After Hospital Discharge, Slow Home Health Care Initiation Increases Risk of Rehospitalization

American Journal of Managed Care | By Jared Kaltwasser

Patients discharged from the hospital are at a higher risk of re-hospitalization if they experience a delay in post discharge home health care initiation, according to a new study.

The study, published in Journal of the American Medical Directors Association, shows the risk of a re-hospitalization or emergency department (ED) visit jumps by 12% when patients wait more than 2 days for their at-home care to start.

More than 6 million Americans receive home health care each year, noted the study’s authors. In many cases, those home visits follow discharge from a hospital. Home health care providers can perform a range of services, including clinical assessments, wound management, and medication reconciliation, the authors said. Previous research shows that home health care visits following hospitalization can reduce the risk of readmission, especially for certain conditions, such as sepsis and heart failure.

CMS requires that initial at-home patient visits take place within 48 hours of referral or of the patient’s return home, unless otherwise stated by the patient’s physician. However, the investigators said no study has yet looked at whether the timing of such visits has an impact on patient outcomes.

They decided to examine the records of an urban home health care agency in the northeastern United States in order to see whether the agency’s success or failure in initiating care within 48 hours had a meaningful impact on patient outcomes.

The investigators analyzed a data set of 49,141 home health care visits received by 45,390 patients who were discharged from the hospital during 2019 and referred for at-home follow-up. They compared the timing of home health care initiation with 30-day hospitalizations and ED visits to see whether the timing affected outcomes and whether there were any disparities based on factors such as race/ethnicity, age, insurance type, and clinical status.

In total, about one-third of initial home health care episodes in the data set were delayed, meaning they did not happen within 48 hours. Previous research by the present study’s authors suggest that patients not answering the door or postponing visits were among the most common reasons for such delays.

Of those 34% of cases in which care was delayed, 14% of those delays resulted in a rehospitalization or ED visit within 30 days. And that translated into a 12% higher risk of rehospitalization or ED visit for patients whose home health care was not started within 2 days vs those who received timely initiation of home services.

Read Full Article

Increase VA Funding for HCBS by Supporting the Elizabeth Dole Act

Dear Home Care Association of America members, 

Veterans have sacrificed greatly for our country. Most senior veterans want to remain in their own homes as they age and home care providers stand ready to support their wishes.

Not only are home care agencies ready to serve our veterans, but HCAOA actively supports and advocates for veterans on both the state and federal levels. HCAOA's Veterans Services Advisory Council works closely with the Veterans Administration to ensure veterans receive the care they need, when they want it and where they want it, which is usually at home.

On this national observance of Veterans Day, HCAOA pledges to continue advocating for our veterans to ensure they receive the services and supports they need and deserve. 

And we ask you, our members, to honor our veterans as well by urging  Congress to pass the Elizabeth Dole Act. This bill would increase VA funding for home and community-based services, as well as respite care for family caregivers. Click here to send your personalized message.

Vicki Hoak, Home Care Association of America CEO

Guideline for Prescribing Opioids for Pain

Centers for Disease Control and Prevention

Pain affects the lives of millions of Americans every day and improving pain care and the lives of patients with pain is a public health imperative. The Centers for Disease Control and Prevention (CDC) is releasing updated and expanded recommendations for clinicians providing pain care for adult outpatients with short- and long-term pain. These clinical recommendations, published in the CDC Clinical Practice Guideline for Prescribing Opioids for Pain, will help clinicians work with their patients to ensure the safest and most effective pain care is provided. The publication updates and replaces the CDC Guideline for Prescribing Opioids for Chronic Pain released in 2016.

“Patients with pain should receive compassionate, safe, and effective pain care. We want clinicians and patients to have the information they need to weigh the benefits of different approaches to pain care, with the goal of helping people reduce their pain and improve their quality of life,” said Christopher M. Jones, PharmD, DrPH, MPH, Acting Director of CDC’s National Center for Injury Prevention and Control.

The 2022 Clinical Practice Guideline addresses the following areas: 1) determining whether to initiate opioids for pain, 2) selecting opioids and determining opioid dosages, 3) deciding duration of initial opioid prescription and conducting follow-up, and 4) assessing risk and addressing potential harms of opioid use.  The Clinical Practice Guideline supports the primary prevention pillar of the HHS Overdose Prevention Strategy – supporting the development and promotion of evidence-based treatments to effectively manage pain.

The guideline is a clinical tool to improve communication between clinicians and patients and empower them to make informed decisions about safe and effective pain care. The recommendations are voluntary and provide flexibility to clinicians and patients to support individualized, patient-centered care. They should not be used as an inflexible, one-size-fits-all policy or law or applied as a rigid standard of care or to replace clinical judgement about personalized treatment.

CDC followed a rigorous scientific process using the best available evidence and expert consultation to develop the 2022 Clinical Practice Guideline. An independent federal advisory committee, four peer reviewers, and members of the public reviewed the draft updated guideline, and CDC revised it in response to this feedback to foster a collaborative and transparent process. CDC also engaged with patients with pain, caregivers, and clinicians to gain insights and gather feedback from people directly impacted by the guideline. The expanded guideline aims to ensure equitable access to effective, informed, individualized, and safe pain care.

Read Full Article

How to Have the ‘You May Need Help’ Conversation

Today’s Caregiver | By Matt Vasile, MSW, ACSW

When we don’t live with our elderly loved ones, it can be difficult to know how they’re really doing living independently at home. But if you see physical, emotional or cognitive signs that they’re not able to take care of themselves the way they once were, it’s important to speak up. This could happen while you’re at their home or after you’ve visited them for the holidays.

If you think it will be a difficult conversation, know that you are not alone. When well-meaning children or other relatives bring up their concerns or suggest their older loved ones move somewhere they could have more assistance, they’re often met with pushback, disregard, and hostility. This is understandable, because any changes involved in one’s routine or home environment can feel like a compromise of independence and privacy, especially for seniors who may be experiencing physical and cognitive changes.

Having the “you may need help” conversation can be awkward and uncomfortable. But it’s possible, and you can do it if you approach the topic with patience, kindness, and respect. Based on my experience working in different home environments with older adults and family caregivers through Gary and Mary West PACE, here are some tips for having this important talk with your loved one.

• Use “I” statements and factually observe what has changed. (“I notice there are a lot of past due bills stacked on the table. You were always so good about paying things on time when we were growing up, have you been able to keep up with paying them?”)
• If commenting on their appearance or hygiene, ask open-ended questions. (“I’ve noticed you don’t like to style your hair as much lately, has anything changed?”)
• Try to restate what they are saying to you back to them to make sure you convey that you understand their wants, needs, and fears. (“It sounds like you’re concerned about people not respecting your privacy, is that accurate?”)
• If your loved one acknowledges they need help, don’t tell them what to do. Instead, ask what their priorities are and ask how they might prefer to solve a given problem. (“I can see that it’s hard for you to keep all your medications straight, but it’s really important to stay on top of that. What do you think you need the most help with?”)
• Give your loved one choices when talking about care. (“It sounds like you could either add a chair lift to help you get upstairs, or you could move your bedroom downstairs and have someone come in a few days a week to help you around the house. What sounds more feasible to you?”) 

Read Full Article