Lymphedema program attracts new patients

Certification for therapists is a must

One way to set your agency apart from other agencies is to offer a service not offered by others in your market. A Florida hospital home health care facility established a successful lymphedema program that resulted in an increase in referrals and a reputation as an expert in specialized care among physicians.

"I was working in the outpatient services department of the hospital before I transferred to home care, and I saw how use of the new lymphedema treatments could prevent hospitalization for patients if they were administered before the patient reached an acute stage," says Susan Allen, OTR/L, CLT/LANA, staff occupational therapist and lymphedema specialist at Florida Hospital Homecare in Orlando. "By treating the lymphedema in a timely manner, we can help improve wound care because improved circulation helps wounds heal more quickly," she explains.

The typical patient in Florida Homecare’s program is an average age of 69 and on Medicare, says Craig Moore, MSPT, rehabilitation supervisor at Florida Hospital Homecare. Female patients comprise 67% of lymphedema patients, with cancer treatments and surgical procedures causing the lymphedema. Thirty-three percent of patients are male with venous problem contributing to their lymphedema, he says.

Because many of his agency’s lymphedema patients also require wound care, it is important for therapists and nurses to work together, Moore explains. "We usually schedule back-to-back visits for the nurses and therapists so that a therapist comes to the patient at the end of the nurse’s visit, he says. This enables the nurse to provide the wound care before the therapist provides the lymphedema treatment.

Cost-effective program

Developing a program specifically for lymphedema treatment is cost-effective, Moore points out. "These patients have a chronic condition that can result in infections and other complications that require hospitalization if the lymphedema is not treated or monitored," he says. "By setting up a home care visit, we can see patients before these complications occur," he adds.

Not only does reimbursement cover the costs of the therapist and supplies for lymphedema treatment, but also, by treating the lymphedema, the patient’s wounds heal faster and signs of infection are more likely to be discovered before they require hospitalization, Moore explains. "Plan on seeing these patients for a while; 90% of our lymphedema patients require more than 10 therapy visits," he continues.

Advances in treatment of lymphedema make home care of the condition much more effective, Allen points out. "In the past, we were limited to the use of pumps, diuretics, and elevation to reduce the swelling, but we now know that manual drainage, or massage, as well as compression bandages and patient education can improve patients’ conditions and reduce the risk of complications," she continues.

An important part of patient education is making sure the patient knows the signs of infectious cellulitis, a complication of lymphedema, Allen notes. "When infections are caught early, they are more easily treated," she continues.

While home care nurses can be taught how to massage a patient and put compression bandages in place, it is important that you have lymphedema specialists on staff, Allen suggests. "Five of our therapists have undergone the 140-hour training course to become certified as lymphedema specialists so we do have the expertise to set up a treatment plan that is most effective for each patient," she explains.

"Because the number of lymphedema patients waxes and wanes, these therapists also see other patients," Moore explains. When there are a high number of lymphedema patients, home care nurses who have been taught the basic massage and bandaging techniques can see some patients between therapist visits, he says.

Referrals to the lymphedema service come from hospital case managers and physicians, Moore says. Although the home care agency did provide inservice education to local hospital discharge planners and case managers, the service has grown primarily because of good outcomes, he explains. "We have seen a 97% improvement in activities of daily living for patients on this service."

"Word-of-mouth promotion from physicians who have told us that they are pleased with the dramatic results they’ve seen in their patients have generated the most referrals," Moore adds.

The best way to ensure a successful lymphedema program is to invest in training some therapists as specialists, Allen notes. "Therapists can attend a three- to four-day conference and learn some skills, but they won’t be prepared for all types of lymphedema," she says.

"The two-week certification course is the best way to make sure that your therapists have all of the skills needed to positively affect outcomes and reduce emergency department visits and re-hospitalizations," Allen explains. (For more on the courses, see contact information at the end of this article.)

While lymphedema is a chronic condition, home care provides the best chance for patients to regain a better level of independence and handle their condition on a long-term basis, Moore says. "The one-on-one education gives patients a better understanding of lymphedema and gives them more confidence that they can manage it after home care ends," he adds.

[For more information about setting up a lymphedema home care program, contact: Craig Moore, MSPT, Rehabilitation Supervisor, Florida Hospital Home Care Services, 600 Courtland St., Suite 300, Orlando, FL 32804. Phone: (407) 691-8205, ext. 4346.

For information on certification as well as links to other lymphedema organizations, contact: The Lymphology Association of North America, 1901 N. Roselle Road, Suite 800, Schaumburg, IL 60195. E-mail: lana@telusys.net. Web site: www.clt-lana.org.]