Why HOP into Homecare!

There are over 10,000 skilled Medicare-Certified home care agencies in the United States employing over hundreds of thousands of skilled clinicians providing care to over 2.4 million elderlies annually. The annual turnover rate for an average home care agency is over 60 percent, with replacement costs estimated at $50k per nurse.

This means Industry is spending hundreds of millions of dollars to train tens of thousands of clinicians to keep up with their current patient needs. With Baby Boomers beginning to utilize Medicare resources, demand for skilled home care clinicians is expected to grow significantly (per BLS Data ~40%) over the next decade.

A robust orientation and meaningful mentorship program have been shown to be two important protective factors for nursing retention. A successful transition-to-practice helped new nurses become competent and confident in their roles and enabled organization to build a dedicated nursing staff to achieve their mission (Pennington, Gwen et....

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Story Behind Fundamentals of Home Health!

Hello & Welcome to our blog!

For the first blog, I want to share why I decided to build a standardized education and orientation platform for home care agencies.....

During my post as the Director of Quality, Education & Program Development in the area's biggest Home Health Agency, the agency was under constant pressure to grow!  Growth meant capacity management, and in order to grow capacity we needed a solid recruitment and retention strategy. 

Our program had the following barriers:  

  1.  Hiring full time educators was not an option (initially!) We were part of a major corporation and getting FTEs approved would have meant giving up our first born or at a minimum a limb!  Also, it would have taken closer to a year just to get approval and finally hire an educator!
    1. So all of us in management were tagged for teaching part of orientation! Our clinical management, Utilization Review and Quality Consultant all had to dedicate 2-4 hours per week to...
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Home-Based Palliative Care Program


Across the United States, the homebound population is expected to increase by more than 50 percent over the next 20 years (Desai, 2008.)  Lack of home-based palliative care for the homebound population is associated with several adverse outcomes, including increased emergency department visits and hospitalizations as well as decreased caregiver well-being.  As the healthcare market moves towards bundled and shared savings payment models, the incentive will be to keep the patient at a “lower cost setting.”

Innovative care models designed to deliver high quality care while containing cost are vital for sustainability of healthcare delivery at the local and national level.  In 2011, approximately two million people or 5.6 percent of the elderly Medicare population living in the community were completely or mostly homebound. The majority of these patients experience significant symptoms associated with their advanced diseases, in particular, pain and...

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Impact of Reduced Hospitalizations During COVID - 19

Multiple studies conducted (referenced below) have found a substantial decrease in the number of non–COVID-19 hospitalizations across a range of diagnoses during the peak COVID-19 period.

The decrease was observed for exacerbations of chronic conditions (heart failure, COPD), acute medical events that typically require inpatient management (myocardial infarction, appendicitis), and injuries.  Most of these studies relied on diagnostic codes, which have imperfect capture of both COVID-19 and other diagnoses.



To summarize the trends observed above, clearly patients with chronic conditions accessed fewer acute care and post discharge services as compared with years prior.  Can we safely conclude that some of acute and post acute care services accessed in years prior could have been excess or unnecessary? 

One of the theory outlined in a study was that due to the COVID pandemic, patients started practicing better infection prevention and...

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Hospital at Home & Covid-19


As the Nation seeks ways to provide safer care to a vulnerable population, post acute care services will undoubtedly play an increasingly important role in the healthcare system .  In the current times (COVID-19 pandemic), home care industry is best positioned to provide safe care in the comfort of patient's home.  

Hospital at home programs are gaining popularity during this pandemic,  and thus I wanted to share some components of existing programs, and my thoughts on "if you decide to go down the path!" 

Transfer Model

  • Patient is transitioned earlier (then traditionally estimated) from in-patient unit to home depending on strict clinical criteria and Physician to Physician collaboration and referral. 
  • The transfer model is for population at reduced risk of :
    • Further exacerbation of symptoms and can safely finish care in home settings.
    • Exacerbation of symptoms while being at high risk of iatrogenic complications and would be safer in...
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M1242 Pain Interfering with Activity


M1242 Pain Interfering with activity is a very important Oasis Assessment Item as it impacts home care agencies Outcomes, Risk (profiling,) Home Health Value Based Purchasing (HHVBP,) and Star Ratings!

In my prior blog I highlighted National data associated with patient's pain interfering with activity at start of home care.  In our approach to quality improvement, we help agencies design a customized strategy that takes agency specific data to engage frontline clinicians in improving outcomes for the agency.  

Contact us to learn more about our strategy and how we can help your agency improve outcomes.  

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National Data - Pain Interfering with Activity


Pain is one of the most common reasons that patients seek medical attention. Chronic pain most often requires a multifactorial approach to management.

In addition to nonpharmacologic therapies, many patients require medications to manage pain.

This vlog covers data home care clinicians can use to understand the impact of pain on vulnerable home care population.  

  • 64% of patients at start of home care report that they have pain that interferes with activity
  • 73% of patients post discharge report moderate to severe pain
  • 50% of community dwelling adults report pain that interferes with normal activity
  • Almost 30% of patients at start of home care have a diagnosis of chronic pain
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MD Verification at Time of Referral to Home Health

MD verification at the time of referral is a very important step for home care agencies.  If not done in a timely manner, it can lead to unintended inefficiencies.  72% of patients being referred are from acute care facilities, homecare agencies must develop an efficient process that helps them verify physician at start of care or better yet, at time agency receives referral.  This process can help prevent the trickle down negative effects such as:

  1. No physician to sign Plan of Care after care has been initiated
    • In over 21% of start of care (SOC) visits clinical staff finds problems with drug regiment. 
      • Not having a physician to help with medication reconciliation could leave the frontline clinical scrambling to get urgent orders during SOC home visit  
  2. High non-billable visit cost (not to mention revenue loss) on not being able to provide care for the full episode for patient in need.  
  3. Negative experience for patient and community...
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Pneumonia Management: Field Decision Tree - Home Health

In the past few blogs, I have talked about clinical management of vulnerable high-risk population in home care.  I want to use the algorithm (see below) as an example to demonstrate the standardized approach.  I suggest home care agencies  use the following operational processes for high-risk patients: 

  1.  At start of care, obtain patient specific parameters and orders from the physician (NP, PA) managing patient's home care services
  2. Establish baseline vitals, infection status, pain level (comfort function goal,) functional capacity (e.g. use 6 minutes walk test), behavioral status, etc.
  3. If/when patient's condition deviates from baseline for the worse, initiate the protocol and go down the decision tree.  

Algorithm below is an example of pneumonia management in field.  If you are a home care agency looking to develop similar processes, 

  1. Work with your referring physicians and hospital systems to establish protocols for the specific patient...
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Immune Senescence - Decline in Immune Function in Older Adults

Persons of middle-older age are more likely to acquire severe acute respiratory syndrome coronavirus (COVID-19) infection, and older adults are more likely to have worse outcomes. So, what makes older adults more susceptible?

As we age, our immune system goes through physiologic (quantitative & qualitative) changes. These age-related physiologic changes include:

  • Alterations in the barriers posed by the skin, lungs, and gastrointestinal tract and other mucosal linings
  • Changes in immunity including decrease in specific cell populations
  • Decreased antibody response to vaccines
  • Impaired immunoglobulin production

Having a chronic disease further weakens older patient’s immune response resulting in greater susceptibility to common infections. 

Skilled home care agencies predominantly serve older patients (average age 75) and therefore, it is essential for home care agencies to develop and actively implement standardized and holistic approach to assessment, care...

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