New mom respite care: A frill or good business?
New mom respite care: A frill or good business?
What two hospital-based agencies are doing
Despite the tendency among most insurers to view new mother respite care as nonessential, at least two hospital-based agencies have decided the service makes good sense, both medically and from a business standpoint.
HealthEast Optional Care of HealthEast System in St. Paul, MN, and Private Home Care Services of Northside Hospital in Atlanta, offer private duty programs that feature newborn medical assessments and respite care for new mothers, who often are traumatized and exhausted and need help at home. Both coordinators see their programs as savvy marketing tools as well as logical complements to their hospitals’ continuum of care policies, even if patients are picking up the tabs.
"It sort of fits in with the hospital’s mission statement," explains Diana Christy, RNC, director of Northside’s home health agency, who administers the newly revived program. The not-for-profit hospital, which leads the Southeast in infant deliveries (11,000 in 1995), offered the service until about 18 months ago. A physician-ordered service then, it was dropped because fewer doctors were ordering it. Now patients request the service, and Christy says her agency receives at least two or three calls a week. She attributes the patient interest to the separation of extended families. "A patient’s family might live in New York, and they have no one close by to help.
"It’s another community resource where the hospital is offering a service for a fee. It ties in the good name of Northside, and the community recognizes that. And that will benefit the hospital," she says.
HealthEast Optional Care’s Julie Ranczka, LPN, a triage nurse, describes hers as a "community-based resource" that serves the 11-county Minneapolis-St. Paul metro area. Because of managed care’s push for shorter hospital stays (48 hours for normal vaginal deliveries), follow-up at home is also growing more popular in Minnesota, she said.
Need may be a few days or a week of service
Under most insurance or managed-care plans, patients will receive one follow-up visit by a nurse if the hospital stay is shorter than 48 hours. However, some states, reacting to protests against "drive-through deliveries," have passed laws prohibiting a new mother from being discharged without her consent before 48 hours, similar to the Newborns’ and Mothers’ Protection Act President Clinton recently signed.
But even a follow-up visit is a far cry from respite care, which not only includes a medical check of mother and baby but also provides someone to perform household chores and care for the baby.
HealthEast Optional Care charges $18.25 an hour for an aide, with a three-hour minimum. Northside, whose service will be up and running by the end of the year, will charge between $10 and $16 an hour. "We don’t have that part of it put together yet," Christy conceded.
Northside’s home health agency will send a staff RN to the home "to set up the service agreement; assess the mother and baby; if needed, assess the home for safety; and see that all they need is a home health aide," Christy says.
The nurse teaches the family about caring for the infant, then prescribes a written plan of action for the aide, a personal care attendant, or homemaker companion to follow. Duties and length of stay are tailored to the family’s wishes.
"It may be they need someone for a few days or for a week," Christy says. "It will be up to the family requesting the service."
On the initial postpartum visit, the RN:
• reviews the doctor’s orders;
• checks vital signs of both mother and baby;
• checks mother and baby for infections;
• checks for postpartum bleeding;
• bathes the baby;
• performs perineal care;
• teaches about diet, breast care, perineal care, menstruation, resumption of sexual activities, exercise, rest, and postoperative limitations;
• checks the caesarean-section incision.
Aides, though not licensed, have been trained in the care of new mothers and babies, says Christy, and have CPR certification. Aides may clean house, prepare meals, bathe, feed, and sit with the baby while the mother catches up on her rest.
The RN would be available if the infant becomes sick. The nurse would either deal directly with the problem or consult the doctor.
Not everyone, however, agrees such a service is practical when considering the bottom line. Virginia Valentine, MS, RN, director of pediatric/clinical nursing home care program at South Hills Health System Home Health Agency in Pittsburgh, expresses mild surprise at the concept. "It’s hard enough to get one home care visit [paid for]. It sounds like the Doula idea, but it isn’t covered by insurance."
Managed care won’t pay for it’
Valentine says that with an early discharge (24-36 hours after birth) her agency provides one visit from an obstetrical nurse for "teaching, postpartum care, and a physical [for the infant]. If anything is wrong, such as jaundice, we ask the doctors to go in. That’s pretty much it.
"In our area, I can’t imagine a hospital doing it. It’s the bottom line; who’s going to pay for it? This seems like a frill, but it’s a nice thing to offer."
Franciscan Home Health Services at St. Therese Hospital in Waukegan, IL, offered respite care up until five or six years ago, but now, "managed care won’t pay for it," says Home Care Quality Assurance Director Karen Van Buren, RN, BS.
As at South Hills, a nurse will visit if a mother and baby are discharged early. "Our patients are so ecstatic over it," she says. "One of our new mothers told us, I was never so relieved when that nurse walked through that door.’"
Northside’s Christy counters that "we offer it because it makes sense. We know the patients in the hospital and follow them at home. It’s our continuum of care. We have a nurse who is strictly a hospital-to-home nurse. She can inform them of the services the doctor ordered and introduce them to home care so patients will know somebody will follow through."
Staff will be selected from a pool of personal care assistants and homemaker companions throughout the six-county Atlanta metro area. Aides will be chosen not only on their training and experience but also by their proximity to patients. Staff RNs will set up the service agreement with the family.
"They’ll try to define what the family wants, the hours, and what they want the person to do. The nurse would explain basic infection control, patient rights and responsibilities, how the services are billed, and how to handle complaints," says Christy.
All instructions and duties are documented with checklists.
To be hired as a personal care attendant by Northside, a candidate must be a registered home health aide or personal care technician in Georgia and be experienced in home care with mothers and babies.
Homemaker companions must have a high school equivalency diploma, provide their own transportation, and possess basic communication skills.
Ranczka, whose for-profit agency has been providing respite care for five years, says HealthEast aides also will do whatever the family needs, such as "cleaning house, making meals, taking care of baby, and letting mom rest for a couple of hours. Our nurse would go out and do an assessment and write a plan of care for a home health aide."
Although Northside is a not-for-profit entity, whatever monies the respite care generates will go back into the hospital, Christy said. "Your margin of profit is not going to be that much, but it’s something that’s needed in the community, and it’s something we feel like we can offer, in comparison with what other private home care agencies can offer. These [patients] are people we’ve provided skilled nursing care [in the hospital] to anyway, so it just makes sense to keep it all in the family."
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