“I’m never still. I have a new pair of tennis shoes and I’m running all the time I’m at work,” said Angela Riggins, LPN, telehealth coordinator for the high-risk program at Visiting Nurse Health System, the largest nonprofit home health provider in Georgia.
Riggins monitors a roster of 110 patients, checking their electronic vital signs, phoning them regularly and visiting as needed. She’s available by phone any time.
“I love reaching out and helping them, so running is what I do,” Riggins said.
She’s not alone. The entire home health industry is running to stay ahead of increasing demand and changes in health care. Home health is the fastest-growing sector of the rapidly expanding health care industry. The U.S. Bureau of Labor Statistics projects 22 percent employment growth through 2018 for health care, with home health jobs growing by 46.1 percent.
“We have doubled the number of patients and doubled the number of staff in five years. In 2010, we saw more than 22,000 patients and our clinicians logged 2.4 million miles in caring for them,” said Mark Oshnock, president and CEO of Visiting Nurse Health System. “I see no end to the growth and it should be growing even faster, because home is a much lower cost setting for patients than either the hospital or nursing homes, and it’s where most patients want to be.
“A hospital stay costs about $3,000 a day, a nursing home about $1,500 a week on average, while a week of home health care is about $400.”
Many factors are driving changes to home health, not the least of which is patients themselves. The country’s population is aging and living longer. Senior patients require more health care. Largely due to insurance and Medicare reimbursement schedules, hospitals are discharging patients more quickly and in more fragile conditions.
“Post-acute care is defined very differently today than it was five to 10 years ago,” Oshnock said. “We’re seeing patients at home now that would have been in the ICU five years ago and because of that, we’re delivering care differently”
Working to reduce inpatient hospital stays and allow more patients to transition to home health care as soon as possible, Visiting Nurse partnered with Atlanta hospitals last year to create its high-risk program.
“The purpose is to decrease the rehospitalization rate of what we call our ‘frequent-flyer patients,’ ” said Andrea Ragin, RN, clinical manager of the program. “These are patients with chronic diseases like congestive heart failure, COPD [chronic obstructive pulmonary disease], diabetes or coronary artery disease, who are at high risk for hospitalization.”
Visiting Nurse Health System’s home-care coordinators are stationed at hospitals to assess referred patients and determine if they are a fit for the program. If they are, Ragin monitors them and creates individualized orders and protocols.
“We front-load the nursing visits for these patients, seeing them more often in the first few weeks to help them understand their disease processes, medications, diet restrictions and other challenges,” she said. “Constant communication with nurses is important. We have to keep a keen eye on what’s going on at home, so most patients receive a telemonitoring device and are educated on how to use it.”
Riggins, the telehealth coordinator for the high-risk program, is the eyes and ears on the other end of the telemonitoring device.
“Every day I boot up the laptop to look at my patients’ vital signs and see who has issues,” Riggins said. “If something isn’t normal, I’ll call to talk to the patient. Sometimes a patient’s son didn’t take out the trash and her blood pressure will shoot up.”
If the situation is more serious, Riggins calls in a team member or makes a visit herself.
By developing a level of trust with each patient, Riggins often hears useful information that patients haven’t told their other health care providers.
“You have to let your patients talk and get comfortable with you,” she said.
“Elonda was a patient with a bad heart and other co-morbidities, who was afraid of dying in her sleep. Before she was our patient, she’d end up in the emergency room about once a week,” Riggins said.
Now, Elonda calls Riggins when she’s short of breath and scared. Riggins educates, calms and encourages her to follow her diet. By losing weight, Elonda is healthier and has only been hospitalized once since she came into the program.
“We’re definitely keeping more patients out of the hospital and we’re learning a lot, too,” Ragin said. “Other home health organizations take high-risk patients, but we actually have a dedicated team for these patients. Our nurses have a weekly huddle with patients and their hospital nurses when a patient is readmitted. We want to understand what happened, so that we can improve.”
A nurse for 31 years, Ragin believes this kind of care is the wave of the future. Visiting Nurse Health System plans to upgrade its telemonitors to include teaching tools that help patients better understand and manage their diseases.
“We’ll do more teaching and support, because our ultimate goal is to improve outcomes,” Ragine said. “Our patients want to be home and we want them to be there safely. We’re very excited about this program.”
Providing sophisticated levels of care at home offers real improvements to health care delivery, Oshnock believes.
“It’s a win for patients, for hospitals and for the whole health care system,” he said.
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