Health care is entering an uncertain time, especially given the election of a new president who proposed to repeal and replace the Affordable Care Act. No one can predict exactly what that outcome will be. 

What we do know is that any health care reform will be focused on providing high quality care at the lowest cost. That is where the use of home health care comes in. Approximately 12,000 Medicare-certified home health agencies currently are operating in the U.S., according to the National Association of Home Care & Hospice.  Eight certified home health agencies serve Spokane County, including Sunshine Home Health Care, where I serve on the executive team.  

Gretchen Anderson, the administrator for Sunshine Home Health, believes home health certainly has a positive outlook for the future. The company provides services to residents of Spokane County who need nursing, rehabilitation services, aide services, and social work services in their homes.  

Home health care frequently is confused with “home care” or “private duty care.” The differences are important. Home health care focuses on acute and chronic episodes of care that are ordered by a physician, and services are covered by health insurance plans.

Services generally follow a stay in a hospital or skilled-nursing facility, but orders can come directly from a physician’s office for patients who don’t have a hospital stay. Most insurance plans, including Medicare and Medicaid, cover the cost of home health care. 

Many times, inpatient stays are significantly shortened when home health is involved, which decreases costs and improves outcomes. For example, the new trend is to have patients come home from the hospital as soon as 24 hours after joint-replacement surgery. With home health services in place, patients are able to meet their rehabilitation and nursing needs in the environment they prefer to heal in: their own home.  

Home health also is provided to patients without a hospital or nursing home stay when a physician sees a need for medical or rehab care due to a decline in a person’s health or function. 

For example, home health nurses can come in and work with patients on their medication management or teach management of chronic disease. Physical and occupational therapy can work to minimize fall risk or loss of independence with activities of daily living. Home health in those situations can be effective in preventing a hospital stay entirely.

Current trends indicate the preference for care in the lowest-cost setting. Home health care fits into this trend. We are seeing an increase in the use of home health care, often bypassing more costly facility-based care.   

Certain qualifying criteria generally must be met, including that the patient must require assistance to leave their home and demonstrate a need for the skilled care of a nurse or therapist. Home health care can provide highly skilled wound care, infusion therapy, and rehabilitation modalities—all geared toward improving patient outcomes. 

On the other hand, home care—sometimes referred to as private duty care—is nonmedical care with a focus on supporting the patient in their home with housekeeping services, personal care, transportation, errands, and other tasks. Some private health insurance will cover that level of care, but many times it’s an out-of-pocket expense for the patient. Home care agencies often work closely with home health agencies and truly can make a difference in a patient’s ability to remain in their own home. 

In recent months, the Centers for Medicare and Medicaid Services (CMS) has been pilot testing several value-based purchasing models. In these models, agencies must improve certain patient outcomes or achieve a benchmark threshold that will impact payment.  

For example, home health physical therapists often are called in to help improve a patient’s ability to walk. When the home health agency provides rehabilitation services that improve a patient’s ability to walk, they can be paid an additional amount to improve this outcome for the patient. Other payers are expected to adopt such a model eventually of only paying for improving patient outcomes. 

Sunshine Home Health Care, along with the other home health agencies in the state of Washington, is currently participating in a pilot project to test the value-based purchasing model for home health care. The savings projected over a five-year period for the model are expected to be about $378 million by decreasing more costly inpatient care. 

Genworth Financial Inc. published data last year regarding cost comparisons for various levels of long-term care, including home care. The average national cost of home care services was about $3,800 a month. A private room in an assisted-living facility averaged $3,600 a month, and a private room in a skilled-nursing facility was $7,700 a month. Medicare-certified home health care is paid based on a 60-day episode of care. For 2017, those agencies are being paid about $3,000 for a 60-day episode. That amount varies based on a number of factors, including the acuity of a patient’s condition.

Patients prefer to be cared for in their own homes whenever possible. Home health care is far less expensive than inpatient care and helps patients achieve improved outcomes. Consumers can research home health care agencies by going to www.homecarecompare.gov. 

Sunshine Home Health Care is part of a larger continuum of care provided by Sunshine Health Facilities.

Other services provided by this locally owned company include skilled nursing, and rehabilitation through Sunshine Health and Rehab, formally known as Sunshine Gardens; behavioral health treatment and housing at Sunshine Terrace; and senior housing options through Sunshine Adult Family Homes and Sunshine Memory Care.   

Donna Goodwin is a post-acute care consultant working with Sunshine Health Facilities as the chief operating officer.