word) that essentially place a dead end in managing SDoH or HRSNs. Primary Care is an ideal place to screen for and identify these needs. But without a connected and integrated system of interventions to mitigate those, they are worse than “sound and fury signifying nothing”. Primary Care Providers can identify and even quantify what their patients need, and it isn’t in this case prescriptions, tests, or procedures. But they can do NOTHING about it. So they get the burden of the work, the stress of financial and performance accountability, and no resources to deal with it. These providers care about their patients deeply so: Problem identified—>No resources to deal with it—>Moral Distress—>Symptoms of Burnout—>A lot of really bad outcomes. This is not unique to the USA. Shockingly, in the Canadian provincial and territorial systems where healthcare, public health, social services, education etc… are all funded from the same public dollar, the connection and pathway between patients presenting with HRSNs to a primary care provider(where identification and measurement of them could be undertaken) and subsequent mitigation of them is poorly delineated, and in many cases not even defined. There are some excellent programs for sure. But a comprehensive system of care built around those HRSNs is simply not present. Patients suffer. Physicians and NPs suffer. Our system suffers as the endpoint of the failure to address is hospitals and “sickness care” as the banker of last resort. We can, we must do better.
A recent study published in JAMA demonstrated that physicians who are more actively engaged in addressing the Health Related Social Needs (HRSN), aka Social Determinants of Health, are more likely to experience burn out. This should not come as a surprise. We have long understood that health outcomes are impacted less by direct clinical care and more by our environment, community and personal behaviors. Yet, in the US health system, physicians have been held responsible for the outcomes of health with very little offered in the way of support or tools to address the factors impacting 80% of outcomes. This is a distorted Pareto principle. For example, primary care physicians are now required by some payers to screen for SDOH. Yet our health system does not incentivize or make ready a support system for these patients that adequately addresses their concerns. Physicians are at risk of moral injury when we are asked to screen and identify causes of poor health without resources to address what is found. The problem lies in the disjointed system of healthcare in the US, which is not a system of care at all. Primary Care alone is not and cannot be responsible for SDOH. Payers have long recognized the increased cost of unaddressed SDOH and have attempted to address these through care management and social workers who are largely estranged from the primary care team and patient relationship. It is not shocking that this is ineffective. So the payers try to incentive physicians to be engaged in the process through compensation mechanisms without adequately funding the wrap around services needed to actually impact outcomes. These services require an integrated system of care with collaboration among social services, mental health and addiction services, public health, the education system, justice system and the politicians. Screening through primary care has helped identify and highlight the problem. The solutions lie in developing a collaborative system to address the interventions that can have impact. Some medical clinics with business models funded by Medicare Advantage plans have created microsystems that create the full continuum of care services, albeit limited to their attributed population. When I practiced as family physician, I didn’t realize how fortunate my patients were to have access to the Muskegon Health Project. Thirty years ago, this community collaborative evolved to fill the gaps in wellness care and serve as the glue for community care to address SDOH. This was a lifeline for me as a family physician pressed by the social needs of my patients. Most communities are not so fortunate to have this level of collaborative support. Perhaps this example along with the Medicare Advantage primary care business model can serve as a foundation for reimagining a health system in the US. If we can imagine it, we can achieve it. #healthcare #SDOH #medicareadvantage #leadingwithtrust
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As a provider of premium live-in care services, A Star Care understands the importance of ensuring our clients receive the highest quality of care. Live-in care offers a unique solution for individuals who require daily assistance but prefer to remain in the comfort of their own homes. By having a carer live with you, you not only receive around-the-clock support, but also peace of mind knowing that someone is always there to assist with daily tasks, offer companionship, and address any concerns or emergencies. In addition to helping with daily tasks, live-in care can provide an extra layer of care that can greatly improve your quality of life. Beyond the practical benefits, there are also emotional and mental health benefits associated with live-in care. Having a carer live with you provides a valuable source of emotional support, helping to alleviate feelings of loneliness or isolation. This can lead to a more positive outlook and improved overall well-being. In addition, live-in care can help to maintain a regular routine, which is particularly important for those with medical conditions or cognitive impairments. Unlike traditional care facilities, live-in care allows for a tailored approach to care, with the carer working closely with the client to understand their specific needs and preferences. This can result in a care plan that is tailored to the individual, which can help to improve their quality of life. In addition to personalised care, live-in care also allows for continuity of care. By having the same carer live with you, you can build a relationship and a level of trust that is difficult to achieve with traditional care facilities. Moreover, live-in care can help to reduce the risk of falls and other accidents that may occur when an individual is left alone. For those who are worried about the costs associated with live-in care, it's important to consider the long-term benefits. While live-in care may have higher upfront costs than traditional care facilities, the benefits in terms of personalisation, continuity of care, and overall well-being can make it a more cost-effective option in the long run. Moreover, live-in care allows individuals to age in place, which can help to preserve their independence and maintain a sense of dignity and control over their daily lives. Contact us today at 0208 058 3302 [email protected] www.astarcare.co.uk
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Graduate - Human Resource Management | Project Management : Skilled in Training and Development | Data Analysis I Employee Relations | Proficient in creating and updating online training modules
CARING Absolute care plays a vital role in extending life span by focusing on preventive healthcare. Regular medical check-ups, early diagnosis, and preventive measures such as vaccinations reduce the chances of severe illnesses. When diseases are identified early, treatment is more effective, preventing complications and improving outcomes. Additionally, chronic conditions like hypertension and diabetes can be managed better, slowing their progression and enhancing the individual’s quality of life. Another essential aspect of absolute care is addressing mental and emotional well-being. Providing access to mental health services, such as therapy and counseling, reduces stress, anxiety, and depression, which are known to affect physical health. A healthy mind contributes to better decision-making, including adopting healthy habits like exercising and eating well. Emotional care also enhances resilience, enabling individuals to cope with life challenges effectively, which supports longevity. Social and lifestyle support offered through absolute care further promotes a longer life. Encouraging physical activity, balanced nutrition, and avoiding harmful habits, such as smoking, significantly lowers the risk of chronic diseases. Additionally, fostering social connections and emotional support reduces feelings of isolation, improving both mental and physical health. In advanced stages of illness, palliative care ensures comfort and dignity, leading to a higher quality of life even at the end stages. This holistic approach ensures that individuals thrive in all areas of life, contributing to a healthier, longer life span.
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Rosemary Mugwe ? Global Health || Women leadership, Health and Human Rights Defender || Policy & Advocacy Specialist || Writer. Speaker. Narrative-Changer. Board Member
Health is a Human Right: Empowering Communities One Story at a Time! In our daily lives, health is at the forefront of our minds—our health is our most cherished possession. It fuels our aspirations in various domains such as education, strengthens our families, and boosts the economies. Health is recognized as a fundamental human right, established within our national constitutions and upheld by global and regional commitments affirming that every individual is entitled to "the highest attainable standard of physical and mental health." ?The right to health encompasses both freedoms and entitlements. Let's dive a little deeper into what is meant by "entitlements" in the context of health. It means that everyone should have an equal opportunity to attain optimal health- includes access to disease prevention, treatment, maternal care, essential medications, and most importantly, health education that empowers us to take charge of our own well-being. The household serves as a fundamental environment within the community where health is cultivated. This is the setting in which health promotion occurs, diseases can be prevented, and common illnesses addressed. It is imperative that access to health services is regarded as an inherent right within this context. Community Health Workers are instrumental in championing and advancing this right to health at the household level in their efforts to create healthier communities &promote health equity. I will illustrate this concept with a real-life scenario "Meet Debs, a committed community health worker in a rural village in Kenya. During her routine visits, she meets Rosie, an expectant mother facing concerning symptoms. Recognizing the potential risks, Debs carefully listens and assesses Rosie’s situation, suspecting a possible risk of preeclampsia. She promptly informs Rosie about the nearest health facility offering free prenatal care, emphasizing that access to health services is a right, not a privilege. Cue the superhero music! Recognizing that cultural barriers may prevent care, Debs offers to accompany Rosie, turning a daunting trip into an empowering experience. Along the way, she educates Rosie about prenatal care, nutrition, and signs to watch for during pregnancy—providing crucial knowledge that benefits Rosie beyond just her current situation. Debs continues her support after the visit, regularly checking on Rosie’s health and medication adherence, ensuring she stays on track for a healthy pregnancy, and reinforcing that health services are essential for everyone". Debs exemplifies the vital role that community health workers play in advocating for health as a fundamental human right, reminding us that it should be upheld for every individual. Here’s to unsung heroes like Debs who transform health rights into realities, one community at a time. Health isn’t a privilege for a few; it’s a fundamental right that belongs to us all! #RightToHealth #HumanRights #CommunityHealth #CHWs
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Care Workers to Receive Training for Routine Health Checks in Major Refor The UK Government is introducing measures to empower care workers with new training to perform routine health checks, including monitoring blood pressure, managing diabetes with insulin administration, redressing wounds, adjusting catheters, and offering mental health support. These steps aim to enhance access to routine care and alleviate the growing backlog within the NHS. Under the new plan, care workers will be authorised to deliver specific health interventions, ensuring faster access to care and improving patient experiences. Health Secretary Wes Streeting highlighted the benefits of these changes, stating they would "free up hospital beds" and reduce the need for patients to repeat their medical histories to multiple healthcare professionals. National Standards and Digital Integration As part of the reforms, the government will establish national standards and guidelines to help care providers invest in advanced technologies that support patients effectively. The initiative forms a key component of broader adult social care reforms and plans to strengthen integration between the NHS and the social care sector. One significant aspect of the strategy involves the development of a unified digital platform to facilitate seamless data sharing between social care, GPs, and hospital staff. The aim is for all care providers to be fully digitised by 2029, granting care workers real-time access to comprehensive medical records. Revolutionising Care with Technology Health Secretary Streeting described the initiative as transformative: "There is a revolution taking place in health and care technology, and this government is reforming social care so disabled and older people benefit from the latest cutting-edge tech. Patients won’t need to repeat themselves, staff will be equipped to deliver the best possible care, and hospital beds will be freed up to tackle other pressing needs." Dr. Vin Diwakar, National Director of Transformation at NHS England, echoed this sentiment, highlighting the benefits of digital integration: "Research shows that digitising social care and linking up records helps people live independently for longer, enables families to be more involved in caregiving, and frees staff from administrative tasks, allowing them to focus on providing care." These reforms are expected to modernise the social care sector, fostering better communication across healthcare systems while improving patient outcomes. By equipping care workers with the skills and tools to perform routine health tasks, the government aims to ensure that social care remains a cornerstone of community well-being. These initiatives are designed to integrate services, reduce pressures on the NHS, and deliver a more responsive and patient-centred care system. Read More:
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HEALTH SYSTEMS STRENGTHENING IN INDIA Adoption of the Indian Public Health Standards:?This defined not only the service package that each facility must provide, but also specified the minimum inputs required to ensure quality of care, in terms of infrastructure, equipment, skilled human resources, and supplies. It was an assurance to the states of financing the gaps between available levels of these inputs and the levels needed to achieve the IPHS norms. A substantial increase in these inputs was driven by facility surveys to identify gaps and then planning and financing to close these gaps. Quality standards?have been defined with respect to clinical protocols, administrative and management processes and for support services. The Operational Guidelines for Maternal and Newborn care published by the Ministry of Health and Family Welfare comprehensively defined such quality standards for RCH care. Skill gaps and Standard Treatment Protocols:?Skill sets and standard treatment protocols required for provide quality RCH services and training packages that would provide these skill sets were designed. These include the Skilled Birth Attendance (SBA) training package for ANMs, the Navjat Shishu Suraksha Karyakram (NSSK) and the IMNCI packages for ANMs, the Home Based Newborn Care (HBNC) for ASHAs, and the Emergency Obstetric Care (EmOC) package for doctors. These training packages also introduced the standard treatment protocols in each of these areas. Hospital Management Societies (JAS/ RKS) and untied funds:?The mandatory creation of a hospital management society (Rogi Kalyan Samiti) and empowering this body with untied funds has allowed public participation also contributed to improved quality of care. RKS members were trained and sensitized on quality of care issues. Before the onset of NRHM, many states generated funds from user fees, however the untied grants to all public health facilities were made available under NRHM which reduced financial barriers to access of health care. This is clearly evident from the increased utilization of indoor and outdoor services at health facilities Quality Improvement Programmes:?NRHM also supports initiatives for building quality management systems. These range from formation of quality assurance committees which use check lists and periodic monitoring visits to assess quality gaps, to more structured quality management systems leading to a third party audit and quality certification- either using NQAS/ LAQSHYA/ KAYAKALP/ SUMAN/ MUSQAN etc
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AR Specialist | RCM | Health Care | HIPPA Certified | Sr. Billing Executive | Content Writer
Annual Wellness Visit (AWV) and Welcome to Medicare Visit codes are part of Medicare’s preventive services to promote health and prevent illness for beneficiaries. Here's a brief overview: Welcome to Medicare Visit (CPT Code G0402) - **Purpose**: A one-time preventive visit available within the first 12 months of Medicare Part B enrollment. Services Included: - Review of medical and family history. - Measurement of height, weight, blood pressure, and BMI. - Screening for depression and other risk factors. - Education and counseling about preventive services (e.g., screenings, vaccinations). Notes: This visit does not include a physical exam. Annual Wellness Visit (AWV) (CPT Codes G0438, G0439) Purpose: Annual visits for beneficiaries who have been enrolled in Medicare Part B for more than 12 months. Codes: G0438: First Annual Wellness Visit (initial). G0439: Subsequent Annual Wellness Visits. Services Included: - Personalized prevention plan. - Health risk assessment. - Review of medical and family history. - Development or updating of a list of current providers and medications. - Cognitive impairment screening. - Education and referrals for preventive services. Key Differences Eligibility: Welcome visit is limited to the first 12 months of Part B enrollment, while AWVs occur annually after that. Focus: Both focus on prevention but differ in timing and scope. These visits are preventive and not intended to diagnose or treat acute medical conditions.
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?? Embracing Systems Thinking in Public Health: A 360-Degree Approach to Lasting Change! ?? In public health, tackling complex issues, be it chronic diseases, infectious outbreaks, or mental health—requires more than treating symptoms. It calls for systems thinking, a holistic approach that connects dots across sectors, communities, and policies to identify root causes and design effective, sustainable solutions. Here’s how systems thinking transforms public health!?? ?? Understanding the Bigger Picture Systems thinking isn’t just about isolated actions; it’s about understanding how every part of the health ecosystem is connected. Imagine tackling the rise in type 2 diabetes. Instead of focusing solely on medical treatment, we ask questions: How accessible is healthy food? Are there safe spaces for physical activity? Is there community awareness about nutrition and lifestyle? In New York City, public health officials recognized that diabetes was tied not only to personal choices but to environmental factors, leading to initiatives like healthier food access, safer parks, and community exercise programs that shifted the health landscape. ??????? ?? Preventing Future Health Crises When COVID-19 hit, the importance of systems thinking was crystal clear. Health agencies worldwide had to look beyond hospitals and ICUs. They coordinated with transportation, education, and technology sectors to keep communities informed, safely manage transportation, and adapt to school closures. Systems thinking here meant seeing public health as part of a larger ecosystem—one where infection rates, mobility, and social behavior were all connected. ???? ?? Empowering Health Equity Let’s take an example from mental health services in rural areas. Systems thinking identifies the complex web of barriers—such as healthcare deserts, socioeconomic factors, stigma, and the digital divide. For example, programs that integrate mental health care with primary healthcare in rural India addressed these factors holistically, training local health workers to identify and address mental health needs within the community. This layered, comprehensive approach reaches underserved populations and ensures that mental health support doesn’t just exist but is accessible and effective. ?????? ?? Driving Lasting Impact Systems thinking allows us to tackle issues at every level, creating sustainable solutions that empower communities. From addressing climate change’s health impact to tackling substance use, a systems perspective helps public health professionals craft solutions that evolve with the world. ???? ?? By embracing systems thinking, we’re not just addressing problems—we’re building a resilient, healthier future for all. Let’s reimagine public health from the ground up, connecting ideas, actions, and communities for a truly transformative impact! ???? #PublicHealth #SystemsThinking #HealthEquity #SustainableSolutions #CommunityImpact #HealthcareInnovation
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