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Demonstration proves to reduce readmission rates; improve outcomes
Adult day services offer socialization for patients and respite for caregivers
Decreasing hospital readmission rates from 28% to 12% for the patients participating in the Centers for Medicare & Medicaid Services (CMS) Medical Adult Day Services Demonstration is only one indication that enabling home health patients to attend adult day center programs during their home health episode is beneficial.
In addition to reducing readmissions for the group of patients participating in the demonstration project through her agency, Sue Meier, RN, administrator of Landmark Home Health Care in Allison Park, PA, points to the 30% of project participants who continue adult day services after discharge from home health as another indication that patients and families believe there is a benefit to the program, even when they may pay for it themselves.
With only four months left in the demonstration project, home health managers are watching the project carefully to see what lessons have been learned and if this will be a viable new service for home health to offer.
Although the data for the entire project has yet to be compiled and analyzed, anecdotal stories of success can be found at all of the demonstration sites. "One of the first patients we enrolled into the demonstration project was depressed and had not talked in quite a while," says Mercy Flores, BSW, MA, social worker and demonstration manager at Doctor's Care Home Health in McAllen, TX. Being able to socialize and go to the adult day center several times a week, without missing his home health visits, the patient is now smiling and alert, she says. "His quality of life has improved, because he has a chance to be with other people," she adds.
Patients enrolled in the demonstration project are home health patients covered by Medicare. Previously, home health could not be reimbursed for seeing patients in a setting other than their own homes, but the demonstration project allows for care to continue for the home health patient even at the adult day center. Patients who choose to participate are able to go to the adult day center and be assessed, receive medications, have blood pressure monitored, see a social worker, or even receive physical therapy while at the center. Home health agencies in the demonstration are reimbursed for the visit, then the agency reimburses the adult day center a portion of the CMS payment for each day the patient is at the center. Reimbursement for home health visits to the day services center are reimbursed at 95% of normal reimbursement, because the initial assumption was that cost of care would decrease if the home health nurse could see several patients at one location.
The lower reimbursement rate is one issue that home health agencies in the project want to see studied further, says Kim Delp, RN, BSN, director of business development for Landmark. "The only thing we don't have to pay is travel expense between several homes if the nurse sees multiple patients," she says. "We still pay per visit, so seeing three patients at one adult day center counts as three visits. Then we have to pay the adult day center their fee out of our lower reimbursement," she adds. Even with the financial challenge, Delp says that her agency plans to continue the service if it is approved by CMS. "Our patients benefited from the service, and our staff enjoyed working at the adult day centers."
Lack of knowledge creates obstacles
The need for education was the biggest challenge, as home health agencies began establishing partnerships with adult day centers and recruiting patients. "There was a lot of information for everyone at the beginning of the project," admits Flores. Patients and home health staff had to learn about adult day care, because the impression of adult day care was that it was little more than a babysitting service, she points out. "The adult day center could act as an extension of the home health agency by providing socialization opportunities for patients, transportation, and meals," she says.
Home health agencies in the demonstration had to partner with adult day centers that offered on-site nurses and medical monitoring for high blood pressure, diabetes, and other chronic conditions. "Our challenge was that these adult day centers had never promoted the medical aspect of their services, so we had to educate medical staff, case managers, and social workers at our referral sources," says Delp.
Adult day centers also had to be educated, says Flores. "Adult day centers had the expectation that the patients would come to the center every day and receive all home health services at the center," she explains. In reality, the number of days at the center was determined as part of the overall plan of care and differed for each patient according to the patient's needs, she says.
Although her agency is not part of the demonstration project, Judith Bellome, RN, BSN Ed, MS Ed, CEO of Douglas County Visiting Nurses in Lawrence, KS, is watching carefully, because her agency is evaluating the feasibility of this service for her community. "I do think education has been the biggest challenge for agencies," she says. "This is a new way to provide home care, and it is hard to explain," she admits. A home health aide might help the patient dress in the morning, then the adult day center's van transports the patient to the center, she says. "At the center, a nurse or a therapist might conduct the patient assessment, provide care needed that day, then the patient joins other people in various social activities," she explains. Continuity of care even when the patient is not at home is the goal of the program, she adds.
Another issue that participating agencies see now is the need to address funding of adult day services once the patient is discharged from home health. They learned that many patients wanted to continue adult day services after the home health episode ended. Delp says that her staff began looking for financial resources at admission. State funding such as Medicaid, or private pay for families and patients with the ability to pay, was identified early, so that there was no interruption in adult day participation, she says.
Regardless of the demonstration project's outcome, it is still good practice for home health agencies to establish relationships with adult day service providers in their communities, suggests Bellome. "It is smart marketing to make friends with all potential referral sources, and adult day centers can offer beneficial services to your patients and their caregivers," she says. A home health agency can conduct a health fair, along with an adult day center, and both organizations can distribute each other's brochures. She adds, "Adult day services can also be a good resource to provide respite care for family caregivers."
For more information about home health and adult day services, contact:
Judith Bellome, RN, MS Ed, Chief Executive Officer, Douglas County VNA and Hospice, 200 Maine Street, Suite C, Lawrence, KS 66049. Telephone: (888) 295-2273 or (785) 843-3738. Fax: (785) 843-0757. E-mail: email@example.com.
Kim Delp, RN, BSN, Director of Business Development, Landmark Home Health Care, 4842 William Flynn Highway, Allison Park, PA 15101. Telephone: (724) 444-6767. E-mail: firstname.lastname@example.org.
Mercy Flores, BSW, MA, Social Worker and Director of MADCS Demonstration, Doctor's Care Home Health, 2507 Pecan Blvd., McAllen, TX 78501. Telephone: (956) 683-7401. E-mail: email@example.com.