Think Home Care, July Issue

The July Issue of Think Home Care is now available for download.  The full text is also available below.

Return to www.thinkhomecare.org.


July 2009

In This Issue:

  • Alliance’s Nurse Delegation Bill To Be Heard
  • MMS Study:  Physicians Value Home Care

Alliance’s Nurse Delegation Bill To Be Heard

A bill to allow nurses to delegate medication administration to home health aides in the home setting is scheduled for a public hearing on Tuesday, July 28, and the Home Care Alliance will be at the State House in strong support of the proposal.

Submitted on behalf of the Alliance by Senator Richard T. Moore, Senate Bill 860, An Act Relative to Home Health Aides, will come before the Joint Committee on Public Health.  The bill would amend the MA Nurse Practice Act (NPA) to allow for appropriate nurse delegation practices already accepted in many other states.

“There was more RN involvement in care, and less unlicensed and unregulated practice with Nurse Delegation,” says a report on nurse delegation ordered by the Washington State Legislature. “Rather than bring higher risk tasks into the settings, Nurse Delegation has actually enhanced the quality…of supervision.”

The Alliance is hoping that Massachusetts will be the next state to realize the potential of successful nurse delegation practices. Along with 18 legislative cosponsors, the bill has the backing of Mass Home Care, the MA Council for Home Care Aide Services and the Hospice and Palliative Care Federation of Massachusetts.

Given the increasing number of elderly citizens and an effort to fulfill the goals set out by the Equal Choice Law of 2006, which looks to expand community-based health care options and accessibility, Senate Bill 860 will remove barriers to home based services by addressing identified needs that may not be possible to have performed by a nurse daily.

The National Council of State Nursing Boards has recognized that the issue of nurse delegation is being deliberated in many states. In August, 2007, the Council adopted model language acknowledging delegation as a nursing task and addressing training of nurse-delegated medication assistants to be implemented by states within their individual delegation frameworks. Senate 860, according to Alliance Executive Director Patricia Kelleher, is within that framework.

“This legislation is a sensible approach to helping home health patients maintain their independence,” said Kelleher. “Allowing delegation will enhance quality and efficient care by providing patients with another support to help them adhere to a medication regimen and schedule.”

MMS Study:  Physicians Value Home Care as Cost-Effective Way to Reduce Institutional Care

A recent survey of Massachusetts physicians revealed overwhelming support for the use of home health services in managing patients as well as its ability to improve quality and reduce costs without compromising outcomes.

Conducted by the MA Medical Society in collaboration with the Home Care Alliance, the survey represents one of the few efforts to learn more about the under-examined area of physician use of home health services such as skilled nursing care, physical and occupational therapy, speech-language therapy, and medical social services provided in the home.

Among the study’s findings:  97 percent of physicians believe that home health services help them better manage their patients’ care at home and nearly 90 percent believe home health services can reduce inpatient hospital admissions.

“With the constant focus on cost and quality in health care today, these findings can be critical to developing future health policy,” said Mario Motta, M.D., President of the MA Medical Society. “With a rapidly aging population, more seniors will rely on health care services, and many will have chronic conditions. Those factors will add to already-soaring health costs.”

The main advantages to home services cited by responding physicians were better compliance with the patient’s care plan (78% of respondents), reduced stress on caregivers (73%), improved coordination of care (65%), and fewer visits to emergency departments (63%).

Barriers to using home health services cited by physicians were administrative burdens and paperwork (54%), reimbursement issues (40%), and availability of workers (33%). The barrier of reimbursements, however, appears to be one that can be readily fixed by education and information: of the 71% of physicians who reported that they did not submit charges to Medicare for the services, 64% of those said they were unaware of the reimbursement.

Both the advantages and barriers uncovered in the MMS survey present a compelling case for the expanded use of home health care.  “This survey validates the essential role of home health services in both post-hospital and chronic care,” said Home Care Alliance Executive Director Patricia Kelleher. “As our state looks at system redesign and cost efficiency, the survey shows that strengthening existing relationships between physicians and home health care would be more promising than reinventing new models of care coordination.”

The Alliance has sent a letter to state legislators regarding the physician survey drawing special attention to the main barriers and other notable results. For instance, the Alliance letter pointed out that 53 percent of physicians reported they had to prolong a patient’s stay due to lack of access to services. As the state looks to contain health care costs wherever possible, the Alliance asked legislators to ensure home health plays a prominent role in the Commonwealth’s health care system.

“As physicians see it,” added Dr. Motta, “greater use of home services can ease costs without compromising quality of care. In today’s healthcare environment, that’s a winning formula.”

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