Given the complex, health-related challenges that often burden the elderly, delivering healthcare tailored to their needs can be daunting. On the other hand, the Miami Jewish Home and Hospital for the Aged has cared for the elderly in such a focused way since its inception in 1945. Today, this institution stands out as the most comprehensive, not-for-profit, geriatric healthcare center in the Southeastern United States.

“When you walk onto this campus, you enter a rare care-giving environment for older people. Our system of care supports those who live independently and those needing different levels of medical care and support,” said Fred Stock, Chief Operating Officer and Executive Director.

Older adults who live independently with some support reside in 98 modern, tastefully designed studios and one-bedroom suites in the Irving Cypen Tower. Here, they access recreational, emotional, physical, and medical support unavailable in the community.

As the elderly age, they may need a higher level of care and choose to live in the Hazel Cypen Tower, an assisted living facility consisting of 92 apartments for residents who prefer to live independently, but who require a certain level of physical care. “Older people who live here don’t need to be in a nursing home, because they are not sick. But they do need a level of care they cannot get in an independent setting,” said Stock

A major clinical situation may create the need for greater supervision in the 462-bed nursing home on the campus of the Miami Jewish Home and Hospital for the Aged. Specialized units attend to the needs of dementia patients and residents whose clinical needs require specialized medications, more monitoring, and greater medical and registered nurse supervision. The home is fully accredited by the Joint Commission on Accreditation of Health Care Organizations (JCAHO).

“Some patients in the nursing home require only short-term care following a broken hip or knee. Some may have cardiac issues requiring rehabilitation. Currently, about 30 to 40 such patients participate in the rehabilitation program on average for 30 days, and then return to the community to be assisted with home-care services,” said Stock.

In February 2004, the home launched a service that accommodates patients suffering from extremely complex medical conditions – pulmonary problems, for example – who may need to continually be on a ventilator. The home currently serves the needs of 15 residents requiring this level of medical care.

With few facilities serving patients this way in Miami-Dade County, the service addresses a major underserved need in the area and complements the work of hospitals in the region. “Besides the medical and nursing staff serving this ventilator unit, we provide the services of a full-time social worker and recreational therapist to assist patients,” Stock emphasized.

The ventilator service underscores the role of the Miami Jewish Home and Hospital for the Aged as a resource for Dade County and southern Broward County. “We take a holistic approach to patient care in a comfortable environment. We take these people out of bed and put them in wheelchairs so they can be outside. The quality of life that we provide on a long-term basis for people who are so clinically complex is much greater than they could find in a hospital,” he said.

According to Stock, the home offers a level of nursing, medical, social work, recreation, and rehab services that few other nursing homes can match. The home employs a medical staff of three, full-time physicians and four, full-time nurse practitioners.

Just as important, the staffing ratio at the home consistently exceeds the per-patient nursing ratios mandated by the State of Florida. “The state ratio for certified nursing assistants is 2.6 hours of nursing care per resident. We run between 2.8 and 2.9 hours for certified nursing assistants. For LPNs and RNs the state ratio is 1 hour of care per resident. We run at about 1.26 hours of care,” Stock said.

In an industry that suffers from high staff turnover, the Miami Jewish Home and Hospital for the Aged prides itself on the longevity of its staff. Stock attributes this to hiring the best people and offering them an unparalleled wage and benefit program. In fact, he anticipates that by July 2004, the home will be one of 11 nursing homes out of 700 in Florida to be designated as meeting the Florida Gold Seal standard.

A stable staff assures that the home will continue to serve the aged with high-quality continuum of care as it has now for nearly 50 years.

Fred Stock may be reached at (305) 751-8626 or at fstock@mjhha.org.



In an effort to provide support, encouragement, and resources to the Boatswain Bay Presbyterian Church community members and those served by the Church throughout the hurricane rebuilding period, The Doug Williams Group, Inc., Miami, is spearheading relief efforts. The support of this Grand Cayman community will be accomplished through pastoral support, medical support donations, material donations, labor teams, and prayer teams. All administrative costs are being privately funded; therefore, 100% of all donations and donated materials will directly benefit members of this Grand Cayman community.

Financial Donations: Checks should be made out to Old Cutler Presbyterian Church and designated as follows: Boatswain Bay Presbyterian Church Hurricane Relief. Mail to The Doug Williams Group, Inc., 8900 Southwest 107th Avenue, Suite 302, Miami, Fl, 33176.

For more information, please contact the effort’s full-time relief coordinator, Kenia Pol, at The Doug Williams Group, 305-598-9880, or e-mail Relief@TheDougWilliamsGroup.com



In today’s healthcare market, physicians have been desperately seeking a solution which will address their reduced reimbursements and increasing costs. Medical Office Software is pleased to announce a solution to help physicians increase their revenue by utilizing technologies which streamline their processes and billing procedures.

MOS has been a leader in the sales and installation of computerized solutions for physicians in South Florida since 1984. These solutions have improved the physician’s efficiencies in the billing, collecting and electronic filing of claims, using the latest technologies available. They are known for providing first-class service and support to thousands of users in South Florida for the financial accounting systems they have developed.

In an effort to provide physicians with a comprehensive clinical solution (Electronic Medical Records) MOS has partnered with MedcomSoft, a leading supplier of EMR software throughout the United States. Ken Barnes, Vice President of Sales & Marketing, has spearheaded MOS’s EMR division over the past year-and-a-half. Barnes explains, “We have done our research over the past year and evaluated many different systems. We felt that MedcomSoft Record is the most comprehensive software solution available in today’s marketplace. This solution fit all of the needs to fully automate the clinical side of a physician practice. In addition to the clinical aspect of the product, it also has a fully integrated practice management (financial) component built into it as well. It automatically does the correct coding and fully documents the visit. This full documentation is designed to prevent and defend frivolous lawsuits and also provides the physician the government-mandated documentation for billing and HIPAA regulations.”

Based in Toronto, the designer, MedcomSoft Inc., develops and markets software solutions that change the way the healthcare industry captures, manages, and exchanges patient information. Powered by MEDCIN, MedcomSoft Record has one of the largest numerically codified medical vocabularies in the world. By using MedcomSoft Record, healthcare providers can record patient data using an easy point-and-click system. It reduces the time and effort required to produce documentation compliant with today’s rules and regulations, and is able to reduce costs and risks—all of which result in better quality of patient care and increased billing productivity. True efficiency can only occur by implementing a fully integrated automated solution. MedcomSoft Record is a comprehensive software solution that enables healthcare providers to use one single platform to achieve automation of the majority of the tasks required for the management of their patients and practices. This includes an Advanced Integrated Practice Management System, an Electronic Medical Record System, an Order Entry System, a Document Management System, a Referral & Authorization Management System, MedcomSoft Portable Chart, and a variety of integrated tools for clinical decision support, coding and compliance checking for medical necessity.

Regarding the software, Barnes said, “Not all EMR solutions are equal. Very few systems in the marketplace currently utilize a codified medical vocabulary. This technology does not rely on text-based phrases and allows for direct correlation of patient outcomes. In the future, all EMR solutions will eventually use a numerically coded standard in order for the systems to seamlessly speak to each other. MedcomSoft is one of the few companies that has developed the system from the ground up to this standard. This puts them years ahead of the competition and will eliminate the need to replace the system in the future for a system that adheres to the new standards.”

Physicians need to be aware that HIPAA addresses the need for computerized electronic medical records, and there are current initiatives to develop guidelines that all physicians will be required to adhere to in the future. EMR systems will certainly rapidly replace the paper-based systems that 90 percent of physicians use today. Physicians will find that deployment of these solutions will provide a direct impact to the amount of time they will have to practice medicine. By significantly improving efficiencies within the practice, EMR solutions typically reduce the physicians’ workload by hours each day. Physician practices will also benefit from the reduction of rapidly increasing overhead costs that have had a direct impact on their profitability. As a leader in healthcare automation, MOS will provide your practice with a turnkey solution of hardware and software that will enable you to take control of your practice’s profitability again.



Broward General has launched its Expansion and Renovation Program, a $163 million initiative to expand the existing facility to meet and anticipate the needs of Broward County residents for decades to come.

Targeted for completion in 2005, the multi-phase expansion brings a new era of access and convenience to the state-of-the-art healthcare services Broward General delivers. In addition to new construction totaling 480,000 square feet, there will be extensive upgrades to most of the services on the Broward General campus. The beautiful new environment provides for improved patient flow and greater efficiencies for staff and physicians.

“The New Broward General” will feature state-of-the-art surgical suites, new critical care units, a new outpatient imaging center, private rooms and The Heart Center of Excellence. There will also be an expanded Trauma Center and Emergency Department with separate areas for children and adults. The latest technology available, from advanced diagnostics to internal and external communication, will be integrated throughout the entire facility.

Just steps away from the hospital’s main entrance, a seven-story parking garage provides ample parking for patients and visitors. Additionally, the new hospital structure will provide a focal point for outpatient care, with convenient access to pre-admission testing, outpatient surgery, radiology and other diagnostic services. Separate entrances will be designated for The Heart Center of Excellence, the Comprehensive Cancer Center and the Chris Evert Children’s Hospital.

Across the street from the main campus, a new medical office building will be constructed. A walkway over Andrews Avenue will offer safe access between the parking garage, the hospital facility and the medical office building. In 2004, the first Ronald McDonald House in Broward County opened on the Broward General campus.



It’s after 8 on a Saturday night and your beeper goes off. Your patient is in the emergency room. She’s been declining rapidly; it’s probably time for hospice. The family is anxious and scared, but they will just have to wait until tomorrow—or maybe Monday—because what can you do at this point?

At VITAS Innovative Hospice Care® there is someone waiting for your call. There is an admissions nurse who will meet the family tonight to explain hospice care, talk about the needs of the patient and admit her if that’s what they choose to do. There is an admissions coordinator who will follow up with you, the admitting physician, to whatever degree you request. What there are not are more pages, voice mail and messages. Your call puts you in touch with a hospice expert who is on the job, knows how to take your referral call and is skilled at talking to the family at such a difficult and confusing time.

“We need the caller’s name and number and the patient’s name and location. Then we’re in business,” says Don McChesney, director of customer service for VITAS admissions in the Southeast, which covers 14 hospice programs in six states. “We can go to the patient, talk to the case manager, do what is needed. We’ve designed the intake process to be painless, quicker and easier than anywhere else. Add to that our extended hours of operation and the professionals we have waiting for your call, and VITAS is the ultimate one-stop shop.”

As stripped down as the referral process can be, those professionals will take all the time necessary to discuss the patient’s situation if that is the caller’s need. They explain hospice to those new to the concept, discuss end-of-life care and related issues; explain Medicare, Medicaid and private insurance coverage—or just listen if a caller needs to vent. Admissions coordinators are trained to expect the unexpected.

VITAS regionalized its intake process in 1997, enabling professional admissions coordinators to specialize in a specific community and enabling admissions nurses to meet with patients and families until midnight.

“VITAS is 24/7,” says Mary Zalaznik, vice president of hospice program resources. “Since the early 1990s, every time we have increased our hours of operation, our referral sources have responded so well that we’re encouraged to add even more hours. Our admission coordinators are staffed from 8 a.m. to 11 p.m. six days a week and 8 a.m. to 8 p.m. Sundays and holidays. And we’re ready to bump that up if it’s called for! A referral call made after 11 p.m. is managed by our after-hours Telecare staff.”

“We don’t believe in nine to five,” McChesney agrees. “We’re available when patients and families are available. It turns out, people work for a living; they may not be making hospice calls from work.” It also turns out that the stress and isolation of caring for a seriously ill family member tends to peak during the night, which inevitably generates hospice referrals and inquiries.

“We see every referred patient the same day, unless they request otherwise,” says Zalaznik, adding a firm “always. Our goal is to see a new referral within the hour—certainly within two to three hours.”

It’s no small feat. The Southeast Admissions Center, located in Miramar, received 2,200 referrals last month. Eighty percent of those became VITAS patients, and the other 20 percent were followed up based on the admissions nurse’s conversation with the patient and family. McChesney figures every referral call generates 25-30 follow-up calls from and to the patient and caregivers; his records show that Miramar handled 65,000 calls last month.

Those calls may be to a case manager or social worker inquiring about the next of kin, to the physician confirming the treatment plan or who will sign the death certificate. It could be to a family member to determine the names of any consulting physicians or the existence of any insurance policies. If a key family member lives out of state, admissions might coordinate a three-way phone call, perhaps at 10 p.m. Eastern time, in order to facilitate family communications. Sometimes the patient and family haven’t yet heard the word “terminal” from their doctor, and the admissions nurse needs to be forewarned. Some physicians ask to be kept in the loop as the patient transfers to palliative care; others turn care over to the hospice physician. As “stripped down” as the intake process is, ongoing and thoughtful questions during admissions makes for the best hospice experience for the patient and family. And every answer is different.

Except for one:
Q: How soon can you see the family?
A: Today.