T oward the end of last year, the Office of Inspector General (OIG) from the Department of Health and Human Services (DHHS) published three reports^1-3 on how the home health industry was managing after Medicare?s home healthcare prospective payment system (PPS) was initiated at the end of 2000. Medicare data show that between 1997 and 2000, the number of Medicare-certified home health agencies (HHAs) dropped 32% from 10,556 to 7,175. Between fiscal years 1991 and 1997, Medicare annual expenses for home care rose from $4.7 billion to $17.6 billion. The Centers for Medicare and Medica

J etta Tressel, RN, BS, CWOCN, of Idaho, faced a challenge - a 22-cm midline abdominal incision started out as a wound, then presented as a transverse loop stoma. How could healing be achieved and feces be kept separated from the wound?

Ostomy care is but one part of Jetta's responsibilities at Eastern Idaho Regional Medical Center, Idaho Falls, Idaho. With 300 beds, it is the largest acute-care hospital in the state and services 200,000 primarily rural clients in an area that runs from Jackson, Wyoming to West Yellowstone, Mont., and includes metropolitan Salmon, Idaho. In fact, when th

S ensory processing of painful stimuli does not change as we age. The widespread belief among clinicians is that pain tolerance decreases with age and that the elderly tend to increase their complaints over minor painful experiences. In fact, older people may experience more pain than younger people though they may be less likely to complain about it. As a result, the elderly receive poor pain management. Cultural mores and personal values also affect pain treatment. The beliefs that pain relief is not possible and that medications are addictive prevent optimal intervention.

Unrelieved p

T he loss of moisture from the stratum corneum and intercellular matrix leads to dry skin, or xerosis. Clinically dry skin appears rough, uneven, and cracked. Raised or uplifted skin edges (scaling), desquamation (flaking), chapping, and pruritus may be present. A person who has a decrease or loss of function of the sweat glands on the plantar surface of the foot will experience xerosis of the feet.

Xerosis of the feet is a skin condition found in all age groups but can be aggravated by certain conditions. The incidence of xerosis increases with age, exposure to dry environmental conditi