Pamela Mangen MSN, MBA, RN, PHN, PCCN-CMC, LSSGB - Sorbet
Pamela Mangen MSN, MBA, RN, PHN, PCCN-CMC, LSSGB

Pamela Mangen MSN, MBA, RN, PHN, PCCN-CMC, LSSGB

Pamela Mangen is the CEO of Transition Care Telemetry, Inc. (dba TCT Health), a Home Care and Home Health agency and a Hospice agency.  Prior to the formation of TCT, she held executive and clinical management positions with a few large hospitals here in Orange County and has also conducted various health research projects.  If you want more information please call 888.757.2018 and speak with Brian Flammer at ext. 509 or Maylia Tsen at ext. 510.

Hospice care is a type of health care that focuses on the palliation of a terminally ill patient’s pain and symptoms and attending to their emotional and spiritual needs at the end of life. Hospice care prioritizes comfort and quality of life by reducing pain and suffering. Hospice care provides an alternative to therapies focused on life-prolonging measures that may be arduous, likely to cause more symptoms, or are not aligned with a person’s goals.

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You qualify for hospice care if you have Medicare Part A (Hospital Insurance) and meet all of these conditions:

  • Your hospice doctor and your regular doctor (if you have one) certify that you’re terminally ill (with a life expectancy of 6 months or less).
  • You accept comfort care (palliative care) instead of care to cure your illness.
  • You sign a statement choosing hospice care instead of other Medicare-covered treatments for your terminal illness and related conditions.

Medicare-certified hospice care is usually given in your home or other facility where you live, like a nursing home. You can also get hospice care in an inpatient hospice facility. Original Medicare will still pay for covered benefits for any health problems that aren’t part of your terminal illness and related conditions, but this is unusual. Once you choose hospice care, your hospice benefit will usually cover everything you need. The following are four levels of hospice care:

ROUTINE HOME CARE

  • Most common level of care in hospice. Patient is generally stable and the patient’s symptoms, like pain or nausea and vomiting, are adequately controlled
  • Usually provided in the home

GENERAL IN-PATIENT CARE

  • Crisis-like level of care for short-term management of out-of-control patient pain and/or symptoms usually provided outside the home, in an inpatient setting at a medical facility like a hospital or skilled nursing facility.

CONTINUOUS HOME CARE

  • Crisis-like level of care for short-term management of out-of-control patient pain and/or symptoms
  • Usually provided in the home.

RESPITE CARE

  • A level of temporary care provided in nursing home, hospice inpatient facility, or hospital so that a family member or friend who’s the patient’s caregiver can take some time off
  • This level of care is tied to caregiver needs, not patient symptoms

Level of care is one of many things to consider when choosing a hospice. Patient and caregiver needs may impact the level of care a hospice provides. Additionally, hospices that see a small number of patients might not have patients that need a level of care besides routine home care. If you’re considering a hospice that hasn’t provided a level of care beyond routine home care in a 3-year period, talk to your doctor and/or hospice representative.

Your Costs in Original Medicare

  • You pay nothing for hospice care.
  • You pay a copayment of up to $5 for each prescription for outpatient drugs for pain and symptom management. In the rare case the hospice benefit doesn’t cover your drug, your hospice provider should contact your plan to see if Part D covers it. The hospice provider will inform you if any drugs or services aren’t covered, and if you’ll be required to pay for them.
  • You may pay 5% of the Medicare-Approved Amount for inpatient respite care.
  • You may have to pay for room and board if you live in a facility (like a nursing home) and choose to get hospice care.

When considering a Care Giver, it is important to know the specific type of care you require; for example, Skilled Nursing or simple companionship or a person to assist with your Activities of Daily Living (ADLs) such as dressing, continence, eating, etc. Do you need a 24-hour live-in, full or part-time skilled nursing/assistance, or round-the-clock technology access such as tele-monitoring?

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The next step is to choose the Agency who will be providing the services. Are they credentialed and licensed with the California Department of Public Health (CDPH)? When was the last time a survey, audit or on-site exam been completed at the facility? Do they have the necessary insurance requirements and bonding? What are the licenses and credentials of the management team, the governing body and their board of field supervisors? Are there any unfavorable outcomes such as ‘letters of deficiency, practice violations or any other complaints or grievances submitted to the CDPH or other regulatory body?

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What are the credentials and licenses of the caregivers or the skilled nursing staff? Are their medical exams, testing and vaccinations (including Tuberculosis, Hepatitis, COVID, etc.) current. Have they been subjected to a thorough background check including Federal & State Health Care Sanctions, the National & State Sex Offender Registry, the Adult Abuse Registry or the Nurse Aide Registry. Have their previous employers and patients, if known, been contacted by the Compliance Dept. and approved for hire? Do they have good credit history reducing the temptations of theft and fraud? Do they have any DUIs or reckless driving violations, etc. which would indicate irresponsibility, etc.? Do they have a history of workers comp claims, etc. It is prudent to be diligent when screening and selecting your caregivers.

 

What about Training? Are their medical professional licenses or certifications current? Do they have CPR and Advanced CPR current certification? If only caregivers, are they Certified as a Home Care Aide (CHCA) by the CDPH? If not, are they currently undergoing field training, passed compliance checks, been fingerprinted and completed the education necessary for licensing? If licensed, have they met their annual 12-hour mandatory in-house training?

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What supervisory oversight and control measures are in effect? Is the Field Supervisor, properly qualified by reason of training, education and experience, able to provide an initial health evaluation of the patient and a risk assessment of the patient’s environment as well as provide adequate supervision over the employee(s) so assigned? Transition Care holds our home-care employees to the same high standards as our home-health employees when it comes to quality patient care and acting in an ethical and professional manner. Regarding live-in caregivers or personal attendants, TCT’s Field Supervisors (RN) bring the employee(s) to meet the patient and their family members so they can interact and feel comfortable with the new individual(s) to be assigned.

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There’s a common misconception that a high-protein diet is bad for bone health but nothing could be further from the truth! In fact, years of research show that getting plenty of protein is crucial for bone density – provided you get enough of a key mineral.
Studies show that getting the right amount of protein in your diet improves your bone health. It lowers your chance of osteoporosis (bone loss) by helping you hold on to your bone density, and it helps prevent breaks as you age, too.

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Proteins form the foundation of every living thing! But what proteins, exactly? Under a microscope, proteins are made out of long chains of amino acids linked together as links or blocks. There are 20 amino acids needed for metabolism and human growth found in food or supplements. The best sources of amino acids are found in animal proteins such as beef and in poultry. Eggs are a good source of lean protein. And even though there is cholesterol in the yolk, it is not as likely to raise your cholesterol level as foods that contain saturated fats and trans fats do.

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Animal proteins are the most easily absorbed and used by your body. Foods that contain all nine essential amino acids are called complete proteins.

When it comes to your bones, protein is especially important. Protein makes up roughly one-third of your bones mass (the amount of protein your bones contain) and half of your bone volume (the amount of space protein takes up). Women need at least 50 grams of protein a day -- men about 60 grams per day. With a high-protein diet, it can be much more than that. This extra protein can come from beans, meat, nuts, grains, eggs, seafood, cheese or vegetarian sources like soy. These diets often restrict carbs like cereals, grains, fruits, and possibly vegetables. When it comes to Beans, One and a quarter cup of beans has about as much protein as 3 ounces of broiled steak. Along with protein, the fiber in beans helps you feel full longer and also helps lower your LDL (“bad”) cholesterol.

Be choosy. The best high-protein plans focus on lean proteins and include some carbs. Avoid huge helpings of fatty meats and make sure to include vegetables.

Fish is loaded with protein and almost always low in fat. Even the fish that have more fat, such as salmon and tuna, are good choices. Those fish generally have omega-3 fatty acids, which are good for your heart. Most people don’t get enough omega-3s. Milk, cheese, and yogurt give you protein and calcium for strong bones and a healthy heart. Low-fat, nonfat, or reduced-fat dairy products can help you keep calorie counts down.

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The protein in your bones is continuously broken down and built back up, as part of your bone remodeling process. Unfortunately, the protein that’s broken down isn’t reabsorbed and reused. That’s why you need a daily supply of protein to maintain your bone density.

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Now we realize that for the last 70 years, most of the westernized world has been told red meat is bad. Interestingly, our extracellular bone matrix is made primarily of collagen. Collagen is a protein. Our matrix is like a flexible framework for bone. Calcium hardens this framework and adds strength to it. Together they are 2 components of bone. With 28 different types of collagen, type 1 is the most abundant form found in bones. Our body doesn’t absorb collagen molecules, but rather they are broken down into amino acids. The bottom line is: 

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