Home Health Services: Bringing the Hospital Home

  • By Lisa Amstutz
  • October 3, 2011
  • 318
                        
“Instead of bringing the patient to the hospital, we bring the hospital to the patient.” That’s how Alexsandra Davis, Home Health Services Manager at Wooster Community Hospital (WCH), describes her department’s role. Home Health Services’ team of 35 staff members includes RNs, LPNs, occupational, speech and physical therapists, medical social workers and home health aides. They see close to a thousand clients each year, making around 14,000 visits in Wayne, Holmes and Ashland counties. Qualifying clients must be under a physician’s care and generally confined to their home. Home Health Services are covered by Medicare and Medicaid as well as many private insurance companies. Chronic diseases such as congestive heart failure, diabetes, pneumonia and COPD are some of the most common health issues seen in home health care. Without proper management, these conditions often result in repeated hospitalizations. Compassionate home health care can help post-surgical and stroke patients regain their independence as well. “Our goal is to reduce unnecessary re-hospitalizations, which are costly and stressful for the patient,” said Davis. “In order to do this, we looked at why patients are being re-hospitalized. Congestive heart failure and respiratory disease were the top reasons. So we put together a training program for staff on those two issues. The patient also gets continuing education on their disease and how to respond to certain symptoms.” Thanks to this training initiative, the hospital’s re-hospitalization rate for congestive heart failure decreased from 11.11% to 3.95% in 2010, while their respiratory re-hospitalization rate fell from 16.67% to 10.53%. WCH’s overall re-hospitalization rate is 18-20%, far below state and national averages (the average in Ohio is 35%.) Patient satisfaction scores for Home Health Services are all higher than the Ohio average as well. The hospital is now involved in a national study, sharing their successful methods with other agencies. Dr. Jill Schaeffer has served as medical director of Home Health Services for the past eight years. She identified three foundations of the program’s success: the team approach, chronic disease management, and improved quality of care. “Using a team-based approach improves outcomes, is more cost-effective and decreases admissions and re-admissions,” said Schaeffer. “For the homebound patient, home health is a big part of that team.” The focus on chronic disease management for conditions such as chronic heart failure, diabetes and emphysema allows the team to decrease re-admissions by coordinating care. Another factor is Home Health Services’ nonprofit status and close connection with the hospital, Davis said. They can offer continuity of care beginning while the patient is still in the hospital and have built close working relationships with physicians. Home Health Services clients may be referred by a physician even if they haven’t been hospitalized, but for those who are, the process begins even before they are discharged. The hospitalist and nurses determine whether they are eligible for Home Health Services (specialized care). Eligible patients are evaluated on their ability to cook for themselves, answer the phone, do laundry, ambulate, etc. Their medical condition is also assessed, along with current medications. The nurse then assists the patient in goal setting and decides what services are needed. Another type of assistance offered by Home Health Services is non-skilled care, or companionship services. Staffed by nurse’s aides, it provides monitoring, bathing assistance, cleaning, laundry, food preparation, grocery shopping and transportation assistance as well as medication reminders. The Home Assistance program is not regulated or covered by Medicaid. It can provide 24-hour care if needed, as well as respite care for those caring for someone with Alzheimer’s, dementia, etc. Hospice support is available as well. Davis said the trend is toward expansion of home health services: helping to manage medicines, address safety issues such as falling, staying in touch with the patient’s physician in a timely way to monitor their blood pressure and preventing re-hospitalization. She predicts that home health agencies will continue to get busier as demand for them grows. “I think the future of Home Health is to be involved in cases even before the patient is admitted to the hospital,” Davis said. “We would like doctors to contact us when patients are diagnosed with congestive heart failure or respiratory disease, because then we can start early, and give the physician more support.” “I think it’s on the verge of exploding because it’s low-cost and very successful,” Davis added. “I’m proud to work for this organization!” To learn more about Home Health Services or their Home Assistance program, visit www.woosterhospital.org or call 330-263-8630 for more information.


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