Silver Lining Services

1. Silver Lining Services

2. Why choose SLS LLC? • SLS currently serves approximately 458 clients throughout our various programs, and employs approximately 480 people in the greater Cibola and McKinley County Areas.  • We have been acknowledged for our outstanding business performance by many local officials and pride ourselves on our above average quality services and genuine concern for those in need. • SLS Supports individuals and works to improve the quality of life for those of any age who might otherwise require institutional care. • SLS provides care for individuals in their own homes and community. • Our agency has an open door policy and our Executive Director can always be reached on or off the job. • SLS provides home and community based services to all EEOIC recipients.  • Family members may serve as HHA providers.  • SLS now has two locations to serve you. • SLS has a complete education department all skilled nurses will be able to receive continued education credits. • Our most recent additions have been service provisions to the Developmentally Disabled and EEOIC-DOL Uranium industry workers and our skilled nursing department. • Exceptional Customer Service • Family like atmosphere • Determination to do what it takes to serve the community • Strong business staff • SLS is in the business of sharing and caring to the needs of those around us • Locally owned and operated • The owners are from and live right in Grants, NM. • We provide weekly home health aide training

3. Our agency prides itself on providing top quality Skilled Nursing Homemaker/Caregiver services, Case Management, training, and advocacy.To do this we provide all of the following services…______________________________________________________________________ Skilled Nursing • Pain Management • Pulmonary & Respiratory Maintenance • Musculoskeletal Assessment • Restorative therapy & Ambulation • Range of Motion Exercise Daily • Nutritional Maintenance • Wound & Skin Breakdown Prevention • Emotional Support for Client and Family Members • End of Life Support • Monitor Vitals & Oxygen Saturation • Assessments of all Body Systems • Neurological Assessment • RN Case Management • Registered Nurse • Licensed Practical Nurse • Social Services • Physical Therapy • 24/7 skilled nursing available to those that qualify  • Wound Care • Wound Vac • IV Therapy • Post-operative care • Respiratory services • Infusion therapies • Comprehensive wound care therapies • Palliative care services • Renal disease services • Cancer recovery services • Digestive disease support • Respite care • Hospice care

4. Cont: HHA- Eligibility • Family members may serve as HHA providers.  • SLS.LLC now has two locations to serve you. • SLS.LLC will make every reasonable attempt to accommodate out of town or out of state participants to complete training needs. • Our agency will train and certify all HHA-Home Care Providers at no cost to the HHA.  SLS.LLC assumes all training costs.  Home Health Aid - HHA • Companionship and Conversation • Arrange Appointments • Medication Reminders • Plan and Prepare Meals • Assist with bath, hygiene and grooming • Light Housekeeping • Changing Linens/Laundry • Grocery Shopping • Escort to Appointments • Errands • Case Management • Information and Referral Services • Vitals, General Care and Preventive Care • Added value Benefits • SLS.LLC has a complete education department all skilled nurses will be able to receive continued education credits.  • CNA’s available

5. Other services and care options Social and Cultural Activities • Encourages learning and recreation • Supportive setting for residents and their families • Activities that support transition back into the community • Full Cycle Rehabilitation Program Physical therapy • Nursing and Restorative Care • Customized plan of care for each individual • Assistance with Activities of Daily Living Case Management • Patient and resident advocacy • Clinical and financial resource assistance • Discharge Planning • Prior to admission • Discuss recuperation goals and plans for on-going care • During care delivery, plan is re-evaluated

6. What is Skilled Nursing? Important Background Information Regarding “Skilled Level” Patients: There are certain conditions that must be met for a patient to qualify for skilled home health services under Medicare, Medicaid, and some insurance companies; they are: • Be confined to the home (homebound); • Be under the care of a physician; • Receive services under a plan of care established and periodically reviewed by a physician; • Be in need of skilled nursing care on an intermittent basis or need physical therapy or speech therapy; • Have a continuing need for occupational therapy Clarification of Homebound: This does not mean the patient must never leave their home. In general terms, a patient is considered “home bound” if they: • Have a medical condition or an injury that restricts their ability to leave their home unless they use an assistive device (crutches, cane, wheelchair, walker); • Require the use of special transportation; • Require the assistance of another person; • Or, leaving their home is not medically advised Patients may leave their homes occasionally; for church services, hairdressing, attending a family functions while being driven in a vehicle by another person. Absences from the home to receive medical treatments are also allowed, such as: • kidney dialysis; • chemo/radiation therapy; • and outpatient physical therapy, including whirlpool therapy

7. Clarification of Skilled Nursing Duties: A skilled nursing patient is one who requires the skills of a Registered Nurse or Licensed Practical Nurse. The nurse is responsible for: • making the initial evaluation visit to the patient, • reevaluating their needs regularly, • initiating and revising the nursing plan of care, • providing the services that require more specialized nursing care, • planning for preventative and rehabilitative care, • preparing clinical notes and informing physicians and others participating in the patient’s care of changes as they occur. According to the Medicare Benefit Manual, 30.4, (Medicare reimbursement) “skilled nursing care must be reasonable and necessary, needed on an intermittent basis, and not be solely needed for venipunctures for the purposes of obtaining blood samples.” Some examples of patients who would qualify for skilled nursing care: • Patients who require intravenous and intramuscular injections • Patients needing Foley catheter insertions • Patients with pre-existing peripheral vascular or circulatory disease (needing observation for complications, pain management, teaching related to skin care, preservation of skin integrity, and prevention of skin breakdown) • A patient who requires teaching related to illness or injury until they can demonstrate independence in their care. • Patients in need of medication management which also requires a nursing assessment (such as blood pressures, pulses, respiratory assessment, blood sugars, oxygen saturations), monitoring of medication changes or physician consults. In home health care, it is anticipated that the patient and/or caregiver's) will be taught how to perform self-cares by the registered nurse. Typically this teaching is done over several days/weeks, depending on the complexity of the task and the patient’s condition. For this reason, agencies can expect to see patients frequently upon admission, and then begin to reduce the number of registered nurse visits when competency in the task is demonstrated and documented. If the patient’s nursing goals are met (considered to be stable), or teaching can be completed in one visit, the patient is no longer considered “skilled” and no longer considered “qualified” for skilled care. Any DOL cardholder with moderate to severe respiratory problems qualifies for skilled nursing care.

8. Examples of patients who do not qualify for skilled care: • Skilled nurse admits a patient to agency for bathing, and completes the teaching of medication administration and safety in the home, at the admission visit. • Patient is not compliant with taking medications, and needs reminders to take them on time. • Patient has a wound, which the caregiver manages competently, and patient is driving their own vehicle. • Medication set-up when the medications taken do not require ongoing nursing assessments, monitoring or physician consults. Venipunctures alone do not qualify a patient for home care. The documentation must support the rationale behind the venipunctures, for example: • A patient is taking coumadin (blood thinner) and requires protimes to monitor it effectiveness. Documentation reflects no changes in the coumadin therapy for 6 weeks. This patient would not qualify for skilled care based on this alone. • A physician requests a chemistry panel and CBC drawn on his patient prior to the patient’s 6 month check up. This patient would not qualify for skilled care based on this alone. • A patient newly diagnosed with Atrial Fibrillation, and new to coumadin therapy, needs protimes to monitor for therapeutic effects. This patient would qualify for skilled care.

9. Contact Information If you have any further questions or concerns please contact Silver Lining Services Director of Nursing Shelia Gholston. Office: 505-285-3445 Cell: 505-240-0252 shelia@slsnm.net