Follow by Email

Tuesday, April 26, 2016

Home Care and Hospice Care: Creating a Culture of Person Centered Care




A few weeks ago, I had the opportunity to attend the Visiting Nurse Association of America (VNAA) annual conference. The meeting was held in Miami, FL, which made it local for me, so I decided to attend to catch up with what was happening in the post-acute sector of our healthcare system.  I am glad I did, as it opened my eyes to one of the most dynamic and growing sectors of the industry.

As a registered nurse, I spent some time as a home care nurse. I recall it being a very personal experience as it was me, the patient and his/her caregiver. We had to make do with what we had in the home. I had to use my skills, my intuition and depend on my expertise when handling a variety of challenges that arose. I also had to rely on the caregiver when providing care, by helping me re-position the patient and better understand the patient and their condition so I did not over react when a problem occurred. Home is where most people want to be when sick or recovering, so it is no wonder the focus of all involved in the home care industry is to ensure care is person-centered.  

Today, home care, like the rest of the healthcare industry, is in the state of disruption. Payment models are shifting from volume to value; organizations are consolidating, and patients are demanding care that is increasingly convenient, high-tech, personalized and high-touch.

Most healthcare professionals think their jobs is to ensure health and survival for the patients we care. But it is larger than this because in reality, it is our jobs to ensure well-being. Well-being is the reasons one wishes to be alive. So, our work is really deeper in that we as healthcare professionals have to strive to understand what is important to our patients, what their goals and dreams are and work to ensure that their wishes guide the care we provide.

Healthcare has gotten so wrapped up in regulatory issues; finding ways to use data to meet the metrics needed to qualify for the new incentive plans that reward the work we do while finding ways to guard against the disincentives being implemented to change provider's behaviors. In a way, it feels like we have lost the focus of what is important. 

The theme of the VNAA Annual Conference was Leading Innovation. The conference brought together the country's top home-based care executives and clinicians to meet, to learn about trends impacting their industry and gain valuable insights from nationally known experts in the field. The meeting helped those who attended refocus their attention on how they are using the changes taking place today on how to ensure care is patient focused first and foremost.

There were two keynote sessions that provided insights into compelling topics affecting the entire industry. The opening keynote presentation was titled: Coordinating with Accountable Care and was presented by Donald Crane, CEO, CAPG, The Voice of Accountable Physicians Groups. He shared insights on mega trends, federal policy directions and strategic implications for the home care and hospice industry. Many home care and hospice organizations realize they need to re-organize to meet the demands of the changing industry. This session gave them the blueprint to assist them as they move forward during these disruptive times.

The second keynote was titled Death: Redesigned. There was a great deal of anticipation surrounding this session and it seemed like everyone was looking forward to the session while wondering what the speakers could tell a seasoned audience about end of life care. 

Tracey Moorhead, President, and CEO of VNAA opened the session and shared that VNAA and the legendary design firm IDEO began a partnership to advance awareness of end-of-life and palliative care options and support for providers and caregivers. She shared that this session was the kickoff of the alliance and that more information would be forthcoming. Tracey then introduced the panel that included: Dr. Lucy Kalanithi, Internist, and widow of the late Dr. Paul Kalanithi who began the discussion with a thoughtful reading from the book her late husband wrote: When Breath Becomes Air. She was joined by, Bruce MacGregor and Grant Wedner, representatives from IDEO, who discussed how they were working on ways to design 'thinking approaches' and some new resources to support the home and palliative care workforce as well as the patient, the family and caregivers during end of life events.  The moderator of the panel was Alexandra Drane, founder of Engage with Grace. Alexandra led a lively discussion that touched me deeply as it reminded me of my experience last year when I came so close to death. I could see others were moved as well, as all of us have had some experience with death and realize that we have to do better. It will be exciting to watch how this partnership moves forward.

At the end of the session, everyone was given the book; When Breath Becomes Air through a sponsorship from MEDALOGIX. At the cocktail reception that followed, we were able to have the book autographed by Lucy Kalanithi as a special gift. 

Because each person attending the conference came with different needs, the breakout sessions were divided into different groups that allowed attendees to choose what suited them best. The sessions were: Operations/Financial, Payment Models, and Leadership Strategies/Partnerships. There was a fourth breakout session that was sponsored by Medtronic titled: Navigating Health Systems. People could mix and mingle various sessions or stay within one track depending on their needs. Those that came with colleagues from their organizations came together after each session to compare notes and share what each other learned.

I mostly stayed in the Leadership Strategies/Partnership sessions. It was very interesting, and I gained valuable insights that helped me better understand the challenges those in the home care and hospice community faced as well as some of the innovative work being done to meet the demands of regulatory efforts being put into place to improve quality and contain costs.

As I listened to the various speakers, I began to realize that the home care industry has the potential to lead the rest of the industry as it strives to understand how to create a culture that values person-centered care.  This is because the professionals who work in home care meet the patient where they are in the home. Home health care professionals; nurses, aides, companions, therapist and physicians all go into a person’s home and work with what they have – regardless of how much or how little. They meet the patient and their caregivers in their home and try to determine what they know, what they need to know and provide tips that allow them to manage a multitude of conditions. They also work to ensure the patient and families have the tools and resources needed to care for themselves effectively. Home care providers provide education, support, and empathy to each patient they meet and many times are the lifeline for both the patient and the caregiver.

I also realized how important it is to have a coordinated plan of care and excellent communication skills to assist the patient transitions from one setting to another.  They work with the acute care team as well as other post-acute providers to maintain continuity and ensure each patient is safe. 
 
Today's home health care workforce, like the rest of the industry, is under tremendous pressure to be efficient, effective and cost conscious. They also are under regulatory pressures to complete forms, develop plans of care and address issues that vary from patient to patient. To be effective, organizations are looking to develop specific competencies that ensure care is person-centered and focused on:

Developing relationships/partnership
Identifying the patient's values, needs, and preferences
·     Presenting information, evidence, and review options in plain language
·     Helping the patient reflect on and assess decisions
·     Action planning that promotes empowerment

In addition to the various sessions, the exhibit hall showcased over 70 vendors unique to the home care and hospice industry. Vendors brought their tools, their supplies, and technologies that are helping agencies to be smarter, faster and more efficient. 

There was a wealth of information to be gained from talking to the various vendors and a sense of community was evident as I met vendors and attendees. I really got the feeling that all knew they were partners and that by working together they would get through these challenging times.

VNAA also had a great application that all attendees could download to their smartphone that let them review the various vendors and what the products and services they provided. Participants could make notes to follow-up after the meeting with those they wanted to learn more about or explore their websites to learn about their services and products if they missed them in the hall.

The app also had the entire agenda listed so attendees could mark sessions they wanted to attend. They could also review the speaker’s bios and contact information as well as their slides.  It was very convent and user-friendly. The app had a place to keep notes on the sessions/exhibitors for future reference and provided the ability to tweet or send a post to Facebook if you wanted to share information on social media about the sessions, the speakers, trends or issues that was important. I used this feature a lot during the day and found it very convenient. 

On Day three, VNAA held an awards program to celebrate the unique qualities and contributions of home-based care providers. The winners were announced in the following categories:

Innovative Leadership Award: Geisinger Home Care: Survival Strategies for non-acute providers in a value-based contracting world.

Innovative New Model: Financial Award: Home Healthcare Hospice & Community Services: Unlock the keys to value-based care and alternative payments: clinical targets for care programming.

Innovative New Model: Clinical Award: Penn Care at Home: Rigorous focus on quality and patient safety will improve patient outcomes and ensure financial success.

Innovative Partnership Award: VNA of Kansas City: Impact of an In-Home Pharmacist Working in conjunction with nurses.

Innovative Program Design Award: Sutter Care at Home: Home Health Reimagined

Innovative Clinical Award: Use of Bordered Polymetric Membrane Dressing to Promote Patient Participation in their Own Wound Care in the Home Setting.

If you would like to reach out to any of these organizations, please email Taney Hamill, Senior VP at VNAA. Her email is thamill@vnaa.org.

I would like to thank the leadership at VNAA for allowing me to attend the Annual Conference. It was an important meeting and provided insights, information and innovative ideas that I and all who attended can use to understand better the changing landscape of our healthcare system as well as how all can improve operations and processes that will over time will improve the entire system.

Home care and the post-acute industry will continue to become a more and more valuable resource for each of us as well as our family and friends because we all want to be in our homes as much as possible. Having a reliable home care and post-acute network allows for this to happen.

It is not an easy time working through the disruption taking place today. But with organizations like VNAA providing support and resources professionals and organizations are showing progress as they work through the process.

Thanks for reading this issue of Nurse Advocate and if you have attended an interesting conference please feel free to share what you learned in the comment box below. 

Have a good week!

Resources:

Here are some resources that you might want to check out as they will provide insights into how YOU can help as the healthcare industry continue to move toward a patient and family centered care system.

Visiting Nurse Association of America:  If you are a consumer, caregiver, or healthcare professional make sure you follow VNAA for news, information, and resources to assist you as you transition through the complex healthcare system.

Blueprint for Excellence: Pathways to Excellence: The VNAA Blueprint for Excellence is a quality improvement and workforce training resource for home health, hospice and palliative care providers. It advances the use of best practices by gathering into one virtual location curriculum and training tools, as well as the relevant research supporting those tools. The VNAA Blueprint and its best practices demonstrate the value of home health, hospice and palliative care--both in lowering the overall cost of care and in improving health outcomes.

 Crossing the Quality Chasm, A New Healthcare System for the 21st Century Institute for Medicine. This landmark report laid out the challenges in our healthcare system and the imperative for change.

Always Events: Picker Institute Although this site is not managed by the Institute for Patient and Family Centered Care it is an important resource for all. The Picker Institute adopted an organizing principle focus on the concept of Always Events. Always Events are defined as those aspects of the patient and family experience that should always occur when patients interact with healthcare professionals and the delivery system.

Healthcare Professional Education: A Bridge to Quality: Institute for Medicine. The Institute of Medicine study Crossing the Quality Chasm (2001) recommended that an interdisciplinary summit be held to further reform of health professions education in order to enhance quality and patient safety. Health Professions Education: A Bridge to Quality is the follow up to that summit, held in June 2002, where 150 participants across disciplines and occupations developed ideas about how to integrate a core set of competencies into health professions education.

These two books are must reads for all healthcare professionals: Check them out at your local library!

Being Mortal: Medicine and what Matters, in the End, Atul Gawande, MD, MPH

When Breath Becomes Air, Paul Kalanithi, MD.