According to Vidant Health’s Pam Cowin, a shift to ambulatory services is a defining feature of the emerging healthcare culture. As a result, there is an increased focus on enhancing the nursing case management model, care coordination, and system-wide performance.
The roll-out of healthcare reform, population health management programs, and accountable care organizations are driving new innovations between hospitals and home health organizations.
As a result of their quest to help hospitals provide a more fluid care experience for patients and prevent readmissions, among other quality goals, home health organizations are carving out a permanent role on the healthcare continuum.
“We’re really seeing a shift in which ambulatory services are more of the focus of healthcare today,” says Pam Cowin, clinical administrator for home and transitional care at Vidant Health in Greenville, NC.
Cowin, with 20 years’ experience in home health, is not the least bit surprised. “In home health, the goal has always been to keep patients at home and out of the hospital,” she says. “So, when CMS began enforcing penalties for hospital readmissions, hospitals really started paying more attention to post-acute services.”
These newly forged collaborations are translating into changes for home health nurses on the frontline. In fact, home health nurses will play a starring role as hospitals and home health organizations continue to evolve their relationship. Cowin says now there is an increased focus on improving the nursing case management model, care coordination, and system-wide performance improvement work.
“We are seeing higher expectations and a new level of accountability for nursing-driven patient outcomes,” says Cowin. “There is a shift occurring in which nurses are becoming an extension of primary care providers in identifying and helping address care gaps.”
Cowin says over the last few years, Vidant Home Health and Hospice has created new processes to bridge gaps in care. One change has been to ramp up patient contact in the home. In addition to normally scheduled nurse visits and having an on-call nurse on duty after hours, Vidant now schedules nurse/patient phone checkups.
Cowin notes, “The combination of home visits and phone checkups increases our contact with the patient and family. This improves our oversight of the plan of care and facilitates early recognition and intervention of problems which may have resulted in readmission.”
Additionally, Vidant is working closely with providers to improve transitions when patients leave the hospital. “Now, we send staff to the hospital prior to the patient being discharged or admitted to facilitate a seamless transition,” says Cowin. “It’s now become more of a transfer than a discharge or an admission and gives patients ongoing access to care.” she points out.
When a hospital readmission does occur, Vidant and the hospital share information and look for any gaps in care. “That can range from doing a patient interview on what brought them back to the hospital to doing a chart review on both sides to identify any opportunities to improve care,” says Cowin.
Home health’s case management nursing model is ideal when it comes to the type of improvements hospitals and home health organizations are starting to make. From the moment the nurse enters the patient’s home, they provide a holistic care approach, taking into consideration how well the patient is doing from a physical, psychosocial, environmental, and spiritual standpoint.
“Nurses in home health are truly the case managers,” says Cowin. “They are looking at every aspect of that patient’s care in the home. Nurses are on alert to identify any barriers to a patient’s care and wellness, including safety hazards in the home, lack of family/caregiver support and medication issues.”
Home health nurses often work alone and have a high degree of autonomy compared to nurses in hospitals and other care settings. Critical thinking is highly valued and nurtured in home health nursing because clinicians are expected to take on multiple roles. “Often one person wears many hats including areas of quality, risk management, and infection control, whereas each of these would be a dedicated department in other healthcare settings,” says Cowin.
Home health is an attractive work environment for nurses who like having a flexible schedule and a work-from-home experience. As home health organizations move toward participation in new payment models and seek to meet new quality and patient experience expectations, they will need to recruit and develop nurses who not only have strong critical thinking skills but also those who are comfortable making decisions that would normally be made by someone else.
Moreover, nurses must have the ability to serve patients in any type of environment. “Home health nurses really have to exhibit a non-judgmental attitude because one home may have holes in the floor and infestation issues while the next visit may be in a million dollar home,” says Cowin.
Long-term success also hinges on helping nurses strike a healthy balance between home and work to prevent burnout. Because there is more flexibility with their schedules, home health nurses sometimes blur the line between home and work.
Their home becomes their office, says Cowin. “We start working with them on setting boundaries during the interview process by asking them to focus on what they like to do in their downtime. “We continue the conversation when they are hired, making sure that they have an adequate orientation time, and we help them with setting boundaries.”
Nurses are also encouraged to avoid isolation by committing to routine communication with their peers and supervisors.
This post excerpts an article in the Spring 2015 issue of HealthStream's PX Advisor (), and is used here with permission.