In the News

After Hospital Discharge, Slow Home Health Care Initiation Increases Risk of Rehospitalization

American Journal of Managed Care / By Jared Kaltwasser

Patients discharged from the hospital are at a higher risk of rehospitalization if they experience a delay in postdischarge home health care initiation, according to a new study.

The study, published in Journal of the American Medical Directors Association, shows the risk of a rehospitalization or emergency department (ED) visit jumps by 12% when patients wait more than 2 days for their at-home care to start.

More than 6 million Americans receive home health care each year, noted the study’s authors. In many cases, those home visits follow discharge from a hospital. Home health care providers can perform a range of services, including clinical assessments, wound management, and medication reconciliation, the authors said. Previous research shows that home health care visits following hospitalization can reduce the risk of readmission, especially for certain conditions, such as sepsis and heart failure.

CMS requires that initial at-home patient visits take place within 48 hours of referral or of the patient’s return home, unless otherwise stated by the patient’s physician. However, the investigators said no study has yet looked at whether the timing of such visits has an impact on patient outcomes.

They decided to examine the records of an urban home health care agency in the northeastern United States in order to see whether the agency’s success or failure in initiating care within 48 hours had a meaningful impact on patient outcomes.

The investigators analyzed a data set of 49,141 home health care visits received by 45,390 patients who were discharged from the hospital during 2019 and referred for at-home follow-up. They compared the timing of home health care initiation with 30-day hospitalizations and ED visits to see whether the timing affected outcomes and whether there were any disparities based on factors such as race/ethnicity, age, insurance type, and clinical status.

In total, about one-third of initial home health care episodes in the data set were delayed, meaning they did not happen within 48 hours. Previous research by the present study’s authors suggest that patients not answering the door or postponing visits were among the most common reasons for such delays.

Of those 34% of cases in which care was delayed, 14% of those delays resulted in a rehospitalization or ED visit within 30 days. And that translated into a 12% higher risk of rehospitalization or ED visit for patients whose home health care was not started within 2 days vs those who received timely initiation of home services.

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Guideline for Prescribing Opioids for Pain

Centers for Disease Control and Prevention

Pain affects the lives of millions of Americans every day and improving pain care and the lives of patients with pain is a public health imperative. The Centers for Disease Control and Prevention (CDC) is releasing updated and expanded recommendations for clinicians providing pain care for adult outpatients with short- and long-term pain. These clinical recommendations, published in the CDC Clinical Practice Guideline for Prescribing Opioids for Pain, will help clinicians work with their patients to ensure the safest and most effective pain care is provided. The publication updates and replaces the CDC Guideline for Prescribing Opioids for Chronic Pain released in 2016.

“Patients with pain should receive compassionate, safe, and effective pain care. We want clinicians and patients to have the information they need to weigh the benefits of different approaches to pain care, with the goal of helping people reduce their pain and improve their quality of life,” said Christopher M. Jones, PharmD, DrPH, MPH, Acting Director of CDC’s National Center for Injury Prevention and Control.

The 2022 Clinical Practice Guideline addresses the following areas: 1) determining whether to initiate opioids for pain, 2) selecting opioids and determining opioid dosages, 3) deciding duration of initial opioid prescription and conducting follow-up, and 4) assessing risk and addressing potential harms of opioid use.  The Clinical Practice Guideline supports the primary prevention pillar of the HHS Overdose Prevention Strategy – supporting the development and promotion of evidence-based treatments to effectively manage pain.

The guideline is a clinical tool to improve communication between clinicians and patients and empower them to make informed decisions about safe and effective pain care. The recommendations are voluntary and provide flexibility to clinicians and patients to support individualized, patient-centered care. They should not be used as an inflexible, one-size-fits-all policy or law or applied as a rigid standard of care or to replace clinical judgement about personalized treatment.

CDC followed a rigorous scientific process using the best available evidence and expert consultation to develop the 2022 Clinical Practice Guideline. An independent federal advisory committee, four peer reviewers, and members of the public reviewed the draft updated guideline, and CDC revised it in response to this feedback to foster a collaborative and transparent process. CDC also engaged with patients with pain, caregivers, and clinicians to gain insights and gather feedback from people directly impacted by the guideline. The expanded guideline aims to ensure equitable access to effective, informed, individualized, and safe pain care.

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RAISE Act Council Offers National Caregiver Support Strategy 

A 102-page report marks the RAISE Act Family Caregiving Advisory Council’s September completion of the first-of-its-kind National Strategy to Support Family Caregivers. The product of extensive deliberation and analysis of expert contributions, the report includes substantial background information on the current landscape of family caregiving, as well as many proposed federal, state and local actions in support of caregivers. The proposals are organized under five major goals: 

  • Improved awareness of and outreach to family caregivers; 
  • Inclusion of family caregivers in the care team; 
  • Services and supports for family caregivers; 
  • Financial and employment protections; and 
  • Data, research, and best practices.  

The ACL website provides access to the entire document and supporting materials. Comments from the public are encouraged through the deadline of November 30. 

Publication of the national strategy has been met by enthusiastic reactions across the caregiving spectrum, including the Family Caregiver Alliance (FCA). “We share the authors’ hope,” FCA stated, “that as the Strategy is implemented—and as the nation more fully comes to understand and respond to the challenges faced by family caregivers—society will embrace the cultural and policy shifts necessary to support them. As a result, over time, lawmakers likely will be called upon to propose legislative changes to better support family caregivers. This is a historic moment for family caregiving because, as the Strategy introduction states, ‘This is the first time that ideas from local and state agencies and nonprofit organizations are integrated with recommendations for the federal government in a combined initiative dedicated to family caregiving. The development of these lists also represents the first time that agencies across the federal government have formally worked together to coordinate family caregiver support planning.’”

 

President's Message

Posted: November 15, 2022

Recently, an APTA member brought to my attention that a large health system eliminated all of its home health rehab management staff, stating that “industry standard” dictated this change, and that they were “no longer qualified” to hold management positions. As President of APTA Home Health, I couldn’t disagree with this more! Our members, and physical therapists in general, are well qualified to lead in many practice arenas. I know of several Academy members who are successful agency owners and agency leaders! Furthermore, it is well within our scope of practice and education to lead others. In this reimbursement environment, I feel that it is key that rehabilitation professionals are led by other rehabilitation professionals who understand and have experience with the detailed clinical and documentation requirements of rehabilitation in home health. Quite simply, most nurse managers and business professionals don’t have a deep enough understanding of these requirements.

I challenge each of you, and your agencies and employers, to promote physical therapists as leaders and managers. It is vital to the success of our profession, and it is vital to the success of our employers!

Sincerely,

Phil Goldsmith
President
APTA Home Health

 

2023 APTA Home Health Award Nominations

The APTA Home Health Awards are presented annually to deserving individuals, recognized by peers and colleagues, at the Home Health Business Meeting during APTA's annual Combined Sections Meeting in February.

The Academy is now accepting nominations for the following awards through December 16, 2022. Please take a moment and consider an impactful individual to the home health practice worthy of recognition. 

  • President’s Award: Recognizes a Home Health Academy member who has provided notable service to the Academy.

  • Emerging Leader in APTA Home Health: Recognizes and honors one Physical Therapist or Physical Therapist Assistant who has demonstrated extraordinary service and clinical passion early in his or her home health career. The individual should have made exceptional overall accomplishments and contributions to the APTA and/or the Home Health Academy mission and vision, and to the physical therapy profession to advance quality and evidenced‐based care in the home.

  • Excellence in Home Health Clinical Practice Award: Recognizes a physical therapist or physical therapist assistant for outstanding clinical practice in a home health care setting.

  • Excellence in Home Health Leadership Award: Recognizes the exceptional contribution of an APTA Home Health member in promoting home health physical therapy practice.

  • Dr. Carol Zehnacker Friend of the Academy Award: Acknowledges an individual, group or organization that has made an enduring contribution to the home health industry and that has been an advocate of the profession of physical therapy in the home, as is relates to clinical practice and/or regulations. This award is dedicated to the late Dr. Carol Zehnacker who passed away in November 2021. Dr. Zehnacker was a physical therapist and a member of the APTA for 56 years. She served our profession in many ways at both the state and national levels as a leader, mentor, and advocate. She served as the Federal Affairs Liaison and Government Affairs Committee Chair for the Home Health Academy. In this role she advocated fiercely against administrative burden and regulations that hamper PTs ability to provide quality care. 

  • Preceptor Award: Acknowledges an individual that has been chosen by their agency/company to be a preceptor. This therapist demonstrates the unique qualities, high standards and clinical skills that are exemplary. They are organized and able to teach processes and procedures to newly hired staff, molding them into confident and talented home care clinicians.

To view awards criteria and to submit a nomination, click here

 
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