Merrily Orsini's Thought Leadership

Part 3: Shifting Perspectives and Steps Toward Lasting Change

home care perspectiveInsights from the Future of Home Health Care: IOM-NRC Forum on Aging, Disability and Independence Workshop

(Written by Merrily Orsini. Reposted with permission from Axxess.)

It makes perfect sense that looking at something from a different angle makes you see it in a different way. And, when you see something in another way, you think and act in new ways. This type of perspective shift is required to produce real, lasting change.

In his closing comments recapping the two-day workshop on the future of home health care, George Taler, MD, said: “Stop thinking of us (in-home care providers) as small fish in a large pond; and start thinking of us as the oxygen in the tank.” Now there’s a perspective shift. Air is a necessity, and in today’s evolving health care environment, home care is as well. In-home care is possible, attainable and preferred by most people. In fact, a high percentage of people, when surveyed, select care at home as the preferred option.

So, if this industry is the air that healthcare needs to survive and thrive, what are the possibilities for the future and how can we get there? The first step is to identify societal needs and put great minds to work at a national policy level on emerging issues. As part of funding the Future of Home Health Study, Axxess facilitated an important first step by sponsoring this gathering of diverse interests to discuss ways to solve high-level healthcare delivery issues. Policy changes when momentum reaches a critical point; and thought processes in health care circles are starting to shift toward long-term support at home.

Technology will continue to play an increasingly crucial role in the future of the healthcare delivery system. First, technology harnesses the power of the entire care team, including the patient, to communicate and share data. Technology helps monitor and manage patients in more efficient and cost-effective ways, as is the case with telehealth. Headway is being made toward the adoption of interoperability standards so systems can “talk” to one another. While licensure varies from state to state, and presents a barrier to some technology usage, just getting this item on the list and looking at ways to solve this issue, is another important step.

As we start to think about health care delivery in a different way, we will start to educate future “deliverers” in different ways. Perhaps we will add inter-professional care as a component to educating health care workers with an emphasis on in-home care. The scarcity of workers to provide the care needed as the population ages is an issue not easily addressed. However, we can start by offering better training for today’s workforce; and continue to look at ways that technology can help meet care needs when a person’s physical presence is not necessary.

It will also be necessary to adopt a common language in order to communicate feedback and care plans in a meaningful way to patients and other care providers. At its most basic level, “frailty” must have a common definition. Along with thinking of frailty as a determinant for care, comes a focus on function instead of just a disease state. Adding in exercise and wellness as a prescription given to people who need care, or who are predisposed to chronic diseases due to lifestyle, is one way to get society moving and eating better so we are all involved in the health of our population.

There are many current innovative projects and payment model options, and a growing recognition that payment models must change so that value and quality are the key to reimbursement, not just episodes or visits.  We are seeing more responsibilities being allowed to the nurse practitioners, and that responsibility needs to expand so there is not a bottleneck caused by physician shortages. Lastly, moving to true coordination of care is desperately needed. We must change thinking to the concept that the home is a place to be healthy and safe; and allow health care to be delivered there efficiently and effectively.

Home-centered care can be the “oxygen in the tank” for our future; but we must all be willing to give up some turf, look at how to better accomplish what we are currently providing, and be open to change. Change is upon us in the home health world, and more is to come. Let us be masters of our fate to help decide how best to solve the complex issues surrounding the services we provide daily.

To see the presentations from this two-day workshop, log onto the IOM site.