‘Boots On The Ground’: Why Home Care Provider-Home Health Agency Partnerships Work

Home Health Care News / By Joyce Famakinwa
 
Personal home care and home health care are both branches connected to the post-acute care family tree. As such, home care leaders believe that there are numerous ways that their organizations can help alleviate home health provider pain points.
 
One major pain point that can be seen across home health care are referral rejection rates. Last year, the industry had a 76% referral rejection rate, compared to 54% in 2019, according to data from WellSky. 
 
Jeff Bevis, chief operating officer at Caring Senior Service, sees home care as a natural ally for home health providers that are struggling in this area. 
 
“It’s been a matter of time [that we] partner with them,” he told Home Health Care News. “[One way we do] is by trying to limit the hours, or the time, that the home health nurse is spending with their client. In other words, when the home health nurse is with a client for 15, 30 or even 60 minutes, home care workers can pick up more of the non-medical client needs to keep them happy and healthy in the home.” 
 
The San Antonio, Texas-based home care franchise company Caring Senior Service has roughly 50 locations across nearly 20 states.
 
Bevis noted that this kind of arrangement gets to the heart of the referral rejection rate problem. It allows the home health agency to take on more referrals without making new hires or having to stretch their existing employees.
 
Currently, Caring Senior Service is collaborating with two home health agencies in rural Illinois to help lift the burden on these providers.
 
“We assigned a care manager to each of those home health agencies, and they’re meeting with those agencies once a week to talk through the patients that are most in need of non-medical home care activities and services, in order to reduce the amount of time and pressure on the home health agency,” Bevis said. “It lets us pick up a larger part of that slack for them, and makes more efficient use of their home health nurses.” 
 
On its end, partnering with home health providers has been a referral boon for Caring Senior Service…

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Census Bureau: ‘Aging-Ready Homes’ May be in Short Supply 

McKnight’s Home Care / By Adam Healy
 
As the older population of the United States continues to grow, the Census Bureau fears that the stock of what it calls “aging-ready homes” may be inadequate to keep up with demand.
Aging-ready homes are defined by three features: A step-free entryway, and a bedroom and bathroom on the entry level, according to the bureau in its new report. Informed by the 2019 American Housing Survey, estimates place the number of aging-ready homes in the U.S. at about 50 million households, or only 40% of all homes in the country.
 
Many older households — where at least one resident is 65 years or older — do not have the accessibility features to support aging in place. Around 4 million of these older households, or 11% of older households in the U.S., reported challenges related to living in their home. For households where a resident is 85 years or older, about 25% reported home-related living challenges.
 
The most frequently reported difficulty among older households was trouble entering the home. Though step-free entryways can help, this feature may not be available for many. Of the 124 million housing units included in the report, nearly half had steps leading to the entryway. This challenge can be more pronounced for residents of certain geographic areas. For example, only 1 in 5 houses in New England have step-free entryways, and many of these homes are multistory. Multistory homes are less likely to have both a bathroom and a bedroom on the entry level, according to the report.
 
Home accessibility challenges also disproportionately affect people of lower income levels. These individuals generally experienced more accessibility issues within their homes compared to those earning greater incomes.
 
Despite the importance of home accessibility features for aging in place, very few people reported plans to make modifications to support aging. Only about 6% of older households reported plans to make accessibility improvements to their homes. The Census Bureau report noted two possible reasons for this: First, home improvements are costly and may be unaffordable for low-income households; building an entry floor bathroom can cost anywhere between $6,000 and $90,000, according to the report. Second, people who rent rather than own their homes may have a lack of control over home modifications for accessibility.
 
A Harvard study released in March found that older homeowners spent more than $84 billion in projects to facilitate aging in place. Some organizations, such as the U.S. Department of Housing and Urban Development or Habitat for Humanity, provide financial aid for older adults looking to make such accessibility modifications to their homes.

Addressing Realistic Timelines for the Dying

By Barbara Karnes, RN

When it comes to looking at how long someone diagnosed with a life-threatening illness has to live, we tend to give people more time than they actually have.

Doctors do it, family does it. It is the hospice nurse or end of life doula’s job to be the realist, to guide all present.

Families give more time by seeing through the lens of their emotions, their fears, and their lack of role models. People don’t have accurate role models on what dying looks like anymore, other than movies, and people don’t die like that.

It is the end of life team (hospice or EOL doulas) that must be clear, observant, and honest while being gentle and supportive as they guide families and significant others through this challenging yet sacred time.

This guidance comes in the form of explaining the signs of approaching death. This guidance is teaching pain management and use of narcotics (what they do, how much to give and the response). This guidance is not just explaining the way death comes and what it will look like, but ensuring that those listening understand what this means.

Addressing the most realistic timelines of approaching death allows families and significant others the opportunity to do and say what needs to be done and said, to put affairs in order, to bring family and significant others together. 

Addressing the timelines of approaching death also neutralizes the false hope that our person will get better, that there is more time. It addresses the “I can do it tomorrow” procrastination we tend to have when we are experiencing something uncomfortable. 

Addressing the timelines of approaching death gives families the opportunity to come together, spend time with each other, support each other, and to say goodbye.

House Uncertainty Puts Shutdown Specter Right Back on the Table

Roll Call | By Aidan Quigley and Laura Weiss 
 
The chances of a partial government shutdown next month have risen significantly with the House’s ouster of Rep. Kevin McCarthy, R-Calif., as speaker, lawmakers and aides in both chambers believe.

With the current stopgap spending law set to run out Nov. 17, legislative action, including consideration of two appropriations bills set for this week, has ground to a halt in the House.

All eyes are on the upcoming election for speaker, with Majority Leader Steve Scalise, R-La., and House Judiciary Chairman Jim Jordan, R-Ohio, declaring bids Wednesday. Republican Study Committee Chairman Kevin Hern, R-Okla., is also considering a run.

“It’s an all stop, buddy, until we get this [speaker] seated,” Rep. Morgan Luttrell, R-Texas, said Wednesday. “That’s absolutely unfortunate. We owe the American public the appropriations bills, plain and simple.”

In its final action before ousting McCarthy Tuesday, the House adopted a rule to bring the fiscal 2024 Energy-Water and Legislative Branch appropriations bills to the floor. But no further action on those bills is anticipated until there is a new speaker.

At least one House Republican — McCarthy ally Rep. Garret Graves, R-La. — wants the speaker pro tempore, Patrick T. McHenry, R-N.C., to kick-start appropriations talks with the Senate. McHenry could be in the position for an extended time period, Graves said.

“I think we need to be very thoughtful about the roles and the authority that he can exercise in that position,” Graves said. “I would love to . . . be in a situation where we can move forward on appropriations bills and other things right now, and at least have some informal conversations with the Senate, where we don’t find ourselves set behind a month, maybe just a few days.”

However, with no historical precedent for McHenry’s role, it is not yet clear what authorities he will be able to exercise as speaker pro tempore. Graves said he is having conversations with the parliamentarian about McHenry’s powers.

It’s also unclear if the unelected McHenry would have the support of the Republican conference to start appropriations negotiations with the Senate, with so much about the fiscal 2024 process up in the air without a speaker.

Sen. John Kennedy, R-La., an Appropriations Committee member in that chamber, dismissed the idea of trying to “pre-conference” spending bills before they emerge from the full House and Senate.

“Not if somebody doesn’t want to lose a limb,” he said.

‘Worries me a lot’

McHenry and Graves were the architects of the debt limit deal that set spending caps but faced opposition for not going far enough in the eyes of some in the conference. The appropriations cap they ultimately negotiated was $119 billion higher than the hardest-line spending hawks in the party wanted and were under the impression McCarthy promised them back in January in exchange for letting him become speaker.

Senators in both parties believe that the lack of a speaker imperils the chances of keeping the government open next month.

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