The Division of State Operated Healthcare Facilities recognizes May 11-17, 2014 as National Nursing Home Week. The three Neuro-Medical Treatment Centers within the Department of Health and Human Services – Black Mountain, Longleaf and O'Berry – join the thousands of nursing facilities across the nation in celebrating a week of recognition.
This year’s theme, Living the Aloha Spirit, captures the importance of ensuring that our staff in the facilities provide an environment filled with deep caring, respect and humility. We are fortunate that the neuro-medical treatment center staff embody the spirit of the Hawaiian islands by applying the spirit of “aloha” to their daily work by creating a better world for the people we serve in these three facilities. Thank you so much to the employees of these facilities.
The population of our state is increasing. By 2025, 89 of our state’s 100 counties are projected to have more people age 60 and older versus those ages 17 and younger.
This month is Older Americans Month, an an observance that recognizes older Americans for their contributions and demonstrates our state’s commitment to helping them stay health and active. Throughout the month, local aging service providers across the state will be conducting activities and providing tips on how to avoid the leading causes of injury.
North Carolina is facing a very big mental health care challenge — 28 counties across the state do not have a single psychiatrist. That’s despite the fact that in recent years, emergency rooms in the state have seen more patients with mental health, developmental disability or substance abuse problems.
So the state is trying telepsychiatry. When a patient comes into an emergency room, they can be connected via a two-way video connection with a psychiatrist. A recent study by the nonpartisan North Carolina Center for Public Policy Research found that the method is having some success in providing more timely treatment.
One of the psychiatrists, Dr. Sy Atezaz Saeed, told NPR’s Robert Siegel that that’s very much like being face-to-face with a patient.
“When you ask patients about this experience, most of them will tell you that after a few minutes of some hesitation, they even forget that they are talking to the doctor via this monitor,” Saeed, the chairman of the psychiatry department at the Brody School of Medicine at East Carolina University, says.
The program uses a secure teleconferencing system to connect doctor and patients rather than services like Skype.
Saeed answered more questions about the differences, privacy concerns and the long-term effects.
Interview Highlights
On whether it’s feels different for the psychiatrist
Usually people would think as if there is a loss, but really — just like for the patient — once I have been involved with this visit after a few seconds, I will even forget about the fact that it’s coming via telepsychiatry. [But] I would not want to do a clinical visit via telephone.
On how telepsychiatry can work in the long term
It’s not only possible, there are places that are doing it. There was a very interesting study that was done a few years back where patients who were being seen via video conferencing were given the option — about a year into it — by their therapist to come back on campus and meet with their therapist. And more than half of them declined.
On privacy concerns
I’m very clear in my very first contact with the patient that the conversation is not being recorded. If a visit is being recorded for some educational purpose or research purpose, we have to go and explain to the patient why this is being recorded and the patient must sign the release for that.
The only person that may be listening in is an emergency department nurse. Because sometimes situations arise where the patient expresses some thoughts which lead us to the concern of harm to the patient or others. And if I say, ‘Well, you know, you need to be admitted,’ and the patient says, 'No, thank you, I don’t want to be,’ there are times that I have a legal obligation of admitting someone, even against their will. So I need someone on that other end.
On building rapport
There are different types of examinations. So when I’m seeing someone in an ongoing fashion, absolutely, a rapport is needed. But there are times that we get called in to see a patient for a consult and this is the only visit that ever takes place.
The project that we are talking about, that’s only a consultation project. So we get to see a patient only once. … And that patient then gets referred to someone else. Now that someone else, if they elect to see this patient via telepsychiatry, that therapeutic alliance would still develop. And there is nothing out there that says you can’t do that via video conference.
North Carolina General Assembly legislative assistants from across the state attended a training April 28 to help them work with older adult constituents and their family caregivers, as part of an in-service training.
The training was hosted by AARP and the N.C. Division of Aging and Adult Services (DAAS) and was intended to empower the legislative offices to be able to help their constituents to stay at home by helping them find resources to stay safe and healthy.
North Carolina ranks 9th overall in the older adult population resulting in a significant number of varying issues being brought to the legislative offices. By 2025, North Carolina will grow to have 89 of 100 counties with more people 60 and over than 17 or younger as the baby boomers continue to age. This shift in dynamics makes the DAAS’ & AARP’s mission to prepare the state to handle that shift even more important.
This training came just in time for the start of Older Americans Month, which began on May 1. The theme of the awareness campaign is Safe Today. Healthy Tomorrow.
“Cut the Tie” participants sport shortened neckties, from left to right: Randy Burwell, Rick Coble, Ralph Leggett, Jack Rogers and Ron Byrd.
North Carolina is hosting the ERISCA (Eastern Regional Interstate Child Support Association) conference, on May 18-22 in Greensboro. At each conference, the host state is asked to select a children’s charity to support. North Carolina chose Victory Junction, a camp for children with acute illnesses or disabilities.
Located in Randleman, Victory Junction enriches the lives of children with serious illnesses by providing life-changing camping experiences that are exciting, fun and empowering at no cost to the children or their families. Victory Junction is a member of Paul Newman’s renowned SeriousFun Children’s Network and is accredited by the rigorous guidelines of the American Camping Association.
Daisie Blue, Child Support Services Section Chief, asked all Division of Social Services staff to participate in the fundraiser activity for Victory Junction. The concept of the activity was to have the men of DSS wear a tie which they would allow to be cut off one inch in exchange for a minimum $2 donation.
With a total of $659.15 raised, including $177 from the supervisor’s annual meeting, Ron Byrd, section chief, Division of Child Development and Early Education (DCDEE) was the fundraising leader with $105 raised for the cause with multiple cuts on one tie. Ron credits the generous donations of the staff from DCDEE for supporting his efforts and noted, “This was more fun than putting socks on a rooster.”
Traditionally, ERICSA brings together child support professionals from government and private agencies, the courts, and public and private attorneys from 35 states and territories bordering on and east of the Mississippi River, as well as several tribal nations. A special focus of ERICSA is to improve communication and cooperation among states and jurisdictions for the interstate enforcement of child support obligations.
NC DHHS nurses serve North Carolinians with mental illness, substance abuse issues and developmental disabilities in our facilities located across the state.
Cherry Hospital sponsored a booth on April 25 at Berkeley Mall in Goldsboro to share information with the community about the new hospital and services available, such as a speaker’s bureau and museum tours. In the photo above, left to right: Vernell Grantham, volunteer; and Arlene Lindsay and Darrell Raynor, Cherry Hospital Public Relations Committee members, are ready to greet their next visitor.
Louisville, MS - Tornado recovery continues in hard hit Winston County where residents will soon find the return of medical care.
One week after an EF4 tornado slammed into the Winston County Medical Center, a temporary hospital is going up about two miles away. The FEMA Mobile Medical facility was transported from North Carolina this weekend to Louisville.
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“What my dream was when I developed this for the White House as senior medical advisor to the Department of Homeland Security was to try to keep the medical infrastructure in the community operating so that they could not only take care of the patients in the community, but they could keep their staff employed,” said Mobile Disaster Hospital Advisor Dr. Lew Stringer with the North Carolina Department of Health and Human Services.
The mobile hospital will have 10 beds, a five bed emergency department, an x-ray unit and full surgical capabilities. It sits on the concrete slab of new concrete in some areas, surrounded by sheared trees. The hollowed out shell of the former facility is a noticeable backdrop for the giant connected containers.
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Electricity, water and sewer must be connected to the mobile medical site. The hospital should be fully operational in about two weeks.
“Close to 6,000 healthcare workers haven’t returned to Louisiana after Hurricane Katrina. They had to go somewhere to eat. So if you can keep it going, you not only help the community, you help the whole community including the healthcare providers,” added Dr. Stringer.
According to medical officials, the mobile hospital will serve the people of the Louisville area until the Winston County Medical Center is rebuilt.
To view photos of the Mobile Disaster Hospital, including the setup in Louisville, click here.
For more information on the Mobile Disaster Hospital, click here.
Photo by Erin Brethauer, ebrethau@citizen-times.com
ASHEVILLE – As retired surgeon Robin Cummings takes over as head of North Carolina’s Medicaid program, he faces major changes in the health care system, Medicaid reform efforts and a state agency that has seen its image damaged over the past year.
State Department of Health and Human Services Secretary Aldona Wos named Cummings, 58, to the job Tuesday. He replaces former Medicaid director Carol Steckel, who resigned last year.
“Medicaid is a $14 billion company. We’re the largest insurance company in North Carolina, when you look at it,” Cummings said. “But unlike Blue Cross Blue Shield, we’ve got a ton of federal and state people looking over our shoulder, which makes it even more difficult. We’ve got a lot of challenges.”
Cummings was in Asheville Friday meeting with officials at Mission Health. He also sat down to answer questions from staff at the Citizen-Times.
Question: What impact will Medicaid reform have on overall health care in Western North Carolina?
Answer: I think the reform package, the proposal we put forth has a lot of potential to put providers in charge of health care and give them a chance to — if they perform — have some financial benefits as well.
The proposal, the idea behind it is it will allow providers in areas to come together as a group and form what we call an accountable care organization. The idea behind an accountable care organization is the providers come together, they bring a number of Medicaid patients to North Carolina. North Carolina will then contractually work with them to say if you take care of say, for example, this 20,000 Medicaid patients, at the end of the year if we look and you’ve met our quality parameters and you’ve done a good job taking care of these patients and there are savings, the state is willing to share those savings with you.
Q: How many accountable care organizations do you envision in North Carolina?
A: Don’t have a set number, but we think eventually it will be 25 give or take five. So 20 to 30 to cover the state.
Q: What about Community Care of North Carolina, the network that is in place now, what will its role be?
A: I was a medical director for CCNC for five years (at Community Care of the Sandhills) and so I believe in the model. I know it’s a good model, and I think it’s one we can build upon and incorporate into this ACO model.
If you think about what an accountable care organization will be doing, they will be doing exactly what CCNC does — the care coordination, going out working with the patient, making sure the patient knows medications they are supposed to be on, why they’re on them, encouraging them to keep their appointments, getting them involved in their own care …. All of that really is what an accountable care organization is going to want to do, and in a way CCNC has laid the ground work for us.
There are 14 networks (as part of Community Care). It may be that some of the networks will want to form an ACO. It may be that some of the networks will join with their local Mission hospital or their local health system and form an ACO.
Q: What is the biggest goal with reform?
A: My vision for what we’re trying to do here is create a health care system with Medicaid that is patient-centric, provider-driven and has predictability in the budget and then finally is sustainable for the future.
Q: Any chance that North Carolina is going to expand Medicaid?
A: I would say that, as they say, is above my pay grade.
I would agree with what the governor said. We need to get Medicaid itself stabilized. Expansion would have brought 500,000 to I’ve heard as high as 750,000 additional people into the system. I’ll tell you right now, I think that would have broken it. We’re challenged now with what we’re doing. … The departments of social services in the 100 counties are responsible for signing people up for Medicaid and for a lot of other things. Those folks are hurting. What has happened is that system in our counties has not evolved with the load, with the work demands.
Q: What is the future of the local management entities/managed care organizations that have oversight for state-paid and Medicaid-paid mental health services in the state?
A: When the secretary and Medicaid director Steckel went around (to talk about a reform plan last year), they heard a couple of things. No. 1, we don’t like managed care…. The other thing they heard from the LME-MCOs and the behavior health world was, ‘You guys change what we do every three to four years.’ They said please we’re working with this, give it a chance to work. Let’s see if we can build on this. The decision was made to leave the LME-MCO organization in place, but our experts told us you really need to consolidate them. … The goal is to consolidate the LME-MCOs down to four regions.
Q: Is NC Tracks (the system for processing Medicaid claims) working better?
A: Without question, we have come a long way. We are not where we need to be, but we have come a long way.
Up until three or four months ago, I was getting killed with providers sending me emails (saying) 'Robin, you’ve got to do something about this. I’m not getting paid. I’ve got to have help.’ I get an email maybe every other week now. … We predict another six to 12 months, and it will be to the point where it will be stable. A system like this is always going to require tweaks and adjustments and corrections. Even the 30-year-old system we just replaced, we were tweaking it. This system will be the same.
Winston County Medical Center’s temporary replacement left North Carolina Friday.
That state’s office of emergency medical services is hauling on a convory of tractor trailers its mobile disaster hospital that will serve as Louisville and Winston County’s medical facility until WCMC is either repaired or rebuilt.
The existing Louisville hospital was one of dozens of homes and businesses Monday’s EF-4 tornado either damaged or destroyed. The mobile facility that will temporarily serve in its stead will start to arrive over the weekend, said Jonathan Wilson, University of Mississippi Medical Center’s director of emergency services.
Wilson, who along with the Mississippi State Department of Health is coordinating the mobile unit’s arrival, said the hospital would likely be operational some time next week.
“We’re trying to find a suitable location for it,” Wilson said. “Currently, we’re letting local leadership in Louisville give their ideas about where it could be. Once that’s decided, FEMA will have to give their approval.”
It’s an elaborate set-up. The hospital – which will be staffed by Louisville physicians, nurses and support personnel – will have a 21-bed emergency department featuring an X-ray unit, a pharmacy, a clinical lab, a medical supply unit and a logistical support unit.
Joining it will be a 12-bed intensive care unit, three operating rooms (one with a C-arm and operating microscope), a six-bed post-op recovery room and a rapid response unit.
It’s a perfect fit for the need in Winston County, Wilson said. Mississippi has three mobile hospitals the state used after Hurricane Katrina. But they’re not practical for Louisville, Wilson said, because they’re tents. The North Carolina mobile unit has a hardened outer shell more suited for long-term deployments, like the one in Louisville will require. The latest estimate from the North Carolina Office of Emergency Medical Services is it will spend at least a year in Louisville, according to a press release.
The mobile hospital became available because of an existing relationship between emergency response agencies in North Carolina and Mississippi, said UMMC spokesman Jack Mazurak. North Carolina held training exercises last week designed to sharpen response to situations like the Louisville tornado that Mississippi officials attended.
“The collaboration goes all the way back to Katrina, when North Carolina sent support to Hancock County,” Mazurak said. The two states entered into an emergency management assistance compact after that storm.
Once FEMA approves the location, N.C. Baptist Men, a subsidiary of the Baptist State Convention of North Carolina, will erect the hospital.
Location criteria include an outdoor site with a hard, flat surface with adequate drainage that is clear of overhead obstacles. Good access to roads, including a nearby major highway, are required. A helicopter landing zone also must be available.
For long-term deployments like the one in Louisville, tie-ins to water, sewer and electrical lines are preferred.
“We are anxious to get this equipment in place to help this community begin its recovery,” Aldona Wos, secretary of the North Carolina Department of Health and Human Service, said in a press release.
To contact Clay Chandler, call (601) 961-7264 or follow @claychand on Twitter.
