April #HomeHealthChat: Palliative Care In The Home

The April #HomeHealthChat was co-hosted by the Home Care Alliance of Massachusetts (@ThinkHomeCare). The Home Care Alliance of Massachusetts is a non-profit trade association of home care agencies that promotes home care as an integral part of the health care delivery system

The April #HomeHealthChat focused on Palliative Care in the Home beginning with perceived definitions and moving through workforce challenges and considerations for quality of care.

The Alliance hosts a home health-focused Twitter chat on the fourth Tuesday of every month at 2 pm ET. Be sure to check here for updates on topics, co-hosts, and questions!

If you have topic ideas for future Twitter chats, or are interested in co-hosting a chat, please contact the Alliance’s Director of Communications and Events Jen Schiller here.

Below are some of the highlights from the chat:

Street Medicine Brings High-Quality Healthcare to the Homeless

Home health care most often occurs in a rather obvious location: a patient’s home. What though happens when a patient doesn’t have a traditional home? Enter street medicine, an emerging model that delivers care to patients where they are, be that in shelters or in the streets, in an effort to improve public health and care for some of the country’s most vulnerable patients.

Street medicine is, in many ways, similar to traditional forms of house calls, with a physician or physician assistant treating a patient where they live. The difference is the location, and sometimes the transitive nature of the patients.

A mostly grassroots model, a few health systems are keying in to the benefits of street medicine, while the Department of Veteran’s Affairs also already employs a similar model. The VA’s program, Homeless Patient Aligned Care Teams (H-PACT), serves over 5,000 patients a year in 31 locations.

One of the pioneers of street medicine, Dr. Jim Withers, founded Operation Safety Net more than 20 years ago within Pittsburgh Mercy Health System. Operation Safety Net offers a number of focused initiatives for homeless patients, treating the patient as a whole through partnerships with the area agency on aging, the VA, shelters, food banks, and more. The innovative program trains more than 100 residents and students each year and offers a one-month residency for University of Pittsburgh School of Medicine fourth-year students.

Lehigh Valley Health Network also runs a street medicine program, led by physician assistant Brett Feldman. Feldman, who was recently profiled by the Associated Press, treats about 100 patients a month in the program.

What these programs have in common is reduced rates of emergency room visits saving hospitals and health systems money while improving the overall health of the communities they serve. Estimates have shown a decrease in 30-day readmission rates at Lehigh Valley hospital down to 13 percent from 51 percent. Add to that the fact the rate of uninsured homeless has gone up nearly three fold from 24 percent to 73 percent and that’s a lot of savings for the hospital and health system. Many of the other health systems discussed in the AP article have seen similar savings and outcomes improvement.

Just like traditional home health providers are increasing their focus on preventative care, street medicine seeks to treat repeat patients before they wind up in emergent care, where care delivery is much more costly. Focusing on preventative care, and treating patients where they can be or need to be treated is a critical piece for the future of health care delivery. Street medicine, like home health care, aims to reduce readmissions and provide high-quality healthcare that truly serves the patient, especially those who are most vulnerable.

Improving Health Care for All This April and Beyond

April marks the Department of Health and Human Services’ Minority Health Month for 2016, focusing on “Accelerating Health Equity for the Nation.” As a critical piece of the health care system, home health care is a vital ally in the mission of improving health equity.

Data from the Alliance’s 2015 Home Health Chartbook shows that home health care already serves a disproportionate share of racial and ethnic minority patients as compared with the general Medicare population. However, there are still plenty of areas of focus with regard to health equity in home health care. Black and Hispanic home health users are more likely to have an income under 100 and 200 percent of the federal poverty level compared to all Medicare home health users, as well as being half as likely as all Medicare home health users to have an income over $25,000 per year. On top of that, both black and Hispanic home health users are more likely to have two or more activity of daily living limitations.

Work is being done to improve home health care for all, and a number of providers are already utilizing innovative programs to improve care for minority patients. In 2014, the Alliance released a Faces of Home Health profile highlighting the racial and ethnic diversity of home health patients and how one agency is meeting the needs of such patients. The profile featured Asian American Home Care, an agency based in Oakland, California, serving a diverse array of patients. Staff at AAHC speak nine different languages and have extensive knowledge of, and sensitivity to, cultural, ethnic, and racial diversity. Staff undergo training courses and are offered teaching materials in a variety of languages, meeting once a month to coordinate patient care. It’s not just languages in which AAHC staff are fluent. Emphasis is placed on being sensitive to unique considerations for minority patients in many areas of communication, including non-verbal communications, dietary customs of various cultures, understanding political and natural disasters that patients may have endured, and financial and socioeconomic barriers to care. Taken in combination, these specialized skills and tailored approaches help provide more well-rounded care to minority patients, improving overall health care and increasing the likelihood of adherence to care plans and improved outcomes.

Specifically, the profile shares the story of a 91-year old native Chinese speaker being treated by AAHC who prefers Traditional Chinese medicine (TCM) to Western medicine. The patient’s nurse utilized a series of tools to help improve the patient’s care, including making flash cards for her patient to use with doctors to address the language barrier, and finding dietary substitutions that improve the patient’s condition while still maintaining a sensitivity to the customs of the patient’s culture. These small things had a tremendous impact on the patient’s overall health, while still maintaining empathy for the patient’s culture and preferences.

Tailoring care to include cultural, ethnic, and racial sensitivities is vital to not only achieving better clinical outcomes, but to truly providing patient-centered and patient-preferred care. In doing so, home health care can continue to strive toward health equity, and improved patient outcomes and experience. The quicker health equity is achieved for all, the better we all are.

More information on National Minority Health Month is available online at: http://minorityhealth.hhs.gov/nmhm16/. Follow on Twitter using #NMHM16.

New Research and Initiatives Pave Way for Better Home Health Care for All

A few weeks ago the Huffington Post highlighted some new and emerging models of home care being utilized by the Visiting Nurse Service of New York. Some of these models involve treating chronic conditions, such as congestive heart failure (CHF), including front-loading visits in the first week and an evidence-based screening tool.

Additionally, the VNSNY is looking at the demographics of home health users in order to discern ways of providing higher quality, more patient-centered care. One new study looks at language barriers between patients and nurses, while another focuses on access to care for LGBT patients.

To read the full article, click over to the Huffington Post here!