Advanced Home Health is Growing Treats Heart, Mind, Body and Soul

By Shelly Lembke  |  2017-01-26

The dedicated management staff of Advanced Home Care; Angela Sehr, Owner, Angie Macadangdang, Chief Clinical Officer, Debi Moroles, Director of Business Development, Deb Ryan, Administrator and Lisa Gaza, Director of Patient Care Services. 
--Photo courtesy of Colby Barrett

One Sacramento-based company has quietly and efficiently carved a niche into the home health care business by providing superlative care for patients and caregivers alike. The “whole-istic” business model of Advanced Home Health and Hospice (AHHH) has earned them not only professional accolades and a thriving business, but a stellar reputation for their positive results for even the most complex patient care. The beating heart of this organization is founder Angela Sehr. Sehr is a woman with a mission and a vision with patient wellbeing in the Sacramento area.

Born in Xian, China, home of the famous Terra Cotta Warriors, Sehr started college at 15 and became a nurse at 18. The youngest of nine children, her siblings are also high achievers with a judge, college professor, engineer and a teacher among her immediate family.

Shyly self-admitted as a teacher’s pet, she loved science from a very young age. She says her mother encouraged her children to all be independent. “Marry well, she said, but always be able to stand on your own two feet,” was her mom’s advice.

Sehr may now be the boss, but she is far from being afraid to roll up her sleeves when it comes to patient care. She paid her dues with years in hands-on nursing. In fact, she still takes care of patients herself, in addition to her many other duties. AHHH offers patients around the clock care, just one of the many aspects that separate them from their competition. “I go out to patients’ homes at 2 in the morning if they need it, just like everyone else on staff,” said Sehr.

Sehr is a Registered Nurse who has worked around the world with patients of all ages and many different health issues. She came to Sacramento, having worked in places like China and Saudi Arabia. She attended Sacramento State’s Nursing program and earned her BSN here, spending over a decade in pediatric care and found her way into Infusion care as a nurse for patients in need of this specialized help. She has built her company on years of caring for infusion patients. Her company carries her compassion forward, providing top-notch, compassionate care for patients and their families.

During a time when healthcare laws and models are in flux. Sehr’s company, AHHH has built a company that successfully and efficiently treats and maintains a base of anywhere from 600 to 800 patients, more than double similar programs of even healthcare giants like full-fledged local hospital systems. To meet the need AHHH has found, the company currently has a staff of approximately 400 highly-trained specialists performing an impressive array of care and support services, and specializes in “complex” patients, often avoiding such patients having to be readmitted to hospitals.

AHHH is as advertised. Staff is on-call 365 days a year, 24 hours a day. They provide truly advanced wound care, infusion nursing, orthopedic, occupation and physical rehabilitation, speech and swallow function therapy, specialized medical social workers and a chaplaincy ministering to the patients and their loved ones. The tiniest staff member is a therapy dog.

AHHH is a Medicare Certified Home Health Provider. They are licensed by the by the California Department of Public Health. They have provided care for premature babies, pre-and post op patients, patients such as diabetics with wounds that can be nearly impossible to heal. Many of these are patients the hospitals have given up on and AHHH has succeeded where others have failed, improving patient outcome in terms of health and healing. Sehr is intent that her teams utilize the latest technology to treat patients and makes available ultrasound and laser therapy, in addition to debridement if physician ordered.

The Low-Level Laser Therapy (LLLT) alone, per Sehr can be highly effective in treating, diabetic ulcers, venous stasis and arterial ulcers, and many other types of non-healing wounds.

The hospice care that Sehr’s company provides is a growing service, based on industry best practices, but also on her own experiences as a nurse. Most hospice patients they see are given six months or less to live, but that isn’t an outcome set in stone. “We don’t give up,” she says. “We’re not God, but people do ‘graduate’ from hospice. They do get better.”

Hospice care provides comfort care to patients and family. “Advanced hospice nurses are registered nurses specifically dedicated to end-of-life care. They are focused on pain and symptom management for our patients around the clock. In addition to serving the terminally ill, hospice clinical team counsel and educate caregivers and family members on the needs of the patient, guiding them through every issue that may arise. Our hospice nurses work as a part of an interdisciplinary team that develops and manages the care for our patients and their families.”

A vital part of their team are the hospice social workers who are there to support patients and their families. “Our social workers are trained to assist our patients and their families on developing an individualized plan of care, researching ways to relief stress and anxiety by non-medical means, and connecting them with appropriate local resources.

 “We understand that our patients and their families may have financial problems. Our social workers are equipped with the necessary tools and knowledge to provide counseling in these areas, as well as coordinating possible aid from other organizations,” Sehr commented.

What does it mean to be an advanced hospice social worker? According to AHHH, “It means to be a supporter of our patients and their families. Our social workers are trained to assist our patients and their families on developing an individualized plan of care, researching ways to relief stress and anxiety by non-medical means, and connecting them with appropriate local resources.

“A loss of a loved one, even if anticipated, brings a slew of emotions and grief for surviving family and friends. Our hospice bereavement professionals and volunteers are trained to provide counseling and support by understanding the loss and compassionately walking step by step with surviving spouses, children, or parents.”

“To help our patients cope with the end of their life, AHHH provides spiritual services by certified chaplains to promote spiritual and emotional well-being. Our chaplains may also work with the patient’s clergy and coordinate spiritual nourishment and revitalization.”

Sehr credits hospice volunteers for the selfless work they do as part of the organization. “Our hospice volunteers spend time with patients and their loved ones. They run errands and provide caregiver relief, companionship, and supportive services. Volunteers are the backbone of our hospice team.”. Volunteers form bonds with patients and family members. Patients and families often tell volunteers things they feel they can’t tell their loved ones and help open the way for people to talk honestly. Volunteers work alongside paid staff in every area of hospice care.”

AHHH truly treat the entire family, and that includes monthly bereavement support group meeting. “At Advanced Hospice, patients are nearing and passing the end of their life, leaving behind husbands, wives, sons, and daughters,” according to the company website.

“When a patient is diagnosed with a serious illness or is recovering from an injury, our medical professionals, nurses, and therapists work hard to rejuvenate him/her to normal life. In addition to purely medical procedures, medications, and techniques, a huge part of a person’s recovery depends on his/her psychosocial condition.”

AHHH is making a concerted effort to reach America’s veterans. “Veterans have done everything asked of them in their mission to serve our country and we believe it is never too late to give them a hero’s welcome home. That’s why our hospice is taking part in the We Honor Veterans program. Our staff understand the unique needs of veterans and are prepared to meet the specific challenges that veterans and their families may face at the end of life.”

AHHH measures its success with data, not just good feelings. Their clinicians log every visit in detail, right down to wound and physical improvement, modality effectiveness, length of visit and many more details. That data is analyzed for the benefit of each patient, but the accumulation of data is used by the company to improve patient outcome and patient satisfaction. The company has recently broken ground on its next project, a free-standing Hospice Facility. While starting small, at 6 beds, it will be the only hospice in the area and unlike any other, due again to Sehr’s experience and personal touch.

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Crab Health Advisory Lifted for CA Coast

Source: California Department of Public Health  |  2017-01-13

The California Department of Public Health (CDPH) has lifted the last remaining health advisory for Dungeness crab caught along the California coast. CDPH lifted this advisory on January 11th due to recent tests showing that traces of domoic acid have declined to low or undetectable levels in Dungeness crabs caught in the area, indicating they are safe to consume.

Dungeness crabs caught along the coast are safe to consume. However, as a precaution, consumers are advised not eat the viscera (internal organs, also known as “butter” or “guts”) of crabs. The viscera usually contain much higher levels of domoic acid than crab body meat. When whole crabs are cooked in liquid, domoic acid may leach from the viscera into the cooking liquid. Water or broth used to cook whole crabs should be discarded and not used to prepare dishes such as sauces, broths, soups or stews (for example, cioppino or gumbo), stocks, roux, dressings or dips.

Symptoms of domoic acid poisoning can occur within 30 minutes to 24 hours after eating toxic seafood. In mild cases, symptoms may include vomiting, diarrhea, abdominal cramps, headache and dizziness. In severe cases, the victim may experience trouble breathing, confusion, disorientation, cardiovascular instability, seizures, excessive bronchial secretions, permanent loss of short-term memory, coma or death.

Domoic acid accumulation in seafood is a natural occurrence that is related to a “bloom” of a particular single-celled plant. CDPH will continue to monitor conditions to ensure that seafood sold in California is safe to consume.

For more information, visit www.cdph.ca.gov

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Use Caution When Collecting, Eating Wild Mushrooms

Source: California Department of Public Health  |  2016-12-29

Amanita phalloides. 
--Photo courtesy of Trent Pearce, Tilden Nature Area

With seasonal rains promoting the growth of wild mushrooms, California Department of Public Health (CDPH) Director and State Public Health Officer Dr. Karen Smith is reminding people that collecting and eating hazardous wild mushrooms can lead to serious illness and even death.

“It is difficult to distinguish between wild mushrooms that are poisonous and those which are safe to eat,” said Dr. Smith. “Wild mushrooms should not be eaten unless they have been carefully examined and determined to be edible by a mushroom expert.”

Wild mushroom poisoning continues to make people ill and send them to the hospital. According to the California Poison Control System (CPCS), 679 cases of ingestion were reported statewide from November 2015 to October 2016. Among those cases:

  • Three suffered a major health outcome, such as liver failure leading to coma and/or a liver transplant, or kidney failure requiring dialysis.
  • 50 suffered a moderate health outcome, such as dehydration due to vomiting and diarrhea, or injury to the liver or kidney.
  • 348 were children under six years of age. Usually the children ate a small amount of a mushrooms growing in yards or neighborhood parks.
  • 415 were treated at a health care facility.
  • Eight were admitted to an intensive care unit.

The most serious illnesses and deaths have been linked primarily to wild mushrooms known to cause liver damage, including Amanita phalloides, also known as the “death cap” and Amanita ocreata, or “destroying angel.” These and other poisonous mushrooms grow in some parts of California year-round, but are most commonly found during fall, late winter or spring.

Eating poisonous mushrooms can cause abdominal pain, cramping, vomiting, diarrhea, liver damage or death. Anyone who develops symptoms after eating wild mushrooms should seek immediate medical attention. People who develop these symptoms, or their treating health care providers, should immediately contact Poison Control at 1-800-222-1222.

Local mycological societies offer educational resources about mushroom identification, and may be able to help people identify mushrooms they have picked.

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SAMHSA Provides $7,196,038 in Grants for People and Communities Recovering from Trauma

Source: U.S. Department of Health and Human Services  |  2016-12-22

The Substance Abuse and Mental Health Services Administration (SAMHSA) has awarded up to a total of $7,196,038 over the next five years to programs in California for programs that help people and communities recover from, and build resiliency from trauma.

“Trauma, whether from exposure to child abuse, community violence, or natural disaster can have a devastating effect on people,” said SAMHSA Principal Deputy Administrator Kana Enomoto.  “We must help people in every segment of our community -- especially youth and Tribes, many of whom have experienced significant historical, community, and individual traumas.”

The grant programs going to California included in this SAMHSA effort are:

National Child Traumatic Stress Initiative: Purpose – Creates a national network of grantees — the National Child Traumatic Stress Network (NCTSN) or Network — that works collaboratively to develop and promote effective trauma treatment and services for children, adolescents, and their families exposed to a wide array of traumatic events

Community Treatment and Services Centers grants: Purpose – Improves the quality of trauma treatment and services for children, adolescents, and their families who experience or witness traumatic events; and to increase access to effective trauma-focused treatment and services for children and adolescents throughout the nation.  The work of this initiative is carried out by a national network of grantees – the National Child Traumatic Stress Network – that works collaboratively to develop and promote effective trauma treatment, services, and other resources for children, adolescents, and families exposed to an array of traumatic events.

The Substance Abuse and Mental Health Services Administration (SAMHSA) is the agency within the U.S. Department of Health and Human Services that leads public health efforts to advance the behavioral health of the nation. SAMHSA's mission is to reduce the impact of substance abuse and mental illness on America's communities. For more information on SAMHSA grants, visit www.samhsa.gov/grants.

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CDPH Releases Reports on Healthcare-Associated Infections -Vaccination Rates

Source: California Department of Public Health   |  2016-12-22

The California Department of Public Health (CDPH) released two annual reports recently. The reports provide information about healthcare-associated infections (HAI) and influenza vaccination rates among health care providers.

While California hospitals have made progress in preventing healthcare-associated infections, HAIs continue to be a significant public health issue in the state. In 2015, hospitals reported 19,847 healthcare-associated infections to CDPH. From 2014 to 2015, 56 hospitals demonstrated significant improvement in preventing one or more HAI type. Hospitals are making progress in preventing HAI with the exception of C. difficile diarrheal infections (CDI), which increased 8 percent since 2011. CDPH offered infection-prevention assistance to 73 hospitals with high infection rates.

The department’s influenza vaccination report indicates that vaccination rates among health care providers have improved in the past five years. Since 2011, vaccination rates increased 21 percent for hospital employees and 11 percent for non-employee healthcare providers, such as physicians or other contracted staff members.

Both the HAI and influenza vaccination rate reports include data reported by 392 licensed general acute care hospitals representing 419 campuses. The reports are on the CDPH website at www.cdph.ca.gov.

Due to various factors in the way data are classified and validated, the information in this HAI report is not directly comparable to previous annual reports the department released. The report provides additional details about these changes.

Using data from these reports, CDPH created an interactive map for the public, Healthcare Personnel Influenza Vaccination in California Hospitals and updated the data for the My Hospital’s Infections Map.

“Hospitals can utilize the data in our HAI report to implement and improve infection-prevention strategies,” said Dr. Karen Smith, CDPH director and state public health officer. “This same information can help Californians stay informed about what their local hospitals are doing to protect against healthcare associated infections.”

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CDPH Offers Food Safety Tips for the Holidays

Source: California Department of Public Health  |  2016-12-01

With the holiday season approaching, the California Department of Public Health (CDPH) reminds consumers to use safe food preparation and storage measures to prevent foodborne illness. Bacteria that can be found in foods such as meat and poultry may cause illness if they are insufficiently cooked, inadequately cooled or improperly handled.

“We can help ensure that foodborne illnesses don’t ruin our holidays by properly preparing and handling meat, poultry and other foods,” said CDPH Director and State Public Health Officer Dr. Karen Smith.

About 48 million illnesses, 128,000 hospitalizations and 3,000 deaths in the U.S. each year are related to foodborne diseases, according to the Centers for Disease Control and Prevention (CDC)

Foodborne diseases can be prevented by: washing hands with soap and warm water before and after food preparation, and especially after handling raw foods; cleaning all work surfaces, utensils and dishes with hot soapy water and rinsing them with hot water after each use; cooking food thoroughly and refrigerating adequately between meals.

Symptoms of foodborne disease can include diarrhea, which may be bloody, vomiting, abdominal cramps and fever. Most infected people recover from foodborne illnesses within a week. Some, however, may develop complications that require hospitalization. Young children, the elderly, pregnant women and people with weakened immune systems are at highest risk for potentially life-threatening complications.

Additional information about food safety is available on the U.S. Department of Agriculture Meat and Poultry hotline at 1-888-MPHotline (1-888-674-6854). Consumers can also access the national Partnership for Food Safety Education’s Fight BAC! Website www.cdph.ca.gov

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New Statewide Plan Aims to Dramatically Reduce New HIV Infections

Source: California Department of Public Health  |  2016-11-17

California has released a new surveillance, prevention and care plan designed to dramatically reduce new HIV infections in the state, with the goal of eventually getting that number to zero. The “Getting to Zero” plan is a blueprint for state and local health departments and community organizations working to achieve a more coordinated statewide response to HIV.

“Thanks to better treatment and prevention options, new testing technology and better access to health care, California has reached a point where we can begin to envision the possibility of zero new HIV infections,” said California Department of Public Health Director State Public Health Officer Dr. Karen Smith. “In a state as large as ours, it will take an incredible amount of coordination, innovation and work to make this vision a reality. This report lays the foundation for achieving our goals.”

The “Getting to Zero” plan was developed by the California Department of Public Health (CDPH) in coordination with local health officials, other state departments, medical and non-medical providers, and HIV community organizations and planning bodies. The report set four goals to be achieved by 2021. The four goals are to reduce new HIV infections, increase access to care, reduce disparities in underserved communities and achieve a more coordinated statewide response to the HIV epidemic.

To achieve those goals, the report outlines 15 strategies and 12 key objectives that will be monitored on an annual basis by CDPH’s Office of AIDS. Some of the strategies include improving HIV testing and HIV pre-exposure prophylaxis (PrEP) utilization, enhancing availability of HIV care and increasing community collaboration and involvement.

“This comprehensive plan reinforces the state’s ongoing commitment to address the HIV epidemic,” said Dr. Karen Mark, Chief of the Office of AIDS at CDPH. “This commitment includes supporting people living with HIV, reducing the rate of new infections, and recognizing that not all communities have been equally impacted by this epidemic, and making those most at risk a high priority.”

For more information see www.cdph.ca.gov

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