“Avoidable” and “Unavoidable” Pressure Sores

The development of pressure sores on a client can easily go unnoticed to the untrained eye. They can cause serious infections, some of which can be lethal. Pressure sores are a major concern for any home care company.

The Center for Medicare & Medicaid Services (CMS) categorizes pressure sores under both “Avoidable” and “Unavoidable”. These definitions serve as a map for potential malpractice situations, and need to be understood by all home care companies.

“Unavoidable” pressure sores are defined as when the client developed a pressure ulcer even though the team had evaluated the client’s clinical condition and pressure ulcer risk factors; defined and implemented interventions that are consistent with client needs, goals, and recognized standards of practice; monitored and evaluated the impact of the interventions; and revised the approaches as appropriate.

“Avoidable” pressures sores are termed so because the clinical team was at fault because the process above was not implemented.

Pressure sores will be an unfortunate reality for many of your clients that are at high risk, such as those that use a wheelchair or are bed bound. You can use the CMS definitions as a starting point “checklist” to make sure that your company does everything possible to prevent, address and document pressure sore issues.

It is a good idea to assess each client for pressure sore risks at their first caregiver visit. Provide all of your caregivers with basic training about signs of pressure sores and sore prevention. A handy one page checklist tucked in a client journal can keep caregivers refreshed to this often overlooked, but serious issue.

How to Avoid Medicare Marketing Scams

The new post on the Private Duty Today blog has a great article about helping your clients avoid Medicare marketing scams. Click here for more information.

Parent's May Misguide Senior's Long Term Care

When seniors are searching for home care, they often seek the advice of their children first, particularly their daughters. Many seniors assume that their children have a better grip on the current economic situation and understand the health care system. The American Association for Long-Term Care Insurance found some unsettling results in a recent study.

Although the study was about long term care planning for women, if daughters of seniors misunderstand their own long term care plans, they also have the potential to misguide the care plans of their parents.

Almost 20 percent of women participants in a national survey believed that they already had long-term care coverage, while only about 5 percent of U.S. adults over the age of 45 actually had it. The survey suggests that many women may assume that their health coverage includes long-term care, when in reality it doesn’t.

Investigating long term care plans for both the senior and their child will help both understand the ins and outs of the system.

Blackberry Report: The National State of the Home Care Industry Study

The National Association for Home Care & Hospice (NAHC) has announced the completion of The BlackBerry® Report: The National State of the Home Care Industry Study. The study, conducted to provide insights into essential advances and reforms in the delivery of home
health care services, is intended to help providers of these crucial services
prepare for pending overall health care reform.

The study, the largest of its kind, is designed to drive best practices that
can be shared for the benefit of the whole industry. The study demonstrates
the collaboration within the home care industry to prepare for proposed
reimbursement cuts, and to retool to use technology and data to improve
quality and patient care.

The first analysis of the BlackBerry Report (available at
http://fazzi.com/research/state_of_industry_study.html) revealed key insights
that underscore the home care industry's commitment to the utilization of
technology to enhance quality and improve efficiencies and productivity
through the adoption of Electronic Medical Record Systems, Point of Service
(POS) Systems, hand held devices and telehealth.

Our friend and colleague, Dr. Bob Fazzi, presented the results of the survey at the NAHC annual conference in Los Angeles earlier this week. Some highlights from the study are:

• Just over 65% of all agencies now have Electronic Medical Record
         Systems.
  

• Eighty-three percent of these agencies report that the use of
         these systems has led to improvement in quality of care coordination.
  

• Nearly 40% of all agencies now use some form of POS system in the
  field.
  

• Handhelds account for 6.3% of hardware presently being used

• Just over 36% of those agencies seeking to purchase new hardware report that they are
         interested in handhelds.
  

• Twenty three percent of agencies report using telehealth systems.
  

Shield Healthcare Announces Story Contest to Honor Caregivers

VALENCIA, Calif., Oct. 14 -- Shield Healthcare, a leading
provider of medical supplies for care at home, is pleased to announce its 9th
annual story contest on "What Makes Caregiving Rewarding?" designed to
recognize and hear the voice of caregivers and home healthcare professionals,
featuring celebrity contest judge, Sandra Mitchell of KCAL 9/CBS 2 News.
Shield Healthcare understands that caregiving is a demanding job. A
significant number of our customers are family caregivers at home, tending to
a loved one with a chronic medical condition. They unselfishly take on the
challenge and responsibility of meeting the daily health and emotional needs
of the person in their care. This story contest is a positive way to recognize
and reward this important role. The contest runs through November 30, 2009 in
celebration of National Family Caregiver's Month.


Last year's winners included 3 mothers of special needs children, a nurse, and
a social worker. Winner Susan Agrawal wrote, "Among all the blessings that my
daughter has bestowed upon me, seeing her grow through inchstones has granted
me the best gift of all: the ability to see wonder and joy in the most
unexpected places."


The top three story winners will receive $1000 in American Express Gift
Cheques and a 1-year subscription to Today's Caregiver Magazine. The two
runner-ups will also be awarded the magazine subscription and $250 in American
Express Gift Cheques. All contest entries must be one-page, typed or
hand-written and postmarked by November 30, 2009. Entries should be mailed to
Shield Healthcare, Attn: Caring Solutions, 27911 Franklin Parkway, Valencia,
CA 91355 or emailed to caring@shieldhealthcare.com. Full contest details are
available on Shield's website at www.shieldhealthcare.com.

Recovery Audit Contractors

RACs have been established to reduce improper payments by Medicare, to detect and collect overpayments, and to identify underpayments. They are to implement actions to prevent future improper payments.

There is no phase in strategy, and all Medicare provider types are available for RAC review once they have reached out to the providers. However, Mary's thought is that they will focus on recovering big dollars from hospitals, Rehab, and major surgeries, since that's where the biggest opportunities lie. The RACs are paid based on a percentage of the dollars they recover.

There are 4 RACs in place, and each covers one fourth of the country. The RACs jurisdictions match the MAC jurisdictions for DME. Mary suggested that everyone attemd the RAC presentation provided by CMS - Program 814. You need to know where previous improper payment have been found and if you are submitting claims with improper payments. Mary St. Pierre, Vice President for Regulatory Affairs at NAHC suggests that you prepare to respond to RAC Medical Record Requests, and stay calm and stay informed.

Medicare Administrative Contractors

Congress amended section 1816 of the Social Security Act to replace Medicare fiscal intermediaries and carrier contracting authorities with new Medicare Administrative Contractors (MACs). It requires all providers and suppliers to be generally assigned to a MAC based on geographic location. Large chain providers - EXCEPT Home Health & Hospice - are permitted to consolidate their billing activites under the MAC with jurisdiction over the chain's home office.

Home Health Care Regulatory Update

At the annual conference of the National Association for Home Care & Hospice, Mary St. Pierre, Vice President for Regulatory Affairs presented her update on new regulations affecting home health care. As always, Mary was wonderful in helping us understanding the regulations that will be affecting us. Here's a brief list of the regulatory issues the Mary covered, and a link to her handout materials for this presentation. A short report on each element will follow in future blog postings.

http://www.nahc.org/Meetings/AM/09/Handouts/513.pdf

Regulatory Update Items*

* Medicare Administrative Contractors
* Recovery Audit Contractors
* Survey & Certification Future Considerations
* Post-Acute Care Demonstration
* Home Health Quality
* CHAMP - Collaboratin for Homecare Advances in Management Practice
* Red Flag Rule
* Medicare Home Health PPS Rule
* Case Mix Creep
* Outlier Policy Change
* Proposed Coverage Standards
* Provider Enrollment
* Physician Certification and Recertification
* Oasis Compliance and OASIS-C
* CAHPS - Consumer Assessment of Health Providers and Systems
* Delta OASIS-C Best Practices Project

There's clearly a lot of valuable information here, and you'll want to learn as much as you can about each of these items. Stay tuned for more details.

We appreciate your comments. If you were in Mary's session, what was most important for you?

Injury And Hazards In Home Health Care Nursing Are A Growing Concern

Patients continue to enter home healthcare ''sicker and quicker," often with complex health problems that may require extensive nursing care. This increases the risk of needlestick injuries in home healthcare nurses. While very few studies have focused on the risks of home healthcare, it is the fastest growing healthcare sector in the U.S. In a recent study, led by researchers at Columbia University Mailman School of Public Health, the rate of needlestick-type injuries was 7.6 per 100 nurses.

At this rate, the scientists estimate that there are nearly 10,000 such injuries each year in home care nurses.

The findings were published in the September 2009 issue of American Journal of Infection Control.

Future Technology May Help Keep Seniors Safe

Check out the newest post on Private Duty Today for an insight on new robotic research projects aimed to keep seniors safe.

CNN Survey on President Obama's Health Care Reform

Recently released this morning was an opinion survey on President Obama's Health Care Reform from CNN. The survey questioned over a thousand individuals, mostly non-hispanic whites, about whether they approved of or opposed the current reform. Research found that half of those surveyed were in favor of the reform, while 45% were opposed. Only 5% stated that they had no opinion.

When questioned further, of those that favored the reform, only 23% said that they felt strongly about it. In contrast, of those that opposed the reform, 33%, a 10% increase, stated that they felt strongly about their opinion.

You can learn more about this poll and statistics compared to President Clinton's reform here.

Statistics on Home Health Care Growth

New jobs for health aides, such as caregivers, will outweigh other positions in the health field such as doctors or nurses according to Obama’s Council of Economic Advisers.

Compared to other non-health related occupations, health related fields have seen a 12% increase since 2000, of which 48% came from health care support such as home health care aides.

As the aging population continues to increase, there will no doubt be more home health care aide positions available to be filled.

Boomers Boost Web Traffic

A web traffic study by Neilson Online proved there are growing numbers of seniors seeking information online, particularly health related information. In fact, people 55 years and older accounted for nearly one third of the online traffic in late 2008.

The Pew Internet and American Life Project has shown that 91% of internet users between the ages of 64-72 also use email. Additionally, 85% of this age group uses search engines and 70% are seeking health related information.

Home health care companies can benefit from these numbers by providing additional online services on their websites such as email contact information, search bars, and other health related information.

M.M.S. Study on Home Health Care from a Doctor's Viewpoint

A recent research collaboration between the Massachusetts Medical Society and Home Care Alliance of Massachusetts found that doctors supported the benefits of home health care, but found that there were problems within the medical system for wide spread referrals.

From a randomized sample of 3,000 Massachusetts licensed doctors, there were 248 responses from 12 specialties. Over half of the responses were from primary care physicians.

The majority agreed that these services allowed them to better manage their patients’ care, prevented emergency room visits, and reduced family stress.

Around half of the doctors said that paperwork, payment, and access problems interfered with home health services for their patients. Half stated that they had to keep patients in the hospital for a longer period simply because there was difficulty finding home health services.

I would like to thank The Boston Globe for providing much of the information. You can read their article here.

North Carolina Nurses Educate Legistlators About Effects of Medicaid Cuts

The state senate has recently approved a $55 million dollar budget cut to the Medicaid Personal Care Services (PCS) program. More than 36,000 elderly and children with mental/physical disabilities in North Carolina rely on these services as a part of their daily lives.

The North Carolina Association for Home and Hospice Care (AHHC) and its 900 agency membership have made efforts to educate the state legislators and communities about the devastating effects. The team points out a significant economic loss if the state forces many of these elderly patients into nursing homes, where care costs can nearly quadruple.

Encouraging Communication with Alzheimer's Patients

Caregivers need to understand how to listen to and communicate with their Alzheimer’s patients. This is essential for understanding their needs and developing a friendly relationship between caregiver and client. Make your caregivers aware of these simple steps.

• Be Patient. Alzheimer’s patients may have difficulty finding the right words to describe what they are thinking. They may stay silent when they are trying to organize the words in their head.
• Eliminate Distractions. The tv, phone, magazines, etc. may be inappropriate to use when conversing with your client. If your client is talking during a movie, turn the volume down. If you are on the phone, tell the person to hold for a couple of minutes.
• Agree to Disagree. Expect that the opinions, habits, and interests of your client will be vastly different from yourself.
• Be Reassuring. Alzheimer’s patients may be tempted to give up on communicating because of frustration or anxiety. Encourage your clients to speak their mind in their own words and that what they have to say is important to you.
• Be Positive. Remember to smile when you listen to your clients! Expand on positive statements that your clients bring up.
• Take Interest in Feelings. Emotions may be some of the easiest subjects for a client to express because they experience them daily. Highlight a good day or when you catch your client smiling or laughing.

New Gadgets for Senior Assistance and Entertainment

Lure crowds during your next health fair by offering a free raffle on some fun and functional electronics for seniors. Listed below are brief descriptions of some products available for the elderly in your community.

Jitterbug™
Easy-to-read simple cell phone for seniors to help them keep in touch with friends and family.

Kindle™
Electronic library that holds downloadable e-books. This product comes with a variety of built-in audio options that may help visually impaired seniors enjoy book reading.

GrandCare™
This electronic day planner lets busy family members upload photographs, check appointments, and messages at the touch of a button.

SeniorPC™
These senior friendly computers, a product of HP and Microsoft, are designed to make everyday computer tasks easier. They also come with a variety of memory games and a prescription planner.

7 Ways for Caregivers to Improve Senior Quality of Life (attached link)

This is a post that will help all caregivers build meaningful relationships with their clients.

Check it out

Boomers May Face Bankruptcy and Long-Term Care Collapse

Check out a related article, posted on Private Duty Today, that explains more.

Newly Named Healthcare Faculty Regulation

The Healthcare Faculty Regulation (HFR), lead by division chief Doug Colburn, will be the new name for the former Georgia Dept. of Community Health as of the first of July. This will be a division of the Georgia Office of Regulatory Services.

The move was in response to Senate Bill 433, which has forced the Dept. of Human Resources to transfer responsibility for licensure and regulation of hospitals and other health related institutions.

HFR will enforce licensing and regulate nursing homes, home health agencies, private duty home care, personal care institutions, and personal care home employee record checks.

Medical ID Theft

Many of your clients that do not check their medical records closely may be at risk of medical identity theft. According to the World Privacy Forum, as many as 500,000 Americans have been the victims of medical identity theft, most of which don’t even realize until it is too late. Recovery from identity theft can take years at the expense of the victim’s bank account, health plan, and dignity.

Surprisingly, a vast majority of the thieves are corrupt doctors, nurses, and other health care professionals that know their way around medical billing systems. A thief can ruin credit history, medical history records, and can even put the victim at risk of lost insurance coverage.

You can encourage your clients to be more aware of their medical record history by having them follow these simple steps:

• Always review your explanation of benefits (EOB) that is sent in through your medical insurer. Notify personnel if you see changes that do not correlate to your history.
• Monitor your insurance benefits
• Keep a copy of your medical records on hand. In case you would become a victim of medical identity theft, these important documents act as evidence.
• Correct inaccurate medical record immediately. Even minor mistakes need to be corrected to ensure accuracy.

By providing some basic information about medical identity theft prevention, your clients will respect your company for protecting their dignity and be more responsive to your services.

Nursing Home Negligence and Prevention

Court systems statewide are noticing increasing rates of nursing home negligence and elder abuse. The economic crisis is tempting too many caregivers to take advantage of these sensitive individuals.

The jump in abuse is creating an ever more competitive environment for nursing homes. Families are double checking safety and negligence records of nursing homes to ensure that such abuse doesn’t happen to their loved one.

Even if the nursing home does have a reliable record, it does not guarantee your family member will not be abused. Such unfortunate events are rarely to be blamed on supervisors, managers, and other higher level staff, rather they are simply the symptoms of an unjust caregiver.

If abuse is suspected and has supporting evidence, an elder abuse lawyer, nursing home abuse lawyer, or a nursing home negligence attorney can assist in obtaining compensation. Different cases receive varying levels of compensation. In some instances, a situation may be settled out of court.

Cases of elder abuse, not matter how small, can be a huge setback for any home health care business trying to entice new customers. To prevent such situations, provide incentives for experienced caregivers. Maintain yearly and quarterly caregiver training meetings. Require background checks for caregiver applicants and invest in random drug screening. Those not able to deal with the stress of caring for another individual may react inadvertently. Caregivers that are educated about dealing with stress and are provided with outlet options will be less likely to abuse their clients.

Hospitals losing Money. What will be the impact on Home Health Care?

According to a report from Thomson Reuters, U.S. hospitals maintained their operating margins through the third quarter of 2008. But steep investment losses pushed 50 percent of them into the red for 2008, resulting in a “near-zero” median margin for the industry. The bottom quartile of hospitals posted average losses of 7 percent or more for the year.

Meanwhile, the recession-fueled increase in the numbers of uninsured and Medicaid patients is making hospitals’ financial position worse this year. The rout has been compounded by a drop in the number of surgeries, which have affected 44 percent of the hospitals in the survey.

What are you seeing with hospitals in your marketplace? How will this impact home health care?

One trend we observe is that when hospital census is down, home health referrals drop off as well. Are you seeing a decline in your hospital referrals?

Another trend we have seen in the past is that when financial performance lags, hospital executives decide to exit the home health business. With many hospital based home health agencies losing money anyway, look for some executives to cut their losses and get out of the business. If so, this will be a great time to pick up some market share. It will also be a time for strategic buyers to move into your marketplace, acquire the hospital based agency, and become your new competitor.

What are you seeing? Give us your comments below.

Ohio Home Health Agency Issues Press Release about Muffins for Doctors

"No Donuts!" That's a sign that we put up on slides in our Certified Home care Sales Professional workshop as we teach home health and hospice sales professionals how to engage in meaningful dialog with physicians without buying lunch or bringing food.

I was stunned today when I reviewed my daily Google Alert for news on home health care and found the following post on an ohio newspaper web site:

"February 27, 2009 - MANSFIELD, OH -- Signature Health Services, a skilled home health care provider with local offices in Mansfield and Marion and a new office in Ashland, will deliver fresh muffins to Ashland-area physicians and facilities for 13 weeks.

The deliveries also will include information on Medicare Home Health Services and Signature and clues to a well-known sayings. The first person to reach Administrator Pat Long or Clinical Relations Specialist Beth Pennell in person with the correct saying will win Buckeye Bakery treats for their office or facility. Call 567-203-7770 with questions."

It's one thing to bring muffins to the doctor's office from time to time as a way of saying thanks to the office staff for helping you get access to the doctor. But to put an article in the paper with a contest for the first person to call is over the top.

What do you think? Is bringing muffins a good way to get referrals? What are the most effective techniques your agency uses to gain access to referral sources? How do you engage in a meaningful dialog with a physician to provide information on the benefits of using home health care or hospice for his or her patients?

For more details on how to sell to physicians and hospital discharge planners without buying lunch or bringing muffins, look at the Certified Home Care Sales Professional workshop information on our web site.

Obama Budget Proposal Cuts Money from Home Health Care

Health care stocks dragged down the stock market yesterday after the White House proposed cutting payments to private insurance plans. The Obama administration's $3.55 trillion budget plan for 2010 includes cuts to Medicare and Medicaid. Private insurance plans serving Medicare seniors would take the biggest hit, but hospitals, drug manufacturers and home health agencies also face cuts.

The Dow Jones industrial average fell 88.81, or 1.22 percent, to 7,182.08.

The Standard & Poor's 500 index fell 12.07, or 1.58 percent, to 752.83.

The Nasdaq composite index fell 33.96, or 2.38 percent, to 1,425.43.

What do you think will happen to home health agencies if this new budget proposal is passed into law by Congress? How can we communicate the importance of home health care in saving money by keeping patients out of hospitals?

Give us your comments below.

Do Female Executives Lack Vision?

Research conducted by professor Herminia Iberra at Insead, The Business School for the World,(r) has revealed some interesting insights for female executives in home health care.

Studies by professor Iberra show that in almost all measures of executive performance women are equal to or outperform men, with one exception: vision. Ibarra’s review of the 360 degree reviews of nearly 3,000 women revealed that, in general, they were seen as less visionary. What could explain this? Ibarra offers three possibilities:

1. Women may have a vision but they may be using a different process to develop their long-term strategy.

2.Women may have a vision but may be hesitant to make audacious statements.

3. Women may not value visionary pronouncements.

Whatever the reason for this perceived lack of vision, Ibarra suggests that those women wanting to climb the career ladder not simply wait around for visionary inspiration. She tells ambitious women,to get out and not think about how to set strategy in the safety of their own office, but how to start networking in a way that gives them a broader vision of the future. The way you envision the future is by being out there and trying to understand trends in the industry, in society and talking to people.

At Leading Home Care, we have been talking about Vision and Leadership in Home Care for the past 25 years. We even conducted a research program that revealed The Top Ten Competencies of Highly Effective Home Care Executives. The Number One competencies is, "Seeing the Bigger Picture."

Where does Vision come into play in the leadership of your home health agency? Do female executives in home health care demonstrate less vision for the future that their male counterparts? What do you do to see the bigger picture and develop your vision for the future?

Give us your comments below.

Home Health Nurse Writes Editor about Information Technology

I saw a letter to the editor of the Casper, Wyoming Star-Tribune on February 18, 2009 written by a home health nurse by the name of Wanda Jones. She says,"For every hour I spend with a patient in Home Health, I spend another 2 to 3 hours or more writing, documenting every required aspect of patient care required by Medicare and patient care in general. Although I agree with Medicare on these standards of care and that these must be documented, the time involved is costly to my agency financially, to me in the aspect of fatigue and stress, and more than likely one issue that burns out so many of our much-needed nursing staff in America and probably on a global scale."

Wanda goes on to comment that, "IT Health would affect the patient care in our health system across the board of physicians and other professions, institutions, hospitals, nursing facilities and others. Fast and complete transfer of information facilitates better patient care and treatment, frees up professionals to focus on patient care, feel less burned out than they would spending so much time dealing with paperwork."

I recall working with one of our clients, a very large home health agency in Alabama that was experiencing high turnover of nurses. As the leaders of this very successful company explored the causes of this high turnover, they discovered that nurse dissatisfaction and frustration with their information technology system was the cause. They made a major financial and strategic decision to purchase an entirely new system with a modern point of care computing capability.

Although the conversion to the new system was time consuming, expensive, and frustrating, the outcome was worth the investment. Not only did the new IT system improve there ability to capture and access clinical data, but the level of nurse frustration and burnout improved. Although this technology solution did not solve all of their problems and totally eliminate turnover, it made a significant contribution to the company.

As we move toward Home Health Care 2020, and the Agency Of the Future, more and more agencies will make significant investments in Information Technology to improve productivity, AND, to improve employee satisfaction with their work.

What do you think? How is this factor affecting your agency? What do you think about the Federal Government's economic stimulus plan and the provisions for health care IT?

Give us your comments below.

Gentiva Refocuses on Home Health Care for the Elderly

Gentiva Health Services, Inc. a leading provider of home health services, announced that it has entered into an Agreement for the sale of six branch offices in four cities that specialize in pediatric home health care. These offices comprise more than 80% of Gentiva's current pediatric care operations. Gentiva has deteremined that pediatric home health care will not be a core focus of the company's offerings.

What is your core focus? Have you clearly defined what business you are in, and more importantly what businesses you are NOT it? One of the factors that has made the large home health care companies like Gentiva and Amedisys so successful is their ability to define their core business, and their willingness to revisit their core business decisions regularly.

What are you and your executive team doing to refocus your core? What major decisions have you had regarding the focus of your home health business? Give us your comments below.

Amedisys reports growth in home health earnings

In my daily google alert on home health care, I see that Amedisys, one of the leading companies in our home health care industry has reported a significant growth in their profit for the fourth quarter of 2008. The company said its fourth-quarter profit rose about 58%, on 75% revenue growth. Amedisys has outperformed estimates in the past four quarters, and the company said the results mark the sixth consecutive year that earnings per share growth has exceeded 20%.

What level of growth are you seeing in your revenues and profits? This report by Amedisys supports what I have been saying in my Keynote speech, Home Health Care 2020. Successful home health care companies are continuing to grow rapidly and show profitability in spite of the challenges with the reimbursement systems at CMS.

If your agency is not growing, and if you are not increasing in profitability, it's time to get your executive team together to discuss your strategic focus, and to set new priorities for your strategic competencies.

What are you seeing in the home health care marketplace in terms of growth and profits? What is happening with your agency? What are the biggest barriers you see to growth and profits? Give us your comments below.

Celebrating 100 Years of Home Health Care

By Stephen Tweed

Congratulations to the Visiting Nurse Association of Hanover and Spring Grove in Pennsylvania for celebrating their 100th anniversary. I started my career in home health care back in Pennsylvania in the early 1980s, and I remember working with the then Executive Director of this VNA.

In my keynote presentation, Home Health Care 2020, I give a brief history of home health care in America, which goes back to 1880, and the fruit and flower mission of Albany, New York. The VNA movement really begain in the 1880s and 1890s in the northeast, in Albany, Buffalo, Boston, New York, and Philadelphia. These agencies are still debating about which one was first, but I'll let you decide.

In the mean time, we continue to celebrate this long legacy of serving the elderly and the disabled. We can all be proud that we are part of an industry that is leaving a lasting legacy.

What is the legacy you are leaving behind with your agency? What do you know about the history of home health care? Tell us in the comments below.

Telehealth Improves Access to Health, says VA Study

By Stephen Tweed

One of the areas of technology that I talk about in my future trends presentations is telehealth. Many of our home health agency client around the country are getting measurable results from their telehealth programs. The biggest outcomes improvements are in the areas of reduced acute care hospitalization and unplanned urgent care for CHF and COPD patients. Today, I received a news release about a study conducted by the Veterans Administration showing the reults of their telehealth program.

WASHINGTON, Jan. 5 -- Veterans with chronic conditions can manage their health and avoid hospitalization by using special technology provided by the Department of Veterans Affairs (VA) in their homes, according to a recent study.

"The study showed that home telehealth makes health care more effective because it improves patients' access to care and is easy to use," said Secretary of Veterans Affairs Dr. James B. Peake. "A real plus is that this approach to care can be sustained because it's so cost-effective and more veteran-centric. Patients in rural areas are increasingly finding that telehealth improves their access to health care and promotes their ongoing relationship with our health care system."

The study found a 25 percent reduction in the average number of days hospitalized and a 19 percent reduction in hospitalizations for patients using home telehealth. A's home telehealth program cares for 35,000 patients and is the largest of its kind in the world. The study looked at health outcomes from 17,025 VA home telehealth patients.

Are you using telehealth in your home health agency? Tell us about your results in the comments section below

Another Look at the Agency Of The Future

In my keynote speech, Home Health Care 2020: The Six Pillars of the Agency Of The Futuree, one of the pillars is the Technology Pillar. Here's an item that advances that concept.

The Victorian Order of Nurses in Canada (VON) has signed a two-year deal worth more than C$10 million with IBM to help the organization transform the way home and community health care is delivered in Canada.

IBM will provide new business processes and clinical technologies - including mobile wireless hand-held devices for hundreds of home health care providers to schedule appointments and collect, share and access patient information in real-time. Other systems such as human resources, talent management, benefits administration, finance and accounting will also be automated and interconnected as part of the project.

This transformational initiative will enable the national, not-for-profit organization's 52 locations across Canada to be more integrated and cost-efficient, thereby improving community services and patient care.

"VON's vision is to streamline practices and create a technology platform that is compatible with provincial systems, so we are in better position to integrate into the larger healthcare system," says Judith Shamian, president and chief executive officer of VON Canada.

Home health care is the fastest growing sector in health care and as the Canadian population ages, demand will increase. Approximately 900,000 Canadians regularly access home care. Between 1995 and 2002, the number of Canadians receiving home care increased by more than 60 per cent.

What are you doing in the Technology Pillar? What new innovations are you using to streamline practices and improve outcomes in home heath care? How are you using technology to grow your business?

Give us your ideas and innovations in the comments section below.

For Profit Hospice Pays $24.7 Million to Settle Fraud Claim

SouthernCare, an Birmingham, AL based hospice company, is paying the federal government $24.7 million to settle claims that the company fraudulently enrolled elderly people in hospice and charged Medicare for services when the patients were not dying, according to the U.S. Department of Justice.

The charges stem from two lawsuits unsealed Thursday that were filed in Birmingham's federal court by two former employees of SouthernCare, a private company with 95 offices in 15 states. The whistle-blowers, Tonja Rice and Nancy Romeo, will get $4.9 million from the settlement. Both are registered nurses. Rice filed her suit in 2005 and Romeo filed hers in 2007. The settlement unveiled Thursday said the fraudulent behavior took place from January 2000 through September 2008.

How Would Your Agency deal with the Death with Dignity Act?

February 2, 2009 - Seattle, WA - With just a month before the Death with Dignity Act takes effect, hospitals and other health-care institutions in the state of Washington are racing to learn the details of the law, decide if they will participate and put together policies that address the law's many nuances and complexities.

The Death with Dignity Act, modeled on a decade-old Oregon law, permits terminally ill patients with less than six months to live to request and self-administer lethal medication prescribed by a physician. It allows institutions and individual doctors, pharmacists and other health-care providers to opt out of participating.

You are the CEO of a home health agency. How would you deal with this new law if it were passed in your state? How would you deal with an employee who refused to dispense lethal drugs if asked to do so by a patient?

Give us your comments on these questions below.

Why Grow Your Home Health Business?

Yesterday, I was speaking in Irvine, California to the regional meeting of one of America's largest home health care companies. During my presentation, "Home Health 2020, the Six Pillars of the Home Health Agency of the Future," I talked about the Growth Pillar. To explain why a home health agency needs to grow, I tell a story about my rose garden. Rose business go through a natural annual cycle of growth, dormancy, growth, dormancy. Every year or so, one of my rose business doesn't come out of the dormancy cycle, and it dies.

The same thing is true of home health agencies. A healthy agency will go through periods of growth, dormancy, and sometimes even getting smaller. But it must return to a growth cycle, or it will die. That's true of all organisms. We are either growing or dying.

After my program, One of the RNs who is a Director of Client Services for one of the branches came up to me. She said, "Thanks so much for helping me understand why we must grow. I never understood that before. I always thought it was OK for us to just stay the same size and take care of as many patients as we could. Now I see in more clearly."

This was a wonderful affirmation of the message, and an affirmation that we learn from stories.

What stories are you telling to you staff to help them learn? Are you creating opportunities for your home health team to come together to share and to learn?

If you are considering bringing in an outside speaker to your next leadership retreat or regional meeting, I'd love to talk with you about some of the programs we have available for home health agencies.

What do you think about growth? How are you convincing your nurses and therapists of the importance of growing your agency?

Give us your comments below.