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Some surprises uncovered during demonstration
Reluctant patients, transportation issues addressed
No one was surprised at the amount of public and referral source education needed to get the Centers for Medicare & Medicaid Services (CMS) Medical Adult Day Services Demonstration off the ground, but there were a few unanticipated challenges faced as home health agencies have recruited patients for the project during the past 2 years.
Patients reluctant to leave home
"Homebound patients are socially isolated, and the unknown is a challenge for them," explains Judith Bellome, RN, BSN Ed, MS Ed, CEO of Douglas County Visiting Nurses in Lawrence, KS. If the patient is not familiar with an adult day service center, the idea of traveling to another location for a day is frightening, she says.
"Traveling to an adult day center is also physically taxing for many patients," points out Mercy Flores, BSW, MA, social worker and demonstration manager at Doctor's Care Home Health in McAllen, TX. If a patient believes that he or she will be exhausted from the travel, the idea of going to an adult day center is unappealing, she says.
Because the physical demands of travel are an issue for older home health patients, be sure you select adult day center partners that are located in areas that don't require long rides in a van from their homes, suggests Bellome.
Transportation can be an issue
Although adult day services centers in many areas offer transportation, be aware of limitations, suggests Kim Delp, RN, BSN, director of business development for Landmark Home Health Care in Allison Park, PA. "Our challenge was a transportation system operated by our state department of aging services that did not have an easy set-up process," she says. Once the home health agency enrolled the patient in the CMS demonstration project, transportation services needed to be available within 24 to 48 hours, she explains. This is several weeks sooner than the existing system could handle unless the patient's need was deemed medically necessary, she says. By working with the department of aging's staff, Delp was able to get these patients' need for transportation deemed medically necessary, similar to the needs of dialysis patients, she says.
Be familiar with your area's state or local regulations, Delp suggests. "Every organization has different requirements, so knowing up front will help you better prepare," she adds. For example, initially her state required birth certificates or drivers' licenses to access transportation services, she says. "Many of our older patients don't have birth certificates or any way to obtain them, and they are not driving," she says. Exceptions to the requirement were obtained due to the medical necessity of the transportation, she adds.