Kenyon Connects

In recent posts I’ve explored some of the reasons why it would be beneficial for the home health industry if Nurse Practitioners (NPs), Advanced Practice Nurses (ARNPs), and Physician Assistants (PAs) were given more independence to make decisions about care and to sign off on important Medicare reimbursement paperwork.  This will be especially true if Congress goes ahead with its plans to cut Medicare payments to physicians and more and more doctors refuse to include Medicare patients in their practice. 

But there are even more reasons why greater independence should be granted to nurses:  the times simply demand it.  Continue reading “It’s Time To Turn Advanced Nurses Into Home Health Decision Makers” »

The holiday season is a special time of year.  It is an opportunity to gather with friends, family, and colleagues.  Regardless of our faith or beliefs, the holiday season is often filled to the brim with an array of festivities that reflect precious memories.  While most of us barely have time to catch our breath between parties and concerts, gift exchanges and joyful gatherings, for the elderly, the holidays are often a time to focus on what they have lost.

For many, that loss is defined by physical disabilities that make it difficult for them to participate in customs and celebrations that were once very much part of their lives.  For others, the holidays are poignant reminders of the loss of a spouse or a friend.

Yeas ago I realized how important this time of year was and what it meant to my clients who found it harder and harder to take part in the holiday season.  In response, I created a Holiday Helper program that allowed my clients to maintain many of their favorite traditions while creating a much needed resource for local college students. Continue reading “Holiday Helpers: A Win-Win Program for Home Health, the Elderly, and College Students.” »

In the Kenyon family, this is the time of year we gather in the kitchen to a cook delicious family feast.  Our Kenyon Family Leg of Lamb dates back to the early years of my marriage when my husband and I wanted to do something festive but couldn’t afford a fancy restaurant.  It is a recipe we have tweaked many times, and each year it is the centerpiece of our holiday table.  Grandma’s Garlic Mashers have also evolved over time.  They are such a big hit I now make enough for fifty people because everyone wants to take home leftovers.  Yes, it’s a lot of potatoes, but so worth the effort.  I invented Ginny’s Broccoli with Feta to entice my own children into eating vegetables.  This trick still works.  We have a dear friend who is now part of our ‘holiday’ family.  Her ten-year old daughter refused to eat vegetables until they came to Christmas dinner and she tried mine.  She is now fifteen and eats this festive dish all year round.  Our holiday table is truly a centerpiece of joy, laughter, and good food.  My husband and I are grateful we can share our blessings with family and friends.  It is an honor to share our traditions with you.

Kenyon Family Leg of Lamb
1 leg of lamb (between 3 and 4 lbs.)
6 to 8 fresh garlic cloves
1 to 2 tbsp. dried or fresh thyme
1 to 2 tsp. garlic salt
Handful of dried parsley

Peel garlic cloves and cut them in half.  Using the tip of a sharp knife, make small slices into the leg of lamb and insert garlic halves into the holes.  Mix garlic salt, thyme, and parsley and rub mixture over the entire leg of lamb.  Roast at 325º for 2 to 4 hours. Using an instant-read thermometer inserted into center of the roast, it should read 125º for medium-rare or 135º for medium to medium-well.

Grandma’s Garlic Mashers
5 lbs. potatoes
1 to ½ pint thick whipping cream (enough to cream the potatoes but still be firm)
½ to 1 cube of butter
1 to 2 cups cream cheese; to taste
1 to 2 cups Parmesan cheese; the more the better for my family
Garlic salt to taste
1 head fresh head of garlic

Cut the top off the garlic head.  Put a small amount of olive oil in a flat, glass baking dish and place the garlic cut top down. Bake the garlic head in pre-heated 350º oven for 20 to 30 minutes, until the garlic is soft.  Take out and cool.  Squeeze the baked cloves out onto a plate and crush them with a fork until finely mashed.  Set aside.

Peel and cook potatoes until soft.  Drain and mash, adding whipping cream, butter, cream cheese; begin with smaller amounts and add to taste.  Add mashed garlic cloves and Parmesan cheese.  Add garlic salt to taste.

Ginny’s Broccoli with Feta
2 to 3 lbs. fresh broccoli
2 to 4 tbs. butter, melted
1 cup Feta cheese

Steam broccoli until just beginning to be soft. Drain broccoli, place in bowl and pour the melted butter over the broccoli.  Cover with Feta cheese and serve.

My Mom baked several different kinds of cookies for Christmas each year.  She generally started in September and froze them in 5-gallon plastic containers.  Fortunately for my siblings and I, the freezer was in the basement where our bedrooms were located.  This allowed us free access to sneak frozen cookies.  Our favorites were her Spritz Cookies.  After my folks passed away, I became the keeper of Mom’s Mirro Spritz Maker Cookie Press and the delicious recipe written in her own hand.  After a couple of challenging (and I must say, amusing) tries, I finally mastered the art of this elegant little tool.  Today, I carry on the baking tradition my Mom began and each year, I send Spritz Cookies to my older brother and three sisters.  Their children are now the ones fortunate enough to ‘sneak’ these delightful treasures and pop them in their mouths.  Each year, as I bake these cookies, I feel a special connection to my mother.  It is my pleasure to share her delicious recipe with you.

Jackie Nagel
Owner, Synnovatia®
Kenyon HomeCare Consulting team member

Dolores Nagel’s Spritz Cookies

Preheat oven to 350º.  Makes 6 dozen
1-cup butter
2/3 cups sugar
3 egg yolks
1 tsp vanilla
2 ½ cups flour

Mix butter, sugar, egg yolk, and vanilla until fluffy. Add flour and mix well. Shape cookies with a Spritz Cookie Press.  Bake on ungreased cookie sheets 7 to 10 minutes until set not brown.

You can find still find a vintage Mirro Spritz Maker Cookie Press (like the one my mother and I use) on eBay or other antique outlets.

I have known Miriam since the day my parent’s brought me home from the hospital and we have been friends ever since.  Her house was across the street from ours and I grew up spending as much time in her home as she did in mine.  Her truly delicious Mandelbrot Biscotti brings together the delicate texture of Jewish Mandelbrot and the crunch of European Biscotti.  When the holidays came around, Miriam and her mother would start baking.  Soon the sweet smells of butter and sugar would waft through the neighborhood. When the flurry of activity in the kitchen finally calmed down, Miriam and I would sit on the back steps of her porch and munch these down with a big glass of milk.  In the evening, her mother would invite the entire neighborhood over and everyone would get their fill of these delightful treats.  I hope you enjoy them as much as we did.

Emily Corey
Owner, Write On The Wind
Kenyon HomeCare Consulting team member

Miriam’s Mandelbrot Biscotti

Preheat oven to 350°
½ lb. of butter (2 cubes), melted
1 tsp. baking soda
1 tsp. vanilla
1 1/4 cups sugar
3 eggs
3 cups flour
‘Extras’ to taste

You can add walnuts, chocolate chips, raisins, orange or lemon zest, or any other ‘extra’ that sparks your imagination. Mix the butter, baking soda, vanilla, and sugar together in a large bowl.  Add the eggs, one at a time.  Add the flour and mix well.  Add ‘extras’ and mix well again.

Divide the dough in four equal parts (it might be sticky) and using your hands, form into four loaves, approximately 1” tall. Place the loaves on two, well-greased cookie sheets.

Bake for 25 minutes.  Remove the cookie sheets from the oven and turn the heat up to 450°. Cut each loaf into 1/2” thick slices and rest each piece flat onto the cookie sheet. When everything is cut, turn off the oven and put the cookie sheets back in and close the door.  Leave them in until the oven cools down completely.

Even as Congress is contemplating making further cuts to Medicare payments to physicians, there are laws in the works that could dramatically reduce the administrative burden and costs for home health agencies.  The Home Health Care Planning Improvement Act would allow Nurse Practitioners (NPs), Advanced Practice Nurses (ARNPs), and Physician Assistants (PAs) to order home health services under Medicare. A bill that has been slowly moving through both the Senate and the House, a recent study commissioned by National Association for Home Care & Hospice (NAHC) found the Home Health Care Planning Improvement Act could potentially do even more to improve quality of care to millions of Americans. Continue reading “Could This Pending Law Save Home Health?” »

It looks like physicians are realizing what all of us in home health have known for the past eleven years: major cuts in Medicare payments hurt.

With Congress returning next week for a lame duck session, doctors and the AMA are stepping up their campaign to press lawmakers to put off the major reductions in Medicare payments that are scheduled to take effect in December 2010.  If Congress does not act, physicians who treat the elderly under the federal program will see a 23% cut in their fees starting December 1, 2010. Continue reading “Home Health Update: Physicians Lobby Against Medicare Fee Cuts” »

The contributions nurses make to the health and wellbeing of the patients we serve has a long history of positive results and outcomes.  Prior to the early 1920s, nurses worked with physicians as independent practitioners.  Nurses were sovereign in their decision making, and performed their jobs without interference or governance from any other discipline.

In the early 20s, the American Medical Association (AMA) began to see nurses as a threat to the fiscal stability of their medical practitioners.  Paul Starr’s enlightening book, “The Social Transformation of American Medicine,” outlines the purposeful and direct effort by the AMA to pass state and federal laws that put nursing under the direct control of doctors.  They were successful, and these laws, and more, are still in place today.

Yet, this stronghold is beginning to weaken. As modern healthcare puts more and more strain on our resources, nursing is reestablishing itself as a viable, strategic, and independent profession.  At the heart of this trend is the push for nurses to take their rightful role, in tandem with doctors, in the move to improve medical care in this country. Continue reading “Nurse Power: The New Voice In Home Health.” »

In a recent editorial, noted health policy expert Kenneth E. Thorpe, PhD, Chair of the Department of Health Policy & Management at Emory University’s Rollins School of Public Health, took the recent Centers for Medicare and Medicaid Services (CMS) cuts in home health to task. Citing the successes of home health throughout the health care system as evidence, Thorpe decries the cuts and finds them to be both politically and fiscally irresponsible. Thorpe goes on further to state that, “…the one notion Democrats and Republicans can all rally behind is that quality, innovative, and cost-effective health care begins in the home.”

Those of us who spend our days in home health know, first hand, the value of the work we do. More than any other care delivery system in the country, home health reduces readmissions to hospitals, decreases nursing home admissions, and helps patients with chronic illnesses, such as diabetes and hypertension, to be monitored and receive medication in the comfort of their own homes. Continue reading “Health Policy Expert Recommends CMS Reconsider Home Health Cuts” »

Are you beginning to feel like it is never going to end? Guess what? It isn’t. The latest data coming out of CMS indicates there has been a decline in the functional domain points that agencies are earning. The general feeling among OASIS-C experts is that when OASIS –C came out, most of us were so focused on the major changes in the wound care sections that we failed to pick up on the smaller changes in the functional areas.

While much of the wording looked the same, upon closer scrutiny it turns out these minor changes make huge differences in the scoring and, consequently, the points and the dollars. For those of you who read the Home Health Line newsletter, the July 12, 2010 issue gives excellent examples of how substantial these changes really are.

What is clear to me is that an assessment is not an interview. Our nurses and therapists must read the responses and be clear on the intent and meaning of each response. Most importantly, the assessing home health clinician must watch the patient demonstrate their functional ability. Continue reading “Surprise! CMS Did It Again and What We Need To Do To Fix It.” »