Editor's note: The Area 1 Agency on Aging commissions freelance writer Carol Harrison to produce Gray Matters every two weeks.
There’s no place like home, especially when it comes to health care.
“There are a lot of hospital-acquired infections in even the best of hospitals,” said Margot Julian, a Eureka resident and client of St Joseph Home Care in Eureka for three weeks this year. “Then there’s the lack of privacy and the noise levels, which make it hard to sleep. However modest your home may be, that’s where you want to be.”
Julian is a retired nurse and former nursing home administrator. She spent four days in the hospital and 13 more in the St. Joseph Rehabilitation unit recovering from a broken leg before her Dec. 28 discharge on Dec. 28 to St. Joseph Home Care, one of three home health agencies available on the North Coast.
In Del Norte County, Sutter Coast Home Health made 6,096 visits and served 433 patients.
Eureka’s St. Joseph Home Health Care served 1,833 people over multiple visits in 2011 while Mad River Community Hospital Home Health Services in Arcata made more than 21,000 visits.
All three are Medicare-covered agencies that offer skilled nursing, physical therapy, occupational therapy, speech therapy, medical social services and home health aides to clients.
“Such services used to be available only at a hospital or doctor’s office,” wrote Medicare’s Far West regional administrator, David Sayen, in a monthly column provided to Area 1 Agency on Aging. “But they’re just as effective, more convenient, and usually less expensive when you get them in your home.”
Getting those services quickly isn’t guaranteed.
“It seems like you keep waiting to hear when you are going home, then all of a sudden, you’re going home tomorrow,” Julian said. “Getting it all together is a bit of a scramble.”
The good news for Del Norte County residents: According to Medicare, Sutter Coast Home Health began timely care for its clients 95 percent of the time, beating the state average by four points, St. Joseph by 11 percent and Mad River by 19 percent.
“When people are coming out of the hospital, or wherever the referral is from, getting a nurse’s eyes on them to see what is going to be needed for a plan of care within 24 to 48 hours is vital,” said Melissa Ford, clinical supervisor with Sutter Coast Home Care. “They can end up right back in the hospital if we are not out there in time.”
Brenda Goosby, registered nurse and director of Mad River Community Hospital Home Health Services, attributed delays to demand and a shortage of home health nurses or physical therapists.
Jeanine Sollom, registered nurse and quality manger for St. Joseph Home Care Network-Humboldt, cited limited resources that required prioritization of care in collaboration with a physician based on the highest level of need.
In contrast, Ford said her staffing situation was good and that the increased demand for physical therapy service might lead to an additional position.
Before home health care begins anywhere, Medicare’s Sayen said a home health agency should explain how much of the bill Medicare will pay.
“The agency should also tell you if any items or services they give aren’t covered by Medicare and how much you’ll have to pay for them. This should be explained by both talking with you and in writing.”
Sayen said home health agencies should provide the Home Health Advance Beneficiary Notice before giving services and supplies uncovered by Medicare.
To be eligible for home health services, Sayen said beneficiaries must be under a doctor’s care and receive services under a plan of care established and regularly reviewed by a physician, who must also certify a need for one or more home health services.
In addition, clients must be certified by a physician as home-bound — meaning unable to leave home because it isn’t recommended or can’t be done without a wheelchair, walker or help from another.
“If you meet the criteria, Medicare pays for covered home health services for as long as you’re eligible and your doctor certifies that you need them,” Sayen wrote.
Round-the-clock care and home-delivered meals aren’t covered. Homemaker services like shopping, cleaning and laundry and personal care such as bathing and dressing are not covered when they are the only care needed or aren’t related to the plan of care, he said.
Skilled nursing services are covered only when given on a part-time or intermittent basis.
Home health isn’t for those who need full-time nursing care — and all home health agencies do not perform equally. As part of its national effort to improve quality and control costs by informing consumers, Medicare tracks and publicly reports the performance of each of its covered agencies on its Home Health Compare website.
To find Home Health Compare, go to: http://www.medicare.gov/HomeHealthCompare/search.aspx.
With a click of the button, the site provides an in-depth look at how St. Joseph Home Care, Mad River Home Health, and Sutter Coast Home Health perform in 21 standards spread throughout five categories: managing daily activities; managing pain and treating symptoms; treating wounds and preventing bed sores; preventing harm; and preventing unplanned hospital care.
“We look at those and see if we are lacking in an area and then we try to be creative to see what we can do to improve that score,” Ford said.
Sutter Coast and St. Joseph met or exceeded the statewide average in 12 of 21 categories; Mad River did so in nine.
The next Gray Matters on June 12 will take a closer look at where Sutter Coast shines in home health and where it’s working to improve.