Celebrating Women in Home Health Care

Happy International Women’s Day!

Women are vital to home health care, both as employees and patients, and today we celebrate the contributions of women in the industry and the patients who benefit from their care.

The National Women’s History Museum credits Lillian D. Wald, founder of what is today the Visiting Nurse Service of New York, with inspiring the New York Board of Health to organize the first public nursing system in the world.

Nationally, women are tremendous assets to our healthcare industry, and this is especially true for home health care. In 2014, a whopping 88.6% of persons employed in home health services were women; that’s over a million women employed in the industry! Nationwide, women make up roughly 47% of the workforce, and while women are more likely to work in the health care industry writ large (78.6%), home health care is still even more female-dominated than the industry as a whole. Within the Bureau of Labor Statistics’ “health care and social assistance” industry marker, home health care services employ the second greatest percentage of women.

It’s not just in the workforce where women are prominent. Looking at information from the 2015 Home Health Chartbook, home health patients are also more likely to be women, with females comprising 61.5% of home health users (compared with 54.6% of all Medicare beneficiaries). Women actually comprise a smaller percentage of home health users than males under age 85, but over a quarter of female home health users are over 85.

Diving deeper into the demographics, women are three times more likely than their male counterparts to be widowers, while less than a third are married. Women who receive Medicare home health services are also much more likely than male users to have an income below $25,000 a year.

According to the Kaiser Family Foundation’s 2009 fact sheet on “Medicare’s Role for Women” across the Medicare population, women are more likely than men to suffer from arthritis, hypertension, and osteoporosis. Almost 50% of women, compared with 38% of men, suffer from three or more chronic conditions. That same paper noted that while Medicare plays a critical role for women, women are still more likely than men to spend a greater share of their incomes on medical care. It is therefore crucial to continue finding ways to both ensure funding of the program and new innovation and models to help women face the challenges posed by a rapidly aging population.

Home health care is shaped very much by women, as patients, providers, and innovators. Today we thank them, and look forward to their continued role in molding the home health care delivery system of the future.

Optimizing Home Health Care: Enhanced Value and Improved Outcomes

This spring, the Alliance for Home Health Quality and Innovation released an electronic supplement to the Cleveland Clinic Journal of Medicine, “Optimizing Home Health Care: Enhanced Value and Improved Outcomes.” The supplement features six research articles from leading home health experts, and can be read in its entirety here.  Physicians can also seek Continuing Medical Education (CME) credit online related to three of the journal articles and free of charge, by clicking here.

In a continuing effort to educate the care community on the value of home health, the Alliance is issuing a series of one-page documents for each article. The first in the series summarizes the article, “Home-based care for heart failure: Cleveland Clinic’s ‘Heart Care at Home’ transitional care program.” The article focuses on potential value for home care in treating patients with chronic heart failure (HF).

Article Highlights

  • Heart Care at Home, a program initiated by the Cleveland Clinic in 2010, seeks to minimize possible risks in the transition of HF patients from inpatient to home care.
  • As part of the program, home care liaisons visit HF patients approximately two days following discharge from the hospital into the home to teach patients how to use their telehealth equipment.
  • HF patients, in the Heart Care at Home program, receive weekly contact and monitoring from telehealth nurses for 30-40 days after the program begins.
  • Home care nurses are trained specifically to work with HF patients and telehealth technologies.
  • The program yielded high success in 30 day readmissions rate, which were nearly four percent lower for first-time enrollees in Heart Care at Home versus publicly reported Cleveland Clinic rates.

To access the one pager please click here.

New Research from the Alliance: Home Health Chartbook

The Alliance has released a Home Health Chartbook, providing a broad overview of home health patients, the home health workforce, organizational trends, and the economic contribution of home health agencies.  The Chartbook also provides data on 30-day rehospitalization rates.

The research, compiled and charted by Avalere Health LLC, summarizes and analyzes statistics on home health from a range of government sources, including the Medicare Current Beneficiary Survey, 2010 Bureau of Labor Statistics, the U.S. Department of Commerce, Medicare Cost Reports, Home Health Compare, Medicare fee-for-service claims, and other data from the Centers for Medicare and Medicaid Services.

Key take-aways about home health that are captured in the Chartbook include the following:

Medicare Home Health Patients

  • Medicare home health patients tend to be older than patients in the general Medicare population.  Nearly 60% of home health users are patients 75 years of age or older, whereas about 40% of the overall Medicare population are 75 or older.
  • More Medicare home health patients have 3 or more chronic conditions as compared to patients in the general Medicare population.  86.0% of home health users have 3 or more chronic conditions, whereas 66.2% of the overall Medicare population has 3 or more chronic conditions.
  • Medicare home health patients tend to have lower incomes compared to the general Medicare population.    64.7% of home health patients have annual incomes below $25,000, whereas 50.4% of the general Medicare population has incomes below $25,000.

Home Health as a Job Creator

  • Data from the Bureau of Labor Statistics (BLS) suggests that home health will continue to contribute strongly to the U.S. economy as a job creator. 
    • In 2010, home health was directly responsible for creating 1,986,905 jobs, leading to a total of 2,860,808 jobs created in the U.S. labor force.
    • Between 2010 and 2020, BLS predicts that home health will create more than 81,000 jobs for Registered Nurses, more than 50,000 jobs for Licensed Practical/Vocational Nurses, and 13,000 jobs for Social Workers.

To view the Chartbook, please visit: http://ahhqi.org/images/pdf/home-health-chartbook.pdf.

New Data on Hospital Readmissions: CACEP Working Paper #4

The Alliance today released Working Paper #4 of the Clinically Advanced and Cost-Effective Placement (CACEP) research project, which examines hospital readmission and admission frequency and associated Medicare episode payments across three episode types: post-acute, pre-acute, and non-post-acute (community-based) care. Hospital readmissions and admissions were analyzed within the context of patients’ chronic conditions and demographic characteristics.

Key Findings

  • Hospital readmissions increased Medicare episode payments by at least 100 percent.
  • Patients with more severe primary chronic conditions tend to have more readmissions.
  • 22.4% of post-acute care episodes have at least one readmission.
  • Medicare post-acute care payments more than double when an episode contains at least one readmission, from an average payment of $15,335 without a readmission to $33,926 with a readmission.

Additional Working Paper #4 Resources

Full Report 
Study Highlights
Executive Summary
Presentation Slides

Home Health Implications

CACEP Working Paper #4 data suggest that better management of chronic disease across all three episode types through home health intervention could enable more patients to remain out of the hospital following an initial admission, or prevent avoidable hospitalizations all together.  Clinically appropriate and cost effective care ultimately can improve the quality of patient care and reduce the cost for the Medicare program and taxpayers.  Home health care combines the right mix of care management, prevention training and close observation to significantly reduce hospital admissions.

As lawmakers look into ways to reduce spending from hospital admissions and readmissions, how can home health be part of the conversation? Please comment below to submit your ideas. 

Stay tuned for the release of the final paper of the Clinically Advanced and Cost-Effective Placement (CACEP) project this fall. Details coming soon!