The decision to place an older relative into a long-term care facility or nursing home is always difficult. Many older Americans yearn to maintain independence in their own home, where they may have lived for decades and raised their families, but struggle due to acute and chronic illnesses that enhance limitations that come with age. Medicare supports home health services including visiting nurses and therapy, but according to Steven Landers, MD, MPH, clinical associate professor at Rutgers Robert Wood Johnson Medical School, the current policy should be strengthened to limit fraud, provide consistent services nationally to reduce health disparities and allow for better care coordination.
“The Medicare home health benefit is the most important piece of our national commitment to helping senior citizens age-in-place,” said Dr. Landers, who also is president and CEO of the Visiting Nurses Association Health Group. “As the medical community is beginning to care for about 76 million Baby Boomers as they age, now is the time to invest in home health.”
Dr. Landers, in a Viewpoint piece published Online First on September 26 in the Journal of the American Medical Association, says that the enactment of the Affordable Care Act (ACA) is the perfect opportunity to improve home health care. According to Landers, implementing changes to the Medicare policy means utilization of home health agencies for management of acute and chronic health conditions reduces the risk of emergency room visits and rehospitalization, thereby reducing healthcare costs for both the government and the patient.
Improving the value of home health can be accomplished, he said, through payment reform initiatives already included in the ACA. “Home Health Agencies should be better aligned with payment reform to allow them to support physician-directed care, help older Americans transition from a hospital to home, and assist with chronic disease management,” he said.
“I believe Dr. Landers makes some excellent, thought provoking recommendations,” said Alfred Tallia, MD, MD, MPH, professor and chair of Family Medicine and Community Health at Rutgers Robert Wood Johnson Medical School, “The Home Visit Service at Rutgers Robert Wood Johnson Medical Group has experienced an explosive increase in demand for services, and Dr. Landers’ recommendations would go a long way to helping us better serve patients in the home, which is where patients prefer to be, and where costs can be significantly less than in other settings.”
Additional changes recommended by Landers include “bridging” interventions that improve the transition from a hospital to home health care. This would reduce the dangerous 24- to 72- hour gap of care that now exists following a patient’s discharge.
Landers also suggests better oversight of home health agencies and requiring the organizations to employ a medical director who can supervise care plans, make home visits and ensure that proper protocols are implemented and followed.
Aiding each of Lander’s suggestions would be the integration of home health care records with a patient’s electronic medical record (EMR) and allowing telehealth interactions. An integrated EMR ensures that all caregivers understand a patient’s health history and medical requirements to continue living safely at home. Telehealth, where patients and caregivers can communicate remotely either by phone or video conference, improves access for patients and offers efficient oversight to ensure the patient is stable.
Landers holds steadfast to the belief that the nation should invest in education and research of home health care, which would provide evidence to the substantial, positive impact on economic outcomes and more importantly, allow Americans to age gracefully and comfortably at home.
“By revisiting the nation’s home health policy, there is an opportunity to improve quality, independence, and compassion for the largest group of older American in the nation’s history,” Landers said in closing his Viewpoint in JAMA.
- Steven Landers. The Future of the Medicare Home Health Program. JAMA, 2013; DOI: 10.1001/jama.2013.278062
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