Discussion w13 650

Q-1

Home health has become a popular option for elderly patients who do not meet the criteria for a skilled care facility for many reasons (What is home health?, n.d.). These options include reduction of travel time, assistance at home, comfortability, and regaining independence (What is home health?, n.d.). 

Home care visit requirements are broken down into different modules defined by Medicare. Modules include a need a qualifying criterion such as the patient being homebound, skilled need, intermittent care, and a physician's order (Medicare Rules for Home Care, n.d.). The important part of this module is that the patient needs to have a requirement for skilled care such as skilled nursing, physical therapy, speech therapy, or continued Occupational therapy (Medicare Rules for Home Care, n.d.).

If the patient is able to meet these need requirements then the patient qualifies for home health (Medicare Rules for Home Care, n.d.); What is Home Health?, n.d.)';(Schroder, Fassmer, Allers, & Hoffman, 2020). 

I honestly think this is a great step forward in the home health world. This creates defined situations and stipulations in order to qualify for home health. There are many pros to this for the patient, most importantly comfortability. One major concern is the lack of specialized equipment, which is understandable, but these patients have all progressed to the point where they do not need special equipment. However, there since there is a growing movement into the home health sector, there are more and more companies that make take home special equipment such as ventilators, feeding pumps, and more (Schroder, Fassmer, Allers, & Hoffman, 2020). 

I also think that Medicare's side of things, such as specifically defining qualifying criteria is a great step due to the preventative measure to reduce Medicare fraud. They also create a payer source, and with demand there already for services, it becomes a very attractive and smooth process to healthcare professionals as two out of the three hurdles are already taken care of. 

Overall, I see the evolution of Home health as a great step forward in the healthcare community. After all, who isn't comfortable at home? 

References:

Medicare Rules for Home Care (n.d.). Medicare Rules for Home Care. [PDF]. Retrieved from:https://cdn.ymaws.com/www.cthealthcareathome.org/resource/collection/19BDE06E-0038-4866-A1AF-522E77832A74/Medicare%20Rules%20for%20Home%20Care%20Module%201.pdf

What is Home Health? (n.d). Medicare. The official U.S. Government Site for Medicare. Medicare.Gov. Retrieved from:https://www.medicare.gov/what-medicare-covers/whats-home-health-care

Schroeder, A.-K., Fassmer, A. M., Allers, K., & Hoffmann, F. (2020). Needs and availability of medical specialists’ and allied health professionals’ visits in German nursing homes: a cross-sectional study of nursing home staff. BMC HEALTH SERVICES RESEARCH, 20(1). https://doi-org.lopes.idm.oclc.org/10.1186/s12913-020-05169-7

Q-2

Stroke is described as the third leading cause of death in the United States and is responsible for more than 160,000 deaths per year (Henderson, 2018, p. 1681). It can be due to thrombosis, embolism, and hemorrhagic. A lesion in the anterior cerebral artery is common and usually presents with paralysis and sensory loss of the contralateral leg. The patient may also have urinary urgency and incontinence due to failure to prevent bladder contractions (Henderson, 2018, p. 1683). The patient who suffers from a stroke needs to undergo rehabilitation to improve the disability based on the area of the brain that was damaged. I will order therapies such as physical therapists, occupational therapists, speech or language therapists, psychologists, and rehabilitation nurses. Physical therapists are crucial to treating motor and sensory impairments. They help the patient restore their physical functioning by evaluating and treating problems with movement, balance, and coordination (National Institute of Neurological Disorders and Stroke, [NINDS], 2020). An occupational therapist is maybe beneficial inpatient to help them improve the motor and sensory abilities. Also, they help the stroke patient relearn skills needed to perform self-directed activities such as personal grooming, preparing meals, and housecleaning. A speech-pathology therapist may help the patient to relearn how to use language or develop a different way of communicating and improve their ability to swallow (NINDS, 2020). A psychologist is maybe helpful in a patient after stroke to support their emotional and mental health as well as to assess their cognitive skills. A rehabilitation nurse can help the stroke patient to relearn the skills needed to carry out the basic activities of daily living and help them to provide information about how to follow a medication schedule, how to manage bowel and bladder issues, how to move out of a bed and into a wheelchair and to support the special needs of patients who have a chronic condition such as those with diabetes.

 

Reference:

Henderson, G.V. (2018). Transient Ischemic Attack and Stroke. S.C. McKean, J.J., Ross, D.D. Dressler, D.B. Scheurer (Eds). The Principles and Practice of Hospital Medicine 2nd edition (pp. 1681-1689). Mcgrawhill education.

National Institute of Neurological Disorders and Stroke (2020). Post-Stroke Rehabilitation Fact Sheet. Retrieved from

https://www.ninds.nih.gov/Disorders/Patient-Caregiver-Education/Fact-Sheets/Post-Stroke-Rehabilitation-Fact-Sheet

Q-3

Home health agencies are certified by Medicare and operate under the supervision of registered nurses. It requires physician referral and recertification every 60 days. The patient profiles in this setting are primarily similar to those receiving SNF care. Comprehensive services, such as complex medication schedules and wound care, are provided with this option. The interdisciplinary team consists of physical, occupational, and speech therapists and social workers. Home healthcare seems effective in bringing support to the struggling patients in the community, particularly in institutional care transitions to home. Medicare covers home health care with no copayments or deductibles as long as patients cannot leave home without great difficulty and need intermittent nursing, physical therapy, or other skilled care that only a trained professional can provide or supervise. Those who qualify can also receive home health care aide services for dressing, bathing, and other daily activities. Medicare coverage for home health aides and nursing services is limited to thirty-five hours a week (Ang & Dave, 2017).

Medicare provided some specific rules to be able for stakeholders to acquire payment or reimbursement for the services ordered. It requires various clinicians, nurse practitioners, clinical nurse specialists, certified nurse-midwives, or physician assistants to evaluate whether home health care is medically necessary only after meeting the patient "face-to-face. Additionally, only physicians have the sole authority to order and certify the patient's need for home health service. According to rules that predate the ACA, Medicare allows only physicians-no other providers-to "certify" that a patient needs home health care. (Jaffe, 2019).

I feel like this specific rule by Medicare is a step backward and not beneficial for the patients in addition to wasting resources available by not maximizing the role of nurse practitioners who are very capable of assessing the patient's need in this type of scenario. Patients who are confined to their home due to their physical illness may wait for the much-needed home health service before their PCP see them at home or in the office. Too many seniors have reported unnecessary delays in accessing home health care because a physician was not available to order the care promptly (Jaffe, 2019)

References

Ang, E. & Dave, J.K. (2017). Post-acute Care Rehabilitation Options. In S.C. McKean (Ed.). Principles and Practice of Hospital Medicine (2nd ed.). The United States of America. McGraw-Hill Education.

Jaffe, S. (2019). Home Health Care Providers Struggle With State Laws And Medicare Rules As Demand Rises. HEALTH AFFAIRS, 38(6), 981–986. https://doi-org.lopes.idm.oclc.org/10.1377/hlthaff.2019.00529