Dr Melissa O'Connor on Policy Reform to Address Unmet Needs in Home Health


Melissa O'Connor, PhD, MBA, RN, FGSA, FAAN, endowed professor in Community and Home Health Nursing, M. Louise Fitzpatrick School of Nursing, Villanova University, and director, Gerontology Interest Group, discussed several policy needs for home health care, including improved caregiver support, updated eligibility criteria for in-home care, and reimbursement for telehealth.

Along with better support of unpaid caregivers, there are several policy needs for in-home health care, including improved eligibility criteria and telehealth reimbursement, said Melissa O'Connor, PhD, MBA, RN, FGSA, FAAN, endowed professor in Community and Home Health Nursing, M. Louise Fitzpatrick School of Nursing, Villanova University, and director, Gerontology Interest Group.


Considering the aging of the US population, what is needed from a policy/reimbursement perspective to improve the care of community-dwelling older adults, since so much relies on unpaid family caregivers?

We could talk for hours about unpaid caregivers, but I realize we don't have that kind of time. So, I will first say that as a nation, we must pay better attention to the caregivers of patients that we serve and assess not only their ability to care for the patient that we are caring for, but also the caregivers well-being.

We know through research that caregivers are no longer predominantly women and older adults, we're seeing caregivers that are younger, we're seeing caregivers that are working. Many caregivers are men, they're not just women.

So the needs of caregivers are changing, and as you asked, the group of caregivers is growing, and is expected to grow even larger as our nation, as our world ages. So, those who leave employment to be a caregiver often end up with poor health outcomes themselves as they age, and many suffer financially, because they've left the workforce prematurely. So, this issue of caregivers and what we're going to do to support them is really critically important to the success of older adults being able to live well or even safely at home.

So, I also want to talk about some policy needs. We need to do a better job of supporting our caregivers, which I've already talked about. We also need to take a look at a few things in home health, specifically related to the homebound rule and also the skilled need role. And in my practice as a home health nurse, as a leader and as a consultant for several years, I've seen so many patients who no longer fit the criteria for skilled home health, such as being homebound and having a skilled need.

They get discharged from services, only to be back in home health, because they were rehospitalized. And sometimes it's for unmet needs, perhaps there was a social determinant of health need or something that home health either was not aware of or couldn't fix, we can't fix everything. Or maybe it's something, an exacerbation of their illness. I often wonder if home health could keep the patient open, and perhaps see them every other week or once a month—keep that connection. Could we have prevented that rehospitalization and ultimately saved the health care system way more than we would have spent if we could have just kept them open and seeing them for, like I said, every other week or once a month.

In regards to being homebound, it's a good thing if older adults can go out and socialize. That doesn't mean that they don't have health care needs. So that rule of being homebound in my mind is incredibly, incredibly outdated. We also know through research that older adults that have limited social activities or are socially isolated, do not have as good health. Their health is not as good if they're socially isolated. I'm just not saying it as I want to at the moment.

We also know that they don't live as long. So, the fact that if they are able to go out and socialize and see people really should not prevent them from getting in-home care, in my opinion. And lastly, another policy-related issue is reimbursement for telehealth, which has become commonplace for many home health agencies even before the pandemic, but even more so now.

We know it's a tool that helps home health nurses and the agency stay connected to older adults. It helps older adults feel more secure like someone is watching out for them. And it really reduces anxiety and also helps them learn more to be able to care for their chronic conditions. They really get an understanding of, for example, if a patient with heart failure might have too much sodium the next day then they go to weigh themselves they can see the impact that sodium has had on their body so it really teaches them self care. It's a fantastic tool and I would really like for policymakers to take a look at the reimbursement for telehealth and in-home health.

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