Home from the hospital already? As stays for hospital patients grow progressively shorter, even for procedures as serious as repairing a brain aneurysm or inserting a pacemaker, patients' need for highly skilled nursing care at home is growing. Indeed, every week, thousands of these patients are referred to home health care services. But many times patients accept the referrals their hospitals make without knowing that they have a choice of care providers. Vulnerable from fatigue and pain, too weak or tired to drive back and forth for doctors' follow-up, and without family to stay with them, they may be more inclined to accept these recommendations without question. Yet, federal law requires that hospital patients needing home health care following discharge be informed that they have a choice.
"Patients and their families have the right to ask questions and talk with their doctors, friends or community service directors, and bring up names of agencies they've heard of, and they do not have to feel obligated to accept a hospital's referral. There are differences in the ways home health care agencies operate and one may meet their needs better than another. In fact, for serious conditions, who they choose may affect the length of their recovery, or their ability to stay out of the hospital for the long term," said Judith Boyko, CEO of the Natick Visiting Nurse Association (www.natickvna.org), which provides services to patients in more than 20 towns in Boston's MetroWest area.
As a result of the Balanced Budget Act of 1997 and the Medicare Conditions of Participation for Hospitals, patients needing home health care must be given a list of their options prior to being discharged from the hospital. The list must include organizations in patients' geographic area that are Medicare certified and have asked to be included on the list, and hospitals must disclose if they have a financial interest in any them.
Natick VNA offers the following checklist to help patients and their families make the most informed choice of a home health care provider:
- Is the organization certified and approved to provide services by Medicare and Medicaid?
- Has the organization taken the voluntary step to obtain accreditation from a leading accrediting program such as the Community Health Accreditation Program (CHAP) or the Joint Commission? These programs validate the performance of home health care agencies by evaluating financial management, strategic planning, human resources, and other aspects of the business, as well as assuring that agencies maintain the highest standards of patient care.
- Is the agency up to date on the latest in home health care technology, such as telemonitoring of patients' vital signs following a stroke, or cold laser therapy to speed healing following an injury? In some cases, this technology is literally life saving -- alerting nurses to drops in patients' blood pressure, heart arrhythmias, and other conditions that warrant immediate attention.
- What specialties or specially trained staff does the organization have available? Many agencies offer a broad range of programs -- including post-partum and pediatric care, rehabilitation therapy, and help managing cancer, heart disease, Alzheimer's Disease, wounds/ostomies, mental health issues, skin care issues, and much more. Their staffs are equally broad-ranging, including registered nurses, rehabilitation therapists, registered dieticians, medical social workers, speech therapists, and home health aides. Patients likely to have a continuing need for help may prefer an agency with comprehensive services, where they can develop comfortable, long-standing relationships with the people who are caring for them.
- Do the staff who will be providing home care to patients reside in their communities? Will they be able to get to them quickly in an emergency? Are caregivers available 24 hours a day?
- What are the clinical outcomes achieved by the agency? How about patient satisfaction ratings, and are these ratings available to be shared?
- How long has the organization been in operation? Is it financially sound?
- Is the agency owned by another health care organization or agency, or is it a free-standing community-based organization?
- Is the organization for-profit or not-for profit? (Not-for-profit home health care agencies can often help people who may not be able to afford needed care).
- How efficient are the organization's operations? Does the agency keep automated clinical records for efficient access by caregivers and medical staff?
- Does the agency treat patients and potential patients well? How do they respond to phone calls?
The Natick Visiting Nurse Association encourages all potential home care patients and their families to remember that they do have a choice of provider when it comes to home care; and, it is important to have satisfactory answers to the above questions, when it comes time to make that choice.
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