Home Healthcare Study Will Try to ID Models of Effective Treatment

How do patients from various ethnic and economic backgrounds respond to different models of homecare?

Olga F. Jarrín, assistant professor at Rutgers University School of Nursing
As healthcare continues to evolve, homecare providers are playing an expanding role protecting the health of senior citizens, disabled individuals, patients with chronic diseases, and those discharged from the hospital with a need for follow-up care.

And, with funding becoming increasingly scarce, there is a growing focus on how to deliver effective, efficient services that enable patients to stay healthy at home.

Among those searching for answers is Olga F. Jarrín, an assistant professor at Rutgers University School of Nursing. An expert on nursing-care models with hospice and homecare experience, Jarrín is using a $1 million grant from the Agency for Healthcare Research and Quality to launch a study on how organizational strategies can help or hinder a homecare agency’s ability to deliver quality care to patients from different ethnic and cultural backgrounds.

The study will build on work Jarrín did with the University of Pennsylvania School of Nursing — considered the largest survey of its kind of nursing care and patient outcomes — that involved caregivers at nearly 1,000 home healthcare agencies in California, Florida, Pennsylvania, and New Jersey. Those reports will be assessed along with data on crime, segregation, socio-economic status, and access to care to determine what models are most likely to provide effective care for diverse groups of patients.

With help from New Jersey’s Visiting Nurse Association Health Group, Penn nursing, Rutgers Institute for Health, Health Care Policy and Aging Research, and 10 undergraduates from various Rutgers programs, Jarrín will start to analyze the findings this fall. The goal is to see how adopting best practices, encouraging continuing education, using new technology, and improving office management – impact patient health.

“I was interested in seeing how vulnerable populations specifically are receiving care, and their level of care, and the improvement in outcomes,” Jarrín said. “People need a lot of help navigating our healthcare system,” she added. “It is really easy for people to fall through the cracks.”

The 2010 Affordable Care Act vastly expanded health insurance coverage for low-income Americans and reformed the way medical care is provided, shifting from a fee-for-service model to one that rewards doctors, nurses, and other providers for keeping patients healthy. One element of this approach is to penalize hospitals when patients are readmitted with infections or other avoidable complications within a month of their discharge.

Federal officials have withheld up to 3 percent of a hospital’s Medicare funds if they were readmitted within a month of being treated for a half-dozen conditions including heart attack or pulmonary blockage, pneumonia and knee or hip replacement surgery. Nearly three quarters of hospitals nationwide faced penalties the first year.

The new requirement has triggered numerous changes for homecare agencies, which dispatch personnel to treat recently discharged patients, a growing population of homebound seniors and disabled individuals who in the past may have lived in a long-term residential facility. While they vary in size and capacity, these agencies employ a mix of registered nurses, licensed home health aides and other caregivers and companions.

The requirement prompted Lenny Verkhoglaz, owner and CEO of Hackensack-based Executive Care, to develop training programs to help staff better care for patients who are dealing with the six conditions flagged by the federal Centers for Medicare and Medicaid Services for readmission penalties. Founded 12 years ago by Verkhoglaz and his wife, the company now employs 300 people at its main office and has satellite sites throughout New Jersey, as well as franchise operations in other states.

[related]Jarrín, who worked as a visiting nurse in poor communities in Connecticut, said this new emphasis on post-acute care is important. “But homecare is really much larger than that,” she added.

For low-income clients, those from a different cultural background, or those without strong English language skills, it can be challenging to stay healthy or manage a chronic disease, Jarrín said.

In her experience, clients benefit when homecare agencies don’t just focus on clinical services, but aim to connect individuals with a full safety-net of resources to help keep them healthy and safe. And often this requires a caregiver to have the resources and flexibility to visit patients regularly in person and spend time getting to know them, their companions, and the community where they live.

Jarrín recalled a visit to a diabetic client who kept having high blood-sugar readings, despite taking medication. While chatting with the client at her kitchen table, Jarrín learned the woman’s stove had been disconnected and – instead of cooking meals in which she could control salt and sugar – the family was feasting on donated food from friends and neighbors and take-out. In situations like this, a caregiver might need to talk to the landlord or call the utility company in order to help their patient stay healthy.

“It takes time and interest to develop the relationship with a patient,” she said. “A lot of these families just work around the problem. And their health would suffer.”

In her analysis, Jarrín will examine how clients are helped by “front-loading” home visits, or ensuring that they receive extra help and attention during the first few weeks following a hospital discharge or new diagnosis. She will also explore the impact of continuing education programs and mentoring from advance practice nurses can help caregivers do their job.

In addition, Jarrín will look at the impact of electronic recordkeeping and other technology that allows caregivers more freedom to work from the road. The study will also review how caregivers can benefit from interacting with colleagues in an office setting and explore how management’s attitude and the weight of their workload can effect how nurses provide care.