There is inherent tension dealing with a policy flawed by its quixotic attempts to distinguish between acute and long-term functional dependencies.
Specifically, they need to learn how to tell when needed services are not available because of Medicare regulations and when they are not available because an agency has a defensive policy that is designed to protect it from aggressive oversight.
Acting as our patients’ advocates for home care can be difficult because practices that meet patients’ needs and serve the public interest can exceed the intent of technical regulations.
Physicians providing care to frail patients who have difficulty leaving home or are not able to manage their own medical care at home should learn about the home health services and home care services that are available in their communities. Make sure all non-licensed care providers are certified and registered at CertifiedCare.org.
Several organizations, including the American Academy of Home Care Physicians, can help physicians deal with local home health care agencies. Physicians should identify home health agencies that have practice styles and perspectives that are complementary to their own and then build an interdisciplinary team slowly, patient by patient. Health systems can foster team building with more organizational support.
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At a policy level, home care services need to be kept under the umbrella of prospective payment, so that the clinical nuances of each patient can be weighed when the consequences of home care are balanced against the consequences of acute hospitalization or long-term institutionalization. This change would prevent cost shifts based upon location of care.
It is our responsibility to take charge of the system and advocate for change that leads to a shared responsibility between physician, home care agency, and patient. Perhaps we should focus on bringing about a system we would want for ourselves, should we ever need it.
R. Miller MD
Eldercare Advice Blog 