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The new face of healthcare: moving out of the hospital, and into the home

For a growing number of patients dealing with chronic illness or recuperating from surgery, the notion that ‘there’s no place like home’ is an ever-increasing reality.

Although often overlooked by patients in the past, home healthcare is a progressively more viable and cost-efficient alternative, particularly considering the increasing cost of hospital-based medical care. Indeed, patients whose medical condition permits convalescence at home can actually save themselves- and their insurance companies -thousands of dollars per day.

“Home healthcare is well-suited to acute temporary care,” said Robert Rossi, Chief Nursing Officer with Apollo Hospital and senior official with Houston-based Wellness Healthcare Inc. “Done properly, it’s a continuation of care, based on the direction of their doctor. We serve as an extension of the primary care team.”

Founded in 2009, Wellness Healthcare employs nurses and social workers, as well as physical, occupational and speech therapists, to assist patients’ transition from surgery, or support those with a chronic medical condition.

Healthcare professionals can visit the individual in his or her home to evaluate their medical condition and serve as a conduit between doctor and patient. Progress is monitored, patients are taught how to use appropriate medical devices, and their overall condition is reported back to the primary care physician.

“All care is overseen and directed by the primary care physician,” said Rossi. “We’re making healthcare more accessible and efficient.”

This is an increasingly important consideration, as a New England Journal of Medicine study found that 2.3 million hospitalized Medicare beneficiaries were readmitted to the hospital after just 30 days, over a one-year period, representing 20 percent of cases. Many of these unplanned return visits were associated with gaps in follow-up care.

“Regular visits can help identify minor problems before they become serious,” said Rossi. “If a patient is not responding, changes in medication or treatment can be made in consultation with the patient’s doctor.”

In-home healthcare also offers patients the benefits of familiar surroundings and, in many cases, the support of family and friends.

“People generally prefer being home rather than in an institutional environment,” noted Rossi. “It’s especially beneficial to those who are ambulatory.”

In addition to having medical expertise, home healthcare workers are in a position to help the family create a more suitable home environment- reducing clutter, moving furniture, or relocating the patient to another area of the home to avoid stairs or other mobility challenges. Home healthcare workers can also be helpful in referring patients to specialized services, such as Meals on Wheels, where appropriate.

However, as helpful as home healthcare professionals are, they should not be confused with a maid service, as Dr. Douglas Curran, board member with the Texas Medical Association explains. “Home healthcare workers are part of the medical team − they are not there to cook or clean,” said Curran. “They are there to provide clinical care as appropriate and update the physician on patient progress or changes in condition.”

Indeed, regular visits by a registered nurse have been a benefit for Lauren Jacobs, a 28-year-old Houston woman diagnosed with Multiple Sclerosis (MS) in 2009. The visits save her time, allow her better communication opportunities to discuss her condition and free her family to run errands during the healthcare provider’s visit.

“MS is the ‘you look so good’ disease,” said Jacobs. “The symptoms may not be apparent, but traveling to and waiting in a doctor’s office or an emergency room is difficult for me. I’m grateful a medical professional can come to me.”

On a typical visit, registered nurse Sue Gragera began the consultation with a review of all the medications Jacobs was taking, along with a discussion of their effectiveness and side effects. Gragera then recorded her patient’s vitals, as prescribed by her primary care physician.

“It’s an opportunity for me to ask questions about different medications, new symptoms or treatment options I’ve heard about,” said Jacobs. “Home healthcare is a blessing for me.”

She’s not alone. According to Rossi, the Baby Boomer generation is going to be looking for cost efficient medical assistance in the near future. For many, home healthcare is the logical choice.

“Insurance companies are cutting back in a lot of areas,” said Rossi. “Where hospitalization is not required as a necessity, home healthcare is often the answer.”

Indeed, as the cost of staying in a hospital has increased, the average length of stay has decreased. Freeing up beds for patients requiring acute care or surgical procedures makes sense, according to Rossi- especially when recovery and patient monitoring can take place safely in the home environment.

The implementation of the Affordable Care Act also has two important aspects; consumers will take on more financial responsibility for their care with higher deductibles and co-payments, and health providers will be faced with smaller margins.

“Employment opportunities for home healthcare workers are definitely increasing,” said Rossi. “Where possible, it just makes sense for people to transition to or remain in their homes, certainly from an economic standpoint.”

Such a shift may be in the works. The federal budget sequestration, Medicare reimbursement cuts, and overall uncertainty regarding the national healthcare reform, led many healthcare systems to reduce their numbers of employees in recent months, according to the U.S. Bureau of Labor Statistics (BLS). In fact, the number of jobs available in the U.S healthcare industry actually declined in December 2013 for the first time since June 2003.

However, while current economic conditions are problematic, BLS employment projections through to 2022 anticipate the addition of more than five million new jobs in the ‘Healthcare and Social Assistance’ category, representing a growth of 29.4 percent in the coming decade.

Key factors include healthcare cost pressures, the aging population and technological advances that are expected to shift services from inpatient facilities and hospitals to outpatient settings and in-home care.

“Home healthcare professionals can be an important part of the medical team,” said Dr. Curran of TMA. “Properly directed and supervised, in-home care offers great benefits to patients and we’re likely to see more of it in the future.”