New Home-Health Model Cuts ER Visits By 24%

July 26, 2016

Giving home-health aides a bigger role in caring for their elderly and disabled clients can help reduce costly ER visits, according to the results of an 18-month pilot program recently completed by the Paraprofessional Health Care Institute.

The Bronx-based home care advocacy group, which received a $1.9 million state grant, trained 14 workers at JASA, Sunnyside Community Services and Cooperative Home Care to be senior aides, salaried office workers who act as educators and liaisons for aides in the field. Independence Care System, a managed long-term care plan that contracts with the three agencies, tracked hospital use by about 1,100 members served during the pilot.

Following their own training, senior aides, who made $28,000 per year, taught workers in the field to help clients adhere to their medication, use mobile software to report signs of deterioration in their condition and set up doctors' appointments. They also discussed with aides when it's appropriate to take a client to the emergency room, and when to use an alternative, such as an urgent care center. The field aides did not receive additional pay for the training.

In 2014, before the pilot started, clients served by the three agencies were taken to the emergency department 760 times. When the program was underway in 2015, the number of emergency department visits dropped by about 24% to 581.

"That's a really big paradigm shift in home care," said Sara Joffe, vice president for organizational learning at PHI. "We have stories of workers saying, 'Whenever my member feels pain, we go to the ER.'"

Each agency participating in the pilot also employed a nurse who was able to provide feedback on any medical issues reported by the aides and consult with a client's physician if necessary.

Unlike the recently-created "advanced home health aide" position, which will allow some aides in New York to administer medicine and perform other tasks under the supervision of a nurse, PHI's model aims to expand the roles of home health aides and offer them a career ladder without the passage of legislation.

Since the state funding ran out, Independence Care System has continued to pay for the model at the agencies that participated in the pilot, because of its potential to generate savings, said Regina Estela, chief operating officer of the managed long-term care plan.

"We saw a moderate decline in hospitalizations and it just didn't feel like we had enough time to test the model fully," Estela said. She added that she did observe improvements in communication between the home care agencies and clinicians as a result of the pilot.

Testing new models will help the home care industry participate in the shift to value-based payments, said Laura Haight, vice president for public policy at the New York State Association of Health Care Providers, which represents home care agencies.

"Through creativity and technology, there are many other things home care aides could be doing to provide value," Haight said. "Our workers have their hands on the patient. They're the ones who can really tell if there are changes happening on a daily basis."

Other pilots are underway to introduce technology into home care, Haight said, but many agencies cannot afford the upfront costs of purchasing tablets and software and offering workers additional training.

"People right now are so stressed just trying to make their weekly payroll" because of low reimbursement rates, Haight said.

PHI is hoping that even without additional funding from the state, more managed long-term care plans will show interest in the senior aide model and choose to help agencies they contract with cover the costs, Joffee said.

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