The need for a new ICD-10 code for sepsis survivors was spurred by findings from a VNS Health study showing that sepsis was noted in admission assessments only 7% of the time. This caused researchers to question whether home health providers were aware that a patient had been diagnosed with sepsis. The study also identified the risk factors associated with early readmission of sepsis survivors.

“Having an ICD-10 code for sepsis aftercare lets providers know when a patient discharged to them is a sepsis survivor,” Dr. Kathryn H. Bowles, director of the VNS Health Center for Home Care Policy & Research, told Home Health Care News. “When people are hospitalized for sepsis, they are not discharged until the illness is resolved. When sepsis is resolved, it falls to the patient’s history and may not be included in the current problem list communicated during the transition to post-acute care.”

VNS Health provides home, hospice, and personal and private care services in New York. The Center for Home Care Policy & Research conducts research to support home- and community-based services and inform decision-making providers, policymakers and consumers.

“Because sepsis has a high readmission rate mainly due to recurrence, any patient who has had sepsis is at risk, and many suffer a long recovery dealing with the after-effects of sepsis,” Bowles continued. “Research showed timely attention the first week after sepsis discharge effectively decreases 30-day readmissions. If the next level of care doesn’t know the patient is a sepsis survivor, providers cannot activate effective protocols for prevention. The new code will alert the next level of care.”

An ongoing study by the same research team revealed the lack of a diagnostic code to identify sepsis survivors after discharge. Home health personnel explained that because sepsis is an acute care condition treated and resolved in the hospital, they cannot place it on the home care record. The study provided evidence that because of this communication gap, home care providers and clinicians may not be prompted to give the attention and close monitoring that sepsis recovery warrants.

“As our team discovered, there was a serious communication gap between hospitals and post-acute care providers when it came to caring for sepsis survivors,” Bowles said. “Without knowing an incoming patient had recently survived sepsis, home care providers were missing an important piece of the puzzle in determining a plan of care. Because there was no aftercare code, sepsis survivors were being coded as having pneumonia or urinary tract infection, or ‘other aftercare.’ However, as we know, knowledge is power, and with this code, home care teams and patients are empowered. They can provide the necessary care to avoid a recurrence of sepsis and preventable hospitalizations or death.”

Following the publication of these findings, the research team led an advocacy effort to persuade the CDC to adopt a diagnostic code defining sepsis aftercare as a separate condition. The new code was accepted and announced in July and took effect Oct. 1.

“Knowing the patient is a sepsis survivor alerts the team to activate evidence-based protocols for timely start of care and outpatient follow-up, close surveillance, antibiotic stewardship and patient teaching,” Bowels explained. “Sepsis strikes fast, so patients and caregivers must be educated to monitor their temperature, take their medications as prescribed and call their home care providers immediately if they feel worse.”

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As of April 9, over 9,000 health care workers had contracted the COVID-19 virus in the United States, according to the Centers for Disease Control and Prevention (CDC). The actual number is undoubtedly much higher — and it’s likely impossible to know how many in-home care workers have been affected due to testing challenges and an overall lack of support for non-facility-based caregivers.

The SEIU represents 2 million workers in health care, the public sector and property services across the country. On the call, home care workers shared emotional testimonies, detailing workplace difficulties that included a severe lack of personal protective equipment (PPE), no sick leave and low wages, among other undesirable conditions.

“I work in home care because it’s a gift from God. I have to do this job because someone needs me to care for them,” a Memphis, Tennessee home care worker said. “But despite the crucial role we have in keeping our clients safe from the coronavirus, this is the most inhumane, unsafe and unappreciated line of work.”

More so than attacking their provider organizations, the home care workers spoke out to advocate for additional governmental support.

During the virtual event, one worker said that her colleagues had been making protective masks out of paper towels. Another said she had been making her own hand sanitizer with a mixture of ingredients she bought at the store — paying for supplies herself.

“We have no voice, especially during this crisis,” the worker said. “I have no paid sick time days through the home care agency or my other job. My agency has tried to provide the resources for us as far as PPE, but they can’t seem to obtain any. We have no shields, no gowns, no sanitizers — we don’t even have masks.”

No paid sick leave

In addition to personal hardships, the virtual press conference also highlighted general challenges facing all in-home care providers, including clients refusing visits.

For example, one home care worker described a time when she went into work and her patient told her she shouldn’t be there. She was sick, and the patient could tell.

Even so, the worker felt obligated to go work to take care of her client — and to make enough money to survive.

Along those lines, one of SEIU’s demands was removing the exemption that the Department of Labor (DOL) placed on home care workers, which keeps them from receiving additional workplace benefits included in the Families First Coronavirus Response Act (FFCRA).

Broadly, the FFCRA grants paid family and sick leave for workers during the coronavirus crisis in the U.S.

Home care industry advocates had vied for agencies that employed either home care or home health workers to be exempt from the act’s benefits in order to ensure that they had enough workers to deploy on a day-to-day basis. If the DOL hadn’t included those workers, there was also concern that smaller, cash-strapped agencies would go under if forced to pay for extra leave.

But that exception backfired for some front-line workers, according to SEIU.

“It’s hard. I wish that they would give us paid sick days, but we don’t get them. We get no time off,” one worker from Richmond, Virginia, said. “And it’s a choice you have to make to live and survive. … We get sick just like everyone else. And home care workers, we take care of seniors and others with disabilities, and we are in high demand, but yet you don’t want to give us anything for what we do? I don’t understand why they forget about us.”

Although they may have an exemption under FFCRA, many home-based care providers have voluntarily implemented comprehensive paid sick leave and emergency leave policies. Others have also launched initiatives that provide bonus pay to workers caring for COVID-19 patients during the public health emergency.

A worker’s point of view

The potential effects of paid leave requirements bestowed upon agencies during the pandemic is a reasonable point of concern. But the workers on the front line — the ones risking their health for the patients — also have reason to feel left behind. 

The press conference was led by SEIU President Mary Kay Henry and National Employment Law Project (NELP) staff attorney Nzingha Hooker. It’s goal: to give a voice to those on the front line who feel like their worries have been back-burnered, they said.

Many of those worries were addressed by the home care workers who spoke Wednesday morning.

Apart from working without adequate PPE, highlighted concerns included an inability to collect hazard pay and a universal lack of COVID-19 testing.

“It’s time to bring home care workers in from outside of the laws, protections and shadows,” Henry said. “[We need] to truly value these health care heroes for the valuable role they play in getting everybody the care they need with dignity and respect in the home.”

Home health and home care agencies need to juggle keeping their businesses above water and keeping their workers feeling safe and valued.

The current circumstances make that juggle increasingly harder.

“It’s a very dangerous job,” a worker said. “I’ve said it is my gift from God to do this work, but I still deserve to be respected.”

The post ‘I Deserve to Be Respected’: Home Care Workers Make Emotional Plea for Better Treatment appeared first on Home Health Care News.

Those are just a few select findings from the American Health Rankings 2019 Senior Report from the United Health Foundation, a not-for-profit arm of insurance giant UnitedHealthcare.

The data comes from more than a dozen sources, including the Centers for Disease Control and Prevention, the Administration on Aging’s State Program Reports and the Dartmouth Atlas of Health Care, in addition to other sources.

Among the findings: The number of home health aides nationwide has increased 44% since 2013 — up from 93.8 workers per 1,000 seniors 75 and older to 135.5 per 1,000.

Access to home health aides is one of 34 different factors that contributes to making a state healthier for seniors, according to the report.

“We see a significant difference in the states that have the highest number of home health care workers — Minnesota [with] about 264 home health aides per every 1,000 adults age 75 and older — and states that had the least,” Rhonda Randall, executive vice president and chief medical officer of UnitedHealthcare National Markets, told Home Health Care News.

UnitedHealthcare National Markets is an arm of UnitedHealthcare that partners with employers that covers health benefits for active employees and retirees.

Florida — the state with the fewest home health workers per capita — has 32 home health workers for every 1,000 adults age 75 and older.

Hawaii is the healthiest states for seniors, according to the report, followed by Utah, Connecticut, Minnesota and Colorado, respectively. The least healthy states for seniors are West Virginia, Oklahoma, Louisiana, Kentucky and Mississippi.

While home health plays a role in earning states a high overall senior heath ranking, Randall says top states usually perform well in many measures — some of which also include social factors and access to gerontologists.

Behavioral health of seniors declining

Despite the growing availability of care, behavioral and social factors pose a growing challenge for seniors today.

“We’re seeing there is an increase in the rates of depression, challenges with mental health and the suicide rate among seniors has been rising over the last few years,” Randall said.

Today, 16% of seniors 65 and up struggle with depression, according to the report, up 19% from 2018. Additionally, excessive drinking among that population has increased to 7.4%, up 12% from 2016.

Meanwhile, the number of seniors who chose not to go to the doctor because it’s too expensive is also increasing. In the past year, 5.2% of seniors reported forgoing doctor visits for financial reasons.

Randall is hopeful that recently expanded Medicare Advantage benefits can help address at least some of these problems.

The Centers for Medicare & Medicaid (CMS) recently announced that MA plans may begin covering benefits that “have a reasonable expectation of improving or maintaining the health or overall function” of beneficiaries with chronic conditions starting in 2020. That could include different services to address mental health and other social determinants.

“We’re really happy about that policy change and allowing Medicare Advantage plans more opportunity to innovate,” Randall said.

However, there’s no quick fix to improve seniors’ behavioral and social health, she said. In addition to awareness and access, markets need professionals who are qualified to support and care for those individuals.

“The next area is policy. Are there any policies that are prohibitive or that need to change in order to attract more professionals?” she said. “So when we’re looking at what’s the solution, it’s often not a single solution. It’s a comprehensive call to action.”

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To come up with its rankings, U.S. News examined the 50 states across 12 metrics, including life expectancy, quality of Medicare programs, cost of care, population health and home quality. The ranking used data from the Kaiser Family Foundation and the Centers for Disease Control and Prevention (CDC).

The top 10 best states for aging are:

1. Colorado

2. Maine

3. Hawaii

4. Iowa

5. South Dakota

6. Wisconsin

7. Minnesota

8. Vermont

9. New Hampshire

10. Florida

Click on the map below to take a virtual tour of the top 10 best states to age:

Written by Tim Regan

The post Mapped: The Top 10 Best States for Aging appeared first on Home Health Care News.

In all, 37 states’ attorneys general signed the letter to Sec. Price.

Currently federal law allows for “review of complaints of alleged abuse or neglect of patients in health care facilities,” but there isn’t specific protection for those in the home.

“[The] Centers for Disease Control and Prevention (CDC) suggest that one in 10 persons age 65 and older who live at home will become a victim of abuse,” the letter says. “Not surprisingly, CDC figures also suggest that most elder abuse is never detected, with one study concluding that for every case of elder abuse that is detected or reported, 23 more are hidden.”

Increased protection for in-home care patients is necessary, but could also bring more watchful eyes on home health agencies and caregivers trying to deliver good care, West Hawaii Today argues.

The attorneys general recommended two changes in the letter:

• Allow Medicaid Fraud Control Unit (MFCU) federal funds to be used to investigate and prosecute abuse and neglect of Medicaid beneficiaries in non-institutional settings.
• Allow use of MFCU federal funds to freely screen or review any and all complaints or reports of whatever type, in whatever setting.

“The MFCUs are valuable assets to help make that freedom a reality for Medicaid beneficiaries,” says the letter. “We respectfully request you take swift action to eliminate federal regulations that needlessly narrow our use of these valuable assets. Instead, we request to be freed to use federal MFCU funds to detect, investigate and prosecute abuse and neglect committed against Medicaid beneficiaries or in connection with Medicaid-funded services to the fullest extend permitted by federal statute.”

Read the full letter from the attorneys general to Sec. Price.

Written by Alana Stramowski

The post State Officials Request More Power to Crack Down on Home Care appeared first on Home Health Care News.

Most Read

New Bills Would Reinstate Old Home Care Wage Rules—The Department of Labor’s rule to extend overtime and minimum wage protections faces new opposition in the form of legislation. Its chances of moving forward are slim, though, prompting one trade organization to vow to take its previously filed lawsuit against the protections to the Supreme Court.

How One Home Health Agency Broke Down ACO Barriers—Home health agencies agree that getting invited into accountable care organizations (ACOs) is a priority, though the barriers of entry are typically high. As the health care system continue to align and reward cost savings, home health will increasingly play a more vital role in ACOs. One Illinois home health agency made its way into an ACO, and its CEO shared how to break down ACO barriers and drive down cost savings.

Q&A: Integrating Home Health in Senior Living—As the only continuing care retirement community organization in Washington state that will soon offer senior living, home health and hospice care, Wesley Homes understands the need to be ready for shifting health system dynamics. HHCN sat down with Melinda Moore, executive director of Wesley Homes, to hear more about the organization’s plans and business integration.

Immigration Ruling Could Prolong Home Care Staffing Woes—Between wage pressures and work that can take an emotional and physical toll, home care agencies are scrambling to recruit and retain staff. A dwindling labor force has many looking to immigration reform as the sector’s saving grace—but a recent federal ruling has effectively staved off any possibility of changing immigration laws in the immediate future.

Weekend Reads

Home Health Aide Becomes a Guardian and, He Hopes, a Father—A home health aide in New York City took his role above and beyond the norm when he welcomed a client into his home permanently. The New York Times tells the heart-wrenching tale of Jose Hernandez, a 17-year-old with severe autism and developmental disabilities, and his aide Marco Muñoz, who became Jose’s guardian after the boy’s mother abandoned him.

Who Still Smokes in the United States, in 7 Simple Charts—Did you know that U.S. adults who are uninsured or on Medicaid smoke at rates more than double those of people who have Medicare or private insurance? That’s according to data released Thursday by the Centers for Disease Control and Prevention, which The Washington Post broke down into seven telling charts.

End-of-Life Care is a Universal Right that Functions as a White Privilege—An opinion piece published by The Guardian provides some interesting perspective about access to end-of-life care as it pertains to race. The author cites a number of studies that point to lower quality end-of-life care for minorities.

Written by Kourtney Liepelt

The post Editor’s Picks: Home Health Aide Goes Above and Beyond appeared first on Home Health Care News.

The three-year grant from the National Institute for Occupational Safety and Health, a part of the CDC, will help researchers from the University of Louisville’s School of Nursing and Ohio State University develop and test a virtual simulation training system to help home health workers recognize, assess and respond to risks. 

The need for such a training program arises as 60% of all injuries experienced by home health aides occur inside patient homes, said Barbara Polivka, PhD, RN, who is working on the project. 

“Our goal is to equip health professionals with the skills to evaluate the homes in which they work for hazards to their own health and safety, and to recognize when and how they need to adapt their tasks or their surroundings to protect themselves,” Polivka said. 

During the first two years of the project, researchers will conduct focus groups and interview stakeholder groups including nurses, occupational therapists, physical therapists, home health care aides, among others. 

The virtual simulation design will require trainees to actively participate in the created scenarios of the program, and interact with non-playing characters such as pets and family members that will have scripted actions and responses. 

The program will represent various rooms in homes or apartments with a range of hazards and distractions, requiring home health trainees to make an assessment of the risks and then choose how to respond. 

Researchers will use the final year of the project to test and evaluate the simulator program, according to a release from the University of Louisville. 

“If we can minimize injuries on the job, we can minimize costs for home health workers and for their employers who must account for things like work sick leave and workers’ compensation,” Polivka said.

Written by Jason Oliva

The post CDC Awards $870K Grant for Virtual Home Health Training appeared first on Home Health Care News.