Home health care providers who tailor surgeries to care for more clinically complex patients

More patients who can be categorized as clinically complex are being referred to home care providers. In response, providers are taking steps to ensure they are able to provide appropriate care to these patients.

Overall, this trend has been visible to most home health care providers for years. However, it has been exacerbated by the pandemic and reduced access to emergency care.

When looking at the demographics of consumers of home health products, 40.3% of women and 37.8% of men say they are in worse health compared to the previous year, according to data from KNG Health Consulting.

In this way, home health care providers care for patients who would traditionally still be in urgent care facilities.

“In the last three years, starting with COVID and moving from that, we’ve seen patients come to us that are certainly more complex from a clinical standpoint,” Blake Nelson, director of home health care at Hamilton Health Care System, told Home Health Care News. “We saw a need to join the hospital in terms of throughput. When patients with COVID were coming to the ER and then being admitted and staying in the hospital for 5,6,7 weeks, we saw a need to step into the gap.”

Serving northwest Georgia, Hamilton Health Care System includes a community hospital, medical center and physician group. The organization also offers long-term care and hospice as well as home health services through Hamilton Home Health.

At that time, Hamilton Home Health created a COVID Max program focused on relieving pressure on EDs. The program will eventually branch out to address diagnosis-related groups that the hospital tends to struggle with, such as patients with chronic obstructive pulmonary disease (COPD) and congestive heart failure (CHF).

Over the past year, Hamilton Home Health has created various “Max” programs focused on COPD, CHF and diabetes.

“Patients with diabetes have other co-morbidities,” Amanda Horne, clinical manager and administrator at Hamilton Home Health, told HHCN. “They often have non-healing wounds that we deal with. Some of the sickest COVID patients who are in the hospital for an extended period of time come out with pressure ulcers. We see a wide range of issues. I would say that people with COPD, CHF and diabetes tend to have the most problems.’

In addition to the new programs, Hamilton Home Health has made other adjustments to meet the care needs of clinically complex patients.

“We had to be creative,” Horne said. “Specifically with CHF, we had to think about what we could do to help these patients stay at home. We were going to get them more breastfeeding visits and we were buying digital scales for our patients. We’ll call their cardiologist for them, set up appointments, and make sure their transportation is in order.

Ultimately, strong communication is a key factor in helping Hamilton Home Health manage its patient volume.

“Communication throughout the system was important,” Nelson said. “From handoff, to making sure we have a good picture of what’s going on with that patient so our clinicians are ready to meet the patient at home.”

The various teams of Hamilton Home Health’s Max program also meet monthly.

“Different thought leaders from across the system come together and discuss how this program is moving forward and what questions, concerns or issues we might be considering to get ahead of what might come up down the road,” Nelson said.

Interim uses its continuum of care model

For Interim HealthCare, ensuring the organization provides a full continuum of care in each of its markets is a top priority.

As such, the organization was uniquely positioned to meet the needs of increasingly clinically complex patients.

Based in Sunrise, Florida — and part of Caring Brands International — Interim is a franchise that provides home health, hospice and palliative care services. The organization is just shy of 600 locations in the US and internationally.

Like Hamilton Home Health, Interim is seeing an influx of more patients who are at the upper end of its full continuum of care. That’s because hospital stays are shorter, according to Jennifer Sheets, CEO and president of Interim.

“People are coming home much more stressed than in the past,” she told HHCN. “We’re seeing, for example, people being sent home much faster after cardiac procedures, after acute heart attacks and strokes.”

Interim sees the greatest clinical complexity as coming from individuals dealing with multiple comorbid conditions in one or more body systems.

“If you take something like that [CHF] and layered on top of cognitive impairment, like dementia, it becomes much more complex,” Sheets said.

A few years ago, Interim developed what it calls its Home Life Enrichment Standard. It’s an approach that continually assesses the changing needs of Interim’s patients.

Since seeing this increase in higher acuity patients at home, Interim has doubled down on this philosophy of care.

As a result, the company has invested heavily in certification and further training of its clinicians.

“The opportunity for clinicians to build on their skills, if they see, for example, more neurologically focused diagnoses coming home, they can build on that specific education,” Sheets said. “Clinicians also have greater access in real time, via devices, to best practice policy and procedures for cases they may not see all the time.”

This wave of more clinically complex patients is also at the forefront when Interim looks to hire new clinicians.

“We do balloon pumps as people wait for open-heart surgery, we do chemotherapy infusions, very high-acuity things that people who have worked in ICUs, for example, are used to seeing,” Sheets said.

Although Interim has taken steps to accommodate these patients, Sheets also pointed out that caring for patients from the clinical complex is part of the company’s history.

“Interim was the first company to bring home a high-acuity, ventilator-dependent child, and that was in 1970,” she said. “We were also the first company to bring home an adult with high respiratory acuity the following year.”

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