Home-Based Care

Home care’s tent is big, and getting bigger

Technology, a pandemic, and patient preference are

forcing providers, suppliers and payers to expand their understanding of “home care.”

In April, researchers in the United Kingdom published a study in the Annals of Internal Medicine demonstrating that hospital-level care at home with a comprehensive geriatric assessment led to similar outcomes compared with hospitalization for medically unwell older persons referred to bed-based hospital care.

Researchers from the Nuffield Department of Population Health at the University of Oxford randomly assigned more than 1,000 sick older persons referred for a hospital admission at one of nine community and hospital sites to either hospital-at-home care with a comprehensive geriatric assessment, or hospitalization. The assessment allowed a geriatric care team to evaluate patient characteristics and contribute to the care plan. Participants were eligible if they were 65 years or older,

and all had complex medical issues (but did not require emergency treatment, palliative care or surgery).

At six months, the researchers found that outcomes were similar between the two groups: ʯ 79% of participants in the hospital-at-home group vs. 75.3% of those in the hospitalized group were living at home. ʯ 16.9% (hospital-at-home group) vs. 17.7% (hospitalized group) had died. ʯ 5.7% (hospital-at-home) vs. 8.7% (hospitalized) were in long-term residential care.

According to the study authors, these findings suggest that a health system that includes hospital-at-home with comprehensive geriatric assessment can create additional acute healthcare capacity for certain older people referred for a hospital admission.

Moving Health Home

In March, a group of healthcare providers formed an advocacy coalition intended to make the patient’s home an option for primary care services, behavioral health, chronic disease management and hospital-level care. The coalition – Moving Health Home – said it intended to do so through evidence collection, policy development, direct advocacy, coalition building, events, webinars and media outreach.

“We know receiving care at home is the preference of most patients, results in higher quality and patient

Leading health innovators launch alliance to advance care in the home

WASHINGTON, March 3, 2021 – Today, a coalition of innovative health care companies launched a group called Moving Health Home to fundamentally change the way policymakers think about the home as a site of clinical service. Americans want to receive health care in their homes. Evidence from the pandemic shows it’s possible, and data proves it is safe and effective. Therefore, it is time to change reimbursement models and the culture around institutional care to allow for Americans to choose their home as a site of care.

The COVID-19 pandemic exposed the untapped potential of home-based clinical care, and the opportunity for a more robust set of services ranging from primary care to hospital-level treatment. The advent of telehealth, remote monitoring, digital therapeutics, provider home visiting, medical records sharing, and other technology has shown that care in the home can be at least equivalent to, if not better than, care offered in facilities.

Different types of home health services have existed for decades, but these services are short-term and designed to help patients – mainly seniors – prevent or recover from an illness, injury, or hospital stay. Making the home part of the regular options available to patients will allow for primary care, behavioral health, chronic disease management and even hospital-level care in the home.

Founding members of this coalition include Amazon Care, Landmark Health, Signify Health, Dispatch Health, Elara Caring, Intermountain Healthcare, Home Instead and Ascension.

“As a company whose mission it is to transform how care is delivered and paid for, Signify Health welcomes the establishment of this coalition to advance policies and practices that will activate the home as an alternate site of care,” said Damien Doyle, MD, Vice President of Medical Affairs at Signify Health.

“Over 17% of Medicare beneficiaries are living with 6 or more chronic conditions. In-home, patient-centered care is critical to managing the complex health needs of our nation’s older adults. We need a public policy agenda that ensures access to innovative in-home care,” said Nick Loporcaro, Chief Executive Officer at Landmark Health.

“We are thrilled to be joining forces with other leaders in homebased care to help remove barriers for patients across the nation while improving outcomes and increasing patient and provider satisfaction,” said Kevin Riddleberger, Co-founder, Chief Strategy Officer at DispatchHealth.

and family satisfaction, and lowers overall cost,” Compassus CEO Jim Deal was quoted as saying. “[W]e look forward to working with other coalition members to shape federal and state policy related to care at home.” (Based in Brentwood, Tennessee, Compassus provides home health, infusion, palliative and hospice care through a network of community-based programs with 200 locations in 30 states.)

“The advent of telehealth, remote monitoring, digital therapeutics, provider home visiting, medical records sharing, and other technology has shown that care in the home can be at least equivalent to, if not better than, care offered in facilities,” said the coalition in a statement. “Although services in the home are traditionally associated with services provided by home health agencies, our members believe that we have

‘We have just scratched the surface on services that can be rendered in the home.’

just scratched the surface on services that can be rendered in the home.”

Founding members of Moving Health Home are Amazon Care, Landmark Health, Signify Health, Dispatch Health, Elara Caring, Intermountain Healthcare, Home Instead and Ascension. As of press time, seven more members joined: Compassus, UPMC, U.S. Medical Management, the Visiting Nurse Service of New York, Advocate Aurora Health and Vituity.

Home dialysis

Meanwhile, Fresenius Medical Care North America and DaVita Kidney Care announced in March an expanded agreement to provide home dialysis technology – including NxStage home hemodialysis machines, dialysis supplies, and a connected health platform – to DaVita patients.

The home hemodialysis machines from Fresenius are portable systems cleared for home use in the United States, including solo hemodialysis during waking hours and nocturnal hemodialysis while both the patient and care partner sleep. (Home hemodialysis typically requires a care partner. To perform solo home hemodialysis, patients require additional training and an order from their nephrologist.)

The agreement also allows patients to access Nx2me Connected Health, a platform designed to simplify the collection and sharing of treatment information with the dialysis clinic and care team. The system accesses treatment information directly from the home hemodialysis machine; including weight, blood pressure, and temperature via Bluetooth; and medication taken, notes, and answers to health assessment questions as entered by patients.

“By transmitting treatment information, we hope to help identify irregularities and prevent avoidable complications, thus supporting patients’ desire to stay on their treatment of choice longer,” said Keith Hartman, group vice president for DaVita home modalities.

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Creating a Safer Physician Office

Why reducing chemical exposure is right and required

Doctors’ offices often struggle to maintain compliance with Occupational Safety and Health Administration

(OSHA) regulations, including the Hazard Communication Standard. But following these regulations is essential to healthcare worker safety because they address substantial risks present in the physician office.

“All it takes is one anonymous call from an employee for OSHA to be on your doorstep.”

– Dr. Karson Carpenter, President of Compliance Training Partners

OSHA’s Hazard Communication Standard outlines how healthcare organizations must inform employees about any hazardous chemicals that they may be exposed to at work. It is designed to protect against chemicalsource injuries and illnesses by ensuring that employers and workers are provided with sufficient information to anticipate, recognize, evaluate and control chemical hazards and take appropriate protective measures.

“All it takes is one anonymous call from an employee for OSHA to be on your doorstep,” said Dr. Karson Carpenter, President of Compliance Training Partners. Dr. Carpenter has extensive experience designing educational programs to bring medical facilities into compliance with government regulations.

“There is a tremendous liability for physician offices,” he added. “Employees understand their rights better than ever before and many physician offices don’t realize their risks.”

Dr. Carpenter said these risks can easily be mitigated without using scare tactics. “We sell through better education,” he explained. “COVID-19 created a better awareness of risks in physician offices and those that have been reactive in the past have become more invested during the pandemic.”

OSHA requires organizations to provide hazard communication training when a worker is initially assigned to a position that has the potential for hazardous chemical exposure. One example of a hazardous chemical is the topical anesthetic spray ethyl chloride, which is HAZMAT, toxic and extremely flammable.

Eliminate the hazard

Fortunately, a safer alternative exists to ethyl chloride. CryoDose TA is a clinical and therapeutic equivalent to ethyl chloride, but is non-flammable, non-toxic and HAZMAT free. Unlike ethyl chloride, CryoDose TA’s safety profile allows it to be used on open wounds and intact oral mucous membranes, and it can be stored and disposed of as a normal aerosol. It is a safer and more economical alternative to ethyl chloride for today’s healthcare practice.

“Patients and staff should know about new and safer products,” Dr. Carpenter said. “Owners and managers of physician offices like to tout products they use that are considered safer and it also creates loyalty from employees if they know their employer is protecting them.”

By educating physician offices on least-toxic practices and introducing safer product alternatives wherever possible, distributor representatives can help healthcare facilities become models of health for their employees and patients.