Asya Rudikoff 

There are three major issues facing the home care and hospice industries: the lack of uniformity across the regulatory environment, the lack of pragmatic and meaningful quality assessment and performance improvement programs, and the inconsistencies across organizations relative to safety and infection control for patients and employees. The regulatory environment is a complex one to navigate. As we seek to make any changes at the federal (or even state and local) level, the mere definition of home health varies state to state and payor by payor. Home health in most states is established for Medicare recipients, age 65 and over. Though historically home health has been a platform for providing acute care, it has trended towards serving more chronic diseases. Until we can get to a place where home health is defined more uniformly and we can push the regulations to more appropriately represent the varied demographics of the patients who receive home health benefits, policies will continue to undermine the long term goals of home health. Barbara A. McCann, author of Limitations in the Design of the Medicare Home Health Care Benefit for Today's Population, says it very well in the The Future of Home Health Care: Workshop Summary: “Designed almost 50 years ago, the home health care benefit emphasizes recovery from acute illness and the opportunity for health improvement, and it presumes that the beneficiary's health problems will end. It does not emphasize wellness or prevention, and it does not pay for comfort care or palliation at the end of life.” In the same vein, the structure of home health does not represent the care needs of the pediatric population, which often requires services to be provided in the natural environment for the greatest effectiveness in long-term goal achievement for patients with chronic conditions. Starting with the basics - the foundation - of home health and how it is defined is key to the successful advocacy of this field in the future. Finding some level of alignment in home health benefits and advocating for its access to patients with chronic conditions across our state seems to be a logical endeavor, and one that is critical to the adaptability and success of this program on a national level. The second issue is the lack of accessible data regarding quality of care and performance improvement. Since 2000, the Centers for Medicare and Medicaid has been collecting “over 100 pieces of data” per patient, per service, according to McCann. Despite aggressive efforts and deadlines for data submission and collection, minimal effort has been made to analyze this data and, more importantly, share it in a way that can foster meaningful changes for home health organizations, hospice organizations, and patient care in general. A lack of analysis makes it challenging to understand performance within a single organization, let alone how that organization compares to others, and makes the standard of care vary greatly from home health agency to home health agency, even within a single county. The ability to access and analyze data across organizations is the first step, but the second and more meaningful step, is to apply the data and findings in a practical and significant way. Quality assessment and performance improvement programs are mandated, on some level, for all home health agencies; however, so many are fruitless efforts that do not amount to meaningful change. If we want to incite growth in the field of home health, we need to utilize this data in a meaningful way and the HHAC is an excellent platform to inspire that level of progress. How can we make quality assessment and performance improvement be more than an empty requirement for agencies? How can we raise the bar on the services we provide and incentivize agencies to improve their programs, engage everyone on their teams, and make the QAPI program a living, breathing program that continually transforms to meet the evolving needs of our patients? This is not about writing more regulations to make all programs the same, as that would contradict the intention of the requirement to make it meaningful for each organization; rather, the goal should be to breath life into the language and use data to influence lasting change. Finally, if we have learned nothing else from COVID-19, we have recognized our shortcomings as a nation to deal with a global pandemic. As a home health and hospice sector, these uncertain times have also highlighted the demand and criticality of our field, shedding light on the paramount role of the post-acute world for both acute and chronic diagnoses. This spotlight has also illuminated the holes in our guidelines, particularly surrounding infection control and safety. While personal protective equipment is based on precautions and is seemingly straightforward, we have been piecemealing guidelines for our workforce due to limited knowledge and recommendations from national organizations for home health and hospice. Recognizing that infection control procedures are top priorities in hospitals and skilled nursing facilities, the sheer inability to control the patient environments in the home health setting makes it very challenging to establish safety and infection control requirements. This lack of data-backed guidance puts our employees and patients at risk and is an area that warrants our attention and investment.

HHAC’s mission of "Advancing the health and wellness of Coloradans through the promotion of home care excellence, advocacy and education” speaks to me from a clinical, personal, and administrative standpoint. My experience as a senior level executive and administrator has trained me to be solutions-oriented and analytical. These qualities are critical in both the world of patient management and advocacy. Most people can identify the problem, but few have the background, experience, and resourcefulness to come up with solutions. Through interdepartmental collaboration and excellent communication skills, I offer and implement practical solutions for complex problems with an understanding of how the proposed changes impact the spectrum of stakeholders. Understanding the interplay of those with vested interests promotes creative, pragmatic solutions that anticipate barriers and results in lasting and effective improvements. My experience leading administrative, clinical, health information management, and human resources teams has given me the unique perspective necessary to plan strategically and make meaningful change. In 2017, I revamped our organization’s policies, procedures, and QAPI program from start to finish to ensure compliance and prepare for our reaccreditation survey. The interpersonal and organizational skills I developed during these last several years have not only contributed to my own professional advancement, but also to the overall success of the team and communities I serve. And finally, on service: I am a responsive, accountable and effective leader who is always customer-oriented, be it a patient, an employee, a referral partner, or a colleague. I pride myself in my integrity and my resourcefulness, my compassion and my drive to be an advocate and leader to those I serve. Bringing my experience, unique perspective, and comprehensive skillset to the HHAC board would be an honor and an opportunity to bring about impactful changes within our field on both a local and national level.