Department of Developmental Services
Office of Quality Management

Living Well

WINTER 2011

Department of Developmental Services 
Office of Quality Management
Living WELL

Winter 2011

Welcome to the Winter 2011 issue of "Living Well", a publication of the Department of Developmental Services, 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 spring and summer activities in a safe and healthy manner.

"Living Well” represents one component of DDS's continuing commitment to share information which will safeguard and improve individuals’ quality of life.  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 Developmental Services

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.

Don’t forget about the pneumonia vaccine!
 Everyone should receive it once between age 19 and 65 and receive a booster after 5 years if they have chronic renal failure, sickle cell disease, a spleen removal or if their immune system is weak.  Everyone should get a booster after age 65.

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!

		

Let It Snow, Let It Snow, Let It Snow 

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 and/or sand handy to use after a snowfall or when icy. Place it in readily accessible places both inside, outside and in the vehicle.
•	  Now that the equipment is handy, shovel quickly after a snowfall and use salt or sand on icy surfaces to ensure that all exits, fire escape routes, sidewalks and  driveways, not just the main exit from the home, are clear and safe to travel.  Also remember that wet leaves and grass can be slippery too.  
•	Have flashlights strategically located in the event of a power outage.  
•	
Winter activities can be fun.  But remember, 
o	When people go out, make sure everyone wears proper footwear to minimize the possibility of falls.  
o	People should dress in layers and appropriately for the weather.  This is especially important for individuals who are less mobile, as they can suffer from the cold more quickly if they are unable to move their arms and legs.  When in doubt, bundle up!  

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.  Blankets help 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.
•	Keep some sand and kitty litter, and a small shovel in the trunk; it can really help get you out of a slippery situation. 
•	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.
•	Only if possible and considered safe to do so, staff and the individual can exit the car from the side away from traffic 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

2011 Medicare Part D Update

Information about the 2010 Medicare Part D prescription plans is available at www.medicare.gov. Enrollment can also be done from this site.

Any individual that we support who has Medicaid (Masshealth, Commonwealth) and Medicare is considered dually eligible and should be enrolled in one of the 11 Low Income Subsidy (LIS) plans available in 2011 in Massachusetts. They are:

•	Bravo Health Insurance Co.: BravoRx  
•	First Health Part D: First Health Part D Premier
•	Health Net: Health Net Orange  Option 1
•	HealthSpring Prescription Drug Plan: HealthSpring Drug Plan – Reg. 2
•	Rx America Advantage Star Plan
•	Silverscript:  CVS Caremark Value  (Formerly SilverScript Value) * New Name 
•	Universal American: Community CCRx Basic
•	Humana Walmart – Preferred RX Plan * New
•	Unicare: Medicare RX Rewards Standard * New
•	United Healthcare: AARP MedicareRX Preferred * New
•	Wellcare Classic * New 

The 2010 plans that will no longer be LIS plans in 2011 are:
•	Aetna Medicare: Aetna Medicare Rx Essentials 
•	Cigna Medicare RX: Cigna Medicare Rx Plan One
•	Medco Medicare Prescription Plan - Value
•	United Healthcare: AARP MedicareRx Saver 
•	Universal American: PrescribaRx Bronze 

In most cases, people will remain in the same plan they had in 2010.  However, some people who were automatically enrolled in their 2010 plan will be moved automatically into another plan if their plan is no longer LIS or available in 2011.  Some of those individuals will be moved to a new LIS plan within the same company as their 2010 plan.  If an individual receives a blue letter from Medicare (CMS) they will be moved to a new plan automatically because the plan they were automatically enrolled in for 2010 will no longer be a LIS plan in 2011.

Others will need to enroll themselves into a new LIS plan if they voluntarily chose their 2010 plan and it is no longer an LIS plan in 2011 or is no longer available. Enrollment starts November 15 – December 31 and the plan will be effective January 1, 2011. If an individual receives a tan letter from Medicare (CMS), they need to actively enroll themselves in a new LIS plan as the plan they voluntarily enrolled in for 2010 is no longer a LIS plan in 2011. 

Enrollment starts November 15 – December 31 and the plan will be effective January 1, 2011

Remember:
•	Blue letter from Medicare (CMS): no need to take any action. Individual will automatically be enrolled in a new LIS plan and receive a new Part D prescription card for their new plan for 2011.
•	Tan letter from Medicare (CMS): Action must be taken to enroll individual in a new LIS plan for 2011. Once enrolled, individual will receive a new part D prescription card. 
•	Dually eligible individuals (those with both Medicare and Medicaid) can change their plans as often as they want during the year.
•	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.

Medication Occurrences: Did You Know?

Based on a review of medication occurrence reports (MORs) entered into the HCSIS system between July 1, 2009 through June 30, 2010 there were:

•	4635 MORs
•	74% (3405) were “Wrong Time” occurrences
•	87% (2977) of the “Wrong Time” occurrences were Omissions (meaning the medications were not given)
•	The second most common contributing factor to MORs overall was “Medication Not Available” at 26%.

What’s the good news?
•	Because we now have the HCSIS system, we are better able to know more specifically why they are happening and provide some ideas about how we can all work to reduce them.
•	Most of the omissions MORs due to medication not being available are preventable with a little planning

What can we do?
•	Set up a system so that medications are reordered when the program is down to a 7 day supply. Write it down so all Certified staff know where to find the procedure.
•	 Know who can order them, where to order them and who should be made aware when they were not delivered.
•	 Make sure you cover for people on vacation if they usually order refills or new medications.
•	If you think a medication will need prior approval from the individual’s prescription plan, have the Health Care Provider order it “when medication is available from pharmacy” in order to prevent having to count it as an MOR when it cannot be started in a timely way.
•	It is every MAP Certified staff’s responsibility to ensure that medications do not run out or are ordered in a timely way.

Remember: the people you support rely on you to make sure they receive their medications as prescribed by their HCP every single day.