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Important Medicare Requirement for Home Health Care Patients (Face-to-Face Encounter)
Information Sheet on Face-to-Face Encounter
VNS Referral Form with Face-to-Face Encounter Information
 
Program Information
Vital Stim
Peripheral Neuropathy
Wound Vac

Referrals from the Physician

VNS Home Health Services is always available to make an in home evaluation visit for your patient.

A referral for home health may be appropriate for any of the following situations:

  • At risk for complications or infections
  • Catheter Care
  • De-conditioned
  • Elderly and living alone
  • Exacerbation of an existing illness- COPD, CHF ,diabetes, etc.
  • History of Emergency room visits
  • Home Safety
  • Newly diagnosed conditions
  • New, changed or multiple medication
  • Ostomy Care and teaching
  • Pain interfering with function
  • Poor understanding of disease process or management
  • Recent hospitalization
  • Recent surgery
  • Recent fall
  • Requires physical, occupational or speech therapy
  • Requires temporary vital sign monitoring
  • Requires assistance in setting up community resources
  • Teaching for injections
  • Wound Care

The home care professional who visits your patient will determine eligibility for further home health services or the need for other resources in creating a safe plan of care.


Forms

Physician Care Plan Oversight Instructions (Word Document)
Physician Care Plan Oversight Instructions (PDF file)

Physician Care Plan Oversight Log (Word Document)
Physician Care Plan Oversight Log (PDF file)


Vital Stim Top of Page

Dysphagia is problematic for many patients with neurological involvement; post head and neck radiation and /or surgery and with advanced age. Dysphagia is a causative factor for aspiration pneumonia, as well as dehydration, malnutrition, and choking episodes leading to bronchospasms.  Speech language pathologist evaluation and treatment is crucial for these patients; to evaluate patients swallowing abilities, to teach safe swallowing strategies and when possible to reeducate swallowing muscles. In the past, standard speech reeducation procedures including tactile/thermal  treatments which were effective less than 40% of the time. For those treated with Vital Stim the outcomes are positive for a majority of patients.

Vital Stim, cleared by the FDA, is a form of specialized microcurrent electric stimulation developed specifically to be utilized over the muscles of the throat. This specialized electric stim avoids possibilities of laryngeal spasm or jugular vein compromise. Vital Stim treatment is contraindicated for patients with severe dementia that is characterized by continued verbalization, or for those patients with significant reflux due to a feeding tube (vital stim has not been studied in this population). Caution should be undertaken when a patient has an on demand pacemaker.

Vital Stim can only be provided by a speech language pathologist who has certification in it use.

Swallowing should be evaluated by a modified barium swallow or a FEST to determine the pathology involved in the dysphagia. Once the pathology has been established, the determination for Vital Stim can be made. The speech language pathologist will then apply the Vital Stim in conjunction with additional dysphagia education and treatment. Typically a series of treatment is given and before a repeat swallowing valuation is performed.

Below is the comparison chart of outcomes for Vital Stim Electrical Stimulation compared with traditional thermal tactile stimulation based upon 892 patients studied from 1993 to 1998; 3 year follow up data for 300 patients submitted to FDA.

Vital Stim Therapy Thermal Tactile Stimulation
98.4% of patients improved their swallow function score 32.7%of patients improved their swallow function score
97.5% of patients with sever dysphagia regained swallow function past the point of PEG tube dependency 38.9%of patients with sever dysphagia regained swallow function past the point of PEG tube dependency
38.3% of patients with sever dysphagia regained full normal function 0%of patients with severe dysphagia regained full normal function
3 year follow up, 76% had retained swallow function and only 3% reported aspiration 3 year follow up, 43% had retained swallow function and 45% reported aspiration

Please call our intake department at 401-788-2345 for a referral.




Peripheral Neuropathy (PN) Rehabilitation Program Top of Page

Overall Statistics - PN affects 15-20 million Americans

Predisposing Events related to PN

• Radiation and Chemotherapy
• Nutritional Deficits
• Bowel/Gastric Surgeries
• Exposure to toxic compounds - organophosphates, mercury, alcohol
• Genetics
• Thyroid imbalance
• Infectious Processes/ medications
• Autoimmune Disease
• Renal Failure

Peripheral neuropathy can involve sensory, motor, or autonomic nerves. The VNS rehabilitation plan is geared to the treatment of PN involving either motor and/or sensory in the feet / lower legs and hands/lower arms. This scenario is quite prevalent in the diabetic population with statistics indicating 50-60% of diabetics will experience this problem.

The Rehabilitation treatment plan begins with an assessment that teases out causative factors from the past medical history and evaluates the need for further referrals including nutritionist or certified diabetic educator. For diabetics, a focus on diabetic management is one of the key factors. The objective data (measured pre and post treatment) includes:

• Range of motion
• Strength and muscle recruitment
• Protective sensation measured by standard monofilament testing
• Stocking/glove measurements
• Timed Get Up and Go Test and Manual Timed Up and Go test
• Standing Balance Testing
• Peg Test (upper extremities)
• Dynamometer testing (upper extremities)


The Rehabilitation treatment plan:
Evaluation followed by 3 x week treatment for 4 - 8 weeks that includes:

• Monochromatic Infrared Therapy (MIRE) - Anodyne Therapy
• Skin Protection Education
• Fall Protection Education
• Adaptive Equipment Recommendations
• Therapeutic techniques to increase range of motion, flexibility, strength and muscle recruitment

MIRE effects the release of Nitric Oxide from hemoglobin or smooth muscle, which in turn stimulates an increase in the vasodilatation of the microcirculation of the distal extremities. The change from vasoconstriction to dilation has a positive effect on PN.

Outcome Data Utilizing MIRE in conjunction with a structured Rehabilitation Program
( Lake Norman Program)
Number of subjects Improvement in numbness Stocking /glove Improvement in protective sensation Improvement in standing balance Improvement in fall risk indicators Improvement in ROM
72 89% 79% 70% 87% 54%

Outcome Data /Record review MIRE utilization- Journal Diabetes Complications,
March/April 2005

Number of subject medical records reviewed Number of subjects with loss of protective sensation Number of patients with neuropathic pain
2239 2078 15634
Post MIRE 1106 had return of protective sensation 53% 67% decrease in pain (Visual analogue scale)

To make a referral call VNS Intake at 401-788-2345


Wound Vac Top of Page

V.A.C.ฎ Therapy™ Patient Selection Criteria

Indications:
The V.A.C.ฎ family of devices*  with wound site feedback control are negative pressure devices used to help promote wound healing, through means including removal of infectious material or other fluids, under the influence of continuous and /or intermittent negative pressures, particularly for patients with chronic, acute, traumatic, sub acute and dehisced wounds, partial-thickness burns, ulcers (such as diabetic or pressure), flaps and grafts.  Feedback control is achieved by measuring the level of negative pressure at the wound site.

Types of wounds for which V.A.C.ฎ  Therapy currently has been indicated include:
• chronic • partial-thickness burns • pressure ulcers
• acute • dehisced wounds • flaps
• traumatic • diabetic ulcers • grafts


*Certain unique indications, contraindications, precautions and safety tips may apply for distinctive products within the V.A.C.ฎ family of devices, such as for the V.A.C.ฎ Instill™ System and for  the V.A.C.ฎ systems that do not utilize  the T.R..A.C.ฎ wound site feedback control.  Please refer to the product labeling for each specific product.

Contraindications:
Contraindicated for patients with:
• malignancy in the wound • non-enteric an unexplored fistula
• untreated osteomyelitis • necrotic tissue with eschar present
• Do not place V.A.C.ฎ dressing over exposed blood vessels or organs

Precautions:
Precautions should be taken for patients with:
• active bleeding
• difficult wound hemostasis
• anticoagulants
• when placing the V.A.C.ฎ dressing in close proximity to blood vessels or organs, take care to ensure that all vessels are adequately protected with overlying fascia, tissue or other protective barriers
• greater care should be taken with respect to weakened, irradiated or sutured blood vessels or organs
• bone fragments or sharp edges could puncture protective barriers, vessels or organs
• wounds with enteric fistula require special precautions to optimize V.A.C.ฎ Therapy

More information available at www.woundvac.com

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