Kimberly Wiles, BS, RRT, CPFT
VP of Respiratory Services
Kittanning, PA 16201-1922
(724) 763-8889, ext. 5220
Fax: (724) 763-4284
Greg Spratt, BS, RRT, CPFT
Director of Clinical Marketing
3144 CR 193
Philadelphia, MO 63463
Office: (573) 439-5804
Mobile: (857) 919-2947
Kimberly S. Wiles, BS, RRT, CPFT
What a great way to end the year! For those of you who were able to attend the AARC International Respiratory Convention and Exhibition, I hope you came home with great ideas and a re-energized mindset for 2015.
The take away message from AARC Congress 2014 was to be all that you can be and think outside the box! The 20-plus lectures that were geared toward the home care therapist offered insight into several ways the respiratory therapist can thrive by looking outside the box. We need to keep the momentum going.
We held our section meeting during the Congress and had a great turnout. Thanks to all who were able to attend. For those of you who were unable to attend, here’s a brief recap of the items we covered:
Home care competencies: We have started the task of creating home care competencies. A small focus group of home care members, along with Dr. Shawna Strickland, Dr. Brian Carlin, and Dr. Kent Christopher, created a preliminary list. Shawna discussed this process in detail. The next step is to send our preliminary documents to the home care membership for comments. Expect to see this in early 2015.
Quarterly Bulletin: The Bulletin was discussed and it was noted that volunteers are always appreciated for their contributions. A special thanks to Becky Thomason, Tim Buckley, and Zach Gantt for helping out in 2014! If you are willing to write an article for the Bulletin, but were not able to attend the meeting, please email me and I’ll provide you with everything you need to get started. The Bulletin is only as good as we make it — let’s use it to share our knowledge and experience with each other.
“Recruit a Member Challenge”: I challenged every home care section member to recruit one new member to the AARC and the Home Care Section. The RT doesn’t have to be working as a home care therapist. Our profession is evolving, and new models of care are arising that utilize RTs in many different capacities in the post-acute care environment. RTs working in the hospital are being challenged to develop effective transition of care programs that cross over into the home. What better way to find out what is going on in home care, than by being a member of the Home Care Section!
Kimberly S. Wiles, BS, RRT, CPFT
The prestigious Thomas L. Petty MD Invacare Award for Excellence in Home Respiratory Care was awarded to Angela C. King, BS, RRT-NPS, RPFT, at the AARC Congress in Las Vegas. Angela has proven that she is the model respiratory therapist that Dr. Petty would have been proud of. Her extensive career has covered all facets of respiratory care, but her passion has been in the world of home ventilation. She is recognized as an industry leader in the area, which has given her the opportunity to speak in 25-plus countries.
Over her career, Angela has published numerous articles and been involved in multiple professional organizations as well. However, with all of that said, it is her compassion and love for her patients that makes her an exemplary respiratory therapist. She is a model for patient advocacy, which has been demonstrated in court on multiple occasions as she battled for patients’ rights and won. Congratulations Angela and thank you for all of the work you have done for our patients and the respiratory community!
Tim Buckley, MS, RRT, FAARC
The start of any new year is a good time to look both back and forward. In fact, the Romans named the first month of the year after their god, Janus, who was the god of beginnings and endings, and also passages and transitions. As a god he was associated with change and time. He was usually depicted as having two faces, one looking at the past and the other looking towards the future.1
January 2015 is of particular interest to respiratory therapists because it is both a beginning and an end. First it is the end of the planning process initiated by the AARC for the 2015 and Beyond project. January 2015 also marks the beginning of the next phase for the respiratory care profession.
In the spring of 2007 the AARC Executive Office formed a task force to create a vision for the practice of respiratory care in 2015 and beyond. This task force was charged with examining the evolving health care delivery system and defining potential new roles for RTs. Members were also asked to identify the skills, knowledge, and attributes that RTs will need for these new roles and responsibilities. Finally, they were asked to determine how we will need to prepare RTs, with minimal impact to the existing workforce.2
According to the 2009 AARC Human Resource Survey of Respiratory Therapists, there are approximately 9,200 RTs working in home care as their primary job. Many more work part-time in home care in addition to their primary jobs in education or acute care.3 The full-time home care RT contingent represents about 8% of the employed respiratory therapists extrapolated by the survey.
The task force consisted of 15 individuals who were selected to represent the stakeholders, and these 15 individuals represented a wide range of associations, employers, and agencies. As I reviewed the task force membership, I noted that three of the 15 (Dunne, Walsh, and Walton) are well known in the post-acute care arena, which is a pretty strong representation for home care and post-acute RTs (20% of the task force).2
The task force identified five drivers of change in health care (Table 1), all of which relate to the practice of the home care RT. It has long been recognized that the home represents a less expensive site to provide care. Most home care patients are over the age of 65 and being managed for a chronic disease. Technology will provide new and effective ways to help our home care patients and reduce our costs. Most importantly, the patients in home care are not really patients, but customers who often have a choice in who provides their home respiratory care.
|Drivers of Change in Health Care|
|Cost of care||The cost of health care in the U.S. is the most expensive in the world. Changes will require more efficient, effective, and safe care.|
|Demographics||The population is aging. As the baby boomers age, there will be an increase in the over 65 y/o population.|
|Shift in the disease burden||Disease burden will shift from acute disorders to chronic disease and disability. There is a mismatch in our ability to manage chronic disease, since our focus for the past 100 years has been acute care.|
|Technology||Information and communication technology will provide new and more effective tools. In addition, medical devices and telemedicine will continue to increase our ability to better manage diseases.|
|Consumers of health care||Convenience, price, and consumer satisfaction will drive purchasing decisions. It is likely that with the changes in health care, the consumer will have more involvement in the choice of equipment and services.|
Modified from: Table 3-Kacmarek RM, Durbin CG, Barnes TA, Kagelar WV, Walton JR, O’Neil EH. Creating a vision for respiratory care in 2015 and beyond. Respir Care 2009;54(3):379.
As home care RTs, we need to embrace the changes and find better ways to highlight our unique skills and expertise in reducing the cost of care. While some of us work in pediatrics, most of us work largely in adult care, which in home care means the growing population over the age of 65. In home care, the disease burden has always been in chronic disease management, not acute care. Our acute care colleagues need our expertise in chronic disease management. Technology changes much faster in home care than acute care. Just think of the number of CPAP masks you have at your disposal. As patients shift to customers, home care RTs are well suited to “market” their services and provide consumer choice to meet the needs of increasingly more sophisticated customers.
Next quarter, we will discuss the competencies required by home care RTs in 2015 and beyond. The future will require more of us as both RTs and home care RTs, and it starts with competency. We will also look at how we should be transitioning from our current role to a role more suited to our customer’s needs and the demands of the new health care delivery system.
When you see a statue of Janus, it is not always clear which of his faces is looking back and which is looking forward. However, when I picture Janus, in the face looking forward he is wearing designer Roman sunglasses, because our future is very bright indeed.
Betsy Thomason, RRT, Millennium Respiratory Services
The voice message on the doctor’s office phone says, “Press 1 if you are calling from a hospital or a doctor’s office. All other callers, press two.” You are a respiratory therapist calling from a home care company. Which number do you choose?
If you’re thinking outside the proverbial box, you press 1. After all, a home care company is actually a medical facility, governed by the same Medicare and Medicaid rules as a hospital, including securing prescriptions and now MD-visit notes. The difference between hospitals and home care companies is that home care patients do not reside at the home care business address!
Out-of-the-box thinking can help the home care respiratory community think globally, feel confident and proud, and act responsibly for the safety and wellbeing of those who entrust their care to respiratory home care therapists.
So, if it’s beneficial to think outside the box, it would help to know what the box actually is!
Each of us can be confined by our own particular box, which could be a building, a protocol, or a habitual way of thinking or responding. The box can change shape, but don’t be fooled! It’s still a box even though it has morphed.
Now, how does one become an out-of-the-box thinker? Start by hanging out at the public library — you’ll soon discover that it’s more than books! Or, take a class in something you hated in school. Consider becoming physically active and discovering how smart your body is. Listen to different points of view in the media and walk in a stranger’s shoes. Develop your imagination and wonder about things. Ask a lot of questions that require more than a yes/no answer. Add a huge dose of self-esteem, and voila! You’re outside the box!
The point is that out-of-the-box thinking can advance the perception of clinical respiratory home care and honor the extensive clinical skills required to function outside the box known as “the hospital.” What are YOU doing to add value to your clinical practice in patients’ homes? What makes you unique and respected among your peers and patients?
Here’s one of my out-of-the-box contributions to clinical respiratory home care: breathing training with a focus on the active, spine-stretching outbreath and passive, relaxed inbreathe. It’s called BODs—the BreatheOutDynamic system. You can learn more about it and my soon-to-be published book on my website.
BODs training helps me develop a partnership with my patients and their care providers, with each of us learning from the others. When you empower your patients for self-care, they feel your energy. This gives them hope and brings you joy. Even patients on vents can influence their wellbeing by using effective breathing to manage their overwhelming stress. I learned this during my very first year of respiratory employment. I taught an intubated ICU patient to modulate her SpO2, respiratory rate, and blood pressure with her very own outbreath and her imagination. This incident sealed my fate as a respiratory therapist breathing trainer and led me 14 years ago on the path to home care—specifically to Millennium Respiratory Services, with offices in New Jersey and Florida and patients in four other states.
What could be YOUR contribution to establishing clinical respiratory home care as a well-respected, credentialed specialty practice? “Press 1 if you’re a clinical respiratory home care facility, and share your story!” Email AARC Home Care Section Chair Kim Wiles and let her know you want to become an active Home Care Section member, and encourage your colleagues to do the same. Then share your uniqueness with the section and the world.
Recruit a new member: Know an AARC member who could benefit from the Home Care section membership? Direct them to section sign-up. It’s the easiest way to add section membership to their overall membership package.
Bulletin deadlines: Winter Issue: December 1; Spring Issue: March 1; Summer Issue: June 1; Fall Issue: September 1.