Winter 2015 Long-Term Care Bulletin

Winter 2015 Long-Term Care Bulletin

Lorraine Bertuola
Director of Clinical Services-RT
Genesis Respiratory Health Services
Kennett Square, PA
Mobile 443-983-5929
Office 410-832-8375
Gene Gantt, BS, RRT
Eventa LLC
Livingston, TN

Accountable Care: What Does the Future Hold for Respiratory Therapy?

Lorraine Bertuola, BA, RRT

It was great to attend AARC Congress 2014 in Las Vegas last December. There were so many topics of interest to long-term care therapists. Particularly of interest were the presentations centered around Accountable Care Organizations and population health management.

Respiratory therapists have a unique opportunity to play a vital role with population health. Who is better equipped to manage the health of people with cardiopulmonary diseases than a respiratory therapist?

I envision respiratory therapists helping to manage the dollars spent on patients diagnosed with cardiopulmonary diseases through case management and disease management. Since health care dollars are not going to increase and we are challenged to manage populations with chronic diseases, health systems are going to be challenged with how to manage those patients who access health care through their systems. It would make sense to manage those patients in a lower cost environment. As respiratory therapists in long-term care we have a huge opportunity to provide services in a cost effective environment.

With this in mind, it is also important to note that the value of our services must be reflected through positive outcomes. I have spoken at the last three AARC meetings about showing value through outcomes and how they tie to our profession’s success in surviving the future of reimbursement. Through a previous study commissioned by the AARC called the Muse Study, we know the value a therapist brings to a long-term care patient when we assess that patient on the first day of admission. But we are challenged to show that value year in and year out as our long-term care centers are challenged with cuts to reimbursement.

Do not miss the opportunity facing our profession today to show our value through population health management.

Screening Women for COPD

Stephanie Koch, BS, RRT

The 2014 guidelines from the Global Initiative on Chronic Obstructive Lung Disease (GOLD) provide a comprehensive look at how to diagnose, manage, and prevent COPD. GOLD also mentions that some studies are showing that women are more susceptible to the effects of tobacco smoke than men.

In 2004, the U.S. Surgeon General reported, “Women smokers are nearly 13 times more likely to die from COPD compared to women who had never smoked.” On average, hospitals reported a 42% increase in female deaths caused by COPD between 1980 and 2000. According to an American Lung Association report on women and COPD, women have surpassed men in the number of COPD hospitalizations, with 52.7% of the 715,000 hospital discharges for COPD in 2010 occurring among women.

So why the shift? Many believe it’s caused by the change in cigarette smoking in women. In the 1960s, women were focused on political and social freedoms. Tobacco companies captured this idea and positioned cigarettes as symbols of liberation, independence, self-confidence, beauty, and adventure. You might recall some of the branding, such as, “You’ve come a long way baby!” Companies even changed the names of their cigarettes to entice women: Virginia Slims, Eve, and Satin are prime examples.

Another factor influencing the increase of COPD in women is occupational exposure. Women began working in jobs that were historically held by men, including those where exposures to dust and chemicals play a major role in the development of COPD. Then there’s the secondhand smoke exposure, as well as the everyday exposure to air pollution.

Physiologically, women have smaller airways than men, which results in a higher exposure to inhaled irritants. Women have a peak FEV1 at about 13 years of age and reach plateau by 16. Men reach their peak FEV1 at 16 years of age and plateau by 18. Cigarette brand preferences and differing inhalation particles between cigarette brands also influence gender-related risk of COPD. COPD has been shown to develop differently in men and women as well. CT scans show women have less evidence of emphysema and a greater significance of bronchitis or thicker airway walls and a smaller airway lumen.

Today, smokers are shifting from cigarettes to e-cigarettes, changing the levels of air pollution affecting the environment and adding different chemicals to the mix, such as those used in nail salons. I wonder what changes we’ll see in 20 years? This is an important question to ask, given that we provide screening for COPD. We cannot forget that this disease isn’t gender specific and affects women too.

Practicing at the Top of Your License

Lisa Ziller, RRT

For the past several months I have been hearing the phrase, “practice at the top of your license,” without having an awareness of what this concept actually means. So I fulfilled my curiosity by learning more about it and how I could utilize this terminology to influence others in my field. In the following paragraphs, I would like to provide you with an overview of this philosophy and then take it one step further by offering some suggestions on how respiratory therapists can incorporate this ideal into their everyday work integrity.

To understand what it means to practice at the top of our license, we must first be aware of our scope of practice. Researching your state licensure regulatory guidelines will help you understand the hierarchy structure of your license at the state level. But we can delve even deeper into the nuances of our scope of practice by tapping into the wealth of knowledge available to us as AARC members. The AARC can provide us with all the clinical resources we need to foster continued growth in our field.

I also recommend becoming a member of the National Board for Respiratory Care (NBRC). This is your credentialing board; they have given you the exams necessary to hold that professional credential. Being a part of the NBRC exemplifies pride and professionalism in your credential.

These resources form the backbone when it comes to maintaining our credential as a respiratory therapist, fulfilling our educational needs, and providing the resources we need to advance our career within the respiratory therapy discipline.

In addition to those tenets, we must aspire personally to learn and grow clinically to fulfill the evolving needs of our patients. With that growth will bring opportunity to better serve those needs.

How can we utilize this information to “practice at the top of our license?” Let us start with the basics. Be a professional respiratory therapist. Take pride and invest your knowledge in your career. Utilize your resources frequently and wisely. Never stop growing clinically or educating yourself, and use that education to move into another area in your field, something unfamiliar, maybe challenging, but also rewarding.

Aspire to practice at the top of your license by utilizing your education and clinical experience to propel yourself forward and make a difference in the lives of those you treat. Demonstrate those tenets to others on your clinical team to encourage their growth as well — not only your respiratory therapist comrades but the supportive medical staff too so they can practice at the top of their license no matter what their clinical area may be.

Join the Long-Term Care TEAM: Together Everyone Achieves More

James Wood, BA, RRT

Recently, I had the privilege of attending the 60th annual AARC Congress in Las Vegas. The lectures were well attended, and a wealth of information was shared with colleagues from all over the world. The networking opportunities were amazing, and the exhibit hall had the latest and greatest technology available. At times, I found myself struggling over which lecture to attend because the topics I found of interest overlapped.

Despite all of these great learning and networking opportunities, I made a point to attend the Long-Term Care Section membership meeting to hear how the AARC is supporting therapists in long-term care. During the meeting, we had a great conversation regarding the profession and how respiratory therapists play a vital role in long-term care. Although the meeting was a success, I found it quite disheartening that of the nearly 400 active section members, only 10-15 Long-Term Care Section members were in attendance.

This meeting is our opportunity to unite and overcome the challenges we are facing with the current and upcoming health care changes. As long-term care respiratory therapists, we have the opportunity to embrace these changes and position ourselves to be successful and sustainable in long-term care. But we cannot do this alone.

This opportunity starts within the AARC Long-Term Care Section, and the section meeting at the AARC Congress is one way to unite as a team working to achieve that goal. With that, I challenge each of you to take a stand and become actively engaged as a section team member. Make your voice heard, and serve as a patient advocate to ensure our patients continue to receive cardiopulmonary care from the qualified experts in health care. Standing alone we will be defeated, but united as a team, we will conquer. The opportunity is yours, and the time is now — Together Everyone Achieves More!

Section Connection

Recruit a New Member: Know an AARC member who could benefit from the Long Term Care section membership? Direct them to online sign-up. It’s the easiest way to add section membership to their overall membership package.
Section Microsite: Visit our microsite to network with fellow section members via AARConnect.
Bulletin Deadlines: Winter Issue: December 1; Spring Issue: March 1; Summer Issue: June 1; Fall Issue: September 1.