Home health and adult care programs team up
Find compatible services, goals to ensure success
In February 2001, the Centers for Medicare & Medicaid Services changed the wording in its definition of homebound to allow for Medicare home health patients to attend adult day care without jeopardizing the patients’ home health coverage.1
Although Sylvia Nissenboim, MSW, LCSW, director of adult care and enrichment programs at the St. Louis Red Cross and president of the Missouri Adult Day Care Association — known as MAHC — in St. Louis, says she thought that she would start seeing more referrals between her adult day program and local home health agencies, nothing happened. After surveying home health agencies in the area, Nissenboim discovered a need for education of both industries.
"There was confusion about the language that described adult day services as intermittent, so home health nurses believed that a patient who attended an adult day program on Mondays and Wednesdays would no longer qualify for Medicare services," she says. "I also discovered that home health nurses didn’t realize that many adult day programs have skilled nursing services available."
To foster communication and create a network that would generate referrals between the two types of services when appropriate, MAHC set up a monthly meeting of home health managers and adult day-care managers to get to know each other. "Each group has learned from the other," says Nissenboim. "Home health managers thought of adult day care as bingo and lunch, while I realized that I had no idea of the differences in Medicare home care, private duty, and therapy services offered in the home," she says.
The Home Health/Adult Day Care Network — as the group of nine home health and adult day care organizations has named itself — spent the better part of its first year educating each other and developing a flyer to use in community education programs that explain the variety of services available to older adults.
Now that members of the network better understand each others’ services, the group has developed a protocol in which a question about home health or adult day care will be asked by each organization upon assessment of new clients, Nissenboim explains.
"Within our adult day program, we now ask family members if they would be interested in talking with a home health agency about services for the client on days that they are not in our program. Home health agencies are asking clients if they have ever attended an adult day-care program and if they would be interested in having someone contact them with more information," she adds.
Not the answer for every patient
Although adult day care might provide needed respite for a family member, or additional social interaction for a patient who may feel isolated, the suggestion might not be welcomed, says Natalie Jablonski, marketing director for St. Andrews At-Home Services in St. Louis. "Some clients relate better on a one-to-one basis, while others are comfortable in a group setting. It’s important for the home health nurse to assess the patient’s ability to function in a group," Jablonski explains.
"We ask patients and their family caregivers if the patient’s social needs are being met," says Nancy Bax, RN, BSN, director of nursing for Lutheran Senior Services Home Health and Private Duty in St. Louis. "Adult day care can be a welcome relief for caregivers who are overwhelmed, but they have to be ready to let go," she explains.
Jablonski agrees and points out, "Some caregivers are in a pattern of providing care to the family member, and they feel guilty if they allow someone else to assume that responsibility." Caregivers who do send a family member to adult day care for even a couple of days each week need to be reassured that it is beneficial to the patient and is the right thing to do, she adds. "You also need to be alert to the caregiver’s loneliness or disrupted pattern now that the family member no longer needs complete attention for the whole day," Jablonski continues. Support caregivers’ decisions to use adult day care by pointing out in a positive way the benefits of adult care for the patient and the advantages for the caregiver to be able to schedule his or her personal appointments more easily, she says.
Plan schedules carefully
While referrals of Medicare home health patients to adult day-care programs do not reduce reimbursement levels, it does require some extra planning. "Because home health services, such as dressing changes, have to be performed in the home by our nurses rather than at the day-care center, we have to make sure we schedule around the day-care schedule," she says.
The difficulty of this scheduling varies, with transportation of the patient being a key factor, Bax says. "If the adult day-care program provides the transportation, the patient usually has a longer day at day care; but if a family member is bringing the patient home, the length of time at day care may be shorter."
One way to work around this problem is to refer patients to adult day-care programs that offer skilled nursing services, she says. If the day-care nurse can handle a dressing change and daily wound care when the patient is at the program, the number of home health visits required would decrease, something that is not detrimental under the prospective payment system, Bax points out.
Before you refer any of your home health clients to adult day care, be sure to check the program thoroughly, Jablonski suggests. Not only do you want to be clear about what services it offers, such as skilled nursing, meals, social services, therapy, and supervision, you also want to find out what types of clients it accepts, she says. Is the clientele a mix of dementia and nondementia patients, or does the program have different groups? "If the day-care program mixes early-stage Alzheimer’s patients with late-stage patients, the early-stage patients may find it very frightening," Jablonski points out.
In addition to the types of services they offer, talk to different people in the community, as well as contacting references provided by the day-care program, to find out what type of reputation the program has, she recommends. "If the program’s mission and goals are compatible with yours and the organization has a good reputation, you can feel comfortable referring to them," Jablonski says.
When looking for an adult day-care program to which you can refer, remember that your goal is to be able to provide services that meet all of the needs of your patients and their families, Bax explains. "We want to provide a full range of services that will make it possible for the patients to stay in their homes for as long as possible."
[For more information on home care and adult day care teaming up, contact:
• Sylvia Nissenboim, MSW, LCSW, Director of Adult Care and Enrichment, Red Cross of St. Louis, 10195 Corporate Square Drive, St. Louis, MO 63132. Telephone: (314) 516-2777. E-mail: [email protected].
• Natalie Jablonski, Marketing Director, St. Andrew’s At-Home Services, 6633 Delmar Blvd., St. Louis, MO 63130. Telephone: (314) 802-1939. Fax: (314) 726-5719. E-mail: [email protected].
• Nancy Bax, RN, BSN, Director of Nursing, Lutheran Senior Services Home Health and Private Duty, 723 S. Laclede Station Road, St. Louis, MO 63119. Telephone: (314) 446-2519.]
Reference
1. Center for Medicare & Medicaid Services. Program Memorandum Intermediaries — Clarification of the Homebound Definition Under the Medicare Home Health Benefit. Feb. 6, 2001. Web site: www.medicare.gov.
In 2001, the Centers for Medicare & Medicaid Services changed its definition of homebound to allow Medicare home health patients to attend adult day care without jeopardizing the patients home health coverage. Sylvia Nissenboim, director of adult care and enrichment programs at the St. Louis Red Cross and president of the Missouri Adult Day Care Association, thought she would see more referrals between her adult day program and local home health agencies, but nothing happened. After surveying home health agencies, she discovered a need for education of both industries.
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