One of the most disruptive trends in health care today is the shift away from hospital care to care in the community. In other words, patients are spending less time confined to a hospital, and spending more time recovering at home, where they are generally more comfortable. However, the shift away from hospital-based care doesn’t mean that patients need less care or help after discharge. In fact, if anything, caring for patients who have left the hospital sooner is more complex than ever before, underscoring the importance of comprehensive discharge planning, skilled nursing care, and home health care services.
So then, what’s the problem? Many patients don’t want help from home health professionals, or anyone for that matter, after they leave the hospital. At least, that is the finding of a new report from Alliance for Home Health Quality and Innovation and the United Hospital Fund (UHF). In the report, “I Can Take Care of Myself! Patients’ Refusals of Home Health Care Services,” researchers discovered that about 30 percent of the patients in the study sample (495 patients who were offered home health services upon discharge from New York and Philadelphia hospitals) refused care — and were twice as likely to be readmitted to the hospital than patients who utilized home health care services.
The report mentions several other studies that support the claim that home health care services reduces hospital readmissions and improves outcomes and overall quality of life. Despite the statistics, though, patients still refuse help after discharge. So, how can home health agencies help convince patients to accept this necessary help?
Why Patients Refuse Home Care
The reasons that patients refuse home health care services are as varied as the patients and their conditions themselves. That being said, they generally fall into a few general categories.
Age/Condition: Researchers have found that the patients who refuse homecare services tend to be younger, and have fewer chronic conditions or less complex medical needs. Often, it’s the patients who have been hospitalized for the first time, or who have not had any major difficulties at home up until this point who refuse care. These are the classic “I can take care of myself” patients, who don’t think they need help.
Fears about the service: Some patients refuse home health because they don’t understand what the services actually are, or how they will benefit from them. In some cases, concerns about an invasion of privacy, security, and safety keep people from using home health services.
Payment concerns: Some patients aren’t sure how they will pay for home health services, or are concerned about their ability to make insurance co-payments. Confusion about what Medicare covers, and rigid, complex regulations about how to qualify for services can prevent patients from accessing the help they need.
Availability of family caregivers: Finally, many patients refuse home health because they have family caregivers available to help them. Often, family caregivers don’t understand the benefits of home health themselves, and refuse services on behalf of their loved ones. Or, a patient may refuse because he or she is more comfortable with a loved one.
Regardless of the reasons for refusal, the outcome is often a return to the hospital or diminished quality of life. It’s up to providers and HHAs to better educate patients, then to convince them to use these vital services.
Convincing Reluctant Patients
While the AHHQI report recommends additional research into home health refusals, including learning more about how hospitals make referrals for home health, the researchers did have some recommendations for increasing the likelihood that patients will accept home health care. Chief among the recommendations is an improvement in communication, both on behalf of the hospital and home health agencies.
Hospital case managers and providers need to coordinate with patients and family members in more depth to uncover challenges to care at home and identify the areas of need, while also more fully explaining the benefits of home health care. Better communication about the availability of services and payment structures is also necessary, to help prevent cost from becoming a factor in decision-making.
Home health agencies can also do their part to help convince patients to use their services. Some of this work is already underway, as the new Medicare Conditions of Participation include more comprehensive care coordination and written care plans that specifically outline visit schedules and the care that will be provided. When developing care plans with patients and their families, emphasize your commitment to communication and the software tools you use to manage care and keep families in the loop, and how billing is managed.
It’s likely that there will always be patients who refuse home health services upon discharge from the hospital. However, if agencies and hospital care coordinators work more closely together to inform patients of the benefits of home care and help develop a workable plan, that number will decrease.
To learn more about software solutions that can improve communication and care management for your agency, click here to see Complia Health’s family of products.
