40% of acutely ill hospitalized patients lack decision making capacity due to cognitive impairment.
ACP helps individuals think in advance about health care choices that they may face and potential risks and benefits of different treatment options.
When ACP doesn't occur, loved ones and health care providers are forced to guess and often struggle with making decisions.
|
|
JSSA and Nexus
Launch Advance Care Planning Program
|
Nexus Montgomery, in partnership with the Jewish Social Service Agency (JSSA), is launching an exciting new program promoting advance care planning in the community.
Advance care planning (ACP) is the process of identifying and documenting what type of health care treatment a person would want during a crisis if they are unable to speak for themselves. ACP can take the form of a conversation, filling out a document or choosing someone to speak for you (a health care proxy). As the US population ages, more and more individuals will be faced with making health care decisions for loved ones and having an advance care plan can help reduce the stress and anxiety of making those difficult decisions.
JSSA will be promoting advance care planning through education, training, and public awareness. JSSA is actively recruiting community partners who will be trained to conduct public information sessions on the importance of advance care planning, how to complete an advance care plan and how to ensure that a health care provider can find the advance care plan in an emergency. JSSA will be also developing messaging to assist the public in understanding what advance care planning is, why it is valuable, and publicize training events.
|
|
Mental Health First Aid Program Trains
The American Muslim Senior Society (AMSS)
|
|
On May 4th, the Mental Health First Aid program trained 15 AMSS members at the Islamic Community Center of Potomac. The First Aid Trainers were from Cornerstone Montgomery. The Mental Health First Aid program has trained 120 people since launching, with a goal of 375 professionals and 375 community members per year.
The Primary Care Coalition was awarded a $370,000 Substance Abuse and Mental Health Services Administration (SAMHSA) grant to provide Mental Health First Aid for Senior Care Providers in the Nexus Montgomery service area. The trainings help front line care providers identify signs of mental illness that may be impacting patients' health, and provide information on how to refer patients to available community-based resources.
For more information or if you are interested in hosting a training, contact Orlando Wright,
[email protected]
|
|
"
Thank you so very much for your incredible support of our community.
We are so privileged to have a program of your stature adopt our community and care so much for our seniors and caregivers in need.
The training was outstanding. We got rave reviews. I would like to thank each of the trainers.
"
- Mona Negm, AMSS Chair
|
|
Urban Behavioral Associates and Green Pharmacy to bring services to Progress Place
Nexus has helped facilitate a collaboration between Montgomery County Health Care for the Homeless, Urban Behavioral Associates, and Green Pharmacy to provide co-located services at the County’s shelter at Progress Place in Silver Spring. Through this collaboration, shelter clients will receive psychiatric services from Urban Behavioral Associates, with medications dispensed and delivered by Green Pharmacy, which will also provide medication therapy management.
These co-located services will increase access to needed, community-based care for underserved clients experiencing homelessness, many of whom end up hospitalized. This program will provide the consistency, time, support, and attention clients need. Nexus is excited to be supporting this productive collaboration with our community partners.
The program will:
1) Provide psychiatric services for individuals experiencing severe mental illness and homelessness.
2) Reduce the use of hospital services for routine medication management that can be more appropriately accomplished in the community.
3) Promote behavioral health management through creative service delivery.
4) If available, collaborate with a client’s existing health care team to provide an additional pharmaceutical resources through Green Pharmacy.
|
|
Nexus to pilot program supporting client transitions from Skilled Nursing Facilities (SNFs) to home
Nexus Montgomery will be implementing a pilot intervention to address hospital readmissions that occur after a patient has been discharged home from a skilled nursing facility.
Patients with limited local family support may have no one enter their home in over a month. In partnership with experienced private duty home health care agencies, Nexus will be providing a resource to accompany the patient home from the SNF, and make the home ready for them – cleaning out the refrigerator, cleaning the kitchen, changing bedlinens, adjusting heating/cooling, picking up groceries and medications, preparing food for a few days, ensuring everything the patient needs is within reach and removing obvious hazards, amongst other tasks. This resource will keep in touch with the patient over the subsequent day or two until Medicare home health is engaged with the patient.
Currently a third of all readmissions of patients passing through a SNF occur after the patient has gone home. There is a 66% reduction in that post SNF readmission rate if the patient receives home health within 48 hours. By addressing the immediate day of discharge needs of the patient, and by providing a better link to home health, we anticipate the pilot reducing readmissions in patients returning home after a SNF stay.
|
|
Project Access Patient Testimonial
|
Name and picture have been changed for privacy.
|
Mario fell from a ladder after experiencing a sudden onset of falls, visual disturbances and gait issues. He was seen in a local hospital emergency room. Through the Project Access program - a network that provides specialty care for low-income, uninsured patients, Nexus Montgomery was able to arrange a neurology evaluation.
The neurologist advised DNA testing for a rare genetic disorder. The cost for one of the two tests was more than $10,000; the other for more than $1,000. Project Access spoke with representatives from NORD (National Organization for Rare Disorders) and GARD (NIH’s Genetic and Rare Diseases Information Center). With their assistance, Project Access contacted a DNA testing company who agreed to provide deeply discounted DNA testing. Project Access and the patient’s primary care clinic coordinated the patient’s financial assistance application and specimen collection. Both DNA tests were performed at a total cost of $100.
Mario is under continuing care with the Project Access neurologist and is deeply grateful for the care he has received.
|
|
|
|
|
|
Project Access
FY19
Fast Facts
- Project Access has received 3,705 referrals, representing 1,842 unique patients.
- 2,517 appointments have been kept or confirmed.
- 30% of Project Access appointments are attributable to Nexus Montgomery.
- Project Access has recruited two new pro bono nephrologists to join its specialty network.
|
|
|
|
Temi Oshiyoye, MPH, CHES - Quality Improvement Manager
|
Temi Oshiyoye recently joined Nexus Montgomery as the Quality Improvement Manager. Temi will be working with the hospital transition care team, especially with the SNF Alliance program to reduce the 30 day hospital readmission rate after discharge.
Previously, Temi worked as the Director for the State Office of Rural Health and the Director for the Office of Workforce Development with the Maryland Department of Health where she managed initiatives and programs to improve access to care in rural and underserved communities.
Temi received an MPH from Indiana University Bloomington and a BA and BS in Psychology and a minor in Human Development from Ball State University. Temi is a Certified Health Education Specialist.
|
|
Meet the Board of Managers
|
|
|
|
Dan Cochran - Finance Committee Chair
|
Daniel Cochran is the Chief Operating Officer and Chief Financial Officer of Adventist HealthCare Shady Grove Medical Center. Dan has over 25 years of experience in health care financial management, operational leadership and strategic planning. Prior to joining the Shady Grove team, Dan served as Vice President of Finance for the Reading Hospital and Medical Center in Pennsylvania
|
|
|
|
|
|
|
