Home Care Thoughts from Six Industry Leaders
Home Care Thoughts from Six Industry Leaders: It’s Where They Want to Be
Those involved in the delivery of home and community-based care, from personal care aides to agency owners and administrators, are dedicated and passionate individuals who work in home care because they understand the importance of being able to offer people a choice about where they receive their health and supportive services. Working in home and community-based care is more than just a job—it is the fulfillment of a desire to help those in need of health and supportive services receive care in the comfort and security of their own homes. These six industry leaders, who come from agencies of different types and sizes from all corners of the State, are no exception. It is the commitment of people like Bob Callaghan, Marge Coffey, Todd Brason, Tom Buckley, Becky Leahy, and Kenrick Cort that has been instrumental in developing a strong and enduring network of home and community-based providers across NewYork State.
Home care’s presence
Home care has been a cornerstone in the delivery of health care for at least a century and a half. Providing health and supportive services in the home—support with activities of daily living,nursing services, therapies, and other necessary health and support services—has saved the health care system by keeping people out of more costly settings and helping them stay happy, healthy and safe as they recover from illness, live with illness, and age at home.
The presence of home care has been constant, but over the years the home care industry has matured and evolved and the opportunities and challenges that the industry has faced have changed. Throughout all of this, the people working in home care and leading the industry have remained flexible and resilient.
Here, these six home care leaders, who have over a century of combined health care experience, share their thoughts for government policy makers, health industry leaders, and consumers about home and community-based care.
Changing patient needs
While the goal of keeping patients in the security of their own homes has remained the same, the patients served by home care, the way care is provided, and challenges facing the home care industry have changed.
One striking change in the past two decades is the characteristics of the average patient being served in the home.
“Patient demographics have changed,”said Bob Callaghan,who has been part of home care for nearly 40 years. “Today, the needs of home care patients have increased significantly as the desire and ability to remain home has grown.”
Modern medicine has extended the average lifespan in the United States. People are living longer, but they are also living with one or more chronic illness, which necessitates the need for ongoing health and supportive services. Home care plays a critical role in the delivery of this care. These changes have increased the number and types of patients that do not need the intensive level of care provided in a nursing home or hospital, but still require some assistance and medical care to remain in their home.
Additionally,changes in the overall health care system have driven changes in home care patient needs. “Patients receiving post-acute care in the home often spend fewer days in the hospital than they did just 10 or 20 years ago,” said Tom Buckley. “This means that patients leave the hospital sooner and require more rehabilitative care in the home.” Patients with higher acuity levels—more complicated and intense health care needs—are commonplace in the home setting today and present new challenges to those trying to meet their needs.
The culture in our country has changed as well, and that has resulted in an increased desire for home care services. “Patients have become much more knowledgeable and sophisticated when it comes to their care, ”Bob Callaghan said. Patients and their families are more conscious of the care options available to them and have high expectations for their care. More and more, people are choosing home care to meet their needs—it truly is the preferred setting to receive post-acute and chronic care services.
Another cultural shift is in family structure and support. Home care services are used more to address decreasing family and informal caregiver support. Families of today have different challenges than in years past. Among these challenges are households with adults working outside of the home, “sandwich” generations that are stretched because they are caring for both aging parents and young children, families that are geographically spread out, and individuals’ desires to remain independent. All of these changes have led to less, or different, family support than in the past.
“Less family support in some households makes it more difficult to develop a comprehensive care plan,” said Becky Leahy. “…more and more family members are all working and unable to afford to put their jobs on hold to help with care.”
Technology—efficiencies from many perspectives
As industry leaders have shared, people are living longer and with greater needs and home care has adapted to these changes. In addition to an evolving patient profile, technology continues to advance and become more sophisticated. There are more services that can be provided in the home setting and more efficiencies that can be realized. Options for both patients and providers have increased.
New technologies, such as telehealth remote monitoring systems that measure vital signs, track patient status and even monitoring what a patient is doing throughout the day, have opened up the benefits of home care to people of all ages with many types of medical conditions.
Todd Brason’s WILLCARE has invested in telehealth and point-of-care units to more effectively collect and disseminate important patient information, which can literally save a patient’s life.
These tools also create effiencies in the delivery of care. Telehealth equipment allows home care providers to better monitor a patient’s status and then deploy scarce human and fiscal resources to manage their care based on real-time information.
“Telehealth has proven to improve our patients’ quality of life by preventing hospitalization and making care management easier,” said Marge Coffey. Decreasing reimbursement and increasing regulatory requirements for home care services have incentivized agencies to employ technology beyond telehealth equipment to make more efficient use of their resources.
At Tri-Borough Home Care, Kenrick Cort has upgraded telephony and regulatory compliance software to ensure that talents and skills of aides and nurses are being used most effectively, and that government regulatory requirements are met and recorded.
VNA of Albany is constantly searching for new efficiencies, which has helped Tom Buckley hold costs at no growth for the last three years. This has been critical for their agency as government policies have restricted adequate payment for services and added costs through unfunded mandates. “We do more with less and implement every efficiency possible without compromising patient care.”
Creativity in care
These home care leaders have also learned to maximize the value of every second of care provided in the home. Over the years, the amount of services authorized by public payers and third party insurers has decreased substantially. Even those paying for care privately have been forced to make difficult choices in a bad economy. Again, home care has adapted to these changes—through the use of technology and investing in their workers. The home care workers—the backbone of this industry—are the eyes and ears in the home setting and make sure that “a little goes a long way.”
“In recent years, the amount of care authorized for each patient upstate has gone from a few hours a day to just one or two hours at the most and delivered in 15-minute increments,”said Becky. “We work very hard to make every second count so our patients can continue to remain safely in their homes.”
“Reduced time in the home challenges our nurses as they teach patients and family members to provide needed care in the absence of a nurse or aide,” said Marge. “Physicians and home care professionals are better suited to determine the level of care necessary to stay at home, but we do our best to work within the level of care authorized.”
Home care has managed to continue to provide critical home care services even in the most difficult circumstances; however, even the most inventive efficiencies are not always able to prevent reductions in access to services.
Leadership—looking beyond the challenges
“It is always incumbent upon businesses to adapt to changing and challenging times,”said Todd Brason. “However, an increasing focus on complying with government mandates and audits on top of reduced reimbursement is taking its toll on access to the most effective and desired care options.”
“Agencies have adjusted remarkably well to current conditions by prioritizing their services,but have also had to reduce some services that are too costly to provide,” said Becky Leahy. “This, unfortunately, eliminates many useful services to the elderly and disabled that enhance their lives.”
Although agencies must sometimes make difficult decisions about whether they are able to provide services, home care and its leaders continue to think outside the box to ensure ongoing access to home and community-based services in their communities.