St. Augustine Woman's Journal - Educational Resource to the Women of St. Johns County Since 2009

By Dr. Larry Lake
BayView Healthcare 

Home Health Care: How it's changing

 

February 1, 2017 | View PDF

Jeffrey Smith (fictitious name), age 82, recently was discharged from the hospital with cellulitis of the right lower leg, diabetes, and hypertension. At discharge, the physician refers Mr. Smith to BayView Home Health. He is ordered to receive skilled nursing, physical therapy and occupation therapy. Lucky for Mr. Smith BayView has all of these services under one convenient umbrella. BayView Home Health care is directed not just to the patient but also to family members-in this case, Mr. Smith's wife, who will be his caregiver. The BayView home health care nurse will teach them both about his medications and care regimen and instruct them to watch for signs and symptoms related to cellulitis, such as fever, warmth, and redness of the leg. In conjunction, BayView Therapy will also assist him in the home to return him to his prior level of function.

Over the last decade or so, home care has grown more complex, this article highlights the role of Home Health, specifically with skilled nursing, physical therapy, occupational therapy, and speech therapy services offered by BayView Home Health. This is especially important because with home care expanding into not only post-acute care but also in education of patients and families to keep patients at home to heal.

What is BayView Home Health care?

Many definitions of home care exist, and home care can "look like" many different things. BayView Home Healthcare exists to facilitate patients in the continued healing in their home setting. Skilled nursing, physical therapy, occupational therapy, and speech therapy are all offered by a BayView Home Health.

However, as government reimbursement decreases and pay-for-performance and other outcome- and quality-driven initiatives take effect, the definition of home care must incorporate prevention and community education. To that end, the US Public Health Service defines home care as services "provided to individuals and families in their places of residence for the purpose of promoting, maintaining, or restoring health or for maximizing the level of independence while minimizing the effects of disability and illness, including terminal illness."

Home care refers to any health care given in the patient's home. Such care may be provided by Medicare-certified or Medicaid-certified home health agencies, visiting nurse associations, hospice nurses who make home visits, community health nurses who provide well-child care to at-risk mothers, and many other types of home care. Also, some organizations provide what generally termed non-medical home care is provided by aides or companions to help frail elders remain safely in their homes. These services might include personal care (such as assistance with hair washing), light housekeeping, shopping, meal preparation and clean up, and other types of care that can help patients stay in the home.

Role of Medicare

The largest payer of home care services is Medicare. This is a federal health insurance program for people ages 65 and older, as well as for certain younger people with disabilities and those with end-stage renal disease. Just as there are hospital covered days or services, Medicare has strict rules and coverage criteria for home care services. The rules are complex and undergo constant change. The Affordable Care Act proposed a budget in 2015 that includes provisions for home health copayments and additional cuts to Medicare for home care. If enacted, these changes (along with previous significant cuts and changes) could have devastating effects on patients and their families.

Assuming the patient is homebound, meets eligibility criteria, and needs skilled care, Medicare will cover nursing services; physical, occupational, or speech therapy; home health aides; and medical social workers. Each of these services has a defined scope and specific types of care that the professional may provide.

BayView Home health care team members

The home healthcare team may consist of:

• Medical Director

• Registered nurses

• Licensed Practical nurse

• Occupational Therapist

• Certified Occupation Therapy Assistant

• Physical Therapist

• Physical Therapy Assistant

• Speech Therapist

• Speech-language Pathologist

In some cases, certain home care services must be provided under the supervision of a licensed provider.

First home care visit

The initial evaluation and assessment/admission visit is comprehensive. They obtain an in-depth history and perform an assessment using the OASIS-C tool. OASIS is an acronym for Outcome and ASessment Information Set, which must be used for all assessments of Medicare and Medicaid patients.

Next, the clinician reviews various forms with the patient and asks the patient to sign them. They typically include consent forms, patients' rights and responsibilities form, Health Insurance Portability and Accountability Act form, insurance and related release forms, and an advance directive. The clinician tells the patient and family members how to contact the Home Health aide and the necessary clinicians, as well as how to access a 24-hour

on-call nurse.

Being all things to the patient

Imagine knocking on a stranger's door and introducing yourself to a patient you've never met in a setting that's personal and private. You are a stranger-a guest in the patient's home. The home setting imparts a certain intimacy that makes the visit seem very personal: All parties must establish a comfort level with one another. As the visitor, you must acknowledge that you're in the patient's and family's space and convey respect for that space.

What's more, you will become all things to the patient, playing multiple roles beyond the clinician. In effect, you'll serve as the admitting clinical decision maker, the person who knows and operationalizes the rules regarding home care, the provider of hands-on care, and the instructor who teaches the patient and family and the advocate for that patient-all while working to meet the plan-of-care goals, coordinating other services the patient needs, and collaborating with the physician.

On the initial BayView Home Health Care visit, the clinician measures Mr. Smith's blood pressure, examines and assesses his cellulitis and the surrounding skin, and follows the physician's orders for the dressing, care, and management of the leg and cellulitis. She teaches the family what warning signs to watch for and explains Mr. Smith's pain management regimen, hypertension medications, and new antibiotics for his cellulitis. Mr. Smith tells the nurse that although previously he was very active, he now spends most days in a wheelchair because of the leg swelling and pain. The clinician develops a plan of care (with input from the physician and patient) that involves a physical therapy assessment as well as an occupational therapy assessment to return him to his prior level of function. She also counsels Mrs. Smith on a low-sodium diet and provides teaching sheets about diet and medications, warning signs and symptoms, and what to do if these occur. Her next visit is scheduled.

Examples of patients who may need home care

• An older adult new to diabetes or

insulin treatment

• A patient discharged with a

urinary catheter for long-term use who

will be homebound

• A patient with a wound who needs further

assessment, care, and management

• A patient who may have a decline in

function or recent falls and weakness.

• A patient who needs skilled care and

education or training after discharge

• A patient with a complex chronic illness

who needs ongoing management, such as

medication management and assessment

for changes in the plan of care

BayView's role in home care

No matter what the setting or patient specialty area, we can help patients function safely at home. In fact, in many cases, the home is the optimal care setting because:

• BayView conducts comprehensive

assessments within 24 hours of post-acute

discharge.

• Patients are taught to be safe in their own

home while working towards their prior

level of function

• There is a nurse available to our patients

by phone 24 hours a day.

• BayView offers skilled nursing services,

skilled aide services, physical therapy,

occupational therapy and speech therapy.

• Our home health works closely with our

skilled nursing facility, outpatient facility

and Assisted Living Facilities to ensure

our patients always meet their needs.

As the population ages, home care is expected to grow and home clinician opportunities are likely to expand. All of our clinicians, nursing and therapy, play a key role in helping patients get back to where they want to be. So think of BayView Home Health care the next time you have a patient who's ready to return to the home-the healthcare setting

of the future.

BayView's Layer of Trust

There is always a layer of trust when it comes to home health visits and care leadership. BayView has exemplified as the leader in ethics and honest accountability. For example, a particular resident was having trouble leaving her pet chihuahua for BayView Assisted Living at Buckingham Smith facility. The BayView Home Health team rallied together and gained the trust behind the resident to make sure her pet had a new forever home. Today, the pet chihuahua is still a member of our BayView family and lives with the director of nursing for home health, Tiffaney Harman.

This forum is a regular contribution from BayView Healthcare to help share the knowledge and expertise of the more than 280 healthcare professional across our continuum of care. In each issue an area of interest is address to help consumers be even more informed about their health and wellness.

We are living longer, and with the changes in healthcare reform, confusion continues to arise regarding what healthcare services are covered and not covered at all. As we age, most of us contend with multiple healthcare issues, many of which are chronic and cannot be cured – only managed. Today's home health care system is complex and very different from "what it used to be." In this FORUM, Tiffaney Harman, RN, Director of Nursing for BayView Home Health will explain how home health care is evolving. She reviews the factors driving the change to a managed care system, its impact on consumers, and what needs to be done in order to successfully navigate the system and advocate for further change, especially in terms of access for all.

Tiffaney Harman is the Director of Nursing for BayView Home Health. Tiffaney brings 24 years of health care experience to our team. Throughout her career she has held many leadership care positions giving a full range of all levels in the continuum. She is the curator of the BayView Home Health and is dedicated in the excellence within patient care and quality of life.

Tiffaney Harman, Director of Nursing for BayView Home Health

BayView Healthcare is a private, not-for-profit comprehensive continuum of healthcare provider founded in 1920. Our superior level of services includes short-term inpatient and outpatient rehabilitation, skilled nursing at BayView Rehab at the Samantha R. Wilson Care Center, BayView Home Health and BayView Assisted Living at The Pavilion and Buckingham Smith, an Emergency Charitable Assistance Program and BayView Wellness. Caring Hands-Caring Community is a separate 501(c)3 charitable organization founded in 2004 by our parent organization. It was formed to support the exceptional services and continuum of care provided to people in need of healthcare services and financial assistance. For further information about any of the programs offered through the BayView Healthcare continuum please call (904) 829-3475.

 
 

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