Top Community Businesses in Ann Arbor, MI 48105
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Visiting Angels
By Oxygen Plus April 17, 2010
Training, excellent care and affordable price for care. Owned and operated by a nurse. ...read more
Visiting Angels
By Karen Frank April 09, 2010
Angil and her company are awesome. I am a nurse with Grace Home Health Care and I have referred clients to her agency and all have been very happy with the care given. I would trust all my clients with her, but more importantly I would trust my family members with her agency! Keep up the important work you do Angil. It is so nice to have an honest and caring agency to intrust your loved ones to. ...read more
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Misunderstanding Homecare
There is so much misunderstanding about homecare that I want to help clarify the misunderstandings. Many refer to homecare as home health or just homecare without ever realizing there are 3 types of homecare. This isn't a just a misunderstanding in the lay community, but there is an enormous lack of understanding among medical professionals and those working in the medical field. Even websites that provide health information can be very wrong in their description of home care. They use home health and homecare interchangeably as if it were one in the same.The lack of knowledge, particularly in the medical community is a huge disservice to patients. Because of the changes we have witnessed in healthcare in the last several years patients are being left to their own accord to educate themselves, and advocate for the best care. If doctors, nurses, social workers, and discharge planners don't understand homecare, or teach their patients about home care options, how are patients supposed to find the resources that would best suit their needs? I have spent most of my career working as a nurse in Home Health Care, Hospice, and for the last 8 years owning Visiting Angels Private Duty Homecare in Ann Arbor. I speak about this from years of experience, and care for countless families in all 3 types of home care.There are 3 types of home care as I mentioned. Home Health Care, Private Duty Homecare, and Hospice Care.The most confusion comes between Home Health and Private Duty. There is also a need for Hospice education, but that is specifically related to hospice services, and when hospice is appropriate. I will briefly touch on Hospice care in this article.HOME HEALTH CARE-Home health care is medical care in the home for homebound patients. It is a benefit of Medicare, Medicaid, and most private health insurances if the patient meets very specific criteria. Home Health provides Nursing, Physical Therapy, Occupational Therapy,Speech Therapy,Social Work, and Home Health Aides.To qualify a patient typically has had an acute health change requiring hospitalization, and home health is initiated upon hospital discharge. The patient must be homebound, meaning they only leave the home formedical appointments. Qualifications don't require hospitalization, but that is the most common qualifier for home health. A patient can also qualify if there is a significant change inhealth status, such as an acute illness or injury not requiring hospitalization. For example, if a patient went to ER for trouble breathing, and was having a hard time controllingcongestive heart failure, they would most likely qualify, but again would have to be homebound. If a patient was physically debilitated due to an illness or injury, and needed therapy to regain strength and balance, they could qualify.Patients also can qualify based on a new and life altering diagnosis, such as insulin dependent diabetes. Diabetics are at risk for a multitude of problems from uncontrolled blood sugar so education and monitoring is essential to prevent complications.Home Health is always set up on a short, temporary basis. It must include either nursing or physical therapy to obtain services. Home Health must be ordered by a physician to be covered by insurance. Visits are determined based on the nurse's initial assessment, and the therapist's assessment. Nurse typically determines which of the services available will be initiated and how often they and the home health aide visit. Therapists either initiating care or being initiated by the nurse provide their own evaluation to determine the frequency and length of their visits.The goal of home health is to improve health outcomes. Their services are guided byMedicare Guidelines. Medicare expects the home health team to educate the patient and family specific to the ordering diagnosis and discharge as soon as possible. Medical procedures that were once done by nurses, such as dressing changes on wounds, daily catheterization and injections, are now being taught to patients and families with the expectation that a responsible party within that patient's family or friends will provide those medical procedures, after being taught by the nurse.Home health aides can only providepersonal careaccording to Medicare guidelines. This includes bathing and grooming, but does not include providing meals, housekeeping, or any type of tasks that aren't directly related to personal care.Therapists provide therapy but their main job is to educate the patient how to perform the therapy and all the work is up to the patient. No one really improves if they don't follow the therapist's directions to follow the exercise plan when they are not there.There is always a care plan that is followed by the team, with the inclusion of the patient, and family if applicable. Home Health is set up on a 60 day basis. The professionals who visit will typically be in the home for 45 minutes to an hour. As weeks go on in the 60 day certification period, visits decrease, unless the patient's health status declines. If the team determines the patient improves to the point they no longer qualify for services, or they do not remain homebound, discharge will be before the 60 day certification period ends. If the patient continues to have significant health needs that cannot be improved in the 60 day period, home health can recertify the patient beyond the 60 days.PRIVATE DUTY HOMECARE-Private duty homecare is non medical. The services are provided by caregiver's and/or certified home health aides (may be dependent on individual State regulations). The services provided are considered custodial care, and do not require a physician's order. Services are designed to help the care recipient remain in their home as independent as possible by providing hygiene, meals, light housekeeping, companionship, errands, and medication reminders. Some agencies or individuals providing services transport clients, some do not.The amount of services is determined by the care recipient, and/or family, because Private Duty is not covered by health insurance. Most Private Duty Homecare services are paid out of pocket, but may be covered in part or whole by Long Term Care Insurance, orVeterans benefits. Individual States may have programs providing limited Private Duty services for low income residents, but my experience is they are very limited on the number of residents they can qualify for services. There is typically a waiting list for these programs, or they are closed to new applicants. They provide very little amount of services from agencies that contract with them.MyVisiting AngelsPrivate Duty Home Care agency in Ann Arbor, Michigan, does not contract with the State of Michigan for the MI Choice Medicaid Waiver program, as it's called in Michigan, because their reimbursement rate is so low I would personally have to cover a portion of care for the care recipient. Agencies that contract for these services typically pay their caregiver's a very low wage, therefore don't attract or retain the best staff. We choose to pay a higher wage to attract and hire the best caregiver's possible. Check with your local or State Department of Aging for your State programs.Private Duty often works in collaboration with Home Health agencies because the services are very different in nature and typically if someone needs home health, they also need assistance with activities of daily living (ADL'S). Because I am a nurse and geriatric care manager, I always assess the need for home health care if our client comes to us before home health. I make referrals so our client's can improve to the best quality of life possible. Many Private Duty agencies do not involve themselves with health care at all because of the lack of knowledge in understanding health care needs.Private Duty Homecare is available 24 hours a day, 365 days a year. Clients can obtain services long term or short term. Some agencies require a minimum amount of hours either per shift, per day or per week, some do not. This varies by the agency, as well as the rates, so check around.Each State determines if they will regulate Private Duty agencies, so check with your State to determine whether they license Private Duty agencies or not. Michigan is an unlicensed State, so there are no regulations on Private Duty homecare in the State of Michigan. Ethical, legitimate agencies, like my own, are pushing for regulation for the protection of the elderly.Private Duty agencies are NEVER certified by Medicare, because Medicare does not cover these services. Long Term Care Insurance companies have been difficult to deal with in the recent years because the language in their policies states the home care agency must be licensed or Medicare Certified. They are beginning to understand this varies by State, and paying claims they tried to deny in the past.Some Home Health agencies also operate Private Duty, but they are run as separate companies. Even when their Home Health division is Medicare certified, their Private Duty is not. Very few companies that offer both Home Health and Private Duty do both well. The focus tends to be ion the Home Health division with little attention to providing excellent Private Duty.I've always believed that if a company diversifies itself too much they typically don't do it all well.I would rather contract a company whose sole concentration and expertise is in Private Duty, or Home Health than one that tries to do it all.HOSPICE- Hospice, as most know is care for the dying. The perception is usually not accurate with what hospice is or what they provide. Hospice can be provided in homes, hospice facilities, long term care facilities and in hospitals. Medicare, Medicaid and most private insurances cover hospice care. This also requires a physicians order, but does not require the patient to be homebound. It is initiated based on a terminal diagnosis. The old rule of thumb used to be if the patient was given 6 months or less to live. That is no longer the case. Although it is expected that death is impending from a terminal diagnosis.Hospice consists of Nurses, Home Health Aides, Social Work, Spiritual Care, and Volunteers, as well as a Bereavement Counselor. Patients may use all or some of the services based on their needs and preferences. Visits are short, typically between 45 minutes and 1.5 hours. Volunteers may be scheduled longer, and of the staff may be in the home much longer than a typical visit if the patient is in need of pain control or other comfort measures.Although Hospice operates under a primary physician or medical director who is a physician, hospice nurses direct care. Nurse's case manages the care and work as a team with other hospice professionals, as well as the family and even friends of the patient.Some Home Health companies have hospice as well, and often have a transitional program. Patients may start out with Home Health, and as they decline decide to transition to Hospice services. Patients never have both. The focus of Home Home Health and Hospice are very different. Home health concentrates on improvement, and Hospice concentrates on comfort, support, and the best quality of life possible for however long the patient will live. They specialize in pain control and the process of dying. They address physical, emotional, and spiritual needs, not only with the patient, but with their loved ones.Private Duty will often work in collaboration with Hospice, to provide care when families are unable or need respite. Private Duty follows the direction of the Hospice team to maintain comfort and support for the patient. Rather than contacting EMS or the client's physician for help with changing status, Private Duty caregiver's contact the Hospice nurse for instruction.I hope this clarifies the misunderstand of home care. There is no charge for most Hospice or Private Duty companies to meet with you to assess your needs, and provide information. Home Health is a bit different in the fact that it is physician ordered, and they make the appointment to assess, and plan the start of care. Hospice and Private Duty are more optional. Understanding your health status, or your loved one's status, and what your needs are can help you obtain the best services for your situation. Most companies are very receptive to calls for information.My suggestion is to always check out the company before beginning services. Most consumers don't realize they have a choice. You have the right to choose a Home Health, Hospice or Private Duty company. Just because a hospital or care facility owns their own home care companies doesn't always mean they are good or the best for you or your loved one. Keep in mind somehealth care companieswant to provide it all and keep their patient's in their system for financial reasons. Their financial goals will not benefit your care. Ask the tough questions. Ask for references. Google the company you are interested in. Know the owner's name and Google them as well. Many consumers are now voicing their dissatisfaction with providers that are all over the web. Just realize one person's dissatisfaction isn't verifiable to exclude a company. A few dissatisfied consumers can provide be the basis for exclusion.I wish you the best care for your needs, and the needs of your loved ones!Angil Tarach can be reached for questions or comments at visitingangelswc@comcast.net, or www.visitingangels.com/annarbor ...read more
By Visiting Angels July 30, 2010
Why Visiting Angels? The Best in Ann Arbor Homecare!
Seniors, disabled adults and families come to Visiting Angels for a variety of reasons and a variety of needs. We meet with family members who say their loved one "does not want care," or their loved one is "resistant to this idea." We are not surprised by this at all. Who would want to lose independence? Who would want a stranger coming in their home to assist them? So when do families call us? Typically we are called after an unexpected illness or injury when a family finds their loved one needs help and they are unable to do it all. We are also called when a family member is exhausted, frustrated, and burned out in their family caregiving role. Families aren't the only ones that call. We are referred to by hospital discharge planners, social workers, rehabilitation facilities, therapists, doctor's offices, attorney's, trust officers, home health agencies, hospice agencies, and even concerned friends and neighbors. No one calls without a reason. The majority call because they are concerned for someone's safety. Either there has been a crisis that has caused a person to decline, someone's dementia is progressing, or a patient or loved one is in the process of rehabilitation and needs temporary assistance. We provide a variety of services that range from temporary to long term, from minimal services to maximum services, from 2 hours to 24 hours a day. Our services include, but are not limited to, companionship, hygiene, light housekeeping, meal preparation, errands, transportation, and medication reminders. We provide incontinence care, linen change, and do laundry. We assist with exercise, socialization, and activities. Our services are not just physical tasks. We are there to provide understanding, support, education, information, compassion, a listening ear, a hand to hold and a hug to be given. We provide peace of mind, and reduce family stress. We value safety, and prevention. Monitoring and assisting a client with a history of falls, poor nutritional and fluid intake, poor hygiene, or poor compliance to prescribed medications and exercise prevents further decline, future hospitalizations, and allows then to remain as independent as possible in their home of choice.Our clients live in houses, apartments, senior living communities, and assisted living facilities. We even help families rest when a loved one is in the hospital and they want someone there 24 hours a day for companionship and monitoring. Many families hire us to stay with their loved ones overnight, so they can go home and get some sleep. We have clients who no longer drive, and just want to get out of the house to shop, dine out, run errands, visit friends, go to appointments, and attend events. These clients are very independent, and we value their independence. Meaning, we do not do anything for them, they can do for themselves. We know if you don't use it, you lose it. We never want to contribute to someone's loss of independence. There are clients we service who need total care. This involves most of our services. We bathe, and groom, prepare meals, and feed clients who are unable to feed themselves. We talk, read, or sing to them. We comfort them and their families. We provide incontinence care, repositioning, and oral care. We change linen, wash clothes, and provide light housekeeping. Many times clients who need this much care live with and are cared for by family members. Family caregiving to this extent is very difficult and requires the family caregiver's to get respite. A family caregiver needs to take time to care for themselves in order to keep their loved one at home, and remain well themselves. We understand and acknowledge the difficulty of family caregiving. Our services and support is not only for the clients we care for, but extends to the involved family members. Our rehab clients are generally recovering from an illness or injury and need temporary assistance. We provide assistance with the things they cannot do themselves, which may be housekeeping, errands, transportation, meal preparation, and assistance with exercises. We help our rehab clients get back as much independence as possible. We encourage and assist with prescribed exercises and activities to help the client regain as much independence as possible. Visiting Angels can fill in where families can't. Our Angels will stay with a client while the caregiving family takes a vacation, or sits with their loved one in the hospital so the family can get some rest. We take clients to doctor appointments and hospital procedures. We attend to an elderly family member at family reunions, holiday parties, weddings, and special events, by helping the family member get groomed and ready, transport them to the event, assist during the event, and transport the person home, getting them comfortable and attended to before we leave. Families who are busy with the event itself love this service! They can attend to their event and enjoy visiting rather than being so busy with the event and family caregiving that there is no time to enjoy family and friends. So why Visiting Angels? Visiting Angels has an excellent reputation, and track record. Our company was founded by a social worker, named Jeffrey Johnson, who has a huge heart for seniors, and their care. He didn't open Visiting Angels to sell franchises. He recognized the need for respectful, dignified, ethical, and reliable care, ran his homecare agency that way, and wanted to duplicate his values and principals across the nation. So although each franchised office is independently owned and operated, the guiding principals and rigorous process to own a Visiting Angels agency is beneath every office in the US, Canada, and now Korea. There are thousands and thousands of homecare agencies and many franchise companies. Some are excellent, some are not. The best indicator is finding out who started the company and/or office, and why. What is the background of the owner? Is their focus care or the bottom line? What experience do they have? What do their current and previous clients say? I believe there is a difference between an owner who is a medical professional or lay person who went into care because of their personal experiences, and an owner who is a business major. Google is a great thing! Google the owner's name and see what comes up. Are they involved with senior issues outside of their business? What do you see that either makes you confident and comfortable or unsure and skeptical? One of the biggest things that set Visiting Angels apart is our initiation of care. This was developed by Jeffrey Johnson and holds true to over 400 offices today. Our process allows our care recipients and families to help select their caregiver. We meet with the care recipient and family to assess their needs, and explain our services. Once we are able to understand the care recipients needs, preferred schedule, and personality, we pre-select a caregiver(s) we think will work well with the care recipient bases on experience, schedule and personality. We then schedule a second meeting for the care recipient to meet and interview the caregiver(s). If the client and/or family feel comfortable with the caregiver(s), we are ready to begin service. If the client and/or family feel it is not a good fit than we will introduce an additional caregiver(s). Homecare is very scary to the elderly, particularly if they have never received in home care or they have had a bad experience. It is also uncomfortable for a stranger to just show up on their doorstep and begin providing care, especially if the care recipient needs personal care. We want our clients to feel safe, and comfortable. We value their thoughts and opinions, and want them to have a voice in their care. Losing independence is very difficult. Deciding to initiate or accept homecare is also difficult. It is important for our clients to know we respect their independence and want to make the process as comfortable as possible. Another reason for choosing Visiting Angels is our employment process and training. We are very selective and spend the time, effort and finances to make sure we are hiring caregiver's we would feel comfortable sending in our own family's homes. We use the most up to date, comprehensive criminal background checks available. Visiting Angels uses a 5 step hiring process. There are 2 interviews, thorough employment reference checks, comprehensive background checks, and orientation. If a potential caregiver can pass our stringent hiring process they are hired. If they fail to meet our expectations in any of these processes, we will not hire them. Since every office is independently owned and operated we differ in our training procedures, service costs, and may even differ in some policies. My Visiting Angels office in Ann Arbor has mandatory training, and testing in 6 areas, including Alzheimer's and dementia. No matter how experienced a caregiver may be, we feel there is always something to learn, improve or refresh. We expect our caregivers to be as prepared as possible to meet our client's needs. For us to provide excellent care we prioritize our clients and caregivers safety. It is our responsibility to send well prepared, knowledgeable, compassionate, hard working, safe, and reliable caregiver's to our clients homes. We also utilize an integrated system for verification that our clients are being attended to on the days and times they have scheduled service. We are immediately notified if a caregiver is 5 minutes late. The system we use helps maintain dependable service and accurate billing and payroll. Our quality doesn't stop there. We maintain open communication with our clients, families, caregivers, and any medical professionals involved in the clients care. We make frequent calls to check on service satisfaction, and have written records of each service visit. Our administrative staff makes unannounced visits to supervise our staff, and spend time with our care recipients. We send periodic satisfaction survey's to our clients, caregivers and referral sources. We constantly work on improvement. Relationships are highly valued in all Visiting Angels offices. It is a rare occasion that I as the owner and registered nurse, doesn't meet with the potential client to assess their needs. If it is not me, it is my Assistant Director, Cindy, who meets with the client and family. Cindy's 14 year background at St. Joseph Mercy Hospital's Senior Health, as the Service Delivery Leader, is more than sufficient to assess and implement care. Angil Tarach-Ritchey RN, GCM, the owner of Visiting Angels in Ann Arbor is a national expert in senior care, as described by her peers. With over 30 years in senior care and advocacy Angil Tarach-Ritchey, who is a registered nurse and geriatric care manager, offers clients, families and the community experience and education that is unmatched in the area. Many agencies care recipients don't even know who the owner is, let alone have the owner prioritize getting to know their clients. "Meeting clients and families and helping them with their needs, by education, resources, referrals, and service is what I LOVE about what I do. There is no better feeling in the world than knowing you did something to help someone." When you find yourself not knowing what to do or where to turn when a loved one needs help, call Visiting Angels. We can meet with you at no cost or obligation to help you determine your needs and how we and/or other trusted companies can help you. After all we are America's Choice in Homecare! For information in the Ann Arbor area go towww.visitingangels.com/annarboror call (734) 929-9201. For information outside of the Ann Arbor area go towww.visitingangels.comor call800-365-4189 ...read more
By Visiting Angels June 05, 2010
Tips for what to do when you suspect Alzheimer’s
There are always precipitating suspicions of Alzheimer's or dementia before someone is taken in for an evaluation. Some memory loss is natural as we age. God knows if I don't write it down, I will forget. When I family notices memory loss, there always seems to be the question of whether the memory loss is "normal" or something more. If you suspect Alzheimer's or dementia in a family member, it will be important to prepare for an evaluation. Don't procrastinate in getting an evaluation out of fear. Many things can cause memory loss, and no matter the cause, you will want whatever treatment is necessary or available, as soon as possible. 路 Monitor and objectively document what causes your suspicion. This will be extremely important to take to an evaluation. a.When did you first notice memory loss? b. Was the memory loss short term or long term? We can all forget what we had for dinner last night, or details from childhood. More indications of short term memory would be forgetting to eat, not knowing the day or time, forgetting to bathe or getting lost, and repeating the same questions, sentence or conversation. c.Is your loved one able to take care of their activities of daily living (ADL's)? Bathing, grooming, meals, household chores, and managing medications are key components indicating abnormal memory. d. Can your loved one attend to their finances? This is often an early indication of something more than normal memory loss. e.Is there a marked weight loss? Although weight loss can be an indication of a physical problem, when combined with noticeable memory loss, this can be a sign of missing meals due to memory loss. f. Are there physical symptoms in addition to notable memory loss? Many physical conditions can involve memory loss or confusion. The elderly can experience confusion with a urinary tract infection, so it is very important to note any physical changes or problems. 路 Gather all medical information. a.Medical history, including diagnosis, surgeries, and hospitalizations. b. All medications, including over the counter medicines and vitamins or supplements. c.Insurance information 路 Choose and make an appointment with the physician for an evaluation a.If you are comfortable and confident in the primary physician, you may want to begin making an appointment with him/her, if your loved one has been a long time patient who the physician is very familiar with. b. If your loved one does not have a primary physician who is longstanding or who you lack confidence in, it's best to first go to a geriatric specialist. Ask around to family and friends for a referral. Getting a trusted family member or friend to recommend a physician they have experience with and confidence in is always preferred. If you are unable to get a personal referral, most hospitals now have senior health departments with geriatric physicians. c.If your initial evaluation is with your primary physician, who is not a geriatric specialist, I recommend a second opinion with a specialist if Alzheimer's or dementia is diagnosed. Many physicians are quick to diagnose these illnesses, without the expertise of geriatric medicine. Take all test results from the evaluation with the primary to the appointment with the specialist, to avoid some repetitious testing. 路 When you call for an appointment ask what is included in an evaluation for Alzheimer's or dementia. a.You will want to know that a full physical workup will be done with psychological testing, and a memory screen. b. Ask if the physician has a treatment plan if a patient is diagnosed with Alzheimer's or dementia. If you hear, "what do you mean" then you know this is not the physician you want to make an appointment with. c.Inquire whether the physician has resources for education and support. You and your family member will need immediate education, if Alzheimer's is the final diagnosis. You will also need resources for support and assistance as the disease progresses. The evaluation won't be a quick process. It may take time to get an evaluation appointment with a specialist, so it is best to find a specialist and call for an appointment when you initially suspect Alzheimer's or dementia. While waiting for the appointment, you can monitor and document the objective data above. It takes time for all of the lab tests to be completed to rule out other causes of memory loss. As you and your loved one go through the evaluation process continue to monitor and document any changes you didn't already provide the physician in the appointment. The more information the physician has the better, for an appropriate diagnosis. To reach Angil Tarach-Ritchey RN, GCM with questions or comments, emailvisitingangelswc@comcast.netor call Visiting Angels in Ann Arbor at (734) 929-9201 ...read more
By Visiting Angels April 30, 2010