Chamberlain University has recently launched a home health specialty initiative to address staffing issues in home health and continuing care. The initiative is funded through a $1.2 million grant awarded to the university by the American Nurses Foundation's Reimagining Nursing Initiative.
As the country continues to face a nursing shortage, Chamberlain University is offering nursing students an overview of home health nursing care through a virtual course, "Introduction to Continuing Health (ICH)," developed with the university’s partner BrightStar Care, the home care and medical staffing franchise.
Students who complete and pass the course can spend 96 hours of clinical time at BrightStar Care and other home health partners. The university's partnership with BrightStar Care will continue as the course is piloted through the university's different campuses.
"Nurses are vital contributors to the health and well-being of our communities and providing nursing students broader access to exposure to home health and other specialties will strengthen the pipeline of prepared nurses in critical need areas that they enjoy," Chamberlain University President Karen Cox, PhD, RN, FACHE, FAAN, said in a statement.
"With our focus on home health, we are delighted to work with Chamberlain on this new nursing education program so we can increase the number of qualified home health care nurses who practice evidence-based care," Shelly Sun, founder and CEO of BrightStar Care said in a statement. "We believe strongly in Chamberlain's pilot to create a successful pathway for nursing students to learn this specialty and make an impact on the future of nursing."
The university plans to evaluate the program in 2025 once the pilot ends, developing a playbook to document the model for public availability. It will then be shared with the American Nurses Foundation and other nursing schools to help them replicate the approach.
The robot is designed to interpret facial expressions, replicate patterns from previous resident interactions, and tailor responses to individual needs.
Riverwalk Post-Acute, a skilled nursing facility, has added a new member to its staff – Robin the robot.
The Riverside, California facility began using the life-sized robot to interact with residents and patients to support their mental health. Robin is HIPAA-compliant, using a combination of science-based therapeutics and AI.
In use, Robin has the personality of a 7-year-old child, allowing residents to feel like they are speaking to their own grandchild. Robin supports residents' mental health and memory care through conversations and playing games, and even alerts staff to potential resident falls. Robin can also be used for remote patient monitoring. In addition, the robotic companion can collect and analyze data on residents' emotional state by interpreting facial expressions, helping it to recognize patterns and create tailored responses to residents.
Robin can be controlled by a medical or assigned staff member, who are also able to communicate with patients and residents via its interface.
"Our patients come from all walks of life, each on their own path to recovery. Robin allows us to provide a companion to someone who may not have any family at all to help improve their stay and recovery while at our facility," Riverwalk Post-Acute administrator Andrew Stephenson said in a statement. "The goal of Robin is to help patients overcome medical stress and anxiety, while decreasing feelings of loneliness and isolation."
There are four other adult healthcare centers in the nation with their own Robin. Psychological research from experts supports its effectiveness.
For example, UCLA Children's Hospital reports that patients and their families experienced a 29% increase in positive affect—"experiencing the world in a positive way, through emotions and interactions with others, and with life’s challenges”—after a visit with Robin, and a 33% decline in negative affect.
"We never want to lose sight of providing the best care possible, while doing it in a safe environment," Stephenson said. "Having as many resources as possible to improve our patients' experience is a top priority for us; and Robin helps make that possible."
U.S. News uses a variety of data from CMS, including its Nursing Home Compare program.
U.S. News & World Report has released their 2022–2023 Best Nursing Home ratings.
Over 15,000 Medicare- and Medicaid-certified nursing homes are evaluated based on care, safety, infection rates, staffing, and health inspections. This year's ratings also considered weekend staffing numbers and infection rates that led to hospitalization.
To develop its Best Nursing Home ratings, U.S. News uses a variety of data from the Centers for Medicare & Medicaid Services, including its Nursing Home Compare program. CMS is also the federal agency that sets and enforces standards for nursing homes.
The ratings showed that California has the most high-performing nursing homes, with 206 short-term care and 148 long-term care facilities getting a high-performance rating. Florida, Pennsylvania, and Texas were also states noted as having the highest-performing nursing homes in both short-term and long-term care.
"Choosing the right nursing home based on care needs and comfort is a critical decision for prospective residents and their families," Zach Adams, senior health data engineer at U.S. News said in a statement. "The Best Nursing Homes ratings highlight nursing homes that excel in short-term rehabilitation and long-term care needs."
"This year, newly available data on weekend staffing and infection rates that led to hospitalizations provides even more information about how nursing homes rate when it comes to the safety of their residents."
Facilities that are eligible to be rated are those that received reimbursements from CMS in July 2022 and had provided sufficient data to evaluate quality within their rating.
The homecare market is experiencing significant growth, with many healthcare organizations looking to add home care to their service offerings. However, the pandemic has exacerbated the industry's staffing shortage, stretching workers to their limits; which is hindering the sector's prospects for growth.
A new report by KLAS Research, Home-Based Post-Acute Care 2022, looks at the current challenges home care is facing.
KLAS Research interviewed 88 home-based care leaders, with 66% identifying staffing as a challenge. Burnout and difficult work environments were named as contributing factors.
"The increased demand for homecare services has greatly strained organizations' resources; many organizations want to expand their services but have insufficient staff to increase their patient census. Customers mention difficulty finding qualified candidates via cross-industry recruiting platforms," the report stated.
Regulatory requirements (38%) are another challenge home-based post-acute care is facing. Many interviewees stated that the new and changing regulatory requirements from the Centers for Medicare & Medicaid Services (CMS) complicate workflows and stretch already thin budgets to their limit.
"Generating required documentation (e.g. for HEDIS measures) can be complicated, and 24% of respondents cite complex documentation as a challenge. Regulations can also cause reimbursement issues," the report said.
The third challenge for home-based post-acute care is changes to reimbursement (34%). With the healthcare industry beginning to favor value-based reimbursement models, organizations must navigate complex billing requirements.
"Reimbursements are expected to become even more challenging in 2023, when CMS intends to roll out the Home Health Prospective Payment System (HH PPS) Rate Update rule," the report said.
Other challenges noted from the interviewee's responses are:
Increasing costs and supply chain issues influenced by the pandemic are persisting issues.
KLAS Research, a healthcare IT data and insights company, recently released its 2022 facility-based post-acute care report detailing the challenges the sector is facing.
Facility-based post-acute care struggled during the pandemic with media scrutiny, patient safety concerns, as well as staffing. Of the 82 leaders interviewed for the report, 73% identified staffing as their biggest challenge, noting that employee burnout, competing with staffing firms for talent, and managing intensive patient care for severe COVID-19 cases as contributing factors.
"Organizations are competing with staffing firms over resources; some respondents must pay triple the standard cost to hire staff," the report stated. "Additionally, many respondents feel that the pandemic has contributed to staff shortages, thus limiting the number of patients an organization can care for."
After staffing, regulatory requirements (29%) were the second challenge facing facility-based post-acute care. Issues with regulatory requirements can impact reimbursements and revenue cycle.
"Many respondents are frustrated that the requirements introduce redundancy to clinician workflows, make documentation overly complex, and increase the need for reporting," the report stated.
The third challenge cited was COVID-19 (24%) with increasing costs, low patient census, and supply chain issues, all effects from the pandemic.
The rest of the report focuses on technology solutions facility-based post-acute leaders are using or investing in to alleviate the challenges.
Ochsner's Skilled Nursing Facility leadership talks about the organization's recent award and how to meet the demands of a growing elderly population.
Ochsner Health recently received the Workforce Innovator Award from the Louisiana Association of Business and Industry (LABI), as part of LABI's 2022 Free Enterprise Awards.
The annual awards recognize members of LABI who "demonstrate exemplary commitment and contributions to the state's business climate and their local communities," as stated by BIZ magazine.
Ochsner Health, which serves communities in Louisiana, Mississippi, Alabama, and the Gulf South, was specifically recognized for its "commitment to training and employing a diverse and compassionate workforce."
William Wright, director of Ochsner's Skilled Nursing Facility, says he believes the honor also came because of the health system's reputation, a reputation that spreads across all the organization’s services, such as its skilled nursing services and staff.
"I believe that the sheer recognition that Ochsner has, that the skilled nursing facility carries with it, that people want to stay in [our] health system when it comes to post-acute," Wright told HealthLeaders. "And they have a lot of faith and confidence in the health system whereby they can transition from acute care to post-acute care with the Ochsner brand."
According to Danielle Yenuganti, RN, nurse manager of skilled nursing care for Ochsner Health, the nation's elderly population is expected to grow exponentially, with the most growth to be seen from 2020 to 2030. There are currently 46 million adults over the age of 65 in the U.S.; by 2050 that number will be 90 million.
"We have to figure out a way to take care of our elderly population and continue to do it with the highest standards of quality that they deserve, and that we as health systems want to give to these patients," she said.
"Moving forward, we are going to have to use different things, whether its home health, skilled nursing facilities, all those different areas of post-acute, so that people get the best quality that's appropriate for them at that time. And there's going to be a shift of what that looks like to be able to meet the demand of that growing population."
The Skilled Nursing Facility is located within the Northshore Medical Complex, with thirty beds and private rooms. During the pandemic, being part of a larger health system, the facility had access to resources that enabled them to maintain operational efficiency and allowed them to pivot quickly to changes.
"One thing we learned was how to adapt quickly to new things," Yenuganti said. "A lot of time in post-acute, it's a lot slower paced, we do things the same way a lot of the time, and during COVID that tested us. We had to think of new ways to do things quickly, [and tackle] problems with the mindset of, 'Let's look at new ways to do this and figure it out.' "
Wright noted that through the difficulties of the pandemic, the skilled nursing staff developed a strong teamwork dynamic.
"With COVID, everyone had to come together and work in interdisciplinary teams. That's something that's continuing as we come out of COVID, everybody being a united front and working together," he said.
Yenuganti, who has a background in geriatric nursing, added that for healthcare professionals who have remained in the post-acute and long-term care sector after the pandemic, they feel that they've found where they're meant to be.
"As hard as it was, it's a lesson to know [you're] in the right spot, [you're] doing the right thing, what [you] do makes a difference," she said. "And that's a lesson you take with you through the rest of your career."
According to Lena Nilsson, vice president of clinical operations for OSF HealthCare Home Care Services, the home setting is the future of healthcare.
The home health sector experienced a rise in services during the COVID-19 pandemic with patients needing—and in some cases preferring—to receive care in their homes. A continued interest in home health services among patients and the industry has persisted as the COVID-19 pandemic becomes endemic.
HealthLeaders spoke with three executives from OSF HealthCare Home Care Services: J.J. Guedet, vice president of operations; Lena Nilsson, vice president of clinical operations; and Matthew Nieukirk, director of skilled nursing facility about the focus on home health and predictions about the market.
HealthLeaders: What are the benefits of a health system having its own home health service?
J. J. Guedet: There are several benefits of owning our own home health service. The first and maybe the most simplistic benefit is that our home health team is accountable to and responsible for the same mission, vision, and values as the rest of the health system. This helps foster a community of caregivers aligned to the same goals and work. A key aspect in our mission, vision, and values is ensuring access to care to all patients, regardless of payer source or other factors that make care delivery more complex. We accept Medicaid and Medicare Advantage patients, and we make them a priority to speed up the discharge process. Not all private home health agencies can afford to take on large volumes of Medicaid patients. Our home health team prioritizes getting patients home from our hospitals as soon as possible to ensure that our hospitals can provide more access to care to patients.
In this work, not only are we collaborating to make the transition process to home smooth and timely, we are taking on more medically complex patients and helping them continue their recovery processes at home. As part of the health system, we have access to technology and robust education services that enable our home health team to serve patients who traditionally would remain in the hospital for several more days. We have our own home infusion pharmacy as well, and they work closely with our home health team.
HL: Why do you think more systems are interested in offering home health options?
Lena Nilsson: The future of healthcare is in the home setting, evident by the development of 'hospital at home' alternatives and recent proposed Choose Home legislation. Furthermore, I believe the ability to ensure continuity of care and minimizing care gaps allows for efforts focused on managing and treating patients to meet needs and goals, limiting unnecessary rehospitalizations.
Guedet: We need to make sure our hospitals and emergency departments can serve our communities. Part of that work is to help lighten their burden by offering robust home care services, including home health and home infusion pharmacy. The cost of keeping a medical patient in the hospital is often more than $2,000 per day with no additional reimbursement.
HL: What are some challenges or pain points you've identified or predict the sector will have to deal with in the future?
Matthew Nieukirk: The biggest pain point is the new minimum staffing levels that are being placed on the facilities. They have to increase the RN coverage to provide better outcomes. The other issue will be that Medicaid rates were not increased enough to help with the increased staffing levels. So many facilities, especially in rural areas, are facing closures. The other ones are closing wings and reducing staff, and by doing this are decreasing expenses to help offset the staffing increases for more acute patients. The issue for health systems is that by reducing wings or beds, patients are forced to remain in hospital beds longer or until beds become open in the facilities. So, increased staffing levels and closing off beds or wings are the biggest impact to our health system.
HL: How would current legislation to change Medicare/Medicaid reimbursements affect home health patients?
Guedet: Home health is certainly impacted by reimbursement models and rates. Medicare Advantage programs are one of the most challenging for us to work with. Many of these payers do not cover the costs of providing care to patients, or the return is so small that many home health agencies will not accept or will cap what they can accept to a certain volume. We don't have that luxury, as the majority of our referrals are coming from our own health system, and deferring a referral just hurts the system in other areas. What we see happening is that as more home health agencies make the decision to limit Medicaid and Medicare Advantage volume, our volume with those payers grows disproportionately. We are being asked to take on patients who are much more medically complex than they were five years ago, and we are asked to take rate reductions to do it.
Neither Medicaid nor Medicare have been able to adjust reimbursement to recognize the cost of nursing growth over the last three years. We've seen our labor costs grow by 10%–15% for nursing, and the cost for traveler nurses has almost doubled. Long term, we expect to see many smaller, privately owned home health agencies close and even more burden pushed to health system–owned home health.
We are working hard to innovate and to provide great patient care through alternate means, such as digital health, but the current home health benefit does not recognize digital health as a billable service. Even though much of home health services is focused on patient education and teaching independence, there is no reimbursement for utilizing these digital solutions.
The real estate investment trust will now enter a joint venture with Integra Health to operate the skilled nursing assets.
Last week ProMedica, a nonprofit health and well-being organization headquartered in Toledo, Ohio, announced plans to transfer real estate and management responsibilities of its skilled nursing facilities to Welltower, a real estate investment trust, also headquartered in Toledo.
According to a press release, the transfer will resolve the operating losses ProMedica had been experiencing within its senior care division, and is also part of a larger effort to improve the organization's financial performance.
"By engaging in this transaction, we will be able to increase focus and resources on the other areas of our health system as we continue to provide high quality, compassionate care and invest in our communities and dedicated caregivers," Arturo Polizzi, president and CEO of ProMedica, said in a statement.
In addition to the sale and transition of ProMedica's 147 skilled nursing facilities, per its agreement with Welltower, it will also surrender 15% interest in the skilled nursing assets currently held within an existing joint venture and provide "significant working capital support" to ensure a smooth transition of patient care and operations.
Along with the news of the transfer, Welltower also announced that it would be concurrently entering into an 85/15 joint venture with Integra Health, and will enter into a master lease agreement , which will result in a combined cash rent increase of over 4% to Welltower. The venture is expected to close before the end of the year.
"We thank ProMedica for its partnership and the high-quality care provided to residents throughout the devastating COVID-19 pandemic," Shankh Mitra, Welltower's CEO and CIO, said in a statement. "We are excited to announce the partnership with Integra as Integra's focused asset management and vast network of strong regional providers allow the new joint venture to build on ProMedica's positive performance momentum, invest in all the communities, and hire talent."
"We are excited to announce this joint venture with Welltower," David Gefner, CEO of Integra Health, said in a statement. "These communities are in extraordinary locations and comprise an important segment of the health care continuum. We aim to bring them back to their previous glory through focused asset management and regional operator strategy with a primary focus on quality of care."
"We believe there is significant value to be created here for all stakeholders, most importantly the facility residents and staff. We could not be more excited about what lies ahead."
The hospital's new rehab unit boasts an innovative Parkinson's disease rehab program.
Glen Cove Hospital, part of Northwell Health in New York, opened its new $11 million, 15,000 square foot, physical medicine and rehabilitation unit this week. The unit, which brings the acute care community hospital's capacity to 247 beds, will specialize in treating patients with neurological conditions including brain injury, Parkinson's disease, and stroke.
"The new state of the art physical medicine rehabilitation unit was designed to provide a holistic therapeutic environment sensitive to the needs of patients with neurological deficits," Kerri Anne Scanlon, RN, executive director for Glen Cove Hospital, said in a statement.
The physical medicine rehabilitation unit is located on hospital's third floor, designed to have a "spa-like atmosphere" to create a calming environment for patients with diverse neurological needs. It has a capacity of 28 beds; 12 of which are specifically designated for patients with Parkinson's disease.
"Individualized care is coordinated by a team of highly specialized rehabilitation medicine physicians, rehab nurses, specialists and therapists, to help patients reach their highest level of function and quality of life," Scanlon said.
Other features include:
A main nursing station equipped for continuous electronic monitoring of patients' cardiac condition and a satellite nursing station
Three large quiet rooms to be used for private speech therapy, neuropsychology, and consultations
Two well-equipped physical therapy and occupational therapy gyms with ample natural light
A simulated apartment where patients can practice hands on activities of daily living including a bathroom, kitchen, and bedroom, to prepare for returns home,
The unit also has an innovative rehab for the Parkinson's disease involving multidisciplinary, led by neuro-rehabilitation physician Lyubov Rubin, MD, consisting of targeted interventions to help patients improve function and independence. Additionally, a virtual reality and a gaming therapy system will be utilized to help patients along in their recovery in an innovative and fun way by interacting in a virtual environment.
"Equipped with cutting-edge therapies, the new rehabilitation units meets the growing needs of our patient community with complex, high-acuity brain and neurological disorders," Susan Maltster, DO, chair of the hospital's department of physical medicine and rehabilitation said in a statement. "We are dedicated to providing the highest degree of quality, innovative care to our patients."
November is National Home Care & Hospice Month, so here's a look at home health organizations who recently expanded services and accessibility through growth initiatives.
The home healthcare sector has experienced significant growth over the last few years. In some instances, health systems and providers have partnered with or acquired established home health providers, while others opted to add it to their service lines to bolster current offerings.
In honor of National Home Care & Hospice Month, recognizing the dedication and innovation of home health providers, here are five recent articles featuring different individuals and organizations making waves in home healthcare.
Interim Healthcare, a home care, senior care, home health and hospice, and healthcare staffing franchise has experienced a considerable amount of growth, recently opening 15 new office locations with plans to open two more by the end of the year.
CEO Jennifer Sheets said in a statement that the pandemic forced the healthcare industry forward 15 years, leading to consumers learning more home care and patients opting to receive treatment in their own homes.
In addition to the expansion of physical locations, Interim Healthcare also announced new executive hires to oversee the organization's branding and recruitment.
TheKey, the nation's leading provider of premium, private pay home care, and formerly known as Home Care Assistance, recently acquired in-home personal care provider Companions & Homemakers private pay division.
Additionally, Accordcare, a home health services, acquired Companions & Homemaker's Medicaid division.
Going forward, the private pay division will operate under TheKey's branding, with members of the acquired care teams and operations staff joining TheKey's existing team. The Medicaid division will continue operating under the Companions & Homemakers brand.
In home care provider Help at Home launched a care coordination service branch to connect home care to healthcare in an integrated experience by connecting caregiver observations to a clinical network of providers and community resources to create a holistic experience for the patient.
Tim O'Rourke, president of Help at Home, said in a statement that care coordination programs play a vital role in managing chronic populations and can help close gaps in care.
Jet Health, a provider of home health, hospice, personal care, and companion services, recently closed its eight acquisition in four years. During its most recent deal, Jet Health acquire. Trio Home Health and Hospice.
Trio Home Health and Hospice will remain a separate brand with Jet Health overseeing operations of its ten locations in Texas. Jet Health CEO, Stacie Bratcher said in a statement that the organization will be extending its services beyond the Central Texas area to include north Texas and the Dallas/Fort Worth metropolitan area.
Shelly Necke, RN, the vice president of post-acute services for PIH Health Home Health, recently spoke with HealthLeaders where she shared the organization's patient-first vision.
During the discussion, Necke shares that being part of larger health system gives PIH Health access to connections and resources they wouldn't have otherwise. Additionally, with the organization's post-acute services aligned under one leadership structure, providing care has a more streamlined approach.
