There is no question that the overwhelming majority of American senior citizens would prefer to live at home, should they become ill or disabled. Now, there is good news for seniors: the world of healthcare is increasingly moving out of the hospital and into the home. What are the conditions that made this move possible? What is different about the world of healthcare today that makes home care such a viable option?
Hospital level of care
In the past, the decision to hospitalize an ill or disabled person was based on the concept of “hospital level of care.” In other words, the decision was based on the question of whether the patient needed a service that could only be provided in a hospital. The list of such services included cardiac monitoring or the need for intravenous medication. For newborn infants, neonatal jaundice might keep the family in the hospital for a few extra days to receive phototherapy.
Today, all of these services can be delivered at home with the help of skilled nursing. Sophisticated cardiac monitoring that once was reserved for telemetry units in hospitals can now be performed in a patient’s home. Intravenous medications can be delivered using home-friendly pumps and frequent visits from home nurses. And for newborns, at-home phototherapy allows parents to begin caring for their newborn at home right away.
Patients love these advances because they are able to recuperate in familiar surroundings. But third-party payers benefit as well, as most home interventions are substantially less expensive than hospital-based care.
Another barrier to delivery of care at home has been outdated reimbursement models that simply did not pay for care that could otherwise be delivered at home. This barrier is currently being breached in the form of Congressional action such as the 21st Century Cures Act, which promises funding for higher levels of reimbursement for home care. However, there are yet more barriers to overcome. For example, current reimbursement models do not cover wellness visits at home. This regulatory oddity requires providers to bill wellness checks as “sick visits.” Hopefully in the future reimbursement models will catch up with the reality of what actually occurs in patients’ homes.
The mobile, connected nurse
The Project Integrity program at the Centers for Medicare and Medicaid Services (CMS) funds transportation for covered patients to and from physician visits. So-called “non-emergency medical transportation” is an innovation that is responsible for preventing thousands of hospitalizations by ensuring that seniors and disabled patients are able to attend physician services. Recently the providers of non-emergency medical transportation have teamed up with ride-sharing companies to seamlessly coordinate rides to physician visits.
What about transporting doctors and nurses to patients? With funding available from CMS, and ride-sharing technology easily available, caregivers can easily visit numerous patients per day, without having to worry about driving. With so many hours in a work day consumed by the need for accurate documentation, ride-sharing greatly improves a visiting nurse’s time-management and efficiency.
The time for the home-based model of care has indeed arrived. Of all the factors leading to this development, technological advances have had the largest impact. The mobile, connected nurse is now equipped to perform many services that were once reserved for the hospital. Patients are finally able to get the care at home that they really want.