The Future of Home Health Care Workshop Summary (2015) / Chapter Skim
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2 Home Health Care: Today and Tomorrow
2 Home Health Care: Today and Tomorrow
Pages 11-22
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From page 11... ...
Current State of Home Health Care Robert J Rosati Visiting Nurse Association Health Group Rosati summarized the current state of home health care, with a focus on Medicare home health care, and the changes occurring in the field to provide context for discussions about the challenges and opportunities of home health care in the future.
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From page 12... ...
Nevertheless, home health care constitutes only about 3 percent of Medicare benefits payments. The Medicare Home Health Care Program People who are recognized as needing home health care are those who have had a recent hospitalization or those who have received a physician referral.
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From page 13... ...
A notable model of comprehensive noninstitutional care is the Program of All-Inclusive Care for the Elderly (PACE) , a program jointly funded by Medicare and Medicaid that provides an integrated set of services at a PACE center in the community, with some home health care support, for nursing home-eligible recipients.2 Quality Measures National home health care quality measures compiled for the Centers for Medicare & Medicaid Services' Home Health Compare website suggest that home health agencies provide high-quality services according to key process measures, Rosati said, with home health agencies providing: • Checks for depression and the risk of falls 98 percent of the time, • Instructions to family members 93 percent of the time, and • Timely initiation of patient care 92 percent of the time.
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From page 14... ...
Finally, how do beneficiaries themselves rate the home health care services that they have received? Again, using national averages from Home Health Compare, Rosati reported that • Seventy-nine percent of patients say that they would definitely recommend their home health care agency to friends and family (whereas 71 percent would recommend their hospital)
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From page 15... ...
For some time, even though home health care has tended to use electronic records for both the collection of clinical information and assessment, meaningful use provisions under the ACA do not apply to long-term care. Home health care also has not benefited from the exchange of clinical data with other providers, nor do home health agencies have the patient portals that hospitals are required to provide their patients.
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From page 16... ...
Home Health CARE 2024: The Ideal State Steven Landers Visiting Nurse Association Health Group VNA Health Group, which Steven Landers leads, is a large nonprofit home health care, hospice, and community health care organization started more than 100 years ago by Geraldine Thompson with the support of her lifelong friend, Eleanor Roosevelt. Predicting the future of home health care is a risky endeavor, but "for this workshop, let's assume the future state is up to us," Landers said, emphasizing the importance of the task.
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From page 17... ...
Emerging trends in the health care system will accelerate strategies to provide post-acute care in the home, he said. Electronic information exchange among providers and other technologies will improve the patient and family experience and ensure the use of home health care services at
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From page 18... ...
For high-risk chronically ill people, organizations like Independence at Home4 practices, patient-centered medical homes, and models of care for advanced illness will partner with home health agencies and community resources to reduce the amount of time patients spend in hospitals and nursing homes, improve key indicators of well-being for patients and caregivers, use technology to improve the home health care experience, and greatly increase the proportion of the oldest old who die at home with hospice care. Ingredients for Progress Four main ingredients will be needed to effect this evolution and can be put in place by all varieties of payers and organizations: • Development and oversight of interdisciplinary home health care plans by physicians and advanced practice nurses informed by proven concepts of holistic geriatric medicine, palliative medicine, and rehabilitation medicine; • Enhanced support during care transitions that addresses self management, care coordination, information transfer, and clinical stabilization; • An advanced capability for escalating the intensity of medical and palliative care at home in times of decline or exacerbation of a pa tient's illness or medical condition (including escalation to hospital like services at home)
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From page 19... ...
A set of policies that would support the home health care infrastructure and help it play the role that Landers envisions would • Tie payments to outcomes and experience and facilitate provider participation in a diverse range of alternative payment models; • Enable the hiring of medical directors (who would, for exam ple, link home health care to the services offered by other key providers) ; • Have interdisciplinary team case reviews, similar to the approach used by hospices; • Make the interventions used during the transition of care a cov ered home health care service, irrespective of whether a patient is homebound; • Facilitate technology upgrades to improve the flow of information among providers and between home health agencies and the pa tients and families served; and • Develop training and careers for agency staff in state-of-the-art geriatric, palliative, and rehabilitation medicine, as well as in strat egies for the coordination of care.
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From page 20... ...
In response to a question from a workshop participant on the role of the individual, Landers said that care starts with medical care based on evidence-based geriatric medicine, palliative medicine, and rehabilitation medicine, all of which take a patient-centered approach using a comprehensive biopsychosocial assessment and a multifaceted model for the planning of care. At the same time, he said, some of the population groups that would benefit the most from home health care are quite dependent, as a result of impairment in cognitive function and an inability to perform activities of daily living.
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From page 21... ...
This speaks to the parallel need for a culture of accountability in places where it does not exist today. Feldman further asked if anything in the existing Medicare home health care benefit could help home health agencies have greater flexibility and even with their survival.
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