May #HomeHealthChat: The Importance of Advance Care Planning

The May #HomeHealthChat was co-hosted by Lee Goldberg (@lmgoldberg). Lee Goldberg is the Project Director for The Pew Charitable Trusts’ Improving End of Life Care Project.

The #HomeHealthChat focused on the Importance of Advance Care Planning.

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:

Prioritizing Care From Hospital to Home

Last week, the Washington Post published the heartbreaking story of Joyce Oyler, a home health patient who passed away after receiving the wrong medication; an error which failed to be caught at all levels, including home health. Ms. Oyler’s story is a terrible reminder of the critical nature of care transitions from setting to setting.

Care transitions are a central area of both focus and improvement for the home health care community. Recognizing the importance of quality and safety issues in the transition from hospital to home, the Alliance developed the Home Health Model of Care Transitions. The model lays out an evidenced-based approach to successfully complete a transition and prevent rehospitalization. The model specifically emphasizes medication management as a core component of an effective care transition, and specifies that a home health agency identify the name of each drug prescribed, what it’s used for, dosage, and when and how often the patient should take each medication. Medication allergies and pharmacy name and phone number should also be listed.

Other organizations are also dedicated to putting care transitions at the forefront of emphasis. For instance, the Visiting Nurse Associations of America (VNAA) compiled the Blueprint for Excellence, which features a module of patient safety including medication reconciliation. The Blueprint defines medication reconciliation and adherence, outlines the impact it has one patient outcomes and safety, and identifies best practices for medication reconciliation and adherence in the home. You can access the VNAA Blueprint for Excellence guidelines and resources on medication reconciliation here.

Federal initiatives are further driving quality improvement and patient safety in home health. Just recently, the Centers for Medicare and Medicaid Services (CMS) began assigning Home Health Star Ratings for quality and patient experience, on top of the existing publicly reported quality measures on Home Health Compare.

Star ratings are one mechanism to help consumers access better quality and patient preferred outcomes in home health care, however a number of additional models are currently being implemented to drive home the idea of value over volume in care. The Home Health Value Based Purchasing Model is tying payment to performance, while bundled payment arrangements and accountable care organizations are using payment models that seek to incentivize efficiency.

At the end of the day, policymakers, home health agencies, hospitals, and patient advocates must work collaboratively on ways to best tackle gaps in care from hospital to home.

Preventing tragic deaths, such as Ms. Oyler’s, is so critically important. We simply need to do better for patients and their families. Federal policy initiatives are paving the way, and the work of the Alliance, VNAA, and others are helping by addressing, compiling, and disseminating evidence-based practices and tools.

Together we as an industry and community can work to prevent critical medication errors, hospital readmissions, and most importantly, unnecessary patient deaths.

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: 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!

What’s in A Star Rating?

Co-authored by the Alliance and Visiting Nurse Associations of America

Over the past few months, the Centers for Medicare and Medicaid Services’ (CMS) introduction of patient experience survey star ratings to Home Health Compare, as a way to better understand the overall patient experience with care provided through Medicare-certified home health agencies, has gained a lot media attention.

While the jury is still out on the star ratings as a whole, home health agencies recognize that both quality of care and patient experience are critical. Agencies are learning from the issuance of the star ratings and are committed to improving their performance on both quality of care and patient experience.

Outlined below, the Alliance and VNAA breakdown the top five takeaways from the Patient Survey Star Ratings:

  1. The new patient survey star ratings do not replace, but instead are in addition to, the Quality of Patient Care Star Ratings used to describe the quality of clinical care provided by a Medicare-certified home health agency.
  2. Health care is moving towards a system that rewards value over volume and more readily engages consumers; as such, performance data will become increasingly important.
  3. The Home Health Compare Star Ratings are the first step towards streamlining communication regarding home health quality and patient experience in a way that is digestible to health care consumers.
  4. The discrepancies in the patient and quality ratings among individual agencies stem from several factors, including the limitation of the Medicare home health benefit, as well as the understanding of skilled versus non-skilled home health health services. For example, Medicare home health care provides skilled, clinical care, not services such as meal planning and house cleaning. Unfortunately, there is a disconnect for many patients when those needed non-clinical services are not met by their home health care team, despite receiving excellent clinical care.
  5. The patient experience survey is a positive step in the right direction, and is essential to capturing the overall home health care experience, but CMS must refine its metrics to capture more accurate data.

As organizations committed to advancing home health care, the Alliance and VNAA stand ready to work with the Administration to perfect the use of patient survey data so that it is balanced with necessary quality data.

March #HomeHealthChat: Interdisciplinary Teams

The March #HomeHealthChat was co-hosted by the ElderCare Workforce Alliance (@ElderCareTeam). The ElderCare Workforce Alliance is a group of 31 national organizations, joined together to address the immediate and future workforce crisis in caring for an aging America.

The #HomeHealthChat focused on Interdisciplinary Teams.

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:

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.

February #HomeHealthChat: Home Health Value-Based Purchasing

The February #HomeHealthChat was co-hosted by Visiting Nurse Associations of America (@VNAA). Visiting Nurse Associations of America leads efforts to transform home-based care toward value-based care delivery and payment models. VNAA directly supports home-based care providers through unparalleled peer-to-peer networking, innovative operational and program development support, organizational strategic planning resources, clinical education and training, and identification of leading vendors, products and services.

The #HomeHealthChat focused on Home Health Value-Based Purchasing.

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: