Form partnerships for better home care: Be part of a continuum

Relationships with other organizations expand referral base and services

(Editor’s note: This is the first of a two-part series that looks at innovative approaches to patient care and expansion of services by home health agencies. This month’s article describes partnerships with other organizations that are designed to both increase referral bases and enhance home health services. Next month’s issue will examine the proactive approach of two agencies that have found a way to offer a more holistic approach to patient care.)

As the population ages and the needs of seniors change, home health managers are looking for ways to make their services more applicable to today’s senior population. One way to expand services and increase the visibility of your home health agency is to form partnerships or relationships with other organizations in the community.

On one end of the spectrum of new ways to serve seniors is Elant, based in Goshen, NY, a senior health care and housing solution that combines a variety of housing options such as independent living units, assisted-living facilities, adult homes, and traditional skilled nursing facilities with community health services such as home care in several New York locations. Clients who join the system at the independent living stage receive services as needed and move into other housing settings as their health and needs dictate, says Susan Schulmerich, RN, MS, MBA, vice president of community health services for Elant, who is based in Newburgh.

"Home health is integrated throughout the system because it is appropriate for an organization that is managing the health needs of its clients to use home health to keep clients in the most independent setting appropriate for them," Schulmerich says.

"Home health can provide services that range from assistance with baths and hair washing to preparation of meals, to care for acute needs such as stroke recovery or wound care. The goal is to provide the level of support clients need to stay in their home," she adds.

Even when the home health agency and the assisted-living facility aren’t part of the same corporation, there is a natural fit for the two types of organizations to work together, explains Schulmerich.

It’s much easier for private-duty agencies to establish partnerships with assisted-living facilities because rules related to anti-kickback statutes don’t apply, says Karon Austin, MPA, RN, CHCE, a home care consultant and owner of Healthcare Concepts in Avon, CO.

"During my 21 years as an owner of a private duty home care company, I was able to establish several relationships with assisted-living facilities," she says. Her arrangements actually specified her agency as the preferred provider when the assisted-living facility needed to refer to a home care agency. While Medicare-certified agencies are unable to establish the same type of formal agreement, there are a number of ways that all home care agencies can establish relationships, she explains.

"One of the services we provided to our assisted-living facility partners was a monthly educational program in which we provided speakers on a variety of topics of interest to the facility’s clients," Austin continues. "We would present topics on health issues such as osteoporosis and Medicare coverage topics, such as benefits for wheelchairs, canes, or other durable medical equipment," she says. "We also provided cholesterol screenings and coordinated annual health fairs," she adds.

Speakers for the educational programs and the health fairs can be a mix of agency nurses with expertise in certain areas, representatives from vendors such as durable medical equipment providers, and medical personnel such as podiatrists or dentists from the local area.

"We never charged the clients for the seminars, and we never paid fees to any of the speakers," Austin says. There was, however, never a lack of willing volunteers to speak, especially when local health care providers and physicians learned about the program and saw it as an excellent way to establish a connection with an audience that would most likely need their services at some point, she adds.

Before finalizing any agreement to provide health fairs or educational programs at an assisted-living facility, be sure to have an attorney review the agreement for violations of state and federal anti-kickback regulations, suggests John Gilliland, an Indianapolis-based attorney.

Basically, a home health agency cannot promise a free service such as an educational program in exchange for a promise of referrals, he explains. The laws differ from state to state, with some state regulations being even tougher than federal regulations, so each agency needs to have its agreements evaluated, Gilliland says.

It also is important to make sure the assisted-living facility has a policy that gives preference to patient choice when choosing a home care agency, and that the facility follows its policy. This gives a Medicare-certified home health agency an extra measure of protection against charges of kickback violations, he says.

The Visiting Nurse Association (VNA) of Central Connecticut in New Britain has relationships with assisted-living facilities through an entirely different arrangement.

The agency’s partnership began with the University of Connecticut as a way to both enhance community nursing training for student nurses and a way to continue care for patients once they no longer had a need for acute care home health, says Karen Reid, RN, BSN, director of public health services for the agency.

The home health agency and the nursing school developed CareLink, a program that uses student nurses to follow VNA patients with chronic, ongoing problems once they are discharged from VNA care for their acute episodes.

"There is no charge to the clients for the care," says Reid. The students make the home care visits, perform assessments and evaluations, and monitor the patients’ condition under the supervision of both the nursing school and a VNA employee who serves as a liaison for the program, she says. (Look for a more detailed description of this program in next month’s issue of Hospital Home Health.)

Students who work with the 200 patients in the CareLink program are excellent representatives for home health, Reid notes. "In addition to providing much appreciated monitoring of chronic conditions, the students are taught to assess changes in a patient’s condition that might signal a need for more acute home health services."

A key to any successful partnership is to ensure that both organizations have the same goals and philosophies, Austin explains.

"I recommend that a home health agency tour the organization with which the partnership is being discussed," she says.

Austin looks for evidence of quality care, concerned staff members, and a clear definition of appropriate residents if she is looking at an assisted-living facility. "I want to make sure that the assisted-living facility makes referrals to nursing homes or other facilities when it is appropriate rather than keeping clients in inappropriate settings." This protects her staff as well, because they know what type of clients with whom they will be dealing and won’t encounter surprise clients who require a much higher level of care than anticipated, she adds.

Working with assisted-living facilities may be a first step in establishing a relationship with another senior care organization, Austin points out.

The passage of the Medicare regulations in 2003 included a directive for a demonstration project that further evaluates the definition of homebound and its application to adult day care, she says. "This type of change will open up entire new avenues for home health to explore," Austin explains.

[For more information on innovative approaches to home care, contact:

  • Karon Austin, MPA, RN, CHCE, Owner, Healthcare Concepts, P.O. Box 2555, Avon, CO 81620. Phone: (800) 352-3910. E-mail: Web:
  • John Gilliland, Gilliland & Caudill, 3905 Vincennes Road, Suite 204, Indianapolis, IN 46268. Phone: (317) 704-2400. Fax: (317) 704-2410. E-mail:
  • Karen Reid, RN, BSN, Director of Public Health Services, Visiting Nurse Association of Central Connecticut, 205 W. Main St., New Britain, CT 06052. Phone: (860) 826-6313. E-mail:
  • Susan Schulmerich, RN, MS, MBA, Vice President of Community Health Services, ELANT, 31 Cerone Place, Newburgh, NY 12550. Phone: (845) 291-3700. E-mail: Web:]