tag:blogger.com,1999:blog-16454947373770805352023-11-16T08:17:27.428-08:00Hospital Discharge RightsMake sure you have everything you need before going home. You have the right to appeal your discharge!James Chionsinihttp://www.blogger.com/profile/00528737009672726724noreply@blogger.comBlogger12125tag:blogger.com,1999:blog-1645494737377080535.post-2037968867856878852012-02-22T12:47:00.001-08:002012-02-22T12:51:51.274-08:00<div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgGblhI2HVF9Mhrf1VPMJ0s-tQi9hz6OEXVdLTUDv_TIN-udb8HsRetNirgSG82MsFbUuhyphenhyphen6Z-OBLH-NK0nGXuWbhPZt-60Dq9qCMnkT1xAlMsTmuXVwgu06ccxHVeDsgTWCYfLKuv_m94/s1600/Untitled-1.jpg" imageanchor="1" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"></a><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgGblhI2HVF9Mhrf1VPMJ0s-tQi9hz6OEXVdLTUDv_TIN-udb8HsRetNirgSG82MsFbUuhyphenhyphen6Z-OBLH-NK0nGXuWbhPZt-60Dq9qCMnkT1xAlMsTmuXVwgu06ccxHVeDsgTWCYfLKuv_m94/s1600/Untitled-1.jpg" imageanchor="1" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"></a><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgGblhI2HVF9Mhrf1VPMJ0s-tQi9hz6OEXVdLTUDv_TIN-udb8HsRetNirgSG82MsFbUuhyphenhyphen6Z-OBLH-NK0nGXuWbhPZt-60Dq9qCMnkT1xAlMsTmuXVwgu06ccxHVeDsgTWCYfLKuv_m94/s1600/Untitled-1.jpg" imageanchor="1" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"></a><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgGblhI2HVF9Mhrf1VPMJ0s-tQi9hz6OEXVdLTUDv_TIN-udb8HsRetNirgSG82MsFbUuhyphenhyphen6Z-OBLH-NK0nGXuWbhPZt-60Dq9qCMnkT1xAlMsTmuXVwgu06ccxHVeDsgTWCYfLKuv_m94/s1600/Untitled-1.jpg" imageanchor="1" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"></a><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgGblhI2HVF9Mhrf1VPMJ0s-tQi9hz6OEXVdLTUDv_TIN-udb8HsRetNirgSG82MsFbUuhyphenhyphen6Z-OBLH-NK0nGXuWbhPZt-60Dq9qCMnkT1xAlMsTmuXVwgu06ccxHVeDsgTWCYfLKuv_m94/s1600/Untitled-1.jpg" imageanchor="1" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"><img border="0" height="640" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgGblhI2HVF9Mhrf1VPMJ0s-tQi9hz6OEXVdLTUDv_TIN-udb8HsRetNirgSG82MsFbUuhyphenhyphen6Z-OBLH-NK0nGXuWbhPZt-60Dq9qCMnkT1xAlMsTmuXVwgu06ccxHVeDsgTWCYfLKuv_m94/s640/Untitled-1.jpg" width="481" /></a></div><a href="http://www.hsag.com/App_Resources/Documents/RightsFlyer_070507-Final.pdf">Your Medicare Rights. Know Them. Use Them. You have the right to appeal your discharge.</a><br />
<div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjSar4Zt_5X0iYDEDqWdzXN22yVd8OBVDOGqwpRPleSV8rSC-2twFtODwP0kFWgbDsREr9Ma5WgMHU9MrFdDcVr4-GAOtARuIvpwzXraYvFS0Jhq-XhbYGe0XMao9tCLqADUDcaMMwimuY/s1600/Untitled-2.jpg" imageanchor="1" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"><img border="0" height="640" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjSar4Zt_5X0iYDEDqWdzXN22yVd8OBVDOGqwpRPleSV8rSC-2twFtODwP0kFWgbDsREr9Ma5WgMHU9MrFdDcVr4-GAOtARuIvpwzXraYvFS0Jhq-XhbYGe0XMao9tCLqADUDcaMMwimuY/s640/Untitled-2.jpg" width="462" /></a></div>James Chionsinihttp://www.blogger.com/profile/00528737009672726724noreply@blogger.com2tag:blogger.com,1999:blog-1645494737377080535.post-60839667461257624802012-02-22T12:37:00.000-08:002012-02-22T12:37:42.844-08:00<a href="http://www.hsag.com/App_Resources/Documents/RightsFlyer_070507-Final.pdf">Your Medicare Rights. You have the right to appeal your discharge.</a>James Chionsinihttp://www.blogger.com/profile/00528737009672726724noreply@blogger.com0tag:blogger.com,1999:blog-1645494737377080535.post-55637488164615790282011-04-11T10:25:00.000-07:002011-04-11T10:41:01.173-07:00What a Difference a Day Makes<span style="font-size: x-large;"></span><br />
<span style="font-size: large;"><a href="http://www.calaborfed.org/index.php/site/page/842/">Download pdf versions of both parts of the report here.</a></span><br />
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<div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjY2RaBxdMRSFqy2sKMfxYa4AqKlJUbS3twLn3aEUwz8Q2BwstbKGtVJs9DZhEhGnsJd7dYR71DCer5pJ47TM5hxk9yNzk2HR-8DeAWvV0-i9Iw6dTPyn_Gp_RKJfCAF2SqJvR1UjWgBAk/s1600/What+a+difference+cover.jpg" imageanchor="1" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"><img border="0" height="640" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjY2RaBxdMRSFqy2sKMfxYa4AqKlJUbS3twLn3aEUwz8Q2BwstbKGtVJs9DZhEhGnsJd7dYR71DCer5pJ47TM5hxk9yNzk2HR-8DeAWvV0-i9Iw6dTPyn_Gp_RKJfCAF2SqJvR1UjWgBAk/s640/What+a+difference+cover.jpg" width="497" /></a></div><br />
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</div><div class="Pa1" style="margin: 5pt 0in 2pt;"><b><span style="color: black; font-family: Arial; font-size: 16pt;">Executive Summary</span></b><span style="color: black; font-family: Arial; font-size: 16pt;"></span></div><div class="Pa6"><span style="color: black; font-family: Arial; font-size: 10pt;">Going home after an acute hospital stay presents significant challenges, particularly for seniors. Discharge from the hospital does not mean that the need for care has ended. The critical issue is making sure <b><i>that after a patient goes home, he or she does not end up back in the hospital in a few days. </i></b>The rapid readmission of a patient strongly suggests that the return home was medically premature, poorly prepared for, or both. This report argues that the current design of the healthcare system results in a serious waste of financial resources. And this means that patients don’t receive adequate care.</span></div><div class="Pa11" style="text-indent: 12pt;"><b><i><span style="color: black; font-family: Arial; font-size: 10pt;">Reducing hospital stays from avoidable readmissions by just one day would save $227,346,788 per year. For a fraction of this sum, we could greatly improve discharge planning and enhance home and community support services. This would result in better outcomes for patients and improved efficiency in the healthcare system. It’s a win-win solution.</span></i></b><span style="color: black; font-family: Arial; font-size: 10pt;"></span></div><div class="Pa11" style="text-indent: 12pt;"><span style="color: black; font-family: Arial; font-size: 10pt;">The avoidable readmissions issue was highlighted in a 2009 review of over 435,000 Medicare records by Jencks et al. They found that approximately 20% of cases resulted in readmission within 30 days without the patient first seeing a physician. </span></div><div class="Pa11" style="text-indent: 12pt;"><span style="color: black; font-family: Arial; font-size: 10pt;">This report examines the costs and impacts of these avoidable readmissions and recommends three key ways to reduce readmissions and save money:</span></div><div class="Pa12" style="margin: 3pt 0in 0.0001pt 24pt; text-indent: -12pt;"><span style="color: black; font-family: Arial; font-size: 10pt;">• <i>increase levels of discharge planning staff and improve ways to pay for them</i></span></div><div class="Pa13" style="margin-left: 24pt; text-indent: -12pt;"><span style="color: black; font-family: Arial; font-size: 10pt;">• <i>fund higher levels of community-based long-term care support services that can assist patients in the community when they leave the hospita</i>l</span></div><div class="Pa14" style="margin: 0in 0in 3pt 24pt; text-indent: -12pt;"><span style="color: black; font-family: Arial; font-size: 10pt;">• <i>mandate coordination of healthcare services in the community regarding the discharge process</i></span></div><div class="Pa11" style="text-indent: 12pt;"><span style="color: black; font-family: Arial; font-size: 10pt;">Unneeded increased spending is a part of the readmission picture in two ways: 1) when additional acute care is needed, at an average in California in 2009-10 of $2,205 per day, and 2) in a significant likelihood of increased health problems and additional costs when patients are discharged prematurely or are not prepared to recover at home. The human cost of this issue can be measured in mortality rates and reduced quality of life for as many as 81,000 seniors annually in California alone. </span></div><div class="Pa11" style="text-indent: 12pt;"><span style="color: black; font-family: Arial; font-size: 10pt;">Numerous studies have shown that readmissions can be significantly reduced. Keys to such a reduction are better hospital discharge planning and more closely coordinated community-based support services. The patients served by these improvements will see a dramatically higher quality of life. Equally important, as the analysis below suggests, is that there is already plenty of money in the system to pay for these services. Policymakers and insurers who pay the bills could act and save the healthcare system from itself. </span></div><div class="Pa11" style="text-indent: 12pt;"><span style="color: black; font-family: Arial; font-size: 10pt;">The charts at the end of the report illustrate exactly how much money could be redirected to discharge planning and community support services. Statewide, roughly 4.5 million Californian seniors are covered by Medicare, and the Medi-Cal program pays a significant share of the cost for approximately 1.1 million “dual eligibles” (people covered by both Medicare and Medi-Cal), including the vast majority of nursing home residents.</span></div><div class="Pa11" style="text-indent: 12pt;"><span style="color: black; font-family: Arial; font-size: 10pt;">This report argues that reducing the level of readmissions could substantially reduce costs to both programs and provide a major source of funding for improved discharge planning and in-home services in the community, as described below:</span></div><div class="MsoNormal"><br />
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<tr style="height: 6.7pt;"> <td colspan="4" style="border: medium none; height: 6.7pt; padding: 0in 5.4pt; width: 422.9pt;" valign="top" width="564"><div class="Pa16"><b><span style="color: black; font-family: Arial; font-size: 11pt;">Cutting</span></b><b><span style="color: black; font-family: Arial; font-size: 11pt;"> Hospital Stays from Readmissions in California by Just One Day</span></b><span style="color: black; font-family: Arial; font-size: 11pt;"></span></div></td> </tr>
<tr style="height: 12.15pt;"> <td style="border: medium none; height: 12.15pt; padding: 0in 5.4pt; width: 105.7pt;" valign="top" width="141"><div class="Pa6"><span style="color: black; font-family: Arial; font-size: 10pt;">Program</span></div></td> <td style="border: medium none; height: 12.15pt; padding: 0in 5.4pt; width: 105.7pt;" valign="top" width="141"><div class="Pa6"><span style="color: black; font-family: Arial; font-size: 10pt;">Annual Savings</span></div></td> <td style="border: medium none; height: 12.15pt; padding: 0in 5.4pt; width: 105.7pt;" valign="top" width="141"><div class="Pa6"><span style="color: black; font-family: Arial; font-size: 10pt;">Full Time Discharge Planners that could be Hired with Cost Savings</span></div></td> <td style="border: medium none; height: 12.15pt; padding: 0in 5.4pt; width: 105.7pt;" valign="top" width="141"><div class="Pa6"><span style="color: black; font-family: Arial; font-size: 10pt;">Home Care Workers that could be Hired with Cost Savings</span></div></td> </tr>
<tr style="height: 6pt;"> <td style="border: medium none; height: 6pt; padding: 0in 5.4pt; width: 105.7pt;" valign="top" width="141"><div class="Pa6"><span style="color: black; font-family: Arial; font-size: 10pt;">Medicare</span></div></td> <td style="border: medium none; height: 6pt; padding: 0in 5.4pt; width: 105.7pt;" valign="top" width="141"><div class="Pa6"><span style="color: black; font-family: Arial; font-size: 10pt;">$179,200,350</span></div></td> <td style="border: medium none; height: 6pt; padding: 0in 5.4pt; width: 105.7pt;" valign="top" width="141"><div class="Pa6"><span style="color: black; font-family: Arial; font-size: 10pt;">3,746 Full Time Positions</span></div></td> <td style="border: medium none; height: 6pt; padding: 0in 5.4pt; width: 105.7pt;" valign="top" width="141"><div class="Pa6"><span style="color: black; font-family: Arial; font-size: 10pt;">14,933,360 additional hours</span></div></td> </tr>
<tr style="height: 6pt;"> <td style="border: medium none; height: 6pt; padding: 0in 5.4pt; width: 105.7pt;" valign="top" width="141"><div class="Pa6"><span style="color: black; font-family: Arial; font-size: 10pt;">Medi-Cal</span></div></td> <td style="border: medium none; height: 6pt; padding: 0in 5.4pt; width: 105.7pt;" valign="top" width="141"><div class="Pa6"><span style="color: black; font-family: Arial; font-size: 10pt;">$48,146,438</span></div></td> <td style="border: medium none; height: 6pt; padding: 0in 5.4pt; width: 105.7pt;" valign="top" width="141"><div class="Pa6"><span style="color: black; font-family: Arial; font-size: 10pt;">1,012 Full Time Positions</span></div></td> <td style="border: medium none; height: 6pt; padding: 0in 5.4pt; width: 105.7pt;" valign="top" width="141"><div class="Pa6"><span style="color: black; font-family: Arial; font-size: 10pt;">4,068,344 additional hours</span></div></td> </tr>
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</div>James Chionsinihttp://www.blogger.com/profile/00528737009672726724noreply@blogger.com1tag:blogger.com,1999:blog-1645494737377080535.post-12703152551287749062010-05-04T13:49:00.001-07:002010-05-04T13:49:48.412-07:00It's Scary to be Discharged on a FridayThis skit demonstrates how a person on Medicare can appeal their hospital discharge plan, demand their rights and save their life. Every state has a QIO, or Quality Improvement Organization that monitors hospitals and doctors that bill Medicare. There are rules hospitals must follow. For example, they must notify you in writing 48 hours in advance of your discharge. These are federal rules that hospitals are legally required to follow. Don't leave the hospital until you are ready. Know your rights!<br />
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<object width="660" height="525"><param name="movie" value="http://www.youtube-nocookie.com/v/DKRJ2vaxsVk&hl=en_US&fs=1&color1=0x006699&color2=0x54abd6&border=1"></param><param name="allowFullScreen" value="true"></param><param name="allowscriptaccess" value="always"></param><embed src="http://www.youtube-nocookie.com/v/DKRJ2vaxsVk&hl=en_US&fs=1&color1=0x006699&color2=0x54abd6&border=1" type="application/x-shockwave-flash" allowscriptaccess="always" allowfullscreen="true" width="660" height="525"></embed></object>James Chionsinihttp://www.blogger.com/profile/00528737009672726724noreply@blogger.com0tag:blogger.com,1999:blog-1645494737377080535.post-92062105536375856082010-05-04T13:47:00.000-07:002010-05-04T13:48:16.334-07:00San Francisco Homecoming Services Network<div class="separator" style="clear: both; text-align: center;"></div><div class="separator" style="clear: both; text-align: center;"></div><div class="separator" style="clear: both; text-align: center;"></div><div class="separator" style="clear: both; text-align: center;"></div><div class="separator" style="clear: both; text-align: center;"></div><div class="separator" style="clear: both; text-align: center;"></div><div class="separator" style="clear: both; text-align: center;"></div><div class="separator" style="clear: both; text-align: center;"></div><div class="separator" style="clear: both; text-align: center;"></div><div class="separator" style="clear: both; text-align: center;"></div><div class="separator" style="clear: both; text-align: center;"></div><div class="separator" style="clear: both; text-align: center;"></div><div class="separator" style="clear: both; text-align: center;"></div><div class="separator" style="clear: both; text-align: center;"></div><div class="separator" style="clear: both; text-align: center;"></div><div class="separator" style="clear: both; text-align: center;"></div><div class="separator" style="clear: both; text-align: center;">If you are in San Francisco and need help transitioning from the hospital to home, or if you are a social worker or discharge planner who needs help making sure clients get everything they need, contact Homecoming Transitional Care Program. </div><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiu6O5EFojuc3xyye_S68RviGGwQPuTUI-LyhTLJxIHvwvibPFmn_4OdJfz-ZXSUcquPpxa52NXKWmOHG5MawIrSUiF9RV5Lp1IX7EJWlD8I4FjMauukcp990K7z7KcZ7iCqaGKRYf-JHc/s1600/Homecoming_Transitional_Care_Program_-_one_sheet1_(1).jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="640" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiu6O5EFojuc3xyye_S68RviGGwQPuTUI-LyhTLJxIHvwvibPFmn_4OdJfz-ZXSUcquPpxa52NXKWmOHG5MawIrSUiF9RV5Lp1IX7EJWlD8I4FjMauukcp990K7z7KcZ7iCqaGKRYf-JHc/s640/Homecoming_Transitional_Care_Program_-_one_sheet1_(1).jpg" width="494" /></a></div><div class="separator" style="clear: both; text-align: center;"></div><div class="separator" style="clear: both; text-align: center;"></div><div class="separator" style="clear: both; text-align: center;"></div><div class="separator" style="clear: both; text-align: center;"></div><div class="separator" style="clear: both; text-align: center;"><br />
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</div>James Chionsinihttp://www.blogger.com/profile/00528737009672726724noreply@blogger.com1tag:blogger.com,1999:blog-1645494737377080535.post-39663475237001714872010-04-06T16:35:00.000-07:002010-04-06T17:38:29.026-07:00Hospital Discharge StoriesGo here to share your hospital story:<br />
<b><span style="font-size: x-large;"><a href="http://www.seniorsurvivalschool.org/index.php?s=44">TELL US YOUR HOSPITAL STORY</a></span></b><br />
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<h5>Personal stories are a critical part of organizing communities and putting a personal face to a policy problem or service gap. Therefore, we encourage all seniors, adults with disabilities, caregivers and service providers to record your personal stories, especially about issues (good or bad) related to homecare and discharge planning.</h5> HAVE YOU BEEN TO THE HOSPITAL?<br />
<ul><li>How were you treated?</li>
</ul><ul><li>Did you get everything you needed when you were discharged?</li>
</ul><ul><li>Did a discharge planner or nurse talk to you about what services you would need when you returned home?</li>
</ul><ul><li>Did you understand the discharge planning process?</li>
</ul><ul><li>Did you feel anxiety about leaving the hospital?</li>
</ul><ul><li>What would you change about your experience?</li>
</ul><ul><li>Do you have everything you need now?</li>
</ul>The California Discharge Planning Collaborative wants to hear from you!<br />
We want to hear your story! <br />
We are collecting testimonies from people who were (or are) hospitalized in San Francisco and California.<br />
<ul><li>Help to improve discharge planning policy.</li>
</ul><ul><li>You can submit your story in writing, in person or over the telephone. All information is strictly confidential.</li>
</ul>Call James at (415) 703-0188 ext 304 or james@planningforelders.org, visit the link at the top of this post "TELL US YOUR HOSPITAL STORY', or just write it below. <br />
<ul></ul>James Chionsinihttp://www.blogger.com/profile/00528737009672726724noreply@blogger.com0tag:blogger.com,1999:blog-1645494737377080535.post-63678946680766755202010-03-02T16:02:00.000-08:002010-03-02T16:07:08.448-08:00<div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgmdWjH7tKDEm3hm_pSf_XjhyWXzzWnBrHORZA_c2uIPKpEtDnLvGZP2gDUJtWDs6cpY9ug0lq-MmyXtKKWiPgPDOZsQH00iM1vYEX7dGm6QMEefacbDOTgfEak1e5Y-dxRS2KNKqiHc28/s1600-h/CDPCTrifoldEnglish1.jpg" imageanchor="1" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"><img border="0" height="496" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgmdWjH7tKDEm3hm_pSf_XjhyWXzzWnBrHORZA_c2uIPKpEtDnLvGZP2gDUJtWDs6cpY9ug0lq-MmyXtKKWiPgPDOZsQH00iM1vYEX7dGm6QMEefacbDOTgfEak1e5Y-dxRS2KNKqiHc28/s640/CDPCTrifoldEnglish1.jpg" width="640" /></a><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiaGMPJi3cMYCGxzRg_jPA99c6oET5JjK0sYvgUtDyL-c2-jZkSBcaUG7CfdGpeBSR8Vs4rI2w_xNtC8dg7W5zy9GnQ1hj4yojDiKHgUvNYEPxs3dV7nU5sNbP_nYRO1gRTMaeUZzEzSPg/s1600-h/CDPCTrifoldEnglish2.jpg" imageanchor="1" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"><img border="0" height="496" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiaGMPJi3cMYCGxzRg_jPA99c6oET5JjK0sYvgUtDyL-c2-jZkSBcaUG7CfdGpeBSR8Vs4rI2w_xNtC8dg7W5zy9GnQ1hj4yojDiKHgUvNYEPxs3dV7nU5sNbP_nYRO1gRTMaeUZzEzSPg/s640/CDPCTrifoldEnglish2.jpg" width="640" /></a></div>James Chionsinihttp://www.blogger.com/profile/00528737009672726724noreply@blogger.com2tag:blogger.com,1999:blog-1645494737377080535.post-44545026685129098202010-03-02T14:35:00.000-08:002010-03-02T14:35:16.941-08:00Advocates Fight for Elder Patients’ Rights, Safety<object width="400" height="225"><param name="allowfullscreen" value="true" /><param name="allowscriptaccess" value="always" /><param name="movie" value="http://vimeo.com/moogaloop.swf?clip_id=8227343&server=vimeo.com&show_title=0&show_byline=0&show_portrait=0&color=&fullscreen=1" /><embed src="http://vimeo.com/moogaloop.swf?clip_id=8227343&server=vimeo.com&show_title=0&show_byline=0&show_portrait=0&color=&fullscreen=1" type="application/x-shockwave-flash" allowfullscreen="true" allowscriptaccess="always" width="400" height="225"></embed></object><p><a href="http://vimeo.com/8227343">California Discharge Planning Collaborative</a> from <a href="http://vimeo.com/namvideo">New America Media</a> on <a href="http://vimeo.com">Vimeo</a>.</p>Advocates Fight for Elder Patients’ Rights, Safety<br />
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New America Media, News Feature, Paul Kleyman / Video: Cliff Parker, Posted: Dec 21, 2009 Review it on NewsTrust<br />
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California Discharge Planning Collaborative from New America Media on Vimeo.<br />
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David Grant was elated to be going home as he phoned a taxi one recent Friday afternoon from the lobby of a San Francisco hospital. But by the time he reached his apartment, he was so weak he could barely make it up the steps and in the door.<br />
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For the first time, Grant fully grasped how vulnerable patients can be -- patients like those he has advocated for over the years -- when they are discharged from a medical facility without proper planning and assistance.<br />
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Grant and his fellow members of the California Discharge Planning Collaborative recently launched a multicultural campaign to inform elders that they have a right to be safely returned from hospital to home — and not simply discharged with scant help.<br />
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The effort is one of numerous projects around the United States aimed at ensuring patients’ safe transition to home care. It could save the more than $17 billion lost to Medicare each year in unnecessary hospital readmissions, according to a study published this year in the New England Journal of Medicine. The University of Colorado study showed that more than one-third of Medicare patients are re-hospitalized within 90 days each year. That’s 4 million people – and this number will grow rapidly as boomers start becoming eligible for Medicare only a year from now.<br />
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These findings led members of Congress to introduce the Medicare Transitional Care Act of 2009. According to the bill, “Insufficient communication among older adults, family caregivers and health care providers contribute to poor continuity of care, inadequate management of complex health care needs and preventable hospital admissions.” The Act would set up demonstration projects to test ways for improving patients’ continuity of care.<br />
Discharging Your Rights<br />
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"You Have a Right to a Safe Discharge" is a handy brochure now available in English, Spanish, Chinese and Russian from the California Discharge Planning Collaborative. California patients and their caregivers concerned about their transition from a hospital or other medical facilities to their home can obtain free advice at 877-223-6107.<br />
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The brochure states that in California, you have the right to<br />
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* A safe and planned discharge<br />
* Have all material presented in your language<br />
* Know of all the services you are entitled to<br />
* Understand what medications you are taking<br />
* A refill of your hospital prescription<br />
* Refuse to leave if you do not feel well enough.<br />
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For a PDF of the brochure in an available language, contact Planning for Elders at 415-703-0188, or e-mail James Chionsini, info@planningforelders.org.<br />
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The California campaign's brochures -- printed so far in English, Spanish, Chinese and Russian -- highlight a toll-free number that patients and their caregivers can call for free assistance if they have complaints about their treatment or discharge from the hospital. The collaborative even enlisted a senior theater troupe to dramatize hospital scenes and spur seniors to share their experiences. The group performs in senior centers and other locations across California.<br />
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"When you get home from the hospital, you're not tap dancing up the steps. You're still sick," stated Grant, a consultant for community health organizations and the former director of San Francisco's Senior Action Network. "I'm only 58 and relatively healthy, and I thought, 'What if I were 80 and living alone?'"<br />
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Like most people just released from a hospital but still needing to recuperate, Grant arrived home exhausted. After slumping into a chair where he slept for hours, he awoke to a house without food, or enough strength to walk to a store.<br />
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Despite having created a computer spread sheet to keep track of his medications, Grant found himself confused: Was this prescription for four pills every six hours and that one for two pills every four hours, or the other way around?<br />
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Unlike Grant, though, the most vulnerable and costly patients have serious chronic health conditions, such as congestive heart failure, stroke or diabetes. They also have medical challenges at home. Often these patients or their family caregivers must learn and manage multiple medications and complex technologies, such as glucose monitors or tube feeding -- technologies that have only been available for use in hospitals for 15 or 20 years.<br />
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Those needing the most help, such as 61-year-old Anaperla Aureoles, have multiple chronic conditions. This group accounts for a whopping 75 percent of all Medicare spending for seniors and those with disabilities.<br />
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Last spring, Aureoles found that poor hospital discharge planning could be "devastating." Only days after her operation to remove a pituitary tumor from her brain, she recovered well enough to be transferred elsewhere.<br />
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Aureoles, who immigrated with her family to the United States from Mexico City as a child, was born with a type of encephalitis that has left her struggling progressively with seizures, as well as declining vision, hearing and mobility.<br />
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She gets along with the help of her service dog, Henry. However, the hospital erroneously told her that Medicare would not cover her transfer to a rehabilitation facility with her dog. Frightened of being without her beloved canine, she returned to her San Francisco apartment -- with its 32 steps and no elevator.<br />
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At home, she said in an interview, she reacted to her post-surgery medication with severe nightmares and hallucinations, couldn't walk, had surgery-related nose bleeds and broke into cold sweats. "I had a terrible reaction. I went into a deep depression and had suicidal thoughts," she said.<br />
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The occupational therapist sent to treat her immediately called an ambulance. Although Aureoles was readmitted to the hospital, they sent her home the next morning.<br />
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Her surgeons and the hospital social worker then tried to get Aureoles admitted to a rehab facility, only to be reminded that Medicare rules require transfer only from a hospital, not from a patient's home. This technicality is typical of the bureaucratic rules that keep people from getting the seamless continuing care they need.<br />
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"The surgery part was wonderful," Aureoles said, "but when I left, everything fell through. I was totally unprepared."<br />
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For patients with limited English-language proficiency, the results of a poorly planned medical discharge can be even more challenging. "From Hospital to Home," a 2006 study by the University of California School of Public Health, quoted caregivers who found themselves unable to communicate with health care providers.<br />
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One caregiver recalled, "I really wasn't prepared for it, and emotionally I felt terrible because I arrived [in] this country alone with my husband. My two children are in El Salvador, so I felt I had no support from anyone."<br />
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Among numerous stories that the California collaborative has documented, a 74-year-old Albanian immigrant, who asked not to be identified, received no translation services following his surgery for stomach cancer. He couldn't communicate with the facility staff, and the hospital did little to assist his family when the staff ordered their father discharged one night.<br />
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Only six hours after taking him home, family members rushed him to the hospital's emergency room, where he was readmitted with pneumonia. The man was reconnected to feeding equipment for nourishment. Still, the hospital sent him home hours later -- only to see him returned to the facility the following day, this time for a two-month stay before he could safely return home.<br />
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"Successful, programs for assuring a smooth transition from hospital to home must involve the patient's family caregivers -- relatives, friends and neighbors," said Carol Levine, director of Families and Health Care Project at the United Hospital Fund of New York.<br />
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Levine said the United Hospital Fund's Next Step in Care program (www.nextstepincare.org) provides family caregivers and health care providers with guidelines for hospital discharge, medication management and other tools for navigating the system.<br />
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Although the approaches of the many programs differ, Levine explained, they all turn on the same principles of "meeting the patient and family where they are," not where the health care system wants them to be.<br />
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Levine, a MacArthur "genius" grant winner, emphasized that effective transitional care cannot be half-hearted, only offering patient education or volunteer programs.<br />
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Key to effective care, she said, is having a professionally guided discharge plan with follow-up through the critical period following hospitalization. That approach can result in better outcomes and fewer unnecessary re-hospitalizations -- and even save money, according to Levine.<br />
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Meanwhile, the California Discharge Planning Collaborative is spreading the multilingual word about its toll-free number for free advice on "everything you need to know before you go home from the hospital."<br />
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Related Articles:<br />
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* Health Care Reform's Missing Piece: Elder Care<br />
* Health Care ‘Reform’ Could Overwhelm Family Caregivers<br />
* Experts Expose Health Reform Gaps for Ethnic EldersJames Chionsinihttp://www.blogger.com/profile/00528737009672726724noreply@blogger.com0tag:blogger.com,1999:blog-1645494737377080535.post-18979903890113327542010-03-02T10:15:00.000-08:002010-03-02T13:33:38.525-08:00DO YOU WANT TO DEMAND YOUR RIGHTS? IF SO HOW MANY OF YOU ARE THERE?Hello Discharge Planning community. <br /><br />The hospital industry has a financial incentive to discharge patients "sicker and quicker" for a variety of reasons. Well, this blog is focused on making sure patients know how to demand the care they deserve. Please contact me with feedback. <br /><br />We want to know your stories also. If you have been discharged from the hospital and you felt it was inappropriate, please send us your story. Thank you and be well.<br /><br />James Chionsini, MSW<br />HealthCare Action Team<br />Planning for Elders in the Central City<br />965 Mission St #550<br />San Francisco CA 94103<br />(415) 703-0188 ext 304<br />james@planningforelders.org<br />AFL-CIO-OPEIU3/JC<br /><br />check out our website: http://www.planningforelders.orgJames Chionsinihttp://www.blogger.com/profile/00528737009672726724noreply@blogger.com0tag:blogger.com,1999:blog-1645494737377080535.post-54486188941490370222010-02-25T15:07:00.000-08:002010-02-25T15:15:53.672-08:00San Francisco IHSS Public Authority Peer Mentoring Program<span style="font-weight:bold;">San Francisco IHSS Public Authority<br />Consumer Peer Mentor Program</span><br />• Started in October 2008.<br />• Text: “The Public Authority is pleased to announce the launch of the new Consumer Peer Mentor Support Program. We believe that people with disabilities who are managing successfully with their disability can be called upon to share their experience with other individuals who have disabilities. Our peer mentors will inspire hope for independence and will actively assist those who have disabilities.”<br />• Actually, we have learned a lot since our start in October 2008. One of the things that we realized after operating for over a year is that the word “peer” in this definition simply means someone who is similar to you—be it in age, gender, race, education or especially disability.<br />• Mentoring simply means serving as a trusted counselor or teacher. Peer mentors then are individuals with disabilities who have faced some of the experiences and challenges that a mentee may face in the future.<br />• Peer mentors have learned from their own experiences. Our peer mentors are knowledgeable about resources as regards independent living, because most of them have made the transition to an independent lifestyle themselves.<br />• Peer mentors will help set reasonable goals and provide emotional support, because quite frankly, they’ve been there themselves.<br />• Simply put, peer mentors can show mentees how to do things. For example, I have a mentor who recently assisted a mentee in transferring; he showed him how to safely transfer from his bed to his wheelchair for the first time.<br />• Some of our other mentors have taught mentees how to get on and off MUNI bus lifts, taken their mentees shopping at Safeway, shown them how to get a Paratransit ID, and how to ride a ramp taxi safely.<br />• Let’s remember again that peer mentors are people with disabilities who are managing successfully and can be called upon to share their experiences with other individuals who have disabilities. Peer mentors will inspire hope for independence and will actively assist those mentees who live in institutions—like Laguna Honda Hospital or St. Mary’s Rehabilitation Unit or Valley Medical or any institution in the City and County of San Francisco—to realize the dream of living independently.<br />• To be a peer mentor for the San Francisco IHSS Public Authority, one must have (a) a disability, (b) been living independently successfully for at least 3 to 5 years, (c) or have made a successful transition to an independent living lifestyle on their own.<br />END<br /><br /><br />For more information contact Sergio Alunan (415-593-8112; salunan@sfihsspa.org)James Chionsinihttp://www.blogger.com/profile/00528737009672726724noreply@blogger.com0tag:blogger.com,1999:blog-1645494737377080535.post-46961632317345968752010-02-25T09:55:00.000-08:002010-02-25T10:01:43.787-08:00amednews: Discharge missteps can send seniors back to hospital :: Feb. 15, 2010 ... American Medical News<a href="http://www.ama-assn.org/amednews/2010/02/15/prca0215.htm">amednews: Discharge missteps can send seniors back to hospital :: Feb. 15, 2010 ... American Medical News</a><br /><br />Discharge missteps can send seniors back to hospital<br /><br />Geriatric Consult. By Beatriz Korc, MD, amednews contributor and Susan J. Landers amednews staff. Posted Feb. 15, 2010.<br /><br />Scenario<br />GERIATRIC CONSULT<br />A column about treating a growing demographic<br /><br />Mr. Park, 85, recently was admitted to the hospital with community-acquired pneumonia and, after five days of intravenous antibiotic therapy, he was discharged home.<br /><br /><span style="font-weight:bold;">Case history</span><br /><br />Mr. Park lives with his daughter. He has hypertension, benign prostate hyperplasia and mild Alzheimer's disease. His medications at home included bisoprolol/HCTZ, 5/6.25 mg; tamsulosin, 0.4 mg; and donepezil, 10 mg once a day. While he was in the hospital, the bisoprolol was switched to 50 mg of metoprolol twice a day because bisoprolol was not on the formulary. At the time of his discharge, an intern reviewed his hospital medication list and wrote out the prescriptions, which were given to Mr. Park by a nurse. Mr. Park's daughter filled the new prescriptions. When he returned home, Mr. Park resumed taking his usual medications, plus the new ones prescribed in the hospital. The combination of bisoprolol and metoprolol made Mr. Park bradycardic and dizzy. He fell on his way to the bathroom. When the emergency medical technicians arrived at his home, his heart rate was just 38 beats per minute. Mr. Park was readmitted to the hospital.<br />Discussion<br /><br />Patients often are discharged from the hospital to their homes unprepared to care adequately for themselves. Because of postdischarge missteps, many involving a medication mistake, patients too often may find themselves back in the hospital. Given the medications Mr. Park was mistakenly taking after he returned home, his dizziness and bradycardia could have been predicted and his readmission avoided.<br /><br /> * Case history<br /> * Discussion<br /> * Key considerations:<br /> What discharge list<br /> should include<br /><br />Mr. Park is not alone. A 2003 study in the Annals of Internal Medicine found that 76 of 400 patients, with an average age of 57, experienced an adverse event after discharge from a tertiary care academic hospital to their homes. Researchers determined that 23 of the events were preventable, and another 24 could have been less severe with appropriate management. The most common adverse events were drug-related. Poor communication is one of the most important reasons for such events.<br /><br />The risks for very elderly patients are even more apparent, since many have cognitive impairments or several chronic conditions for which they take an array of medications, compounding the likelihood of drug-drug or drug-disease interactions.<br /><br />A Transitions of Care Consensus Policy Statement developed by several medical societies, including the American College of Physicians and the American Geriatrics Society, cited findings from a study of 2,644 patient discharges. The 2004 study showed that about 40% of the patients had pending test results at the time of discharge and that 10% of the results had required some follow-up action. Yet the patients and their primary care physicians were unaware of the tests. The consensus statement was published in the July/August 2009 Journal of Hospital Medicine.<br /><br />The prevention of such missteps should be a primary focus of discharge planning, which is required of hospitals by all of the major health care regulatory agencies and accrediting agencies. The Joint Commission has included discharge instructions as a core performance measure in the care of heart failure patients. Hospital performance on this measure is reported publicly on the Centers for Medicare & Medicaid Web site.<br /><br />There are many reasons transitions can be risky. Among them is the absence of a coordinating agency, according to the Transitions of Care Consensus Policy Statement. Studies indicate that patient-centered medical homes can make a difference.<br /><br />Among the principles recognized as vital for a seamless transition is clear communication at several levels, whether between hospital physician and primary care physician or among hospital physician, patient and caregiver.<br /><br />But a 2007 study in the Journal of the American Medical Association found that direct communication between hospital physicians and primary care physicians occurs infrequently and that discharge summaries are rarely available to the primary care doctor at the first postdischarge visit. In a review of 55 studies published between 1970 and 2005, the researchers found that even when discharge summaries were available, they often lacked important information such as diagnostic test results, treatment course, discharge medications, test results pending at discharge, patient or family counseling, and follow-up plans.<br /><br />Since a patient's family member or caregiver has an important role to play in transitions of care, that person also must receive information at discharge about posthospital needs.<br /><br />Several studies have shown that discharge from the hospital is a time of anxiety for patients and their families. But it doesn't have to be that way, says Eric Coleman, MD, MPH, professor of medicine at the University of Colorado at Denver and director of the university's Care Transitions Program, a one-month training course for patients with complex needs and their family caregivers. Patients and families work with a coach and learn self-management skills that ensure their needs are met during the transition from hospital to home.<br /><br />Patients who received this program were significantly less likely to be readmitted to the hospital, Dr. Coleman told a Senate committee in 2008. The program, which received funding from the Robert Wood Johnson Foundation and the John A. Hartford Foundation, was developed with input from patients and caregivers.<br /><br />A new position paper released Jan. 12 by the American College of Physicians also offers guidance to physicians about establishing and maintaining relationships with patients' caregivers.<br /><br />Privacy provisions from the Health Insurance Portability and Accountability Act do not preclude the sharing of relevant information with family caregivers, as long as the patient does not object, the ACP states. After reconciling the patient's inpatient and outpatient medications, Mr. Park's daughter should have been contacted at the time of discharge. The physician or the nurse should review the medication list with the patient and caregiver, and educate them on possible side effects.<br /><br />Barriers of language, education, values and culture may compound the communication difficulties faced by patients, families and caregivers during discharge from hospitals. A 2004 study by the Agency for Healthcare Research and Quality found that low health literacy is linked to higher rates of hospitalization and higher use of expensive emergency services. If a language barrier is identified, the use of a translator is warranted.<br /><br />Dr. Korc is a practicing geriatrician as well as the chief of geriatric services in the Dept. of Medicine at the Memorial Sloan-Kettering Cancer Center in New York. Landers is a staff writer.<br /><br />The print version of this content appeared in the Feb 22, 2010 issue of American Medical News.<br /><br /> ADDITIONAL INFORMATION: <br />Key considerations: What discharge list should include<br /><br />A study on deficits in communication between hospital-based and primary care physicians made several suggestions for smoothing the transition for patients being discharged from the hospital. The authors suggest discharge summaries include:<br /><br /> * Primary and secondary diagnoses<br /> * Pertinent medical history and physical findings<br /> * Dates of hospitalization, treatment provided and a brief summary of hospital course<br /> * Results of procedures and abnormal lab test results<br /> * Recommendations by any subspecialty consultants<br /> * Information given to the patient and family<br /> * The patient's condition or functional status at discharge<br /> * Reconciled discharge medication regimen, with reasons for any changes and indications for newly prescribed medications<br /> * Details of follow-up arrangements<br /> * Specific follow-up needs, including appointments or procedures to be scheduled and tests pending at discharge<br /> * Name and contact information of the responsible hospital physician<br /><br />Source: "Deficits in Communication and Information Transfer Between Hospital-Based and Primary Care Physicians: Implications for Patient Safety and Continuity of Care," Journal of the American Medical Association, Feb. 28, 2007 (jama.ama-assn.org/cgi/content/abstract/297/8/831/)<br /><br /><br />"Deficits in Communication and Information Transfer Between Hospital-Based and Primary Care Physicians: Implications for Patient Safety and Continuity of Care,"abstract, Journal of the American Medical Association, Feb. 28, 2007 (jama.ama-assn.org/cgi/content/abstract/297/8/831)<br /><br />"The Incidence and Severity of Adverse Events Affecting Patients after Discharge from the Hospital," abstract, Annals of Internal Medicine, Feb. 4, 2003 (annals.org/content/138/3/161) .<br /><br />Copyright 2010 American Medical Association. All rights reserved.James Chionsinihttp://www.blogger.com/profile/00528737009672726724noreply@blogger.com0tag:blogger.com,1999:blog-1645494737377080535.post-78418636882283648062009-04-16T14:44:00.000-07:002010-03-02T14:45:26.848-08:00The healing power of pets<object id="otvPlayer" width="400" height="268"> <param name="movie" value="http://cdn.abclocal.go.com/static/flash/embeddedPlayer/swf/otvEmLoader.swf?version=&station=kgo§ion=&mediaId=6765593&cdnRoot=http://cdn.abclocal.go.com&webRoot=http://abclocal.go.com&site=" ></param><param name="allowScriptAccess" value="always"></param><param name="allowNetworking" value="all"></param><param name="allowFullScreen" value="true"></param><embed id="otvPlayer" width="400" height="268" type="application/x-shockwave-flash"
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SAN FRANCISCO (KGO) -- Studies have shown that patients who have emotional support from friends and family recover better from major medical procedures. With that in mind, doctors at UCSF bent a few rules for a surgery patient whose support system walks on four legs.<br />
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Ana Aureoles is disabled, visually impaired and moments away from being wheeled into an operating room. But she is is not alone. Lying by at her hospital bed is Henry Miller, the service dog who has been by her side for nearly 14 years, and one reason she's able to live by herself.<br />
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"Because of mobility problems with my traumatic brain injury, he can help me with my balance, he can pick up objects off the floor when I drop them," said Ana.<br />
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And since he is her only family in San Francisco, doctors at UCSF gave Henry extraordinary access in order to accompany Ana as she faces a delicate surgery to remove a tumor in front of her brain.<br />
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"The risks are great. If there's a problem, there is risk to the eye optic nerve, big blood vessel in area and of course the adjacent brain," said Dr. Ivan El-Sayed.<br />
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"The only place he can't go is in the operating room, and I wish he could. Having him there gives us both a reason to survive. It's like death do us part," said Ana.<br />
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As surgeons attempt to reach the tumor through Ana's nasal passages, Henry waits downstairs with hospital staff. Ana has sent a thank you letter down with him. But as a family member might watch the clock, Henry watches the door.<br />
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"I'll tell you, love is love, and there is so much love between Henry and Ana, and I think it's very healing," said Vicki Kleeman from UCSF Patient Volunteer Services.<br />
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Finally, after three hours, Henry and Ana are both heading for the recovery unit, where the hospital allowed Henry to stay by her bedside.<br />
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While exceptions like this are still rare, officials at UCSF say they have approved similar arrangements on a case by case base, when they believe a service animal can help a patient recover.<br />
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"A number of studies have shown that patients who recover alone -- versus with family and companionship -- the patients with family and companionship recover faster and do better and I think Henry will be a prime example of that," said UCSF neurosurgeon Dr. Manish Aghi.<br />
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When we caught up with Ana a few weeks after her surgery, she still had slight discomfort from the packing placed in her nasal passages, but was up and walking and hoping to soon take Henry for a walk at Fort Mason.<br />
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"I don't think I could have done it without him. I would have been worried, just looking down seeing him on the floor by my bed meant the world," said Ana.<br />
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While her prognosis for full recovery is good, Ana is now trying to make an adjustment for Henry's health.<br />
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Because of canine arthritis, she's often forced to carry him up the stairs to her apartment and is now hoping to find a first floor unit.James Chionsinihttp://www.blogger.com/profile/00528737009672726724noreply@blogger.com0