The Myths of Health Care at Home

Most patients would prefer to receive care at home instead of in an institution. But home health service, according to some professional observers, is the victim of misinformation.

Writing on KevinMD.com, Dr. Michael Fleming, former president of the American Academy of Family Physicians and chief medical officer of a home health and hospice service, says “Most primary care physicians have yet to adequately recognize, understand and appreciate the role that health care brought directly to the home can play.”

Fleming has identified six major myths about health care at home that he hopes to dispel.

1. Myth: Health care at home offers no clinical advantages over a hospital, nursing home or assisted-living facility.

Reality: Health care at home can improve patient outcomes. It can lower the risk of infection, promote patients’ ability and willingness to follow medical advice and ultimately enable them to live longer, healthier, higher-quality lives.

If you can manage a chronic disease at home, you often can prevent many of the complications that lead to costly emergency room visits and avoidable hospital admissions. Home health care is one-on-one, and that focused attention has rewards you can’t really measure. But how often have you felt rushed during a doctor’s office appointment, or hospital visit? That doesn’t happen at home.

“People receiving health care at home,” Fleming writes, “may eventually move better, eat better, breathe better, and suffer less pain.”

2. Myth: Health care at home rarely saves on health-care costs.

Reality: Health care at home can shorten the length of a hospital stay, lower readmissions (having to return to the hospital within 30 days of being discharged) and cut emergency-room visits, all of which reduce overall health-care costs, sometimes by a lot. The U.S. Census Bureau reported that receiving health care at home cost half as much as hospital care, even if the hospital stay averaged only five days and the care received at home was for 120 days. The hospital cost: $10,043 ($1,853 per day); the home care cost: $5,706 ($48 per day).

3. Myth: Health care at home typically provides little more than a custodial service.

Reality: If you and your loved ones choose the right home health-care provider, you will receive care that comes from several medical specialties that offer different treatments for different situations. The best home health-care professionals often are more directly involved in patient care than those in a medical facility.

4. Myth: Health care at home generally is well-coordinated with hospitals, with proper protocols in place.

Reality: Only about 20% of health care is what’s known as “integrated” or “coordinated.” That means all providers for a patient know and understand the diagnoses, recommendations and treatments of all of the others. But most health care is fragmented, especially during and immediately after the crucial transition from hospital to home. (See Patrick’s newsletter, “You Can Go Home Again (from the Hospital), But There’s a Lot You Need to Know First.”)

Proper care calls for all the health-care professionals involved – primary care physicians particularly, but also nurses, therapists and social workers – to be fully aware at any given time of which diagnoses are made, which tests administered and which medications taken to collaborate efficiently. Ideally, the hospital physician contacts the post-acute care physician, who’s responsible for the patient, preferably in advance of discharge. It doesn’t happen often enough, so if you can receive care at home and avoid the hospital altogether, you should. If you require hospital care, you and your loved ones must discuss with members of your care team how you and they plan to prevent recurring problems.

5. Myth: People who staff home health care generally are unskilled aides.

Reality: Again, if you retain the right caregivers, they will be highly trained clinicians if that’s the kind of care you need. They will be nurses, nurse practitioners, physicians’ assistants, physical therapists, pharmacists, speech therapists and social workers who routinely are deployed to home settings to do what they do, all the while serving as eyes and ears for the primary care physician.

6. Myth: Health care at home plays little or no part in driving down preventable hospital readmissions.

Reality: The No. 1 strategy that hospitals adopt to lower preventable readmissions is to partner with home health-care agencies. Fleming’s information in this regard comes from a survey conducted by HealthLeaders Media Intelligence Unit.

To find the right home health-care services for your needs, consult the website of the National Association for Home Care & Hospice. It’s s a nonprofit organization that represents 33,000 home care and hospice organizations and advocates for the caregivers employed by them.

Also, consult the Mayo Clinic website, which has a list of questions you should ask potential home caregivers.

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