‘Not About A Shiny New Toy’: How Home Health Providers Are Succeeding With More Complex Patients
Home Health Care News | By Patrick Filbin
As home health patients become sicker and more complex, providers have been forced to find ways to keep their care models financially viable.
In order to combat some of those “acuity creep” challenges, industry leaders are leaning on technology, data-driven decision making and more value-based care.
“We continue to navigate through a very regulated industry,” Janice Riggins, chief clinical officer at VitalCaring, told Home Health Care News. “That continues to pose issues for us, in addition to expenses for training and education. The recruitment and retention of qualified staff that have that clinical expertise is a financial implication. All of these aspects are at a very heightened level. Now more so than ever.”
The Dallas-based VitalCaring provides home health and hospice services across six Southeastern states.
Staffing costs and physician engagement
When taking care of the sickest and most complicated patients, it’s imperative that clinicians and caregivers are properly trained and that staff resources are optimized.
“Training and education is an investment that needs to be considered,” Riggins said. “It’s really important for our staff to have continuous training in order to handle these complexities of the sicker patients, which add to that overall operational cost.”
In this care environment, clinicians must be operating at the top of their licenses, McBee Associates President Mike Dordick told HHCN.
“Unlike going in and changing a wound or basic injections, you’re going to the sicker patients where there’s a lot more that clinicians have to be able to to deal with,” Dordick said. “Your resource allocation and your staffing strategy has to be at a higher level than if it was a lower-acuity patient.”
McBee Associates is a consulting firm that works with hospitals and post-acute care providers.
Maintaining an adequate staffing level will always be a struggle for providers. The same goes for covering the costs that are necessary to take care of new-age patients.
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Medicare Home Care Eligibility Standards Unfairly Burden Family Caregivers, Think Tank Argues
McKnight’s Home Care | By Adam Healy
Researchers called on the Centers for Medicare & Medicaid Services to act now to integrate more kinds of home care benefits for Medicare beneficiaries to help patients and their caregivers grappling with strict eligibility criteria and inadequate support systems.
“Millions of unpaid family caregivers are providing a broad range of assistance to beneficiaries as they recover from illness, move through rehabilitation or deal with chronic health challenges,” experts from the non-profit research group Aspen Institute wrote in a recent report. “Without more medical and social support from a reconfigured Medicare system, the overwhelming burden on family caregivers will only grow heavier.”
Medicare’s criteria for a beneficiary to be eligible for home care is too high, they argued, and unpaid family caregivers bear the greatest responsibilities caring for those that do not make the cut. Oftentimes these caregivers are forced to “spend down” to become eligible for Medicaid, whereby long-term services and supports, including home- and community-based services, are more easily accessible.
By expanding Medicare’s eligibility pool and offering home care services to a greater share of the Medicare population, beneficiaries can enjoy better health outcomes, the researchers said.
“Current criteria for receiving home health Medicare services, especially the requirement that a recipient be homebound, greatly shrinks the eligible population,” they wrote. “A number of alternative eligibility guardrails, such as functional status or level of risk for potentially avoidable nursing home care, could be considered if the homebound requirement were eliminated.”
New systems to coordinate care between healthcare and nonmedical personal care providers should be considered by CMS, they added. Things like reimbursement for navigation services, better training opportunities for caregivers, and effective use of new technology are especially important and can make it easier for providers and caregivers to help older adults in need of home care.
While a one-size-fits-all solution may not be possible, current support for Medicare-funded home care is simply not enough, Aspen Institute wrote.
“Medicare needs to change. An aging population and the opportunities introduced by technology add to the sense of urgency,” they said. “Coupling immediate steps with longer-term strategies to respond to the needs of a changing healthcare environment can strengthen family caregiving and allow Medicare beneficiaries to remain in the safe and familiar environment of home.” |
Hospice Experts Advocate for Early Admission to Hospice
The Herald-Mail (Story from Hospice of Washington County)
“Former President Jimmy Carter’s months-long time in hospice has helped tens of millions of Americans realize that hospice isn’t a brink-of-death service, that it helps patients and families focus on quality of life and not just length of life,” observed Hospice of Washington County CEO Sara McKay.
With a physician, nurse practitioner, nurse, certified nursing assistant, social worker, chaplain, bereavement specialist and hospice-trained volunteers, “the hospice team is structured to manage the patient’s physical, emotional and spiritual needs and support the patient’s loved ones while helping them care for their loved one,” McKay added.
According to Lee-Anne West, MD, physician executive and chief consultant for Hospice of Washington County, one of the biggest hurdles to overcoming resistance to a timely hospice admission is the misnomer that signing up for hospice means that a patient is giving up and that care stops with a hospice admission. “Nothing could be further from the reality of what hospice care entails,” West explained. A major difference, she noted, “is that before a patient enters hospice, the focus isn’t on the patient but rather is on fighting the disease—even when those treatments aren’t helping. After a patient enters hospice, the focus is solely on the patient’s comfort and dignity, managing pain and other symptoms, thus allowing the patient to enjoy being at home, in a comfortable setting, surrounded by family and friends.”
Instead of endless trips to a hospital emergency room for a patient with a limited time left to live, “the care comes to the patient in hospice,” she explained.
Having worked in hospice and palliative care for more than 18 years, West has seen numerous studies over the years that have demonstrated that patients who enroll in hospice live longer than patients with a similar diagnosis and similar demographics who continue aggressive curative treatments up until they are near death. “For many patients who come on hospice earlier, life expectancy can increase by as much as one to three months,” West stated. “When you step back from doing everything to treat the disease, the patient is allowed to live in the moment. The psychological pressure often melts. Hospice patients tend to live longer when they elect the hospice benefit earlier.”…
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One Year of President Carter Lighting the Way
NHPCO Hospice Action Network
One year ago, former President Jimmy Carter made history by making the courageous choice to share that he was entering hospice care. The Carter family is proving what many of us already know to be true: hospice provides value at any length of stay . By sharing President Carter's end-of-life journey, conversations are being sparked across the nation about palliative and hospice care. To commemorate President Carter's one year in hospice care, we wanted to share the following facts and resources:
President Carter's Hospice Journey Facts:
• President Carter is the first former US president known to utilize hospice care.
• The Carter administration tested hospice care as a model, which led to the Medicare Hospice Benefit we know today.
• The average Length of Stay for Medicare hospice patients in 2021 was 92 days, and the median was 17.
• President Carter is receiving the same hospice care that is available to all Americans under the Medicare Hospice Benefit.
President Carter's Hospice Journey Resources:
• Video commemorating President Carter's courageous choice
• New York Times story on President Carter's one year in hospice. Ben Marcantonio, NHPCO's COO and Interim CEO, quoted.
• Axios article on how President Carter's story is making the public more aware of the truths of hospice care. Logan Hoover, Executive Director of HAN, quoted.
Thank you, President Carter for lighting the way for all of us. |
Research Overwhelmingly Points to Benefits of Smart Home Health Technology
McKnight’s Home Care | By Adam Healy
A growing body of research has indicated that smart home health technology provides a wealth of benefits for home care patients and older adults aging in place.
In a literature review published by BMC Geriatrics, researchers analyzed 163 studies conducted between 2000 and 2021 concerning the use of smart home health technologies. These technologies included tools to monitor patients’ physiological well-being or functional status, safety and security technology; tools that facilitate social interaction; and other instruments like home reminder systems or medication management devices.
The most common benefit associated with smart home health technology was that they effectively helped clinicians and caregivers continuously monitor patients, which “makes caregiving simpler, more efficient, holistic or of higher quality,” according to the study published Wednesday. And at the same time, patients using these tools tended to feel greater confidence and peace of mind as a result of being monitored.
Smart home health technology was also effective at reducing seniors’ loneliness, which has been shown to lead to worse health outcomes. Such tools, the researchers said, promote self-care and adherence to clinically-prescribed medication, exercise or diets. Furthermore, many studies indicated smart home health technology’s ability to prevent emergencies such as falls, as well as enable earlier responses when emergencies do occur...
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Despite these benefits, barriers limited many older adults from using these technologies most effectively. Of the 163 studies analyzed, 110 found that smart home health technology was not intuitive or hard to use. Some older adults were hesitant to use robotic devices in the home, and technical issues such as battery life, internet connectivity, password systems and incompatibilities with existing home medical devices prevented many from being used successfully. |
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