information on these topics or others, we suggest you visit the 

        FALL/WINTER 2007

Department of Mental Retardation
Office of Quality Management
Living WELL

Welcome to the Fall/Winter 2007 issue of "Living Well", a publication of the Department of Mental Retardation, Office of Quality Management.   "Living Well" is published on a semi-annual basis and  features important information for individuals  and their supporters.  

   In this edition, you will find helpful information to assist people you support to enjoy fall and winter activities in a safe and healthy manner.   New to this edition is a “Did you Know” section.  This section will present information we’ve learned through the Incident Reporting System known as the Home and Community Services Information System (HCSIS) .  We trust that this information will be of practical use to you in your day to day work. 

"Living Well"  represents one component of DMR's continuing commitment to share information which will safeguard and improve the quality of lives of individuals.  Information and knowledge is a powerful tool.  We hope that this and future editions of "Living Well" will  be used effectively to enhance the health and well-being of individuals we support.

   We'd welcome your feedback and suggestions regarding content areas for future editions of the publication.  Please submit your suggestions to Sharon.Oxx@state.ma.us.  Thank you!

Elin Howe   Commissioner 
Department of Mental Retardation

Do I Just Have a Cold or Is It …..THE FLU?!!

Flu season is upon us (November through April) and everyone should be alert to early signs and symptoms of the disease. But how do you know if it’s the flu or just a cold (rhinovirus)? Here are some clues:

If you have the flu…
•	You have a fever (sometimes as high as 102+) Know a person’s normal body temperature. A change in their normal temperature by as little as 2 degrees is significant and should be reported to their Health Care Provider or the agency nurse immediately.
•	You have a headache
•	You are very tired (can even be extreme)
•	You have a dry cough (that may progress to a productive cough)
•	You may have a sore throat
•	You have nasal congestion
•	You have severe body aches
•	It probably came on quite suddenly (some people can even tell you the moment they felt ill)
•	You will be very ill for several days and take up to several weeks to recover fully
•	You are unable to go about your daily routine

If you have a cold…..
•	You probably don’t have a fever (and if you do it is very low grade)
•	You have a runny nose
•	You may have a loose productive cough
•	You may have a headache from coughing
•	You are able to continue your daily routine
•	You feel a little “under the weather” for a few days
•	The symptoms probably came on gradually over several days

Uh oh, I have the flu. Now what do I do?
•	The flu is very contagious so stay home!
•	Rest                                                                                      
•	Drink plenty of liquids                                                  
•	Wash your hands often!
•	Avoid alcohol and tobacco
•	Take medication to treat the symptoms (like acetaminophen for the aches and pains and cough  syrup for the cough)
•	Never give aspirin to a child or teenager who has the flu! (it can cause serious neurological 
     damage)  See your physician if you are not improving after several days.

Well…how contagious is it?
•	A person can spread the flu starting one day before they feel sick
•	Adults can continue to pass the flu virus to others for another 3-7 days after symptoms start (children 
      can pass it on for longer than 7 days)
•	Symptoms start 1-4 days after the virus enters the body
•	Some people can be infected with the virus but have no symptoms. They can still pass the virus on to others though. ( I don’t know how you are supposed to spot these people)

How did I get it ?
•	The flu is spread when a person who has the flu coughs, sneezes or speaks and sends flu virus into the air and other people inhale the virus
•	The virus enters the nose, throat, lungs of a person and begins to multiply, causing flu symptoms.
Flu may , less often be spread when a person touches a surface that has flu virus on it-a door handle for instance- and then touches his or her nose or mouth.

How do I prevent the flu?
This is a very simple answer: Get a flu shot!  While it is best to get one before the end of November, it is never too late..

Information about where flu shots are being offered in your area can be found by going to: www.Masspro.org. there you will find information on flu clinics listed by town as well as information on the flu in different languages.

There is also a great video on Cough Etiquette that can be found by going to www.mass.gov and enter into the search box “cough etiquette video”. Then click on the DPH flu site. 

Frostbite:  Prevention and Recognition *
Submitted By Froukje Timmer RN, NP
Southeast Residential Services
What is Frostbite?

Exposure to cold temperature without adequate protection can result in frostbite. Frostbite means that a part of a body has been frozen and this can be quite dangerous. Usually it is the face, nose, ears, fingers and toes that get frostbitten. Frostbite can occur during any outdoor activity including play, and especially fast moving sports such as skating, skiing, snowboarding and tobogganing. Obviously the colder and windier it is, the quicker an unprotected body part or area will become frostbitten. The skin around a frost bitten area initially becomes red then pale and very rarely bluish. As the skin warms up there can be some blisters.

Frostbite Prevention:  
•	Individuals should be dressed warmly with properly fitting clothing. Several thin layers will help keep them dry as well as warm. Clothing should include long johns, turtlenecks, one or two shirts, pants, sweater, coat, warm socks, boots, gloves or mittens, and a hat. 
•	Do not let individuals stay out in the cold too long.  Time limits depend on how cold it is.   Call individual inside periodically to warm up. 
•	When possible, individuals who are particularly at risk (e.g. elderly, people with poor circulation, non-ambulatory status) should not go outdoors when it is colder than 32 F (or 4 degrees C). 
•	Use common sense: for example, if there is a cold or frostbite warning issued, do not let the individuals out outdoors at all.  If they must go out, accompany them and ensure that they continue to wear the protective clothing (such as coat, hat, and gloves) throughout the time that they are outdoors. 
•	Make sure the individual’s clothing is dry.  Change into dry clothing immediately as wet clothing can make frostbite occur quicker 

What Are The Signs of Frostbite? 

The signs and symptoms of frostbite include: 
•	Numbness or pain in the fingers, toes, nose, cheeks or ears 
•	Skin may be blue, white and/or blotchy
•	The skin is blistered, hard to the touch or shiny 

What Should be Done when Frostbite is Suspected ?

Remember that prevention of frostbite is the best approach; if there is a possibility of frostbite, take the following steps: 
•	Take the individual indoors immediately 
•	Ask the individual to gently move the affected body part to increase blood supply to that area 
•	Be gentle, as frozen tissue can be damaged easily. Do not rub or break blisters and do not massage the frozen area or rub it with snow or ice
•	Bring the individual to the nearest Emergency Room for evaluation and treatment.
•	Inform the nurse and/or supervisor

* Adapted from Dr. Paul Roumeliotis’ (an American Board of Pediatric certified MD web site: http://www.drpaul.com .

	You’re Mother Was Right…Wash your Hands!

The return of cold and flu season seems the right time to review with everyone the need to wash their hands often, including the hands of the people we support. Besides the flu vaccine, hand-washing is cited as being the single most preventative step you can take to protect yourself from the flu. Recent studies have confirmed that hand –washing with soap and water or applying alcohol-based handrubs between caring for different individuals and throughout the day reduces the transmission of bacteria or viruses (germs) significantly; in some settings as much as 85%! Below are some facts that you may find very interesting and that may help you, your family and the people with whom you work to stay healthy, especially during flu and cold season.

•	Improved hand washing or use of alcohol-based handrubs has been shown to actually end outbreaks of infections, reduce the transmission of antibiotic-resistant bacteria (like MRSA) and reduce overall infection rates.
•	The CDC is recommending the use of alcohol-based handrubs for people who provide personal care to others because they can address some of the obstacles staff encounter when taking care of people. For example, lack of appropriate hand-washing opportunities when out in the community.
•	Hand-washing with soap and water is still highly recommended to reduce the spread of germs. Using an antibacterial soap like Dial is also recommended. Use of liquid or foaming soaps in pump bottles is better than bars of soap.
•	You should wash your hands for the length of time it takes you to sing “Happy Birthday”.
•	When your hands are visibly soiled you should wash with soap and water.
•	The use of gloves does not eliminate the need for hand-washing and hand washing does not eliminate the need for gloves. Gloves reduce hand contamination by 70-80% , prevent spreading germs to others and protects everyone from infection. Handrubs should be used before and after care is provided just as gloves should be changed before and after providing care.
•	Alcohol-based handrubs significantly reduce the number of germs on the skin, are fast-acting and cause less skin irritation than many soaps. Allergies are very uncommon.
•	Staff should avoid wearing artificial nails and keep natural nails less than ¼” long if they are caring for individuals at high risk for acquiring infections.
•	Just as you encourage people to “ cover their nose or mouth” when coughing or sneezing, you should encourage them to wash their hands after doing so as well as frequently throughout the day.

Remember, the infection you prevent may be your own!

                                                                                                     
WINTER  WEATHER  SAFETY

Snow can be beautiful as it falls, but dangerous as it accumulates on the ground.  So…

•	Make sure equipment for shoveling is in good repair and readily accessible.
•	Make sure outdoor lighting is operating properly. Darkness falls early in winter and navigating icy  paths without proper lighting can be treacherous.
•	Have salt or sand handy to use after a snowfall or when icy. Place it in readily accessible places  both inside and outside.
•	Now that the equipment is handy, shovel quickly after a snowfall and use salt or sand on icy  surfaces to ensure that all exits, not just the main exit from the home, are clear and safe  to travel at  all times.  Also remember that wet leaves and grass can be slippery too.
•	Keep a couple of blankets in the trunk in case you break down or get stuck. It will keep people  warm while you wait for help to arrive. Remember, people who are not able to move  around  much on their own will feel the cold much more quickly. Never leave  anyone unattended in  the vehicle for any reason.
•	Have flashlights strategically located in the event of a power outage.
•	Individuals should be dressed warmly with properly fitting clothing. Several thin layers will help keep them dry as well as warm. Clothing should include long johns, turtlenecks, one or two shirts, pants,  sweater, coat, warm socks, boots, gloves or mittens, and a hat.
•	Do not let individuals stay out in the cold too long.  Time limits depend on how cold it is.   Call individual inside periodically to warm up.
•	When possible, individuals who are particularly at risk (e.g. elderly, people with poor circulation,  non-ambulatory status) should not go outdoors when it is colder than 32 F (or 4 degrees C).
•	Use common sense: For example, if there is a cold or frostbite warning issued, do not let the  individuals out outdoors at all.  If they must go out, accompany them and ensure that they continue  to wear the protective clothing (such as coat, hat, and gloves) throughout the time that they are outdoors.
•	 Make sure the individual’s clothing is dry.  Change into dry clothing immediately as wet clothing can make frostbite occur quicker.
•	Change the batteries in all battery operated smoke detectors, carbon monoxide detectors and  flashlights.
•	Ensure that the fireplace is inspected and cleaned for winter use.
•	Arrange for the furnace to be inspected and cleaned, and ensure that there is plenty of fuel to begin the winter.  
•	Space heaters should not be utilized as a heating solution.
•	Make sure that all outside heat ventilation outlets are free from snow and Fall debris.
•	All residential locations are required to have at least one Carbon Monoxide detector within 10 feet of  bedroom doors.
•	Continue to ensure that there is adequate staffing, especially during and around 
      holidays, winter  storms, and possible illness.
•	Inform all staff of individuals’ holiday plans and routines.
•	Ensure that holiday items are used safely, for example, a live Christmas tree needs to be watered regularly so as not to become a fire hazard, holiday lights and candles should not be unattended, and extension cords should not be used.

WINTER CAR SAFETY TIPS

Drivers, especially those transporting individuals with disabilities should make an extra effort to keep vehicles in good repair and gas tanks at least ½ full at all times to avoid emergencies.   With the beginning of the cold weather season, there are certain additional precautions that people should be aware of.

Prevention is the first strategy.  Ensure that the car and/or van has been tuned and equipped for winter.  
•	Make sure your vehicle has the right type of tires.  There are many tires that are 
      specifically made for slippery conditions and snow.  Tires need to have adequate tire
      pressure at all times.
•	Know what to do and who to call in an emergency.  Consider AAA coverage or other
      roadside assistance membership.
•	Make sure that the car contains scrapers, water, flashlight, and blankets in the event of a
      breakdown.
•	Familiarize yourself with how the particular car/van operates in slippery conditions; know the  braking power and how to drive in poor weather conditions.
•	Allow yourself extra time to get places.
•	Familiarize yourself with the best winter routes to arrive at your destinations safely (hills and some secondary roads can be especially slick in the winter).

In the event of a breakdown, remember the breakdown lane may be a safer place than the travel lane of a road, but it is not a safe place to be.  So,
Pull over as far to the right as possible, away from the travel lane
•	If possible, pick a spot highly visible to oncoming traffic, NOT just over the crest of a hill, or on a blind curve.  It may be safer to pull on to the grass
•	Park in a spot which allows room to get out, not on an overpass or bridge
•	If the breakdown is at night, stay in the vehicle under a streetlight
•	Put on your hazard lights and only if it is safe to do so, put up your hood.    This signals to others your distress
•	Use your cell phone and call 911 for any roadside emergency.
•	One driver and one individual could probably safely exit the vehicle and stay behind a guardrail or on the grass away from the vehicle
•	When one driver is transporting more than one individual it is usually safer to stay in the vehicle with seatbelts buckled, hazard lights on and  hood elevated
•	On any road or highway, know when a “breakdown” lane is an active travel lane. In the Boston area, during the morning and evening commuter rush Routes 3, 93, 95 and 128, allow breakdown travel.  Posted signs show the hours

2008 Medicare Part D Update

Following is information related to changes in the Medicare Part D Prescription Drug Plans for 2008.  More Information about the 2008 Medicare Part D prescription plans is available at www.medicare.gov. 

Any individual that we support who has Medicaid (Masshealth, Commonwealth) and Medicare is considered dually eligible and should be enrolled in one of the 14 Low Income Subsidy (LIS) plans. They are:

Aetna Medicare Rx Essentials
First Health Part D Premier
Health Net Orange Option 1
Health Spring Prescription Drug Plan – Reg. 2
Humana PDP Standard 55884-061
Medco Medicare Prescription Plan Value
Member Health Community CCRx Basic
Pennsylvania Life Insurance Company Prescription Pathway Bronze Plan Reg. 2
Rx America Advantage Star Plan
Silver Script Insurance Company – Silver Script
Sterling Life Insurance Company – Sterling Rx
UnitCare – Medicare Rx Rewards Standard
UnitCare – Medicare Rx Rewards Value
WellCare Classic

In most cases, people will remain in their 2007 plan.  However, some people will be moved automatically into another plan if their 2007 plan is no longer LIS or available.  Some will be moved to a new LIS plan within the same company as their 2007 plan.  Others will need to enroll themselves into  a new LIS plan if their 2007 plan is no longer an LIS plan or is no longer available. Enrollment starts November 15 – December 31 and the plan will be effective  January 1, 2008.

If an individual receives a blue letter from Medicare (CMS) they will be moved to a new plan automatically.

If an individual receives a tan letter, they need to enroll themselves in a new LIS plan. 

Remember:
Dually eligible individuals (those with both Medicare and Medicaid) can change their plans as often as they want
All duals should be in a LIS plan if they want to avoid monthly premiums and have a co-pay of only $1 or $3.
If you need any help, contact Sharon Oxx at Sharon.Oxx@state.ma.us or call 617-624-7792.

If you find that family members of people you support need assistance with their own enrollment they can contact  SHINE (Serving Health Information Needs of Elders) Office at: 1-800-243-4636 and press “2”

                       Did you know?

Beginning with this edition of Living Well, we are starting a new section.  The “Did You Know” section will present information gathered through the Department’s incident management system known as HCSIS.  All providers, both public and private report on unusual or critical events in peoples’ lives.  The reporting system helps us to respond effectively to individual incidents, but also helps us to identify patterns and trends that might help us all to prevent similar instances from occurring in the future. By reviewing and analyzing reported incidents over time, we can share information with you that may assist you in your efforts to support individuals to be safe and healthy.

Here is the first article based on our review of incidents involving missing persons.

Incidents Involving Missing Persons
The definition of a Missing Person is “someone who is missing for any period of time, if considered in immediate jeopardy, or someone who is missing for more than 24 hours without prior arrangement. Based on a review of the incident management system, 208 reports of a “missing person” were documented between April 2006 and March 2007.

•	Most individuals went missing Monday – Friday rather than on weekends , although there was not a big
      difference between weekdays and weekends
•	The hours of 12am and 3pm were the two most common hours during which individuals were reported missing
•	The highest number of individuals missing were in July and August
•	Twice as many males as females were involved in these incidents
•	Most missing person incidents occurred for persons between the ages of 18 and 54 years

What’s the good news?

While law enforcement was called in slightly more than one half (57%) of the cases, most folks are found quickly, unharmed and close to their home.

What can you do?

•	Be aware of the times that people are most likely to wander off ( 12am and 3pm) and be watchful
•	Check the environment when you arrive at work to see if all residents are accounted for
•	Periodically check on individuals who are more likely to go missing
•	Consider staffing needs when planning upcoming holiday and community activities
•	Consider a review for individuals where this is a new behavior and consider what strategies might be 
      put in place
•	Discuss the need for alarms on doors to the outside, or other modifications, if there is someone who is likely to wander.

                                               
PICA
What you should know
What is Pica?

Pica is an eating disorder that involves the eating of nonfood substances.  Some examples are: dirt, paper, paper clips, latex gloves, plaster, plastic, pencils, string and cigarette butts.  People have been known to ingest items that most of us couldn’t even imagine being able to swallow like light bulbs, bed springs, needles, face clothes, etc.  No one really knows what causes it but it is most common in young children and individuals with developmental disabilities.  In some circumstances it may be
 Indicative of an iron or other nutritional deficiency. 

What are the risks of Pica?

Pica can place the individual at great health risk, even death.  It can lead to:
•	Poisoning
•	Infections and parasitic diseases 
•	Severe problems with the gastrointestinal tract (esophagus, stomach and bowels) like tearing holes in the esophagus, stomach or bowel, obstruction (blockage) of the bowel or ulcers.

What should I do if I support someone with Pica?

•	Your agency has probably developed a protocol that is a set of procedures to follow in order to assist a person with Pica
•	Make sure you are aware of all the steps you can take to assist an individual to be safe, including things like level of supervision, securing items that might be ingested, what to do when you are aware or suspect that the person has eaten a non-food item, etc.
•	Review the protocol at regular intervals to make sure it is working

What should I do if I know or suspect that someone has ingested a nonfood item?

•	Follow your protocol
•	Contact your agency nurse or the Health Care Provider (HCP)
•	Do not hesitate to take someone to the ER or insist on an office visit if you feel the individual is not improving after following the protocol or the instruction of the agency nurse/HCP

	
This information is now available on the DMR website under “Health Promotion and Coordination Initiative: Signs and Symptoms of Illness”