Home is where more care should be

Could be key to relieving strain on healthcare system

HEALTHCARE SYSTEMS across the country are increasingly strained as hospitals have grappled with peak capacities and few available beds throughout the pandemic. This is due in part to this summer’s surge of the Delta variant and to the more recent surge due to the Omicrom variant. It is also a result of serious health issues people are experiencing after postponing care early in the COVID-19 pandemic, creating higher demand for acute services.

A poll from NPR, the Robert Wood Johnson Foundation and the Harvard T.H. Chan School of Public Health last year found that nearly 1 in 5 American households chose to delay care or were unable to receive care due to the pandemic. Delayed treatment of health issues that could have been prevented or minimized with earlier attention is unsustainable for our patients and for our healthcare system.

We can alleviate this strain, as well as future impact on our healthcare system, by caring for patients in their homes. To do this successfully, we as a healthcare community must better prioritize the home environment as a safe, effective setting in which to deliver care.

Home health care addresses a wide continuum of needs – including managing chronic illness, recovering from surgery, and providing advanced wound care and infusion therapy. It can improve patient outcomes, prevent unnecessary hospitalizations, lower costs, and improve quality of life.

Often overlooked is the level of care that can be achieved from the comfort and safety of home. Innovations in the home setting include Hospital at Home programs, urgent care visits direct to the patient, telehealth ,and other advanced technologies and mobile diagnostics such as hospital-grade x-rays and 12 lead ECGs. These innovations, and a growing list of others, allow patients to return from the hospital sooner, avoid stays in extended healthcare facilities, or learn to manage newly diagnosed illness or disease.

Although we have made leaps and bounds in our ability to bring care directly to patients, we need to do more to meet the growing demand of people who want to receive care where they live. Cultivating a stronger home healthcare workforce is key to addressing this issue. According to the National Association for Home Care and Hospice, demand for home care workers rose 125 percent since the beginning of the pandemic. Clinician and nursing shortages in home health have been serious problems predating COVID-19. A major contributor is the emphasis our healthcare industry places on hospitals and facilities as premier places to work – particularly for nurses and clinicians just starting their careers.

There is much opportunity for academic institutions to partner with home care and hospice agencies to create better learning opportunities in the home setting. This will take a concerted effort and resources by both the schools and the agencies, but the long-term rewards will be immeasurable. Doing so will teach students the skills needed to independently care for patients away from the structure of a brick-and-mortar building, while also giving them the chance to develop longer lasting relationships with patients. By providing strong clinical rotations and added curriculum supporting students to care for people at home, we can fortify our healthcare workforce and direct a new generation of clinicians to the settings where patients most want to receive their care.

Legislative changes that invest in home care can further strengthen our healthcare system and its workforce. State and federal legislators, as well as regulators, should increase reimbursements for home health to help providers keep up with the demand for home care. As of 2021, Medicaid spent about 57 cents out of every long-term care dollar on home-and community-based services, an increase from about 18 cents per dollar in 1995. Allocating state and federal money appropriately will help home care providers continue to attract and retain talented nurses and clinicians by offering salaries competitive with hospitals, open capacity for more home health patients, and relieve over-burdened hospital capacity.

Meet the Author
It became clear during the pandemic that people across the country prefer to receive care at home rather than in a medical facility. Our talented and compassionate home health, hospice, and palliative care clinicians have the tools and skillsets to make this happen. By reprioritizing the home environment through innovation, educational offerings, and investment in care, our healthcare system can better serve patients while alleviating its own strains in the process.

Jane Pike-Benton, is chief operating officers of VNA Care.