Home Care and Hospice Evolving Policy: A Research Essay

Home Care and Hospice Evolving Policy

The home care industry comprises various segments, including home health care and hospices. Home care and hospice have a dynamic and evolving future in the US. Policymakers have continued their interests in the mentioned areas as reimbursement and mechanisms for health care delivery persistently shift toward risk-based capitated payment models and population management. According to Mason et al. (2016), many home care patients in America have five to six chronic conditions, and more than 45% of the population has at least one chronic disease. To meet the varying medical requirements of this chronically ill and burgeoning ageing population, there is a need to embrace innovative service delivery models, with hospices and home care playing a crucial role.

Home care services are offered to people of all ages. However, most consumers are children with debilitating and chronic diseases or older adults. The service, until recently, has been structured with an emphasis on limiting the coverage of home care to individuals who are considered homebound and require professional services of a speech, physical, or occupational therapist or a nurse. Nonetheless, compared with other institutional settings, the cost benefits of using home care have generated interest, and insurance institutions and the government are increasingly interested in utilizing the services with fewer restrictions. Conversely, hospice care is given in settings that are perceived as identical to the patient’s home. Mason et al. (2016) argued that in hospice care, various experts, including nurses, spiritual care workers, and home care aides work together to organize a care plan for medical consumers and their loved ones. Despite the desirable growth of hospice care, it has fueled increased interest and scrutiny by government policymakers.

Recent Health Care Legislature

Various routes can be taken that could influence federal healthcare policy. The legislative process is one approach that is used to change healthcare laws. It entails Congress passing a bill, which the president signs. The home care and hospice policy have recently been to the legislation process. For example, in the course of a devoted hearing in front of the US Senate Special Committee on Aging, health advocates, including William A. Dombi, and Leigh Ann Howard, argued in support of the Home Health Care Planning Improvement Act (Holly, 2020). The law, which is supported by more than 40 bipartisan co-sponsors, aims to broaden the possibility of who can certify home health services under the rules of Medicare beyond nurse practitioners, physicians, and other advanced-practice nurses (Holly, 2020). If passed into law, such legislation would be particularly impactful in rural regions, such as Maine. Some rural areas leave nurse practitioners as primary care professionals due to shortages of physicians. In brief, this leads to considerable barriers for residents in such regions when accessing home health care.

The barrier to accessing home health care has become even more burdensome as Medicaid programs and Medicare Advantage enforce the same physician-only standards. Initially, an attempt to ensure program quality and integrity of care, Medicare law has, since 1965, made it mandatory that a physician certifies a patient’s eligibility for coverage of home health service, which is long overdue (Holly, 2020). The reason for the widespread support of the law is that the country relies on non-physician practitioners daily to offer primary care to individuals of all ages as the accessibility of physician practitioners reduces. The shortages will continuously grow exponentially with America’s ageing unless a countrywide home care workforce strategic plan is created and applied. In the end, although home health’s value is widely recognized, most institutions are struggling in the present regulatory environment and reimbursement, especially when their services are needed more than ever.

Equally important, everyone hopes for comfort and peace at the end of life. The hospice was designed to make that possible, offering spiritual and emotional support and relieving pain. For this reason, US Senators Ben Cardin and Rob Portman introduced a new bill, which is referred to as the Hospice Care Improvement Act. If passed, the mentioned law would implement new regulations for transparency and oversight. Some examples of such rules include establishing penalties for clinicians who have been proven to mistreat or neglect their patients; the law will also encourage the training of hospices and surveyors regarding the issue of quality (Parker, 2019). Finally, the penalties would be similar to those adopted in other healthcare settings, such as home healthcare providers and nursing homes.

Hospice medical consumers should live their final days with dignity and comfort. Similarly, their families should have composure, knowing their loved ones are receiving the best care. The discoveries from the Health and Human Services (HHS) report on hospice care misapplication across the nation are unacceptable and deeply upsetting (Parker, 2019). Hospice Care Improvement Act has been proposed as a response because it would require the US Centers for Medicaid and Medicare services to offer training to local and state survey agencies. The education will also consider hospice programs and approved accreditation agencies, and it should occur regularly as changes to policies, guidelines, and regulations governing the operations of hospice programs are used and implemented in standard surveys. Overall, the legislation would give the needed oversight for hospices and provide patients and their families the accountability and transparency they deserve.

Literature Review

In this section, the current analysis has outlined, reviewed, and incorporated the relevant literature demonstrating the long history and evolving future of home care and hospice. The investigation enlightens on how home care and hospice are directed by a complex patchwork of federal and state mandates and practices in the private sector. The studies reviewed document Americans’ increasing desire and need for the cost savings resulting from home care and hospice. It also demonstrates their aspiration to minimise re-hospitalization that can be prevented with earlier home care interventions. Last but not least, the literature has also helped to shed light on how home care and hospice are engaged in the triple aim of the Center for Medicare and Medicaid Services to lower costs and improve patient care quality.

Home Care

In their study, Legg et al. (2016) utilized a systematic review of non-randomized studies and randomized controlled trials in which reablement interventions were matched with usual care or no care in individuals referred to public-funded personal care services. The authors concluded that the objective of reablement was to offer regular adult social care (home care) service users greater control and choice, reduce demands for long-term support and hospital resources and encourage individuals receiving home care services to live independently. To ensure active commitment in early intervention, reablement was developed as a strategy to shift the provision of reactive home care services to preventative and proactive dynamics of provisions of home care services (Legg et al., 2016). Therefore, reablement interventions are vital in-home care since the target populations are likely to be older patients with diverse morbidity and mortality risk, disability, prognostic outcomes, and multimorbidity.

In contrast to the findings by Legg et al. (2016), the study by Gandhi (2018) revealed that at present, home health agencies serve more than 3 million beneficiaries of Medicare, and in 2016, unlicensed caregivers provided care for approximately 2 million individuals. It is expected that those numbers will grow as the population ages. There is a persistent trend for the growing numbers of Americans with chronic ailments and the ageing population. In this regard, Gandhi (2018) has produced significant results showing that, as a country, the US is not entirely prepared for this trend. For this reason, policymakers and healthcare leaders would be wise to plan and think more effectively to ensure the safety of caregivers, families, and patients in-home care.

Hospice

According to Harrison and Connor (2016), in 2014, more than 1.6 million Americans were given hospice care, which entailed a set of spiritual, psychosocial, and medical palliative care. The research by Harrison and Connor (2016) concurs with the findings by Gandhi (2018) that caring for the whole person, including spiritually, emotionally, and physically, is being done efficiently in hospice. In this respect, there is a need for person-centred care because it takes a broader approach than only considering the patient and their ailments to more general issues, such as autonomy, wishes, and beliefs of the patient. Harrison and Connor (2016) further argued that the services offered in hospice are consistent with public health strategies to mitigate and prevent suffering and pain among people with advanced life-limiting illness and their families. The current reimbursement aspects for pre-hospice palliative care do not simplify the delivery of interdisciplinary care (Harrison & Connor, 2016). Consequently, there is a need for new payment mechanisms and policies to manage this growing population better. In brief, Harrison and Connor (2016) conclude that in five years, policymakers will be able to use the findings of the Medicare Care Choices Model Demonstration to inform legislative and regulatory changes to Medicare Hospice Benefits.

Earlier research findings by Mor and Teno (2016) showed that Congress, in 1982, formed a Medicare hospice benefit under a capitated per diem reimbursement structure constraining additional care. In that sense, the mentioned authors argued that there are vital lessons from the Medicare hospice benefits that policymakers should consider when implementing new payment models. For example, accountability and transparency must be a priority. At the same time, there is a need for actionable performance measures to ensure that the decisions for treatment promote person-and-family-centred care and mirror the preferences of patients and their loved ones (Mor & Teno, 2016). Individuals at the end of life are susceptible, and many are cognitively impaired. For this reason, having readily available data for advocates, families, and patients concerning outcomes, processes of care, critical structures, and experiences of various symptoms, including pain, assists in ensuring that the care offered reflects the informed values and goals of patients.

Summary

From the reviewed literature, it is evident that allowing medical consumers to be cared for in their homes makes good sense. Home care is a unique practice environment since the team members, including nurses, must function effectively and fit into the space of the patient. At the same time, hospice offers holistic support to caregivers and people living with a terminal illness during bereavement. Opportunities for advancement will develop, as will challenges as home-based technology and telemedicine continue to improve. It is crucial to note that health system leaders and policymakers can assist by encouraging the expansion and growth of current efforts being made in-home care and hospice to ensure the safety of caregivers, families, and patients.

Statistical Data

The population impacted by home care and hospice are those with chronic ailments and the ageing population. For example, America is undergoing an intense alteration in demographics, whereby in 2018, the younger generation will be outstripped by older people aged 65 years and above (Landers et al., 2016). As Americans live longer and age, an increasing number of the population is living with functional impairments, such as managing one’s household and difficulty with life basic like mobility, as well as multiple chronic conditions, including dementia or diabetes. Over the next 15 years, enrollment in Medicare is estimated to grow by more than 50% from the current 54 million to more than 80 million in 2030 (Landers et al., 2016). The trend mirrors a general ageing of the population in the US. More so, “88% of individuals aged 65 or older have at least one chronic ailment, with a quarter of them having four or more conditions” (Landers et al., 2016, p. 272). Such forces of alteration demonstrate a transformation in the system of delivery that promotes the adoption of medically appropriate care in society, with the home as the focal point.

The growing number of senior citizens in America and internationally indicates a challenge for future end-of-life care. It is projected that annual deaths will grow from 38.8% (aged 85 years and over) in 2014 to 53.6% (aged 85 years and above) in 2040 (Bone et al., 2017). Proportions of hospital deaths declined (57.9%-48.1%) between 2004 and 2014, and in the same period, home care deaths increased (18.3%-22.9%) (Bone et al., 2017). The number of deaths will increase by 108.1% in care homes if current trends continue, whereby by 2040, the care home will be the most commonplace of death (Bone et al., 2017). At the same time, it is projected that hospice deaths will upsurge from 5.5% in 2014 to 7.3% by 20140 (Bone et al., 2017). On the whole, although hospice would continue to be the death place for a minority, care homes, compared to hospitals, would be a more conventional setting for death.

Figure 1:

Medicare value-based and authorizing legislation

Note. Chart one above provides a depiction of the summary of the most recently developed future and current mandated value and quality programs for Medicare providers and the legislation creating them (Landers et al., 2016).

Table 1:

Statistical Analysis of Home Health Service Data

Note. From table one above, it is evident that home care and hospices have a positive health outcome (Balan & Otto, 2016)

The figure further demonstrates that home health teams often start treatment promptly and offer suitable instructions to medical consumers regarding their medicines. At the same time, home health trams monitored patients for pain and vaccinations. Consequently, not many home healthcare patients need unplanned emergency room (ER) visits or hospital admissions. The point, then, is that the quality of service offered by the home health team is high. Additionally, table one demonstrates that a median of 13% of medical consumers getting home healthcare required unplanned and urgent care in the ER without being admitted to the hospital (Balan & Otto, 2016). Aside from that, a median of 16% of home medical users had to be exposed to a healthcare facility (Balan & Otto, 2016). Hence, the percentage of home health patients who require admission to the ER or hospital is quite low. Overall, statistical analysis from table one demonstrates that the quality of service offered by the home health team is competent and outstanding.

Nursing Role in Passing the Legislature

Modifying an existing healthcare policy or introducing a new one is an endeavour that is challenging and does not occur in a vacuum, and it is also not the duty of a single person. Moving a proposal through the policy process takes more than an idea. It takes compromise, time, patience, persistence, energy, and resources to attain the desired results (Patton et al., 2019). As chief executives of many home care and hospice organizations, nurses can play a vital role in passing the Hospice Care Improvement Act and the Home Health Care Planning Improvement Act. The group in question is persistently at the forefront of movements that guide decision-making; they endlessly lobby Congress members and take legislatures on home visits. The high proportion of nurses as trustees of the national trade association allows them to champion change and enormously influence decision-making.

Problem identification in legislation is a fundamental and vital but often complex stage of policymaking. In this respect, nurses play an essential role in clarifying a problem by making statements concerning what is current compared to the best circumstance; nurses also assist in elucidating the outcome if the situation is not corrected. According to Patton et al. (2019), reforms in healthcare will only be attained if nurses are persistent in pursuing their rightful place in policy leadership in collaboration with others who are also committed to equitable, effective, safe, and accessible healthcare. Armed with a common goal and data, a practising nurse can apply a sizable impact by handling patient care within her area of responsibility, extending that influence through her institution, and eventually determining national policy. Hence, successful advocacy to implement the changes proposed Hospice Care Improvement Act and the Home Health Care Planning Improvement Act demands access to the resources of energy, time, will, and power, along with the necessary political skills.

Another vital role played by nurses is that of being informally and formally involved in politics. There is no better time to pursue politics in the current era of healthcare reform. The point is that nurses who seek politics provide something that contenders without their experience simply cannot. They offer an accurate and firsthand description of what transpires in home healthcare environments, private practice, and on-site medical institutions (Patton et al., 2019). More so, nurses can seek progressive roles as expertise and time dictate. For example, they can undertake dogmatic campaigns or contend for political office. On the whole, nurses are positioned to provide perspective in passing the legislature due to their knowledge of technology, interface with patients, and their central role in the day-to-day safety of millions of people around the globe.

Conclusion

Home care is the extension of medical office visits and brings clinical care to millions of households each day. The aspiration of this and the coming generation will be to remain in their houses. Nevertheless, the troubles in attaining this will be numerous, including better end-of-life care, the need for technology, transitional and chronic care management, the fight for talent, and reimbursement reform. Based on the statistical data and the reviewed literature, it is evident that home care and hospice care are the solutions to health care policy in the US in controlling access, quality, and cost. At the same time, nurses should be the ones to carry out this undertaking. The insight of nurses is fundamental in persuading legislature through awareness-raising, persuading lawmakers, and working collaboratively to get a statute ratified. On the whole, as the reforms in healthcare are applied in whatever manner, and medical institutions transform their internal procedures and policies to comply with new regulations, nurses will be required to take part in the decision-making to ensure that suitable changes are being implemented and designed.

References

Balan, S., & Otto, J. (2016). Big data analysis of home healthcare services. Information Technology and Management Science, 19(1), 53-56. doi: 10.1515/itms-2016-0011

Bone, A. E., Gomes, B., Etkind, S. N., Verne, J., Murtagh, F. E., Evans, C. J., & Higginson, I. J. (2017). What is the impact of population ageing on the future provision of end-of-life care? Population-based projections of the place of death. Palliative Medicine, 32(2), 329–336. doi: 10.1177/0269216317734435

Gandhi, T. K. (2018, June 1). Trending toward home care: Is our health system ready? Retrieved from https://www.hfma.org/topics/hfm/2018/june/60852.html

Harrison, K. L. & Connor, S. R. (2016). First Medicare demonstration of concurrent provision of curative and hospice services for end-of-life care. American Journal of Public Health, 106(8), 1405–1408. doi:10.2105/AJPH.2016.303238

Holly, R. (2020, February 12). Senator Collins: Penalizing providers with PDGM’s behavioural adjustment ‘makes no sense whatsoever. Retrieved from https://homehealthcarenews.com/2020/02/senator-collins-penalizing-providers-with-pdgms-behavioral-adjustment-makes-no-sense-whatsoever/

Landers, S., Madigan, E., Leff, B., Rosati, R. J., Mccann, B. A., Hornbake, R., … Breese, E. (2016). The future of home health care. Home Health Care Management & Practice, 28(4), 262–278. doi: 10.1177/1084822316666368

Legg, L., Gladman, J., Drummond, A., & Davidson, A. (2016). A systematic review of the evidence on home care reablement services. Clinical Rehabilitation, 30(8), 741–749. doi: 10.1177/0269215515603220

Mason, D. J., Gardner, D. B., Outlaw, F. H., & OGrady, E. T. (2016). Policy & politics in nursing and health care. St. Louis, MO: Elsevier.

Mor, V., & Teno, J. M. (2016). Regulating and paying for hospice and palliative care reflections on the medicare hospice benefit. Journal of Health Politics, Policy & Law, 41(4), 697–716. doi: 10.1215/03616878-3620893

Parker, J. (2019, November 7). Senators introduce bills on hospice quality and transparency. Retrieved from https://hospicenews.com/2019/11/07/senators-introduce-bill-on-hospice-quality-transparency/

Patton, R. M., Zalon, M. L., & Ludwick, R. (2019). Nurses making policy, second edition : From bedside to boardroom. New York, NY: Springer Publishing Company.