In addition to better support for unpaid caregivers, there are several policy needs for home health care, including improved eligibility criteria and reimbursement for telehealth, said Melissa O’Connor, PhD, MBA, RN, FGSA, FAAN, teacher endowed in the community and at home. Health Nursing, M. Louise Fitzpatrick School of Nursing, Villanova University, and Director, Gerontology Interest Group.
Given the aging US population, what is needed from a policy/reimbursement perspective to improve community-dwelling elderly care, since so much depends on unpaid family caregivers?
We could talk for hours about unpaid caregivers, but I realize we don’t have that kind of time. So I will say first that as a nation we need to pay more attention to the caregivers of the patients we serve and assess not only their ability to care for the patient we are caring for, but also the well-being caregivers.
Thanks to research, we know that caregivers are no longer primarily women and older people, we see younger caregivers, we see caregivers who are working. Many caregivers are men, not just women.
So the needs of caregivers are changing and, as you requested, the pool of caregivers is growing and expected to grow even larger as our country ages. So those who quit their jobs to become caregivers often find themselves with poor health outcomes as they age, and many suffer financially because they left the workforce prematurely. So this question of caregivers and what we’re going to do to support them is really critically important for seniors to be able to live well or even safely at home.
So I also want to talk about some political needs. We need to better support our caregivers, which I have already spoken about. We also need to look at some things in home health, specifically related to the stay-at-home rule and the role of qualified needs. And in my practice as a home nurse, as a leader, and as a consultant for several years, I’ve seen so many patients who no longer meet the criteria for qualified home health, like being confined to home and have a qualified need.
They are discharged from services, only to be back in home care, as they have been re-hospitalized. And sometimes it’s for unmet needs, maybe there was a social determinant of health need or something that home health wasn’t aware of or couldn’t address, we can’t not solve everything. Or maybe it’s something, an exacerbation of their disease. I often wonder if home health could keep the patient open, and maybe see them every two weeks or once a month – keep that bond. Could we have prevented this rehospitalization and ultimately saved the health care system far more than we would have spent if we could have kept them open and seen them, as I said, every two weeks or once a month.
When it comes to home confinement, it’s a good thing if older people can get out and socialize. That doesn’t mean they don’t need health care. So this rule of being housebound in my mind is incredibly, incredibly outdated. We also know from research that older adults who have limited social activities or who are socially isolated are not as healthy. Their health is not as good if they are socially isolated. I’m not saying it like I want to at the moment.
We also know that they don’t live that long. So the fact that if they’re able to get out and socialize and see people really shouldn’t stop them from getting home care, in my opinion. And finally, another policy issue is telehealth reimbursement, which has become commonplace for many home health agencies even before the pandemic, but even more so now.
We know it’s a tool that helps home care nurses and the agency stay in touch with seniors. It helps seniors feel more secure, like someone is watching over them. And it really reduces anxiety and also helps them learn more so they can take care of their chronic conditions. They really understand, for example, if a patient with heart failure may have too much sodium the next day, then they go and weigh themselves, they can see the impact that sodium has had on their body, which really teaches them to take care of themselves. It’s a fantastic tool and I would really like policy makers to look at reimbursement for telehealth and home health.
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