Skip to content

Top Challenges In Home Based Health Care Delivery

Top Challenges In Home Based Health Care Delivery
One of the most promising opportunities to lower costs and improve care is to move care delivery to homes. A staggering number of new and established organizations are not just launching but also scaling to move primary, acute, and palliative care to the home. For vulnerable and frail patients, home-based care can delay the need for more expensive care in hospitals or other care facilities.
There are many examples of this. For instance, Independence at Home, a five-year Medicare demonstration to test the effectiveness of home-based primary care showed that all participating programs successfully reduced emergency visits, hospitalizations, and 3—day readmissions for homebound patients. This saved an average of $2800 per beneficiary per year and increased patient and caregiver satisfaction.
There are many opportunities to make care better through home-based care models. Of course, these come with a lot of risks and challenges when adopting them at a broader level. Here are four key obstacles to moving care to the home and possible solutions to overcome these challenges.

1. Patient Preference

As home-based care grows in use and popularity, it is important to note patient preferences for home-based care vs. care in a traditional care facility. A study of older people’s preference for a treatment site shows that about 55% of surveyed participants still prefer treatment for acute illness in a hospital rather than at home.
Many factors drive patient preference for settings other than the home. For some, receiving care at home can be a constant reminder of illness and an invasion of privacy. Previous negative experiences with caregivers or stories of elder abuse and neglect can also affect a patient’s preference for care location. Some patients enjoy the social aspect of seeking care outside the home and interacting with other people. Alternatively, some may be embarrassed about their living situation.
It is important to respect these preferences and not disregard them. Physicians must give information about patients’ needs (which can be different from those of family caregivers) and engage patients in shared decision-making about whether home-based care is the right approach for them. Also, home-based care programs need to have a strong relationship with outpatient facilities, hospitals, and other long-term facilities to accommodate patients’ change of preference and handoffs.

2. Concerns of Clinicians

There are many challenges that can deter clinicians from participating in home-based care. Compared to an office or hospital environment, caring for patients at home requires longer visits and fewer patients for whom a care team may be responsible. Home-based care clinicians can see about 7-9 patients a day. Physicians spend more time understanding and addressing the social and economic conditions that impact health such as remedying medication discrepancies, identifying home safety issues and connecting patients with social services. But they are disadvantaged under traditional fee-for-service models that tie payment to a number of patients seen and procedures performed.
In order for home-based care to scale, payment models have to reward, not penalize clinicians for spending extra time coordinating and managing care. Clinicians should be able to share in the savings achieved from preventing unnecessary hospital and skilled nursing facility stays instead of just being rewarded on a fee-for-service basis. It is not a surprise that a surge of growth in home-based care has come from health systems that work under fully-capitated or other risk-based contracts. Payers also need to remove restrictions on the technologies like remote patient monitoring, telehealth and equipment eligible for reimbursement.
One other challenge is clinician safety. Clinicians are not inclined to visit homes in areas with higher crime rates, which makes it difficult to embed home-based care programs in some underserved areas. If clinicians are to be attracted to home-based care, then measures to ensure their safety are needed.
A final challenge is medical training. Medical schools and residency programs need to prepare the next generation of physicians for the shift from hospital to home by integrating home-based care into the curriculum. Some programs are already taking this step, like the house-call curriculum for internal medicine residents at the Johns Hopkins University School of Medicine. It increased the residents’ knowledge, attitudes and skills relevant to home-based care. Such programs are helpful in bridging the gap in medical education about caring for vulnerable patients at home.
Medical Training

3. Supporting Infrastructure

The lack of supporting infrastructure including life-sustaining and assistive durable medical equipment (DME), makes it difficult to manage patients’ acute care needs at home. The lack of availability of DME is because of the competitive bidding policy of the Centers of Medicare and Medicaid Services (CMS), which prompted a 45% decline in DME companies between 2013 and 2017. These included the companies that supply home oxygen to 1.5 million Americans. Competitive bidding forced the companies to compete for contracts and further lower reimbursement rates, biasing bids towards lower cost and lower quality equipment.
For patients to remain independent at home, payment models have to incentivize DME companies to improve service and produce high-quality equipment. DME such as oxygen or nebulizers have to be delivered to patients within hours. Payment models can perhaps reward companies for speed and reliability.
Patients who are receiving less acute home-based care need help with caring for themselves including bathing, dressing, cooking, toilet-going and moving about safely in order to remain independent and safe at home. Usually, insurance programs do not cover support services to help people hire such care. Health systems and payers have to work together to bring patients more in-home support services.
To fully support patients at home, an ecosystem of care needs to be available. For example, CareMore has a network of vendors to cater to different demands of home-based care delivery systems such as mobile labs, mobile radiology and medication delivery. Such supports are necessary for home-based care to meet the patients’ needs.

4. Patient Safety

There are specific risks to patient safety in the home setting such as environmental hazards, infection control, sanitation, physical layout, challenges with caregiver communications and handoffs, lack of education and training for patients and family caregivers, difficulty in balancing patient autonomy and risk, managing different needs of a patient receiving home-based care and lack of continuous health monitoring.
It is critical to continuously assess and mitigate the risks when moving care to the home. There have to be clear inclusion and exclusion criteria to assess the suitability of a home-based solution. Safety is an important element to consider in each patient interaction – in the type of medical equipment and supplies used at home, the communication tools for home-based care teams, and the education of patients, family caregivers, and home-based care professionals. These considerations should be integrated into clinical care.
On a systems level, there has to be a consistent standard for measuring safety at home and mechanisms for sharing data and health updates across health care organizations. This is where Hucu.ai can be a game-changer for the home-based care industry.
Hucu.ai is a HIPAA-compliant healthcare communication application. Home-care teams are dispersed and use Hucu.ai to communicate in real-time, instantly and remotely. When home-care team members use Hucu.ai to communicate med lists, patient history, schedule needs and other relevant information, they are better able to serve customers. When caring for post-acute patients who are vulnerable and frail, home care team members feel much more confident as they have instant team support via Hucu.ai to help them make quicker decisions.
Hucu.ai supports interprofessional collaboration in healthcare and also connects a patient’s family and care providers. With video conferencing features and family chat channels, Hucu.ai can help them stay up to date with their loved ones’ health status. Hucu.ai offers a virtual infrastructure to support better communication and thus, better quality of care and safety for patients at home.
Hucu.ai is one of the best hospital communication apps out there.
For home-based care to thrive, the fee-for-service model needs to be deconstructed and shifted towards value-based arrangements that reward health systems for moving care back to the home. This move requires aligning the incentives for all stakeholders, including payers and physicians, and implementing risk-based contracts to address the lost revenue from hospitalizations. Adjusting the payment and regulatory environment in which health care delivery organizations operate will be critical to the success and growth of home-based care.
Get Ready To Transform Your Organization For Value Based Care.

Subscribe to our monthly newsletter