After graduating from medical school over a decade ago, I have been working with home health agencies of all different sizes and needs. I observed that onboarding was extremely challenging, regardless of the size or resources of an agency.

Educators & Clinical Management were “recreating the wheel” every time a clinician was onboarded. There was no standard process or content that was in-place. Content had to be updated every time regulations changed, due to competing priorities, content was always lagging regulations and evidence-based practices.

Gap in communication between different functions meant either the new hire was released too soon, or not soon enough.  Both scenarios created disengaged new hire who is likely to quit within first 90 days! 

I searched for content already available that could help me onboard clinicians and streamline my department's processes.  I reviewed content libraries provided by the biggies (Elsevier, Medbridge, Relias)...

In healthcare delivery sequence, home care services are situated downstream from acute and post-acute care (skilled nursing facilities.)  One of the primary goals of home care is to help patient transition back into home environment.  Nurses, Therapists, Home health aides and other interdisciplinary team members such as Social Workers, Nutritionists work together to coach patient and caregiver to adjust to their "new normal."  This interdisciplinary team also teaches patients and caregivers a very important skill of self-triage - Who to call when (nurse versus a physician or 911.) 

I believe that the value proposition of home health services is not highlighted sufficiently when patients are initially setup with home care services.  

I hypothesize that patients who discontinue home care services within the first week do not fully appreciate the value of home care services.  My advice for healthcare systems and home care agencies is to build...

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....

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...

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...

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...