Home health is often utilized as a recovery tool when patients transition out of the hospital because of its ability to improve outcomes. But many of the Medicare beneficiaries who receive referrals after being discharged aren’t actually receiving these services.
Overall, the past several decades have seen an increase in the use of post-acute services, with more than 40% of Medicare beneficiaries receiving such care after being released from a hospital, according to a recently published study in JAMA Network Open.
When it comes to home health care, in particular, roughly 2.3 million Medicare patients were discharged from hospitals with home health referrals in 2016. Despite that large amount of referrals, only 54% of those individuals utilized home health services after their hospitalization within two weeks.
Additionally, 37.7% never received care; 8.3% were either institutionalized or died within 14 days, without receiving a home health visit. This data underscores the role these services can often play in helping patients return to prior levels of functioning.
“After 14 days, patients get home, think they’re fine, then they have a decrease in their mobility or whatever their status is from the hospital,” Mike Gregory, chief patient advocacy officer at Intrepid USA Healthcare, told Home Health Care News.
Dallas, Texas-based Intrepid USA Healthcare Services is one of the largest home health, hospice and home care companies in the country.
Although the study’s findings were gleaned from 2016 Medicare data, it’s likely that the results haven’t seen much improvement, Jun Li, one of the study’s authors and an assistant professor at Syracuse University, told HHCN.
“Certainly from speaking with discharge planners, for example, it seems like not much has changed in terms of their ability to track which patients are actually getting home health care,” Li said.
Falling through the cracks
From a home health perspective, there are a number of factors that contribute to this breakdown of whether hospital-referred patients receive care.
One factor: Providers aren’t always getting useful and accurate patient information from hospitals, Cleamon Moorer, Jr., president of American Advantage Home Care Inc., told HHCN.
“[That includes] contact information of patients, as well as emergency contacts and family members,” Moorer said. “There’s an opportunity to close the gap on clarifying correct contact information. I think from time to time, if a patient is highly sedated, or if there’s been a change to their contact information prior to leaving the hospital, discharge planners, case managers, social workers and the like may not be made aware of the latest contact information.”
Dearborn, Michigan-based American Advantage Home Care provides skilled nursing, rehab and specialty care services across nearly a dozen counties.
In order to avoid inaccurate information, it’s important to validate it on the front-end. For American Advantage Home Care, this means reaching out to emergency contacts in a timely manner.
“We take the patient referral, and we begin to validate as soon as we possibly can,” Moorer said. “To some, it may seem intrusive, if you call the emergency contact number while the patient is still in the hospital. We start by saying who we are and that it’s not an emergency, but we’re calling on behalf of the patient, because we received a referral from either a hospital or a clinic or a primary care physician.”
Providers that aren’t creating multiple points of contact with patients may find themselves having a difficult time keeping track of patients, he added.
“You almost need to be a patient navigator or tracker as a home health care provider,” Moorer said. “If you simply pass along the patient’s information to your start-of-care nurse or clinician … it may not be of the utmost urgency to start a new patient if they already have a full caseload.”
Once a patient has been discharged and an initial visit has been set, American Advantage Home Care’s call center team reaches out to patients to inform them about their assigned clinician and to nail down specifics as well as personal preferences.
“Within the first week of receiving a referral, we try to make at least four points of contact with a patient and/or an emergency contact within their profile,” Moorer said. “Some of that conversation is about educating on what to expect from a skilled care provider.”
Improving patient education
Another factor that pops up is patients leaving the hospital aren’t always educated on the difference between non-medical personal care and home health care. This results in patients turning down services because they believe a family member or friend can fill in as their caregiver.
“In the event that a patient is being discharged and they don’t know the difference between the two, they may lean on a loved one,” Moorer said. “They may say, ‘My son or daughter lives with me. I’ve got a niece or nephew that helps me get in and out of the bed. They bathe me. I don’t need anyone coming in and out.’”
Additionally, some patients may turn down services due to reservations about having someone they are unfamiliar with in their home.
“They’re quite often embarrassed about having strangers in their home,” Intrepid’s Gregory said. “For whatever reason, they’re just not comfortable having someone they don’t know. When you’re able to build that relationship up front, … they’re much more likely to allow a stranger in.”
For home health providers, working closely with referrals partners can go a long way in making sure patients don’t fall through the cracks. This means following up with discharge planners after a patient has been released.
This can also mean working with referral sources in cases where a provider is unable to accommodate a patient, Scott MacInnis, chief revenue officer at Elara Caring, told HHCN.
“If for some reason, if we are unable to see the patient, we would contact the referral source and help to coordinate the sourcing of another provider, making sure that there are alternative resources for the patient, especially in instances where the needs of the patient are beyond the scope of home health,” MacInnis said.
Addison, Texas-based Elara Caring is a home health, hospice and personal care provider that operates across several states, caring for thousands of patients each year.
Looking forward, making sure that patients actually receive quality home health care will be especially important as the U.S. prepares for a possible second wave of the COVID-19 emergency.
“Home health is still underutilized,” Gregory said. “It is one of the most cost-effective forms of taking care of the patients, especially now with COVID-19. Patients do not want to go to the nursing home, they don’t want to be in the hospital.”