According to Karen A. McKnight, RD, LD, CDE, and Mary Teipen, RN, CDE, from the Indiana HomeCare Network, home health care is an effective and cost-effective option for patients with diabetes.
Using their personal experiences as home health providers, McKnight and Teipen shared insight on their home health care company, and made suggestions on how others can successfully handle the sometimes challenging feat of managing diabetes and other chronic illnesses in a home care setting.
“We all know that patients do better in their home setting, it’s a lot safer for them, there’s less risk for infection and it’s more cost-effective,” Teipen said during a presentation.
While the benefits seem obvious, Teipen said many patients and physicians aren’t even aware this form of health care is available.
“A lot of our elder Americans don’t take advantage of their home health benefit in Medicare because medical providers don’t refer them. Providers are so confused about that terminology – being ‘homebound,’” Teipen said. “Homebound doesn’t mean that you’re bedridden or that you can never leave your home. It basically means that they (patients) need assistance to leave the home, or when they do leave the home it’s a very taxing effort.”
McKnight said that one of the biggest challenges of home care is not getting patients interested in the opportunity, but reimbursement. Since 2006, McKnight said, home health reimbursement has declined by 8.5%.
“It seems each year Medicare cuts the amount that they’re paying home health, little by little. Some agencies are seeing as much as a 10% decrease, and some are seeing less, depending on certain factors. The National Association for Hospice and Home Care has estimated that this year 53% of the nation’s home care agencies will be operating at break-even or at a loss. It’s a huge issue and a big concern for those of us in this room who work in home care, in terms of what the future holds there,” McKnight said.
When coupled with deductibles and copayments that are beyond the aging patient’s budget, the impact is greater, she said.
McKnight said other issues have plagued the home health arena, despite its benefit. She and Teipen’s home health company has managed to pull through this complex area of disease management by focusing on four main specialties, one of which is diabetes due to its current trend.
“Our diabetes program is customized to meet the specialty needs of home health patients and it is very self-management education-focused for the patient and for the caregiver. In addition to that patient and caregiver focus, we have been advancing in developing the staff training component,” McKnight said.
All of their clinical staff is trained in basic diabetes patient care, Certified Diabetes Educators (CDEs) attend case conferences to discuss ever-changing complex needs of patients, and the RNs and CDEs visit the most challenging patients to develop a team approach.
Looking to the future, McKnight and Teipen said they will utilize technology at the highest level; with tele-health monitoring, video conferencing, web-based resources, physician portals, transitional care through electronic medical records and telephone patient follow-up time.
Their advice to physicians, nurses and other diabetes educators is to “just get started,” and make staff education a priority from orientation to ongoing training. Additionally, they said each home health company needs a champion with leadership and support to influence the process. Communication is the key, they said. – By Samantha Costa
Disclosure: Ms. McKnight and Teipen report no relevant financial disclosures.
For more information:
McKnight KA, Teipen M. #W20. Presented at: The American Association of Diabetes Educators 2012 Annual Meeting & Exhibition. August 1-4; Indianapolis, IN.
- I got into diabetes education through home care. My goal was to provide home care services to the homebound; it’s always been my first love. I really do agree with what they said – people get better when they’re in their own environment. That’s when you’re going to find out what they really have in their cupboards. Do they have the Rice Krispies or the whole wheat cereal, and so on?
With the new health care reform, I think that home care is going to become an entity that needs to be incorporated because it is cost-effective. Monies are going to have to be spent to facilitate the transition from acute care to home care, and yet still have some sort of follow-up.
So, ACOs or whatever we’re going to call them, medical homes, it’s all going to have to be related. They’re going to have to include the home care perspective. Patients appreciate it. I think the expertise that the nurses are going to have to develop is only going to increase. The diabetes field is just exploding with new products and new technologies.
- Anne Cannon, BSN, RN, CDE
- Senior Medical Liaison for Novo Nordisk