Health care report: Home-based services give patients choices, save system money

BY CHRISTINA OLENCHEK

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Home health agencies have become significant players in the delivery of medical care over the past 20 years. It’s a development that proponents believe is saving the health-care system money.

“The goal of home health is to keep people out of the hospital and the emergency room,” said Vicki Hoak, executive director of the Pennsylvania Homecare Association in Lemoyne. “You can equate that into cost savings.”

The role of home health providers has evolved into a chronic-care manager role, serving people with illnesses such as diabetes, congestive heart failure and high blood pressure, Hoak said. These providers also are called upon to educate patients and families. For example, a home health provider might teach a family member how to care for a patient’s wound.

Home health care can be significantly less expensive than hospital or nursing-home care because it doesn’t require 24-hour monitoring of a patient, said Bonnie Boyer, president and chief executive officer with Comfort Care of Holy Spirit. Comfort Care, which is part of Holy Spirit Health System, serves patients in Cumberland, Dauphin, Perry, western Lebanon and northern York counties.

“The outcomes are better because the patient is happier to be in a home environment,” Boyer said.

New technology adds to the cost savings because it can reduce the amount of time that home health providers have to spend with patients and make it easier for patients to stay in their homes, Hoak said. Telemedicine equipment can send information to an agency about a patient’s vital signs. Special drug dispensers can ensure that a patient keeps up with medication regimens. Sensors installed in a home can alert a patient’s caregivers if a patient’s activities fall outside his or her usual daily routine.

“We can intervene before it’s, ‘Oh my God, we’ve got to go to the emergency room,’” Hoak said.

Not all observers are convinced of home health care’s potential to save money. There are costs associated with keeping a patient at home that are not directly related to the provision of medical services, said Dr. Stuart Shapiro, president and CEO of the Pennsylvania Health Care Association. The Harrisburg-based organization represents long-term care and senior-service providers statewide.

Government programs that pay for home health also often pick up the tab for services such as meal programs, social services, prescription-drug costs and transportation to doctor’s appointments, Shapiro said. He believes those expenditures create a new entitlement and divert much-needed funding from nursing homes.

“You can’t rob Peter to pay Paul,” he said.

Home health agencies and nursing homes must work together to provide the best continuum of care for patients, said Steve Lindsey, chief executive officer of Garden Spot Village, a retirement community in Lancaster County. Garden Spot, which includes a nursing home, recently started providing home health services.

“I really feel they are complementary,” Lindsey said. “One of the keys in the future, especially in serving older adults, is that we’re going to have to be able to provide choices …To be able to mix and match (services) to meet people’s individual needs is very healthy.”

Boyer agreed. There are times when a patient’s level of sickness increases to a point where facility-based care is the best option, she said. A nursing home also might be a better fit if a patient’s family can no longer provide enough support to keep that person at home.

The popularity of home health services is likely to increase, especially as baby boomers reach retirement age, Hoak said.

“The baby boomers are going to want to stay independent as long as possible,” she said.