In presentations on progressive Home Health issues to groups of all sizes (State or National Conferences, small or large profit or not-for-profit agencies, etc), the author consistently encounters providers and clinicians with lengthy and impressive records of care delivery in our industry. Whether currently managing an agency or State Association, supervising clinical personnel, or delivering front-line clinical care, the common thread seen in nearly all homecare participants is a sincere desire to help their clients achieve safety and function in the home. In addition, their role in the relatively new Home Health care delivery model has given them a birds-eye view of the continual refinement that defines our homecare system.
The author finds it curious that, when confronted with the prospects for future changes currently proposed for our industry, many of the same individuals that helped define today’s successful Home Health model resist the inevitable evolution of our care. From top to bottom, homecare professionals greet news of industry changes with the same level of excitement otherwise reserved for root canal surgery. Despite a legacy marked by impressive gains in the transition of acute care delivery from inpatient to community based services, homecare workers often struggle to integrate new concepts, progressive clinical developments, and utilization/reimbursement changes required for future success.
Many factors contribute to the reluctant responses heard from all corners of the Home Health industry when refinements are proposed by CMS. General skepticism from front-line clinicians is the result of the widespread and sweeping modifications to the Home Health model since PPS was first introduced in 1999. Upper level administrators, usually former homecare nurses themselves, still visualize our care in terms of a fee-for-service perspective as a result of the model they initially worked under. Structural realities of the care model also contribute to the in-efficient integration of recent reforms by clinical staff. The community-based working environment eliminates the proximity to other clinicians that is present in nearly all other care environments; resulting in difficulties in implementation of new practices. Pressed to make visit quotas that, until recently, are reflective of the lack of audit activity in Home Health, nurses and therapists rely upon traditional care practices in lieu of progressive developments. Even further, basic elements of the PPS model (i.e. caregiver involvement and education, disease management, and patient compliance) are often lost in the shuffle of care delivery.
The net result is a care component that moves forward under a “business as usual” mentality; the common clinical needs of the homecare patient certainly allow us to effect some sort of change with tried and true levels of intervention. Nurses and therapists working in the industry unwittingly maintain a sort of clinical status quo as they fail to evolve and adapt their care to the latest industry reforms or advances. The contract nature of much of the rehab staff currently employed in Home Health also serves to slow the pace of change as agencies feel unable to supervise these clinicians in the same manner they manage their employees.
Agencies and clinicians looking to continue to provide care in Home Health should consciously take steps to assure that their care evolves to match industry standards and advances. By addressing the innate resistance to change, we can integrate the innovative protocols and care delivery methods required by our rapidly advancing PPS model, changes in reimbursement, and any number of additional pressures that will alter the care patterns required for success in the future. By adopting and embracing a decidedly deliberate approach to what we do, we can change the intrinsic factors at work in our care plans that comprise the difference between success and failure. Deliberate frequencies and duration orders based on patient potential rather than worst-case scenarios, deliberate integration of caregivers, patient education and compliance, deliberate and skilled progression (as defined by CMS); all integral to achieve both clinical and financial success in today’s Home Health environment. As individual clinicians and providers, we can make a difference in our care and outcomes by our emphasis on deliberate delivery.