Many agencies and clinicians describe a general sense of confusion and detachment when discussing the changes that are confronting the Home Health industry. It now seems clear that recent experiences (increased audit/denials, funding reduction proposals), and future programming modifications (OASIS-C, P4P, etc), will alter both the scope and skill content of how Home Health will work in the future. We have previously outlined changes that homecare providers must address to remain viable business entities in the years to come. Today, we will attempt to address a simple technique that will help front-line clinicians, including both nursing and therapy, make care delivery modifications that will position them for success in the Home Health model of the future.
Most clinicians want to provide the best care possible for all of their patients. Whenever care quality lapses or fails to achieve contemporary standards or desired clinical outcomes, and this is not uncommon in today’s healthcare world, the cause is rarely the lack of sincere desire on the part of the clinician. Rather, the root of less than optimal clinical results can be traced to initial clinical programming and the clinical delivery structure employed as the care mechanism. Agencies whose clinicians possess little experience in homecare, or employ out-dated care philosophies and techniques, resulting in un-managed and in-efficient care delivery, have fallen behind in the area of contemporary care. All of the above are common and basic factors in sub-standard Home Health outcomes. Home Health agencies may or may not take steps to address these types of care concerns, but how can the individual nurse or therapist address the clinical concerns they encounter? And how can they provide care programs delivered in a progressive manner in order to keep pace with current and future Medicare requirements?
When auditing Home Health charts from across the country, the author notes a common occurrence in both nursing and therapy care delivery. In general, the issue at hand is a lack of skilled propulsion, and progression, of the functional improvement required to assure payment. When care progression suffers, programs lengthen and outcomes fail to achieve desired levels. When questioned about the lack of timely propulsion in their programs and documentation, clinicians consistently describe the high acuity level, or cite the number of co-morbidities the patient has, as obstacles that prevent faster, or better, outcomes.
In reality, the current profile of the homecare client of today is that of a complex, high-acuity patient with multiple co-morbidities. The basic homecare referral should be in response to some un-safe decline in health or function, and the patient should be qualified as homebound to achieve eligibility for Home Health services. These facts, combined with ever-shortening hospital or SNF length of stay statistics, describe a type of patient that may exhibit profound and numerous clinical diagnoses that might limit progress. But skilled and experienced nurses and therapists respond assertively with patients that possess involved clinical profiles. In fact, the level of complicating factors is often seen as an affirmation of the need to progress forward in a timely manner to achieve stability and progress before further clinical problems arise.
This approach to high-acuity homebound patients has been employed for years in our practice. While providing services at multiple points of the care continuum for 25 plus years, the goal of propelling the patient to the next level (acute to SNF, SNF to Home Health) as rapidly as possible was prioritized. The pace of progress noted when best practice guidelines were followed was replicated with all patients as our basic clinical approach. When the patient reached home, and services were provided via the Home Health benefit, the concept of a rapid pace of progress was retained.
Our attempt to “PRIORITIZE THE PACE” of care delivery and goal achievement has helped us define our expected pace of progress for our homecare clients. We strive to pay close attention to the rapid progression of function based on efficient delivery and full patient compliance. We seek to avoid the use of co-morbidities as an excuse or reason to limit progress expectations. Co-morbidities, or high acuities, may cause us to take smaller steps forward, but we approach the program with the same compliance expectations and clinical progression as we do with all our cases. We are no longer surprised when a complicated patient responds well to treatment; in fact, we embrace our basic plan to “PRIORITIZE THE PACE” with ALL patients.
We in Home Health should resist the inclination to respond to complicated patients with lesser intensity or slower-paced programs. In almost all cases, the faster we are able to achieve patient goals, the faster the complex patient is able to realize a return to a previous level of function. Both nursing (med teaching, patient/caregiver education) and therapy (skilled strength and mobility training) will achieve new levels of outcomes as well as patient safety and satisfaction by finding ways to “PRIORITIZE THE PACE”.
It’s the most caring approach you can employ as you strive to provide the optimal care level for your patient.