HQAA Blog

Just about every July 4^th, I’m reminded of a holiday weekend in the late 1980’s, when I was just a pup. Well, not a “pup”, but a young respiratory therapist working in homecare and enjoying the Monday-Friday routine with no weekends, no holidays, and no night shifts. As an RT, to be in your late 20’s, and achieve a job with no shift work and no holidays was pretty amazing. I had mentors from the local hospitals that were my parent’s generation who were still working every other weekend and still working shifts and holidays. This particular July 4^th fell on a Monday or a Friday (I don’t remember which), meaning there was a three-day weekend associated with it. Picnics, fireworks, getting together with friends, and a trip to the lake were all on the schedule. For the first time since college, I wasn’t going to be working a night shift or a holiday day over this important summer holiday!

You could write a book about “employee vs. contractor” pros, cons, legality, and operational efficiency. In fact, there are books written about that very subject. There are also lawyers who specialize in employment law who advise companies about how to structure their staffing around those two broad categories of staff. While accreditation organizations won’t delve into the legalities (that’s for the lawyers to do), accreditation standards DO in fact address both categories of staffing.

Part of our family’s holiday season tradition is the annual watching of “IT’S A WONDERFUL LIFE”. The movie is –in my opinion, anyway--a masterpiece of happiness and positivity. The primary lesson of the movie is that our deeds, both good and bad, have a profound effect on the lives of other people in our circle of friends and family. The main character, George Bailey, finds out in dream sequences reminiscent of Charles Dicken’s “A CHRISTMAS CAROL” that his life has had profound meaning because of his good work, kind deeds, and charitable attitude.

The holiday season is a time for merriment, good food and drink, decorating home and workplace, holiday parties, gift-giving, and cheer. It’s also a time for giving. When I visit home medical equipment companies in November and December--whether for consulting purposes or accreditation surveys—I sometimes ask about the holidays and what an organization does to celebrate the holiday season. The replies offer insight into the corporate culture and speak to the character of the companies.

I notice with great interest and growing optimism about the future of our industry that the trend seems to be increasingly about giving, sharing, and community service and moving away from the stereotypical office party of days past (think Mad Men).

I’ve heard a wide variety of customs and practices including gift exchanges, taking turns working at Salvation Army kettle drive locations, pot lucks that include inviting the patient/customers, volunteering at a soup kitchen, or simply getting together outside of work for a nice dinner together. These parties and other shared experiences serve several useful purposes. They promote a culture of togetherness and “family”—a sense that the organization you work for is more than a job, it’s a group of people working together for a common goal. They also give team members an opportunity to get to know their co-workers better by sharing a meal or a conversation at a deeper level than possible during work hours. The holiday service projects give employees a chance to work on shared projects which promotes team building. Hopefully, they are also a fun way to spend time together with co-workers to build deeper and friendlier relationships.

One of my consulting customers specializes in mobility: basic wheelchairs all the way up to custom rehabilitation equipment. They also do home modifications such as chair glide systems and building accessible ramps. They are a quality company that was accredited long before it was a requirement because they wanted the community to know their commitment to doing things right. They told me a story about their Christmas “project” last year. The Christmas project was something they elected to do in lieu of a party. The company gave them time off to do it and supported the project financially. Every employee from top to bottom, including the owners, had skin in the game and participated.

It seems that a family in their small town needed medical equipment. The driver delivered the equipment and supplies and identified several hazards around the house as he assessed their environment. He documented his findings and discussed them with the family, who said they could not afford to make many of the changes that were suggested. On a return visit, he noted that they had made some of the changes that were not particularly costly including removing area rugs and moving furniture around so that the family members with mobility problems could navigate the household.

Three generations were living in the house: a couple along with several children, and also a grandchild. The couple both had serious medical problems that made mobility challenging. They needed a ramp to get in and out of the house, and would also benefit from scooters. The husband had COPD and heart problems, which limited his ability to get out and walk; and his wife was a diabetic and an amputee, who got around in the house okay, but could not go out without a wheelchair (or scooter).

The driver mentioned the family again at an organization-wide meeting and discussion ensued. Eventually, the company decided to help the family by building an accessible ramp on their front porch/entrance to the house. They discussed plans with their home modification department and of course, the family. They got consent from the family and an estimate of material costs. The owner donated the material with the stipulation that staff would pitch in and “donate” their labor. The team effort kicked in and the ramp was built in a few days in October 2017.

In the course of working at their house, the owner was talking to the family about accessibility and decided to also make a few minor modifications in their bathroom for enhanced safety. These included grab bars in several places. The owner recounted how “making these small, seemingly insignificant improvements was easy for us—it’s what we do”. He also noted that these improvements were no big deal for his staff, but meant the world to the family.

When the project was finished, the team was so inspired by the good feeling they got and the appreciation the family exhibited that they decided to work together to get the couple scooters. The warehouse manager reminded the team that they had a “trade in” scooter in the obsolete area that could be fixed up easily. The owner bought parts, authorized repair/refurbishing, and considered getting another scooter for the couple. When he called his vendor/sales rep to ask for pricing and explained what they were wanting to do, the rep actually donated a scooter from his demo inventory!

The day before Thanksgiving, 2017, DME staff stopped back at the home to deliver two shiny scooters to a family in need. Along with the scooters, they brought a 20 lb. turkey and several pumpkin pies from a local bakery.

In the DME storefront, hanging on a wall above their license, a copy of the Supplier Standards, and a picture of the store on the day it opened hangs a Christmas card with a beautiful note from the family and a picture of the couple with their children and grandchild visiting a huge outdoor Christmas light display. The card reads, “Made possible by the generosity of a company made up of some of the most caring people we are blessed to have in our lives." 

Incorporate and emphasize giving in your holiday traditions, and you’ll be richly rewarded with a great feeling of satisfaction that is better than any gift exchange or party. And keep your eye on the ball: despite the tough reimbursement climate and the many challenges that face our industry today, most of us got into this line of business and work because it was a caring profession. Keep caring no matter what!

HAPPY HOLIDAYS everybody.

Many in the home medical equipment industry equate policy manuals to their accreditation inspections. And of course, these bulky tomes are certainly a large part of the accreditation and survey experience for every DME. Policy manuals serve as the road map for how work gets done within an organization, a set of rules for the organization, and the document that defines the structure, function, and philosophy of the organization. Let’s look at what a policy manual should contain and how it impacts not only accreditation, but also the overall day-to-day operation of an organization.

A cousin of mine just passed away a few months ago after a long illness.  He was fortunate to be able to spend his last few weeks at home with the family and friends he loved around him, either looking out the window at his beautiful backyard or some days, on the back porch.  “Fortunate” is a relative word: he was in his early 50’s and should have lived a lot longer.  On the other hand, after weeks in hospitals and long term acute care (LTAC) facilities, he (and his family) were grateful that he was able to spend his last days at home.  During those last weeks, he tapped into the durable medical equipment industry more than most people do in a lifetime.  

HQAA fields quite a few questions about ventilator care and whether or not the care is “clinical” in nature or non-clinical.  It may be helpful to clarify some points about ventilator care and review the definition of clinical respiratory services. 

Towards the end of the Provision of Services (PS) standards, almost to the end of the section, is the very simple accreditation standard PS 9: The Coordination of Care.  The standard, in very simple, straightforward language, reads:

The organization documents the coordination of care between all those involved in the delivery of services or equipment/devices to the client. The organization documents communication with the client and between providers in a standardized manner within the client medical record.

Clinical respiratory services (CRS) are hands on care, assessment, or treatment, governed by state regulations including Respiratory Practice Acts and Licensure Laws.  It is usually physician-prescribed in conjunction with medical equipment services.  Most of the DME organizations that provide CRS do not get paid for the services and do them as an adjunct to providing some kind of equipment services, such as an oxygen or ventilation program.  Because of the limited opportunities for reimbursement for these services, organizations

“Ride alongs” are home visits that are performed with a new orientee or current staff member where an evaluator rides along to teach and observe the staff member performing the visit.  These visits are typically done during orientation/training and on an on-going basis for competency assessment.  These visits ensure that all of job-related tasks are being performed in a correct manner while the staff member is unsupervised in the field.