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News Roundup: April 29, 2016

How Home Health Can Improve Fall Rates and Readmissions

Published by Home Health Care News
By Amy Baxter
April 29, 2016

Home health can play a significant role in reducing the number of emergency room readmissions among seniors after a fall, according to a new study focused on why older adults end up back at the hospital after an initial fall. The report determined that older adults who experience head trauma and visit the hospital as a result of a fall are much more likely to return to the emergency department soon after.

The Ohio State University (OSU) Wexner Medical Center looked at the medical records over 250 seniors who were treated and evaluated at its trauma center. The study came up with some surprising results, with nearly one-third of this patient group returning to the emergency department (ED) within 90 days after they were discharged.

“We have a lot of older adults that fall and we see them in the ER,” Lauren Southerland, MD, an emergency physician with OSU who specializes in geriatric care, told Home Health Care News. “We studied who had come to the ED, and found that if they had hit their heads, a lot of them were coming back. Head trauma made a person 2.5 times more likely to come back to the ED. It’s not at all what we expected to see.”

The biggest problem was what happened to patients after they returned home from an ED visit related to a fall.

“When we looked a reasons why people were returning [to the hospital], a lot of the problems were related to the initial fall,” Southerland said. “A lot of them fell again within the next few months.”

Reducing the number of readmissions of fall patients became a priority for the OSU staff, as falls are considered a leading cause of injury among older adults. While some seniors are typically admitted for further medical monitoring, about half will be discharged after visiting the emergency department, according to OSU.

One way to lower the risk of another fall after a discharge is home health, according to Southerland.

“There are a lot of little things that a home health care aide can do that might prevent the next fall,” Southerland said. “The role of a home health care use or aide is vital. They have to watch an older person very carefully [after head trauma]. They need to look for any signs of any unusual behavior, like being extra sleep or confused. Those could be caused by new medications or a concussion. Home health people know patients the best.”

One of the best resources to impact the rate of readmissions is a case manager, according to Southerland. While many ERs aren’t able to afford one, coordinating care between the hospital and a home health care company for a patient can make a big difference in preventing readmissions.

“Having a case manager in the ED is an amazing resource for patients, and getting them set up with home health therapy is invaluable,” Southerland told HHCN.

The transition from the hospital to the home after a head trauma is crucial in the care continuum, but it’s not just home health care companies that shoulder the responsibilities of keeping patients from returning the ER. The current discharge process from an emergency room leaves a gap in the care continuum by not involving home health care coordination.

“Typically in the ED, it’s focused on acute injuries,” Southerland said. “You make sure they didn’t fall from a heart attack and make sure there are no other underlying conditions. We don’t talk about fall prevention and other experiences at home.”

Since deciphering why older adults may be returning the ER, OSU has worked to increase fall awareness among its staff to better coordinate follow-up care in the home, as well as be on the lookout for trauma symptoms that could lead to another fall in the near future, according to Southerland.

Are Providers Taking the Wrong Approach to Coordinated Care?

Published by Home Health Care News
By Elizabeth Ecker
April 29, 2016

For health care organizations, coordinated care is not one-size-fits-all. While it’s a goal of many, the approaches, priorities and budgets vary, according to a survey of health care professionals conducted by Wellesley, Mass.-based Digital Collaboration Solutions, LLC (DCS), including some home health providers. In many cases, organizations are taking a more reactive than proactive approach.

Among the goals for coordinated care, more than 70% of respondents indicated that improving patient outcomes was the main goal. Improving the patient experience was another goal, with 20% of respondents stating it was their most important goal for coordinated care.

DCS sees this as “good news” despite how organizations differ in their goal setting.

“This is good news, an almost universal understanding that yielding better patient outcomes and experience is the net focus of care coordination,” the organization writes in its report of the survey results. “Although driven by revenue penalties and a need to lower costs, most survey respondents believe that improving care coordination to improve patient outcomes and experience makes good business sense as well.”

Coordinated care efforts are a top priority among 86% of the organizations interviewed, although 55% said they do not have a budget dedicated toward those efforts. Many say that coordinated care is a byproduct of the clinical work they are already doing, rather than warranting an added-cost approach. Many say leadership underestimates the time and effort coordinated care requires, leading to a feeling that employees are having to do more with less, DCS finds.

Ultimately, while organizations are aligned in their goal to achieve coordinated care, they lack processes to track their progress. More than 77% reported their organizations treat care coordination as a process improvement, yet 40% have no defined process to review, approve and prioritize their approaches. This leads to a more reactive process rather than a proactive one, DCS notes.

“Due to its lack of leadership, care coordination improvements are driven by reactive clinical teams needing to fix problems and respond to poor measurements,” DCS writes. “This lack of a systematic approach leaves many improvement opportunities unrealized and indicates inefficiency in prioritization. It could also be indicative of a fire fighting culture when the opportunity exists to prevent fires from happening in the first place.”

AARP: We Need Technology to Bridge the Caregiver Gap

Published by Home Health Care News
By Amy Baxter
April 29, 2016

With the majority of older Americans wanting to age in place, the number of caregivers is set to grow rapidly, along with a huge opportunity for supportive technology in this space. But the caregiving market, which represents a $279 billion opportunity over the next few years, is untapped when it comes to technology use, according to a recent report from AARP, Caregivers & Technology: What They Want and Need .

The majority of caregivers—71%—want to use technology to supplement their duties and assist in caring for loved ones, but not many are using technology now, AARP’s report found.

There are roughly 40 million family caregivers in the United States, and more than half are at least 50 years old. The other half are part of the millennial generation and generation X.

“This presents a tremendous opportunity to innovate technologies that serve unmet needs and to leapfrog current offerings with better approaches,” the report reads.

From assisting with activities of daily living (ADL), such as bathing, dressing and eating, to the varied tasks associated with daily living, including driving shopping and managing medications, technology can seriously support caregiver duties.

The top five tasks that caregivers in the report were most interested in using technology to support were:

Medication refill and pickup (79.1% said they were interested)
Making and supervising medical appointments (77.9%)
Assessing health needs and conditions (77.5%)
Ensuring home safety (77.5%)
Monitoring medication adherence (77.2%)
Why Current Usage is Low

While only a small portion of caregivers are already using technology that support their duties—just 7%, according to AARP—most are likely to start using some technology functions, especially if it was provided to them. However, fewer caregivers said they were likely to use technology than those who said they were interested.

“While 79% of caregivers reported being interested in using technology, 59% of caregivers report being likely to use existing technology, suggesting that technology that is currently available on the marketplace does not adequately meet their needs,” the report finds.

There are also a number of barriers to widen adoption of caregiving technology the report found, including a lack of awareness, cost, perception that technology won’t actually improve caregiving and lack of time and resources to learn new softwares and functions. While these represent significant hurdles for the digital health industry, there is a great deal to be positive about, particularly as younger generations become caregivers.

“We see a strong likelihood of this younger, rising and tech-friendly generation of caregivers to seek, adopt and share technologies that support their caregiving responsibilities,” AARP found.

As younger generations are already actively using technology as part of their daily lives, the interest of tech use skews toward future caregivers.

“Innovators can be optimistic about developing technologies that make a meaningful impact on the broad population of America’s caregivers because rates of caregivers already using or likely to use available technology are far higher among millennials and Generation Y than those 50+,” AARP reported.

Above all, caregivers are most interested in simple and inexpensive technology that enables them to “untether” them from needing to observe their loved one at all times to ensure “in case anything happens.” Technology that alerts caregivers when a loved one needs urgent attention also has high potential.

Where Home Health Can Win

Technology that can enable caregivers to arrange in-home care or transportation is an opportunity for the home health industry. However, family caregivers are also hesitant to hire people they don’t know. This represent a huge challenge for startups, which must overcome this barrier of distrust.

“To succeed in this area, innovators will need their technologies to communicate a high level of credibility in the platform and the available service providers, as well as build an adequate screening process into the user experience,” AARP advised innovators. Additionally, as this group represents functions that are typically within the abilities and control of a caregiver, the added convenience must significantly outweigh both the real and perceived costs of giving up control and introducing additional variability to the overall picture of giving care.”

Nurses affirm commitment to patients through home health care

Published by North Jersey Health News
April 29, 2016

I t's all eyes on home health ser-vices as the need for its specialized care grows. At the heart of the matter are nurses who practice in diverse capacities, from field nurses to executives with healthcare organizations.

Every Nurse is a Leader

"Home care nurses are special; they are in the trenches," said Lauren Van Saders, DNP, GCNS-BC, APN, administrative director for post-acute services at Holy Name Medical Center. "Where the rubber meets the road is in the home."

Home care and nursing are an excellent pairing. The nursing curriculum is decidedly holistic, addressing far more than the physical side of illness, said Dr. Van Saders, a registered nurse with advanced training in geriatrics and palliative care. Nurses are taught the assessment skills required to determine which actions are needed for the home care plan to succeed. Their carefully honed ability to lead is especially apparent in home nursing. In fact, nurses are charged with being the patient's advocate. "All the training comes together in home care," she said, and the department seeks out experienced nurses. Today's home nurse is at the front line of quality care, and a registered nurse heads each Holy Name Home Care team, which can include a variety of healthcare professionals.

The hospital-based service cares for adults, many of whom are 85 years of age and older. "The goal now is independence at home," said Dr. Van Saders. Patients might be ailing from any of a number of conditions, such as congestive heart failure, diabetes or lung disease. Some are recovering from surgery. Many are individuals who have had elective hip or knee surgery, as an increasing number of these patients bypass a stay in a residential rehab center entirely.

the Best Care Possible

Noreen M. Hartnett, BSN, RN, is a HackensackUMC patient care coordinator with Forest Healthcare Associates PC, a member of Hackensack University Medical Group. While the medical center's discharged patients receive home care from several agencies in Bergen County and surrounding areas, Hartnett provides an additional layer of support to very high-risk patients. "I provide ... for continuity, preparing them for the next step." Hartnett helps ensure that individuals get the best results from their care plan. That includes lessening the chances of readmission to the hospital. She works closely with the home health team and the patient. "My patients," she said, "have my number."

Being proactive is part of Hartnett's job. When floor nurses at HackensackUMC expressed concern that a patient to be discharged did not understand how to take her insulin, Hartnett made sure that the field nurse visited the patient to provide assistance within the first 12 hours after her return home. Often, services rendered combine strong skills of observation and common sense solutions, as in the case of individuals with basic challenges such as being unable to open pill bottles. "Sometimes it just takes a simple fix," she said.

"Being a home care nurse means you are putting everything together," said Hartnett. These nurses provide the primary care physicians, who direct care, with vital information, supporting them in what is a changing role as quality care is redefined for sick and healthy people. "Home health nurses are key in the evolving healthcare scene," added Hartnett.

Special Skills, Service

A look at Valley Home Care (VHC), part of the Valley Health System, affords insights into the scope of home health nursing. Approximately 162 nurses serve an average daily patient census of 1,100 in Bergen and Passaic counties, said Rose Marie Ranuro, RN, MSN, CPCN, its director of clinical services. The agency has adult and pediatric patients, and includes nurses with advanced training and certifications relevant to home care. For example, about 60 of its nurses have earned integrative chronic care certification, she noted. Certification is an official recognition of a particular level of competency and a highly valued accomplishment in nursing.

"Our hallmark is the specialties we have that set us apart," said Ranuro, who started the pediatric home care program 25 years ago. The commitment is basic. "We know it's best to care for the patients at home." To that end, VHC has numerous specialized services for mothers and children, including teen mothers, women experiencing high-risk pregnancies, newborns with jaundice and infants who have been in the Neonatal Intensive Care Unit (NICU). All of The Valley Hospital's NICU graduates receive a referral for home care, she said. The Butterflies Pro-gram supports children with life-limiting or life-threatening illnesses and their families.

Caring to Collaboration

Englewood Hospital and Medical Center offers home care through the Visiting Nurse Association of Englewood (VNA of Englewood), a non-profit partnership between the medical center and the VNA Health Group. A 5-Star rating from the Centers for Medicare and Medicaid Services for this joint venture brings light to one of the most important aspects of a nurse's skill set. "They are good collaborators," said Ellen Gusick, RN, BSN, chief nursing officer and vice president of clinical oper-ations for the group. "Joining together is what makes us strong."

Uniquely qualified and dedicated caregivers are at the core of excellent home care. In addition, VNA of Englewood is integrated into numerous hospital committees, teams and other activities.

VNA of Englewood supplies homebound patients with a broad range of services. A registered nurse leads the team and provides various facets of care, including pain management, education and wound care.

Home health nursing is a demanding occupation with a big job description and a broad arm. "Our actions can change people's lives, and the way we take care of people matters," said Gusick. Being an excellent home care nurse entails "doing what it takes."


Published by VT Digger
April 29, 2016

Community health leaders say they have figured out how to save money on treating Vermonters with long-term needs.

A half-dozen organizations that make up the Support and Services at Home, or SASH, program gathered at the Statehouse on Wednesday with representatives of Sen. Bernie Sanders, I-Vt., and Sen. Patrick Leahy, D-Vt.

The groups announced that they slowed the growth of federal Medicare spending on long-term care for senior citizens and people with disabilities by about $1,500 per person between 2011 and 2014.

The U.S. Department of Health and Human Services announced the results in a January report. The report said about 3,500 people participated in SASH during the time period, and savings were highest for the roughly 50 percent who had been in the program the longest.

As a group, the people who participated in SASH for the longest also had lower growth in health care costs for emergency room visits, outpatient hospital visits, primary care visits and specialist doctor visits, the report says. The report found smaller savings for patients in the program for a short period of time.

“The real greatness in my mind is about the quality of life improvements, and that is absolutely priceless,” said Kim Fitzgerald, the chief executive officer of Cathedral Square, the South Burlington-based nonprofit organization that set up the SASH program.

Sixty-five social service organizations, including ones handling affordable housing, mental health, primary care, elder care and disability services, are part of SASH. The number of people enrolled has increased to about 4,500, according to Cathedral Square, and 69 percent of them use Medicare. An additional 19 percent have a combination of Medicare and Medicaid.

The SASH program is integrated into Vermont’s Blueprint for Health — a health reform program that encourages patients to establish “medical homes” so a primary care doctor can coordinate the patient’s care with any specialists the person sees.

The cornerstone of the SASH program allows people to “age in place.” That means senior citizens and people with disabilities can receive health care and social services in their home and avoid being placed in nursing homes, which are some of the most expensive medical facilities.

Camille George, the deputy commissioner of the Department of Disabilities, Aging and Independent Living, said the SASH program “puts each person in the driver’s seat” and allows them to remain “happy, safe and at home, on their terms.”

George said the coordinated care program has reduced the rate of participants falling down and getting hurt, increased age-appropriate vaccinations for participants, increased how many people have their high blood pressure under control, and increased how many people have signed advance directives regarding their care.

John Michael Hall, executive director of the Champlain Agency on Aging, called the SASH program “precedent-setting” because Vermont is the only state to use it, and the federal government’s report shows that it’s working.

Hall said he began working in home health care 37 years ago, when social service organizations would often get involved in senior citizens’ health care after they were experiencing severe issues like dementia.

He said that led to “overreliance on hospitals, our continued habit of chasing disease when it’s at its most expensive instead of preventing it.” And he said governments should be “keeping people healthy, instead of being content to pay for them when they are very sick.”