Value. Quality. Innovation.

Sign Up for Updates:

News Roundup: February 12, 2016

Repeat After Me: 'Hospice Means More Care, Not Less.'

Published by Huffington Post
Steve Landers MD,MPH
February 12, 2016

I probably lost many readers just by having hospice in the title; hospice may be the most misunderstood thing in American health care. The mere mention of hospice crosses a line--for many it's synonymous with death or giving up hope. And, while hospice isn't related to highly controversial concepts like euthanasia or assisted suicide, it's sometimes confused for these radically different things. Misunderstanding and mistrust of hospice is leading to unnecessary suffering, quicker and uglier medical deterioration, and missed opportunities for better and occasionally longer lives for people with serious illness.

What is hospice? Essentially, it's a group of services--it's useful stuff that is provided, brought, added (in a personalized way) to the care of a person with advanced stage illness. The extra stuff is delivered by teams of highly trained and caring visiting nurses, social workers, chaplains, personal care workers, physicians, pharmacists, volunteers, and more.

These teams know a lot about serious medical conditions like cancer, heart disease, and Alzheimer's disease, and they also have special knowledge in pain management, relieving anxiety, and helping stressed out families. They can address everything from difficulty breathing to constipation, from not being able to sleep to sleeping too much. Services are mostly provided in the home, while sometimes care occurs in hospitals and other facilities. Medications, medical equipment, oxygen, supplies and bandages are all provided. There is 24/7 availability of help on call.

Conversations about hospice often stop or get delayed because hospice requires you to have a life limiting medical diagnosis where survival is expected to be 6 months or less, and the stated goals of healthcare are more about comfort and quality of life than cure. These requirements are often conversation stoppers because they are misinterpreted by people who would have better and possibly longer lives with hospice. People erroneously see the decision as a black and white choice between fighting on and giving up.

There is no requirement that hospice recipients die in 6 months or less. In my decade plus working closely with hospice programs I have regularly seen that some people enrolled in hospice live longer than what is typically expected for people with their stage of disease--the longer than expected survival is not in small part because of all the extra help, added medical attention and tender loving care provided by hospices. And, though people turn to hospice because cures have been elusive, there's certainly no requirement to give up hope, and if a previously untried or new treatment unexpectedly becomes available or appropriate there's no prohibition on later deciding to dis-enroll in hospice.

I have never witnessed anything being done in hospice to purposely to hasten death or shorten life, the only technical exception being the shared decision to de-activate medical technologies such as ventilators and implanted cardiac devices in situations where the technology was considered futile, harmful, or contrary to the someone's stated wishes.

Another barrier to getting people to choose hospice is how imperfect and unprepared we doctors and nurses are about talking to people about hospice. In the often hurried environments of health care and our mainly technical backgrounds, we sometimes struggle to say the right words, forget to skip the wrong words, fail to spend enough time and don't always convey the real nuances and individualization that is possible in hospice care. I'm optimistic efforts, like Dr. Atul Gawande's "5 Questions," will help us get better in the future.

If you or anyone you know has advanced illness that isn't meaningfully getting better (or keeps getting worse) in spite of many treatments and hospital stays and doctors' visits then you owe it to yourself to learn more about hospice sooner rather than later. This is especially true for more frail elders with serious illness because the hazards of additional hospitalizations and certain treatment side effects are more serious and more common. Ideally, hospice care is set up on a better day, in advance of a true crisis so that the hospice team and person receiving services can get to know one another and set up truly personalized care. Too many people elect hospice so late in their course of illness that they miss out on many of the benefits.

In my decade plus work with and within hospice programs I have seen countless times how more care and services help people with serious illness and their families live better lives with whatever time they have left. For us insiders, we have come to understand hospice is not about death. It is a practical and tangible way to help people continue to live at home and in the community, to live life to its fullest with dignity and comfort, to live more connected to family, friends, and faith, to live more reflective on one's history and more intentionally about one's legacy. On the hardest days hospice is about fighting tooth and nail to make lemonade from lemons, and at its best hospice makes everyone involved more alive and more human.

This blog was inspired by all my colleagues at VNA Health Group. Special acknowledgements to Dr. Jon Salisbury, Bridget Murphy, and Dr. Vikranta Sharma who have encouraged me to address these issues.

mHealth Platforms Are Proving Their Value to Home Health Agencies

Published by mHealth Intelligence
By Eric Wicklund
February 12, 2016

Advances in digital health and the Internet of Things are improving the transition from hospital to home - and keeping patients at home.
A Chicago-based home health agency is launching an mHealth platform to help its chronic care patients transition from the hospital to the home – and stay home.

Health Resource Solutions, which works with more than 1,000 patients a month, will be using an app to keep tabs on its patients with congestive heart failure and COPD. The app is part of a chronic disease management platform that transmits vital signs and other patient data to a portal, where the data is analyzed and presented to the care team.

Glenn Steigbigel, the company’s CEO, says the mHealth platform, developed by San Francisco-based Wanda, not only connects the patient to the care team at all times, but gives the care team access to data and analytics focused on the patient’s daily activities.

“We are looking in on that patient every day,” he said, “and reacting to (that data). This gives us a chance to create a care management plan that teaches and rehabilitates … and moves (the patient) closer to independence.”

HRS is among a number of home health agencies turning to digital health to improve the post-discharge process for patients with chronic conditions, many of whom would wind up right back in the hospital if they didn’t have a care management plan that connect them to a care team at home. The service benefits not only the patient and their families, but also health systems eager to reduce preventable health crises and rehospitalizations.

The process is made simpler with the development of the Internet of Things, which enables healthcare providers to tap into a number of smart devices in the home to gather information on and connect with patients at a moment’s notice. With Wanda, the connection is made through the Wanda Smart App, running on the patient’s Android smart device.

Steigbigel says home health agencies like HRS are just now seeing the benefits from mHealth platforms, which enable them to collaborate with both the patient and the provider – such as the patient’s primary care physician or cardiologist.

A key component to that platform is collaboration. Digital health programs will fail – and have failed – when technology is simply dropped in the patient’s lap at home without any link to the care team, Steigbigel says. The apps and devices in the home will only succeed when they’re connected to a platform that engages the entire care team.

“I truly believe that healthcare is shifting into the home,” he said. “There are more and different things that we can do in the home now that we couldn’t do just a few years ago.”

Home Health Aides Poised for Larger Role in New Jersey

Published by Home Health Care News
By Amy Baxter
February 12, 2016

New Jersey is considering allowing home health aides to expand their role, delegating them some the duties typically performed by nurses.

Some of the duties that home health aides could perform under the regulatory change, but that they are currently not legally allowed to do, include administering medication and other minor medical help. Under current law, only nurses are allowed to perform these duties, though the modification would bring the delegated tasks under nursing supervision. The supervising nurse would be responsible for the succeeding level of oversight.

The role of home health aides can vary, but expanding the types of services they can legally perform could reduce some of the caregiving burden on family members who may be taking care of a loved one and potentially the use of institutionalized care. Expanding duties home health aides are allowed to perform can increase family support by supplementing tasks family members may already be doing.

“It’s precisely the kinds of things that home health aides and nurses do, that can prevent people from being readmitted to the hospital,” Joel Cantor, director of the Center for State Health Policy at Rutgers University, told NewsWorks.

Fewer than a dozen states allow nurses to delegate tasks including administering medication, though modifications can save money across the health care system. Under current conditions, nurses may feel wary about the risks of delegating tasks, while home health agencies may fear liability implications as a result of state regulations, according to a report published by Rutgers Center for State Health Policy published in 2011.

The Rutgers report revealed no adverse outcomes to consumer health by delegating some nurses’ tasks to aides in pilot study in New Jersey. Both aides and consumers expressed higher levels of satisfaction and positive health effects.

“Having an aide to help with the family care gave the family caregivers peace of mind knowing their family member would be well cared for,” the report concluded of the pilot study. “Delegation offered timely and consistent delivery of care. Several participants suggested that nurse delegation helped reduce the risk of future health complications and medical visits, as well as provide a mechanism for clients to leave or avert nursing homes by having someone available to care for them.”

To delegate some tasks, nurses may need to train home health aides and increase communication between health providers.

The New Jersey State Board of Nursing already approved the rule change, according to NewsWorks. New Jersey Governor Chris Christie’s administration has to legally vet the modification before it can be signed into law.

VNAA and AHHQI to Join Forces

Published by Home Care Tech Report
February 12, 2016

The Visiting Nurse Associations of America and the Alliance for Home Health Quality and Innovation have begun to work together for the benefit of their respective members and the entire healthcare at home sector. It is not quite a marriage -- the two entities will continue to have unique missions and member lists -- but they are living together. Alliance Executive Director Teresa Lee and Director of Communications and Events Jennifer Schiller have moved into the VNAA's Crystal City, Virginia headquarters, in an office a few feet down the hall from VNAA Director Tracey Moorhead.

The VNAA will continue its mission to support not-for-profit home care providers with advocacy activities, publications such as its Blueprint for Clinical Best Practices, annual and regional conferences, and the VNAA Center for Value Based Education. The Alliance will remain focused not on policy advocacy but on research and education services, which, though supported by member contributions, will be made available to the entire industry. VNAA membership is currently offered only to non-profit providers. AHHQI is open to all, though its fee structure, Ms. Lee told us, limits participation to larger providers.

Areas of overlapping interests were identified and will be developed together, including activities and services intended to help the healthcare at home sector prepare for coming changes, especially Value Based Purchasing and payment bundling. Services will include a co-sponsored Home Health VBP webinar series and the "Future of Home Health" project, initiated by the Alliance but now jointly developed.

FOHH is a research and strategic framework in development by Avalere and overseen by the Alliance Research Work Group. It is nearing completion and will result in two jointly planned regional FOHH symposia. The first has been scheduled for June 22-23 in Cincinnati and the second will be held in a western city later in the year.

Research and data analysis materials on the Alliance web site are free, provided their source is always cited when quoted or used. One of these, the "2016 Home Health Chart Book," includes lists of who is being served by home health, their top diagnoses, and the cumulative payer spend. The two organizations will collaborate on the popular "VNAA Blueprint for Excellence," which is updated at least once per year. "The current edition has new supplements," the VNAA's Moorhead stated, "including 30-day hospital readmissions data by state, a section on comprehensive care for joint replacement cases, and a hospital-specific database initiative."

During the formal announcement and explanation of this new collaboration, Ms. Moorhead added that the organizations have come together around the ideals of Value, Quality, Innovation, and Transformation to lead heathcare at home through the current period of evolutionary change and an aging population. They will also collaborate on best practices to achieve high Home Health star ratings, including both clinical and operational best practices, and attestations for agencies seeking recognition for achievements.

"The healthcare at home industry needs to address its concerns to its membership and to regulators and legislators with a single, unified voice," Ms. Lee concluded. "We offer a service that offers high quality care at an efficient cost to payers. We want that message of Value, Quality, Innovation, and Transformation to be heard."