Whitney Palmer

Highlighting Home Health

Published in the June 7, 2012, Billian’s HealthDATA/Porter Research Hub e-Newsletter

By Whitney L.J. Howell

Across the United States, more than 7.5 million people need daily health services, but they aren’t getting the help they require in a hospital or outpatient facility. Instead, they’re receiving necessary treatments at home from healthcare providers trained to meet patient needs outside of a clinical environment. This is the home healthcare industry, a more than $60 billion sector of the healthcare system that is ballooning rapidly.

Overall, home healthcare is designed to alleviate the stresses placed on outpatient clinics by moving treatment for injuries and some illnesses to the patient’s residence. Providers, usually licensed practical nurses, therapists or home health aides, make routine visits with the goal of helping individuals regain their independence and self-sufficiency.

Meeting this objective often means fusing traditional home healthcare, such as assistance with daily living activities (often known as companion care), with services provided in skilled nursing facilities. For example, home healthcare aides can also tend to wound care needs, physician or occupational therapy, diabetes care, nutrition therapy, injections, or offering patient and caregiver education.

Employment Opportunities
The Bureau of Labor Statistics has estimated that employment in home healthcare agencies will spike by 51 percent between 2006 and 2016. The reason is clear, according to Michael Hicks, Ph.D., Director of Ball State’s Center for Business and Economic Research.

“It’s not especially complicated – as with most of the developed world, we have a higher population of elderly people for whom the demands of healthcare is rising,” Hicks said. “Many more older people value home healthcare because they wish to remain at home. And, as more want to have these services, we’ll continue to see employment grow in these agencies.”

For example, Partners in Care (PiC), a nonprofit home healthcare services provider under the Visiting Nurse Service of New York, has nearly doubled its workforce in the past six years, prompting the need for a second training facility. The number of aides grew from 5,800 in 2006 to approximately 9,200 in 2011. In fact, according to PiC data, the company hired its second-largest group of new employees – 374 aides – in June 2011.

Cost Savings
In addition to allowing older patients to maintain a level of independence, home health care is also attractive because of its affordability, Hicks said. For individuals, the cost for 20 hours of weekly home healthcare is approximately $1,500 per month, totaling roughly $18,000 annually, according to the National Private Duty Association. Based on 2011 MetLife statistics, assisted living or nursing home care can cost between $36,000 and $70,000 a year.

These savings can be substantial at a national level. In 2007, the Centers for Disease Control and Prevention reported approximately 1.5 million people received home healthcare services for an average of 315 days.

Technology’s Impact
Fortunately, as home healthcare’s customer base has grown, so have the technologies its providers use to meet patient needs in the home, said Sherl Brand, RN, BSN, President and CEO of the Home Care Association of New Jersey. These tools and the ability to use them in virtually any setting make home healthcare and its providers the epitome of mobile health.

“Technology has far surpassed what we had when I first started as a home health nurse in the early 1990s,” said Brand, who also serves as the chair for the National Association of Home Care and Hospice Forum of State Associations. “Today, we have telehealth, hand-held devices, and electronic health records. Data is real time, and we can communicate easily with physicians and quickly intervene when appropriate to manage care needs in any situation.”

For example, Brand witnessed this type of intervention several years ago with a patient who had severe cardiac disease and had been hospitalized multiple times. With the help of a telehealth system that monitored him closely between clinic appointments, he went 18 months without an emergency room visit or hospital admission.

“We were able to help him stay at home with his lovely wife of over 50 years,” Brand said. “It’s a great story, but it’s not a unique story. We see this stuff all the time.”

These technology improvements have also saved considerable federal healthcare dollars, making home healthcare highly cost-effective. According to an Avalere Health LLC study conducted from 2006 to 2009, in-home care for diabetes, chronic obstructive pulmonary disease, and congestive heart failure prevented 20,426 hospital readmissions. The total savings to Medicare during that time: $670 million.

Long-Term Care Connection
There are also other, less obvious, cost savings associated with the use of home health care services. Patients living at home cover the cost of their own food and housing. Once they move to a skilled nursing facility or nursing home, the federal government assumes those costs, placing greater monetary stress on the overall healthcare system.

While patients view home healthcare as a lower-cost, more comfortable alternative to a hospital admission, these agencies also view themselves as collaborative partners with long-term care facilities.

Many patients do eventually need a higher level of care than home healthcare providers can offer, but these nurses and therapists work with patients, their families and their physicians to keep them at home for as long as possible. Their work alleviates the demand patients have for securing a spot as residents in long-term care facilities.

Challenges Ahead
However, home healthcare does face challenges. Despite its proven benefits, Medicare does not reimburse for telehealth. Consequently, agencies must foot the bill for these services, covering the capital expenditures for all equipment and taking on responsibility for communicating with physicians. The result: an increasing number of entities are abandoning telehealth.

“Today, the home healthcare world is being hit from all angles, and we’re facing a barrage of reimbursement cuts,” Brand said. “I’ve seen some agencies close their doors but others are doing whatever they can to maintain services like telehealth because they are proven to produce such wonderful outcomes for patients.”

Here to Stay
But even with the financial challenges and its already significant growth over the past decade, home healthcare shows no real signs of slowing. There is still has room to expand, Hicks said.

“We’re not really at the point yet where electronic health records are so fully integrated into home healthcare that visiting social workers or home healthcare nurses can take vitals in the home and receive diagnostic analysis from a physician or nurse practitioner located elsewhere. But those days are coming,” he said. “This could mean the suite of services nurse practitioners provide will increase or we could see physicians beginning to look into expanding their practices to link with home health agencies. We will see health networks become far more successful.”

To read the story at its original location: http://www.billianshealthdata.com/news/SiteNews/news_items/2012/June/Home_Health.html

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