Optimizing Home Health to Ensure Appropriate Service and Efficiency

By: Nicole Usher, Sr. Director of Operations, Apricus, an Enlyte company

Home health services play a vital role in aiding the recovery of injured employees who cannot independently care for themselves or need ongoing medical treatment after being discharged from the hospital. Understanding these considerations ensures a streamlined and effective approach to home health care for optimal recovery.

Asking the right questions is key to providing effective home health services for injured employees. Factors like medical complexity, physical constraints and mental needs are crucial in determining the appropriate level of service, impacting both recovery and financial outcomes. To assess the level and type of service needed, work with the treating physician to evaluate your options: 

• LPNs for Skilled Home Nursing Instead of RNs

The state-determined scope of practice differs between registered nurses (RNs) and licensed practical nurses (LPNs). While RNs typically have expanded duties, both RNs and LPNs share similar roles like checking vital signs, completing medical treatments and medication administration. Notably, the cost associated with an LPN is usually significantly lower than care provided by an RN.

• Home Health Aide Care Instead of Nurses

Home health aides assist with daily tasks such as getting out of bed, eating, bathing and dressing. When non-medical services are needed, a home health aide can offer cost-effective care without compromising the quality of service provided to the injured employee.

• Companions and Homemakers Instead of Medical Staff

If an injured employee’s needs are primarily supervision or assistance with household chores, a companion or homemaker might offer the required level of service to ensure the injured employee’s comfort and safety. Without the necessity for medical or physical care, companions and homemakers can provide essential assistance at a more cost-effective rate than nurses or home health aides.

• DME to Decrease Reliance on Home Health Care Providers

Employing durable medical equipment (DME) can notably decrease the need for home health services. Specialty rehabilitation equipment like lift systems and chairs, traction equipment, specialty beds and motorized wheelchairs can assist injured employees thereby minimizing the need for multiple care providers in the home.

It’s common for various home health services to be ordered upon hospital discharge, but over time, the specialty service provider may consult with the treating physician and case manager to see whether the number of care providers or the caregiver skill level can be reduced which can help save significant costs.

Determining the appropriate level of care can be complicated, but working with a Specialty Care Coordinator can simplify the process by providing clinical oversight and cost-saving recommendations to the physician’s order. A knowledgeable care coordinator will work collaboratively with examiners, case managers and discharge planners to develop a customized assessment and individualized action plan for optimum injured employee care. 

Evaluation Factors to Consider 

To evaluate the effectiveness of your home health services program, ask these four questions:

1. Has a comprehensive treatment plan been established, outlining specific goals?
   A physician-prescribed plan of care is crucial for conveying the injured employee’s medical condition, the anticipated treatment plan and any necessary precautions. It should undergo regular review and updates with care professionals to reflect the injured employee’s progress or potential setbacks.
2. Do the services aim to enhance the injured employee’s condition and increase their level of independence?
   The treatment goal is to improve health and function, but prolonged home health services beyond necessity may hinder an injured employee’s motivation for self-care, leading to increased dependency instead of fostering recovery.
3. Are service providers reputable?
   The services given to an injured employee should come from care professionals with strong moral and ethical standards. Injured employees should feel assured that the providers entering their home have been thoroughly screened, well-managed and adhere to high-quality standards.
4. Is the injured employee, along with caregivers, receiving education and training?
   A goal of home health is to promote independence through ongoing education and training for both injured employees and their caregivers. Proper training in medication administration and durable medical equipment (DME) use reduces complications and enhances overall independence.

Home health coordination programs offer a range of benefits, from scheduling services to streamlining patient care. At Apricus, we increase care efficiency and overall program savings by partnering with highly skilled home health care professionals that understand the complexities of workers’ compensation cases. Whether the injured employee requires simple or complex home health, we leverage a strong national network of credentialed home health care providers to coordinate excellent care, in a timely and compassionate manner.

About the Author

Nicole Usher has 17 years of experience in the workers’ comp industry and has held multiple leadership positions including roles in finance, quality, and operations. With a longstanding knowledge of quality service delivery, she instills these values within her team, partners, and clients. As an operational leader, Nicole promotes innovative ways to provide superior client experiences that adhere to the complex nature of the industry, state regulations, and the needs of claims professionals.

Nicole is also a regular contributor to our Specialty Solutions Spotlight where portions of this article originally appeared. To ask and find the answers to more work comp specialty questions visit our website and subscribe to our monthly series. 

www.apricusinc.com

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