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News Roundup: April 1, 2013

Home care for elderly is on the increase as economy changes

Published by 7 KLTV
Bethany Moore
March 27, 2013

In East Texas, the trend continues to show more people choosing home health care for seniors instead of the 24-hour care of a nursing home.

Nationwide there has been a steady decrease in nursing home use in the past ten years, and in Texas, the numbers mirror that national trend.

Curt Smith with ETMC Home Health says technology is one reason for the increase.

"I think the industry as a whole has changed and developed new technologies and the ability to care for seniors at home," Smith said.

One of the largest groups of seniors moving to home health is those on Medicaid.

Last year alone, 94,242 seniors in Texas choose nursing home care. And 183,562 chose home health according to the Texas Health and Human Services Commission.

Mark Moore with Briarcliff Health Center says he believes the difficult economy is to blame.

"Whenever someone is placed in our facility, say under Medicaid, there is a Medicaid applied income amount they have to pay, which is basically their social security check. Now the trend that we're seeing is that people are trying to stay home longer so they can retain that social security check, to help out with their daily bills, cost of living, things like that," Moore said.

Mark said it is slightly effecting business.

"Obviously we are reimbursed by our census, so we try to get as many people as we can, as quickly as we can, and hold on to them for as long as we can. And try to get them as healthy as we can."

Layoffs could be an issue, as well.

"With fewer people in here, sometimes we have to do cutbacks on staff and things like that."

Doug Mehling with At Home Healthcare says the option is becoming a more popular option in health care.

"I think that the trend towards home care and the care that home care can exercise is going to continue to be a big factor in the health care system," Mehling said.

But Mehling doesn't think this trend will eliminate the need for nursing homes overall.

"It's not like home health care can really replace nursing homes; when someone needs 24-hour care they can get it much more effectively and cost-effectively through a nursing home," Mehling said.

Home healthcare is when one pays a company to send a nurse to make home visits as frequently as needed. Where as nursing homes provide a place for seniors to live and 24-hour care.

Coordinated health care begins at home

Published by New Hampshire Sentinel Source
Rebecca Crosby Hutchinson
March 27, 2013

One of the important challenges we face as a state and nation in implementing health care reform is how we implement the concept of “coordinated care.” It’s a delivery model which forms the cornerstone of the Affordable Care Act of 2009. In a nutshell, the idea is to coordinate care that individuals receive from multiple members of the medical community so we can improve their care experience, produce better health and functional results and reduce Medicare and Medicaid costs.
When we are creating the care coordination delivery model a good place to start will be with the care staff who best knows the patient. How would this work?
A client of our agency is an 84-year-old retired teacher who has lived alone for 18 years with a half-mile dirt driveway separating her from her neighbors. Fiercely independent and with no children nearby, she, like most of us, wants to remain at home. Until recently her only regular help was a home care aide for 10 hours per week who assisted with grocery shopping, some cooking and cleaning.
Last year, she fell while at home and was hospitalized for treatment of five broken ribs and dehydration. She spent four days in the hospital and then four months in rehabilitation. Medicare paid the majority of her hospitalization and rehabilitation.
This year, her care and health status is closely coordinated by a home care nurse. A registered nurse reviews her health status and communicates with her physician when necessary. Upon the advice of the nurse, she accepted six additional hours of home health care each week, sometimes twice per day.
Her nutritional status has improved; she has gained weight and now weighs 97 pounds. With additional monitoring by trained aides, who communicate with the nurse who, in turn, communicates with her physician’s office, she has avoided hospital re-admission and additional Medicare costs.
This coordinated care and home care support is only possible because our client pays privately for her care. Currently, Medicare only pays for hospitalization and very short-term home care assistance following hospitalization. Medicare does not pay for her home assistance or the nurse who supervises and coordinates her care. She is not Medicaid eligible, but even if she were, Medicaid only pays for limited home care and current reimbursement rates will not support nurse oversight and coordination for persons receiving ongoing homecare assistance.
Effective care coordination will take place over time and it will include the entire team of care providers. For older adults, the home care aide can play a crucial role in providing information about the client when health status declines or changes. No other paid member of the care system is present in the home on a regular basis and can implement the kind of proactive measures and monitoring of chronic conditions — congestive heart failure, diabetes, pulmonary disease, and other conditions common in late maturity — that substantially reduce the cost to our public and private health coverage programs. Experienced home care aides are able to build a reliable and trusting relationship with their clients and family members and encourage healthy habits and safe living.
New Hampshire currently has over 900 home care aides providing thousands of hours of care in the homes of our Medicare and Medicaid recipients each year. New Hampshire would be well served to mobilize our already-existing home care workforce and include them in pilot programs now being developed with funding from the Affordable Care Act as we move toward effective coordinated healthcare.

New scoring system could identify patients at risk of readmission, improve transitions between acute and post-acute settings, researchers say

Published by McKnight's Long-Term Care News
Tim Mullaney
March 27, 2013

Researchers have developed a scoring system to determine which hospital patients are at highest risk of readmission within 30 days of discharge, potentially helping acute and post-acute providers focus on high-intensity transition care for these patients.

The research team from hospitals and medical schools in the United States and Switzerland looked at characteristics of more than 9,200 people admitted to Boston's Brigham and Women's Hospital between 2009-2010. They identified seven factors to create a readmissions risk score. These factors are sodium level at discharge, hemoglobin at discharge, number of procedures during admission period, non-elective versus elective admission, number of admissions within the previous 12 months, length of stay and discharge from oncology.

Based on these data points, clinicians can calculate what the researchers dubbed a HOSPITAL score to determine risk of readmission.

“This easy-to-use model enables physicians to prospectively identify approximately 27% of the patients as high risk of having a potentially avoidable readmission and would allow targeting intensive transitional care interventions to patients who might benefit the most,” the researchers wrote.

Internal testing validated the system, and it will now go through an external validation process, according to the researchers. The full study is available on the JAMA Internal Medicine website.

Study identifies patients at high risk for hospital readmissions

Published by Modern Healthcare
March 25, 2013

How often patients land in the hospital—and how long they stay—were better indicators of which patients would return to the hospital unnecessarily than types of illnesses, number of prescriptions and other factors, a study found.

The results, published by JAMA Internal Medicine, are among the latest in a growing body of research that seeks to identify patients at high risk for avoidable hospital stays by shifting through patient data in search of flags that predict who will make a repeat hospital visit.

Policymakers have targeted hospital readmissions as a source of potential waste. Last October, Medicare began to cut pay to hospitals with higher-than-expected readmissions within 30 days for heart attack, heart failure or pneumonia patients.

Hospitals, too, have targeted readmissions in response to Medicare's push and in a bid to lower healthcare costs under new insurance contracts, such as accountable care, that include incentives to slow health spending.

Dr. Jacques Donze, a research associate with the Brigham & Women's department of medicine who contributed to the study, said researchers sought to identify factors that could be tracked before patients leave the hospital so that clinicians might intervene with support that could prevent a repeat visit. A study already under way will use the score to identify patients to test potential interventions, such as individual coaching, home visits and pharmacist oversight of patients' medication, he said.

The analysis used data for roughly 9,200 patients who stayed at Brigham and Women's Hospital for at least 24 hours between July 1, 2009, and June 30, 2010. Patients either did not return within 30 days to any of three Partners HealthCare hospitals, including Brigham and Women's, or were readmitted within a month for what was identified as an avoidable visit.

Researchers with Brigham & Women's Hospital and the Bern University Hospital in Switzerland combed through two dozen patient characteristics that could be culled from patient records accessible during a hospital visit to look for potential risk factors.

Of those characteristics—which included factors such as age, whether patients had a caregiver upon leaving the hospital and certain laboratory results—the study identified eight that best predicted which patients would return to the hospital within a month.

Ultimately, researchers used seven of the eight factors to create a risk score for potentially avoidable readmissions. The seven factors are hemoglobin at discharge; discharge from oncology; sodium level at discharge; number of procedures during first admission; non-elective versus elective admission; number of admissions within prior year and length of the hospital stay.

Six medical conditions were examined as possible risk factors, and only congestive heart failure appeared to have any predictive value for readmissions. Congestive heart failure was eliminated from the risk score, however, because it was the weakest indicator and because the diagnosis in some cases doesn't materialize until billing data is generated after discharge.

The score will be tested in an international study, which includes seven U.S. locations, said Dr. Jacques Donze, a research associate with the Brigham & Women's department of medicine who contributed to the study.

Researchers said they believe that no prior studies have identified procedures during admission and sodium level at discharge as risk factors for readmissions. The number of hospital visits and length of stay, identified as important predictors, could be surrogates for other indicators that reflect the severity of patients' illness, the authors wrote.

Bills would address palliative care shortage

Published by The Hill Healthwatch
Elise Viebeck
March 22, 2013

New bills from Sen. Ron Wyden (D-Ore.) and Rep. Eliot Engel (D-N.Y.) would increase federal investment in palliative care — a specialty that is increasingly in demand as the U.S. population ages.

The Palliative Care and Hospice Education and Training Act (S. 641 and H.R. 1339) would create education centers devoted to palliative center in medical schools around the country, as well as fellowships to provide additional training to healthcare workers.

Figures provided by Wyden's office estimated that the United States lacks as many as 18,000 needed palliative care doctors.

The American Cancer Society Cancer Action Network (ACS CAN) welcomed the new measures, saying they would improve patients' quality of life.

"Patients want [palliative care] because it gives them and their families the support they need when they're dealing with a serious illness," said ACS CAN President Chris Hansen in a statement.

"That’s why palliative care is one the fastest growing trends in health care, and why we need more trained professionals in the field."

Lawmakers have floated several bills in the last month to cope with the wider U.S. doctor shortage. Read about those here and here.