Everyone knows that medicine’s success in extending both quality and length of life has had culture-changing effects on the population. Aging baby boomers are following their parents into life span expectations that make ninety-something birthdays a common occurrence. But those successes also mean that many patients have more acute conditions, while hospital stays are shortening. The effects of that trend are being felt in home health care. “There are some pretty sick people being sent home,” said J. Lee, home health project manager for the Alabama Quality Assurance Foundation. That reality is putting home health agencies under new stressors, with a need for physician awareness of industry limitations. “The question for physicians to ask before discharge is, ‘Is this person too sick for home care?’” Lee said, adding that patients are often too sick for the scope of what home health services can offer. Although agencies may receive poor marks for their acute care hospitalization rate, “just because the agency has a high rate doesn’t mean the care is poor,” Lee said. “It may have sicker patients.” There are more questions that physicians can ask before referring to home health. Physicians should make sure the agency has the capabilities required for a particular patient’s needs. Lee said that a stroke patient, for example, might need occupational, physical and speech therapy, all of which may not be available through some firms. The referring physician or an office staff person should learn whether an agency has certified professionals to deal with other specific needs, such as wound or ostomy care and continence. The referring office should also ask what kind of monitoring technology is available. Some patients are telemonitored, some are phone monitored and some are not monitored at all. The growing number of private duty home health providers offers another option. Rhonda Perez, RN, is president of Angel Care, a Birmingham firm that offers one-on-one care and companion services not covered under Medicare or Medicaid plans. Perez hopes physicians will consider recommending private care when patients have the means to pay the estimated $50,000 to $100,000 annual 24/7 fee or are covered by long-term care insurance. Perez cautioned that referrals should be made to private care agencies that offer registered nurse oversight and have a physical office. Since private duty nursing is unlicensed in Alabama, “it’s imperative to have RN oversight for credibility,” Perez said, as well as professionals who are insured, bonded and cleared through background checks. The director should also be licensed. Perez said that private duty nursing offers not only peace of mind for family, but also acts as a third-person observer for physicians determining whether the patient is taking her medications, whether she is eating and other facts otherwise impossible to discern in a routine office visit. Traditional home health covered by Medicare and Medicaid “is going to become a real necessity with medical advancement and the aging population,” said Missy Wilbanks of Mid South Home Health, a Gentiva company. She expects more physicians to utilize home health as part of their treatment regimen, using these professionals as their “eyes and ears” in the home. Family expectations should also be tempered when a physician’s office refers to a traditional home health agency. Lee said physicians can help with the transition by explaining that traditional home health may not mean a caregiver is present all the time. Families may not understand that only intermittent care may be offered. A new trend in the industry is for agencies to set up weekly meetings with the attending physician to discuss patient progress. Physicians should ask for regular and appropriate communication on their patient. “More companies are also developing specialization services, such as joint replacement rehabilitation or fall prevention,” said Wilbanks. Physicians or staff members that help explain options to families should offer information on needs assessment, extending an effort to make the right match to the right agency. In this case of assessing an appropriate referral, size doesn’t matter. Lee said that agencies “come in all shapes and sizes,” varying in quality of care and types of services. Lee also suggested that doctors can gain insight on the care quality of individual firms by logging onto www.medicare.gov/hhcompare. Home health firms on the Web site can be accessed by zip code, state or name. September 2007