HHAs have opportunity to lead in management care

Use of programs for chronic disease improves

Between 12% and 13% of the people living in the United States are aged 65 or older, and of these people, 80% live with at least one chronic disease.1 Even when the chronic disease is not the reason for home health referral, care plans must take into account all of the chronic conditions that might affect the patient's outcome.

"Home health disease management programs for chronic obstructive pulmonary disease and congestive heart failure have been around a long time, because we were reporting outcomes and had to respond with a way to manage underlying conditions as well," says Beth Carpenter, president of Beth Carpenter and Associates, a Chicago-based health care consulting firm. The challenge for chronic disease management programs in home care is that the Medicare payment system is based on acute events or episodes, she says. "Even when a home health agency has a program that can manage the patient's condition and improve his or her life, we have to wait for the hospital to treat the patient and discharge to home care," she says.

Pallative care growing

Palliative care also is a growing area, but reimbursement issues face home health managers, adds Marcia P. Reissig, RN, MS, CHCE, chief executive officer of Sutter VNA and Hospice in San Francisco, CA. "There are people who qualify for palliative care as home care patients, and people who qualify as hospice patients whose care can be reimbursed - but there are people that get caught between the two services with no care," she says. "I'd like to see more effort to blend the two payment systems of home health and hospice so that the 'in-between' group of patients can be served."


1. Centers for Disease Control and Prevention and the Merck Company Foundation. The State of Aging and Health in America 2007. Atlanta, GA; 2007.