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Four PillarsHome sweet home. Most of us want to stay home when we are sick and even more as we get older and need care.

Unless there are extenuating circumstances, we certainly want Mom and Dad to stay home and be well cared for instead of seeing them have to go into a nursing home, assisted living or board and care facility.  However, as our loved ones age most of them have some combination of chronic illnesses that present constant challenges. Sometimes they need some help in managing their health issues.

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Alice Summer 2014_edited-1We have proudly known nurse Alice Cresci for quite some time.  Her interview is a follow-up from Palomar Pomerado’s Medical Director and Wound Care Specialist, Dr. Roger Schechter, who we featured in September.  Alice is currently working with Dr. Schechter at the Pomerado Wound Clinic.  We are thrilled to showcase her story here for you as Alice once worked with the Grace Care team as a care manager.  We have always admired her passion for advocacy and drive for helping others.

Alice Cresci graduated from Palomar College with an Associate Degree in Nursing and has a UCSD Certificate in Legal Nurse Consulting.  She is currently working on an Editing Certificate from UCSD as well.

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1521655_10201707678992262_1369856230_nI believe geriatric nurse care management is changing and adapting to better suit the needs of elders and their families. In an ever increasing long term care market, the models of care delivery to the elderly and disabled have to keep pace with the increasing demands and higher expectations of a more educated health care consumer.

Elder care consumers have become quite savvy. The vast majority of them are baby boomers and adult children who are learning, many times through painful personal experience with family and friends, that our current “home care” models don’t fit the needs of their loved ones. 

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JackieThis month Grace Care Management is recognizing Silverado Hospice, a San Diego hospice we not only think very highly of but also work closely with in the community. Recently we personally interviewed with the Administrator Jackie Lleverino to share more information on their services with you.

Jackie has lived in the San Diego County since 1989 and is committed to making an impact on the community. She joined the Silverado family with an extensive background in sales and marketing in the healthcare and IT industry. Jackie has been with Silverado since 2007 and is passionate about providing excellent care and resources to the diverse community.


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lisa_325x244Lisa H. Tooman is a licensed and registered occupational therapist and clinical exercise specialist with almost 30 years of experience in various aspects of the healthcare industry. She is a dynamic, multifaceted, rehabilitation healthcare professional with expertise in diverse, clinical care services, as well as supervisory, management and administrative aspects of healthcare operations.

Ms. Tooman is a strong patient advocate and demonstrates a passion for the services she provides by implementing them in a warm, caring and compassionate manner that generates a high degree of client satisfaction.


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dr-stuart-kipperGrace Care is excited to feature Dr. Kipper’s  concierge medical practice this month.  We think very highly of Dr. Kipper, his Encinitas based team and the care they provide to our patients.

Below Dr. Kipper answers some important questions about his services, what “concierge” exactly means, how it differs from standard office based practice, and his experience working with a care management team.   We thank Dr. Kipper for his time in answering our questions about his practice, and we encourage anyone looking for a San Diego based concierge physician to give his office a call.


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San-Diego-Geriatric-Care-Management-300x225San Diego Geriatric Care Management is being taken to new levels with the advent of telemedicine and new care models fueled by health information technology. With healthcare reform driven legislation and maturing technologies, personal health information is coming back home.

There is a nationwide osmotic shift of health information from the hospitals and larger health centers out through electronic health records (EHR’s), health information exchanges (HIE’s), and personal health records (PHR’s), so that “patient centered medical homes” can become a reality. Patients and families also will have more access to and control of their own vital health information. That is no small change in particular for the elder population facing multiple chronic illnesses.

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chronic-care-300x217According to a recent report out of John Hopkins University, “people with chronic conditions account for 88 percent of all prescriptions filled, 72 percent of all physician visits, and 76 percent of all inpatient stays.”

Chronic conditions are those which last longer than a year, limit activities of daily living and may require ongoing medical care. The report cites the usual offenders: “hypertension (26 percent of non-institutionalized people with chronic diseases), chronic mental conditions (22 percent), respiratory disease (18 percent), arthritis (13 percent), heart disease (12 percent), eye disorders (10 percent), asthma (10 percent), cholesterol disorders (9 percent), and diabetes (9 percent).”

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DSCF2624According to the Journal of American Geriatric Society, “A full 30% of hospital admissions in elderly patients may be related to drug related problems or toxic drug effects.” Potentially inappropriate medication (“PIM”) is widespread with the elderly in both acute and community-based settings.

One of the benefits of hiring a Geriatric Care Manager is that they can monitor medication use and side effects.Anticholinergics are one family of medications that are on the usual offender list. This family of drugs blocks the neurotransmitter acetylcholine and includes such common drugs as Paxil, Detrol, Demerol and Elavil. Common sleep aides such as Tylenol PM, Excedrin PM both contain Benadryl which is an anticholinergic as well. Geriatric Care Management’s role in patient advocacy is to protect their clients from not only polypharmacy but from “PIM” as well.

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