This article originally appeared in The 13th Annual Edition of the HCP Benchmarking Report. To see the latest industry data in the 2022 HCP Benchmarking Report please visit https://www.homecarepulse.com/benchmarking/.
We in the home care business often find ourselves managing competing priorities in our efforts to provide the highest level of care to our clients. We work to find and retain skilled staff, establish strong relationships with client families, and oversee the financial health of our enterprises. When it comes to building strong referral partnerships, I would argue that the one activity on which agency owners should be laser-focused is aligning operations that result in keeping clients healthy at home and out of the hospital.
Hospitals and rehabilitation centers need home care partners that they can trust with “the last mile” of caring for their discharged patients. In most cases, readmissions add pressure on resources that are already stretched due to caring for patients battling COVID-19. Moreover, payors such as Medicare are stipulating quality, based on LOS, readmissions, and other factors, as terms of reimbursement.
Prolonged hospital stays are not always in the best interest of the patient or the facility caring for them. Exposure to nosocomial infections puts patients at risk, and the round-the-clock sounds seldom allow patients to get the uninterrupted rest they require to heal. Moreover, payors must closely monitor lengths of stay to keep costs of care under control so as not to incur penalties from the Centers for Medicare and Medicaid Services, as determined through the Affordable Care Act. Longer inpatient stays also result in patients bearing burdensome medical costs.
As those of us in this business are aware, home care is expected to continue its steep growth trajectory. We understand the drivers for services, such as the aging of the Baby Boomer generation, advancements in medical treatments enabling patients with chronic diseases to live longer, and better technology allowing individuals to monitor their vital signs. Newest among these is the COVID-19 pandemic, now entering its third year, which has caused the postponement of countless medical treatments for people throughout the country.
A recent study revealed that nearly 90 percent of adults over age 50—across all age, race, income, and health status categories—want to remain at home and “age in place.” Older adults stay healthier and happier when they do. For those living at a distance from family members, home care can be a preferred solution to living alone or moving to a costly assisted living arrangement.
So, who is at risk for a trip to the hospital and why?
Individuals with a variety of health conditions are at increased risk of being admitted for inpatient care. According to the CDC, the number one reason adults 65 years and older use emergency services is for the treatment of injuries resulting from falls. Today one out of four older adults will have a significant fall, and only about half will tell their primary care providers. More than 800,000 patients a year are hospitalized due to a fall injury, and if rates continue at this pace, by 2030 in the US, there will be seven deaths from falls every hour.
Think of how many thousands of these fall injuries are preventable.
After fall injuries, the main reasons for emergency room visits are:
• Stomach and abdominal pain
• Chest pain and related symptoms
• Fever and cough
• Shortness of breath
• Headache, other pain not related to a body system
• Throat pain
• Back pain
• Vomiting
These may sound quite familiar, as several of these symptoms are indicative of a COVID-19 infection. Certain chronic conditions, if not managed or under control, could show these symptoms as well.
What are the best ways to keep individuals from needing emergency or hospital care?
The answer lies in reducing the safety risks for older adults living at home.
Simple solutions can be found when caregivers take these steps:
Conduct a thorough audit of a person’s home to identify easily remedied fall risks, such as installing grab bars in bathrooms and handrails on stairwells, adding stronger lighting to better illuminate rooms, and eliminating scatter rugs and loose electrical cords.
Monitor medications that might adversely interact with others or are high-risk medications, such as narcotics, blood thinners, and insulin. Look for a history of depression or signs of depression.
Note a diagnosis of or risk factors for chronic conditions such as diabetes, cancer, COPD, heart failure, or stroke history, all of which are top drivers for readmissions.
Address a client’s frailty or other physical limitations that constrain their ability to significantly take part in activities of daily living and/or post-hospital care.
In addition, home care agencies can employ technology for collecting and reporting a client’s symptoms or vital information and use it to collaborate closely with a client’s primary care provider. In the event a client presents with abnormal symptoms or pain, the home care agency staff can effectively escalate concerns directly with their provider, who can determine if an office visit or telehealth visit is needed and potentially eliminate the need for an uncomfortable, lengthy, and disruptive visit to the emergency department.
How do you know where you need to place particular attention in caring for clients?
How do you show prospective key audiences your effectiveness?
The answer is by measuring outcomes, implementing business improvement processes, and embedding measures in your operations.
Perhaps it is my engineering background that compels me to rely on data to learn the value of the business decisions we make. Shortly after starting my home care business more than three years ago, we focused on gathering all the relevant pieces of information we could on our clients from the time they began receiving care from us. We trained our staff to report falls, trips to the emergency department, hospital admissions, and readmissions. We studied the trends and discussed them at staff meetings to provide everyone on our team with a snapshot of how we were doing and where the successes and challenges lay.
For those who are already tracking results in their home care businesses, the rewards for doing so are hopefully evident. However, in 2020, Home Care Pulse (HCP) reported that only 30 percent of home care agency businesses were using reporting software to measure results. While many owners may feel they have valid reasons for not measuring outcomes, such as cost or time, I believe that embracing data tracking should be the single most important activity within your agency’s operations.
By vigilantly following our results from month to month, we can access information at the individual level to achieve better results for our clients. The resounding factor that matters to all parties, including clients, family members, providers, and payors, remains to prevent clients from an unnecessary trip to the local emergency department, which often leads to hospitalization. The second to that is preventing readmissions.
Making sense of readmission data
We recognize that there are times when it is necessary and appropriate for a client to receive emergency treatment. No amount of preventative care can be the absolute answer in every case. When a client requires a trip to the ED or hospital admission, we document the reason for going in, if admission was required, and the length of stay (dates of admission and discharge). We also track relevant discharge information to better transition the client back to their home and know where our caregivers need to focus their attention to avoid readmission, as those rates are considered a key indicator of the quality of patient care.
When we initially started tracking, our population was small, meaning statistics were low, and we needed to increase our data set to have confidence in our results. We did not have historical data for each client. By sticking to our plan, over time we were able to see how which areas needed more attention and in which areas we were improving. The national average is 18 to 20 percent for 30-day Medicare readmissions. I am pleased to share that now our readmission rate is in the low single digits. Now with three years of history across all our client base, we can be more confident when talking about our results.
When COVID wanes, and we are seeing early signs of this, people will start seeking care that they had deferred. In anticipation of seeing more complex cases in our client mix as a result, we know we will be challenged to innovate strategies to suppress readmissions.
We proudly share these results with key referral sources—hospitals, home health care agencies, and rehabilitation centers. They serve to differentiate our services, giving provider organizations the confidence that we deliver superior care for their patients and truly are partners in that continuum of care. This is the value proposition that data tracking helps us to build, and thus strengthens our brand in the community.
When thinking about what changes you can make to drive business growth and client satisfaction, ask yourself if you are doing everything possible to prevent the first trip (or return trips) to the hospital for each of your clients. Are you tracking and quantifying those results? Are you sharing them with your staff, your clients, prospective clients leads, and other referral sources? When you can answer yes to each of these questions, I am confident you will know the value of your business, and so will your key referral partners.
The expressed gratitude of our clients and their families concerning the effectiveness of the care we are delivering is certainly heartening, as is watching a client’s health and quality of life improve. The feedback from our staff as to their job satisfaction is just as important. However, I have found that the most important piece of information I can offer to prospective clients and referral partners is evidence of how our agency’s standards of practice deliver on our core mission to keep clients safe at home and help prevent them from needing hospital care.
ABOUT THE AUTHOR
Dave saw the value of high quality, individualized care through a family experience – having been inspired by those caring for his grandmother. His experience in program and product management, with a personal interest to directly impact people’s lives, fuels his passion to offer others the same level of care his grandmother received. Dave is owner of Assisting Hands – Boston Northwest based in Bedford, MA, and is also an Area Representative with Assisting Hands Home Care – helping grow the brand presence in New England. He holds an engineering degree from Boston University, an MBA from the University of Massachusetts, Amherst and is also a Certified Dementia Practitioner (CDP). Dave is active in the local community, serving on the Executive Committee of the Board of Directors for the Bedford, MA Chamber of Commerce, supporting local schools and veteran’s programs, and being involved in his church. His commitment to helping families keep loved ones healthy at home is evident in his published book: Thriving at Home – A Handbook for Preventing Hospital Stays. He grew up in Minnesota before moving to Boston, where he met his wife of 20 years, Urszula. Dave and Urszula have two children – a son and a daughter. He loves hiking, sailing, and skiing – all with family and friends. Contact: 781-315-6700 or [email protected]
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