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Rochester Area Home Health Consortium

Presents…

HOME HEALTH CARE

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Home Health Care Services

Within the following presentation, Home Care eligibility, statistics and general information will be discussed.

At the end of this presentation, you will find a 10 question quiz. Successfully passing the quiz requires a score of 100%. You make retake the quiz as many times necessary to achieve a passing score.

This presentation meets the criteria for Two (2) Continued Education Units (CEUs). Please see the homepage for further details.

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Why Choose Home Care?

Registered nurses or therapists provide individual assessments of patient’s care on a regular basis

Skilled staff develop treatment plans under the direction of a physician

Homecare staff observe and report symptoms, reactions to drugs, and changes in the patient’s condition

Therapists and nurses provide rehabilitative and nursing interventions to assure patient’s care and safety

Staff coordinate services to other agencies and health care providers

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Home Care Spectrum of Care

PhysicianPersonnel

NursingPersonnel

Therapist Others

Referringphysician

Family orSpecialtyphysicians

Consultingphysician

Registered nurse

Licensed practicalnurse

Home health aide

Occupationaltherapist

Occupationaltherapy assistant

Physical therapist

Physical therapyassistant

Speech/Language pathologist

Social worker

Durable medicalequipment provider

Hospice

Palliative care

Infusion pharmacy

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Value of Home Health Care

Promotes healing and keeps families together

Reduces unnecessary admissions to the ER or hospital

Increases efficient use of resources (and is often less expensive than other settings)

Home health care improves quality of life while aging at home

There is high consumer satisfaction associated with care delivered in the home

Decreases risk of hospital acquired infections

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Medicare Requirements for Home Care

Care must be provided by a Medicare certified agency

Patient is homebound

Services are ordered by a licensed/ PECO certified physician

Intermittent or part-time care (predictable end)

Skilled service required, nursing, physical therapy, speech/language pathology

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Homebound Patient…

Criteria One

The patient must either:Because of illness or injury, need the aid of supportive devices

such as crutches, canes, wheelchairs and walkers; the use of special transportation; or the assistance of another person in order to leave their place of residence

ORHave a condition such that leaving his or her home is medically

contraindicated

* If patient meets one of the Criteria One conditions listed above, then the patient must ALSO meet two additional requirements defined in Criteria Two (next slide)

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Homebound Patient Cont.

Criteria Two

There must exist a normal inability to leave home

AND

Leaving home must require a considerable and taxing effort and be infrequent in nature and of short duration

*Acceptable reasons for leaving home include:

– To receive health care treatment

– To attend an adult day care program licensed, certified or accredited by the state

– To attend a religious service

– Any absence that is infrequent in nature and of short duration

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Initial Start of Care

May be initiated only by a verbal or written order from a physician (NOT a PA or CNP)

Order should contain the following information– Patient’s condition/diagnosis

– Specific orders for service/updated medication list

– Disciplines to provide the service

Face to Face (F2F) Encounter Form completed in its entirety and specific to the patient

– If patient was hospitalized F2F to be completed prior to DC to eliminate the need for homebound patient to make a special appointment for a F2F at a later time

– May be completed 90 days prior to start of care or within 30 days after start of care

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Examples of Homebound Patients….

A patient who is paralyzed from a stroke and is confined to a wheelchair or requires a walker

A patient who is blind or cognitively impaired and requires the assistance of another person

A patient in the later stages of ALS or other neurodegenerative disabilities

An individual with arteriosclerotic heart disease and needs to avoid activity

An individual who has had a recent joint replacement and requires additional therapy

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Examples of Homebound Patients

A person with psychiatric disorder if the illness is manifested by refusal to leave home or is considered unsafe to leave home unattended, even if there is no physical disability

An individual who just returned from a hospital stay involving surgery resulting in weakness and pain and activities are restricted by a physician

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Functional Limitations Related to Homebound Status

Unsteady gait, prone to falls

Impaired functional limitations

Shortness of breath with slight exertion

Acutely ill or contagious disease

Dependent upon equipment

Draining wound(s)

Fractured lower extremity

Amputation or paralysis

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Homecare Assisted-Living Discharges

Client is discharged with Medicare eligible services:– Need order signed by physician

– Need completed F2F

– Separate referral to Medicare Certified Agency

Client is discharged without Medicare eligible services:– If there is a change in condition or medication, return to assisted

living must be coordinated with the on-site RN. RN needs to update orders/care plan

– If client returns after hours/weekends there may not be an RN on-site to coordinate orders/services

– Client MAY return after hours if family agrees to assist until new services/medications are coordinated

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Skilled Nursing

Observation and assessment

Direct skilled procedures

Teaching and training

Management and evaluation of patient care plan

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Skilled Therapies

Physical Therapy– Can stand alone under Medicare/open and case manage patient

Occupational Therapy– May not initiate care but may continue as a qualifying service after

RN, PT or ST established the need for services

Speech/Language Pathology– May stand alone under Medicare/open and case manage patient

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Physical Therapy…Referral Criteria

Functional limitations Impaired balance, ambulation, or mobility Weight bearing instructions Poor endurance for functional activity Decreased ROM or muscle strength Prosthetic/orthotic training Impaired stair climbing Frequent falls Pain in movement Need for assistive devices or equipment Home safety

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Occupational Therapy…..Referral Criteria

Impaired dexterity/coordination Decreased upper extremity, ROM or strength Cognitive/perceptual impairment Need for adaptive equipment or training Energy conservation education Impaired ability for self care

– Feeding, bathing, dressing, grooming, homemaking

Home safety assessment

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Speech Language Pathology…Referral Criteria

Impaired swallowing Dysphasia Communication impairment Impaired expression, comprehension, voice Non-verbal communication Oral/facial muscle weakness Aphasia/dementia

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Home Health Aides

HH Aide Services must be:– Reasonable and necessary

– Provided in conjunction with a skilled service

– Supervised by a skilled service professional every 14 days

Examples– Bathing, dressing, oral hygiene, shaving

– Skin care

– Assisting with ambulation and activities that support skilled therapy

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Personal Care Assistant (PCA) Eligibility

Be on Medical Assistance

Be able to make decisions about their own care or have a responsible party

Live in a home or apartment

Be determined eligible by a PHN or SW/Case Manager if on a waiver (generally you need help with ADLs or health related tasks or need observation and redirection of behavior.)

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Personal Care Assistant (PCA)

Assist with activities of daily living (bathing, grooming, dressing, eating, positioning, mobility, transfers, and toileting)

Assist with health-related procedures (ROM, assist with self-administered meds, and interventions for seizure disorders)

Behavior redirection

Instrumental activities of daily living such as light housekeeping, grocery shopping or accompanying to appointments

PCAs may also accompany a client in the community for normal life activities if the health or safety of the client would be jeopardized if the PCA was not present

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Examples of Skilled and Non-Skilled Interventions

Skilled NonSkilled

ExaminationPreoperative visitPatient education/training

ScreeningMonitoring an established program

Functional MobilityGait trainingTransfer training

General MobilityAmbulation practicePerformance of transfers

Therapeutic Exercise

Functional strengthening and ROMRevision of exercise program

Routine Exercise

Overall fitness and flexibilitySupervision of exercise program

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Setting Goals

Each discipline must set goals related to the patient’s diagnosis and care intervention– Realistic

– Measurable

– Time specific

– Attainable

– Outcome specific

Quality care for positive patient outcomes

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One License, Two Levels

Basic– Assistance with ADLs

– Homemaker tasks

– NO licensed health professional

– NO skilled nursing services

Comprehensive– Can provide all basic services

– All skilled services

• Nursing

• Physical, Occupational and Speech Therapy

• Medical Social Services• Delegated tasks

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Extended Hour Nursing

What is Extended Hour Nursing:Extended Hour Nursing Services (also known as Private Duty Nursing Services) are deemed medically necessary by a physician with proper orders and authorization to qualifying agencies

Qualifying agencies assess clients cares for appropriate nursing hours and develop a plan of care which is then authorized by the consumer’s physician and appropriate payer source

Nurses observe, monitor, intervene, and evaluate clients during their shifts based on plan of care

Services can be provided in a client’s home or outside the home (school, work, or public settings depending on the client’s condition)

Typically, in order to be considered “Extended Hour Nursing,” clients qualify for 4 or more hours per day; services can be up to 24 hours a day 7 days a week

Often, Extended Hour Nursing is an alternative option for a client with complex medical needs who would otherwise require hospital, transitional care or nursing home level care

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Respite

Is intended to temporarily relieve family caregivers in their absence

Respite Services are provided in or out of the client’s home

Mental Health Services

Mental Health Services includes:– Adult and Pediatric In-Home Therapy

– Mental Health Behavior Aide (MHBA)

– Diagnostic Assessment

– Skills Training - Individual and/or Family

– Supervision

– Day Treatment (children ages 5-16)

– Crisis Assessment

– Adult Group Therapy

– Adult Rehab Mental Health Services (ARMHS)

According to the Minnesota department of Human Services, the average cost of care for one year is:

$20,000 for an average of 2 to 3 home care visits per week

About $40,000 for care in an assisted living facility

Over $62,000 for care in a nursing home

Source: http://mn.gov/dhs/general-public/own-your-future/gather-information/financial-planning/care-cost.jsp

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One License, Two LevelsHow much does Care Cost in Minnesota?

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There’s No Place Like Home…..

Home Care is about Hope, Dignity and Peace of Mind.

The Hope of continuing to live in the place we all love and want to be…..HOME

The Dignity of receiving care in the privacy of home and not surrendering your healthcare choices to a facility

The Peace of Mind of having a home care professional to meet health care and lifestyle needs

Quality patient care with Quality patient outcomes

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Aging & Health in America

Nearly 90 percent of people over age 65 indicate they want to stay in their home as along as possible. (AARP)

The number of people 65 years old and older is expected to rise by 101% between 2000-2030. (CDC)

In 2050, age 65 and over is projected to be 83.7 million, almost double the population of 43.1 million in 2012. (Census.gov)

Loneliest older people were nearly twice as likely to die during their six-year study as least lonely. (The Guardian)

18 percent of seniors live alone, while 43 percent report feeding lonely on a regular basis. (Aging Care.com)

1 in 7 people with Alzheimer’s disease live alone. (Alzheimer’s Association)

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Quiz - Slide 1 of 2

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Quiz - Slide 2 of 2

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