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...

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...

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...

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...