You are using an outdated browser. Please upgrade your browser to improve your experience.

You are using an outdated browser.

To ensure optimal security, this website will soon be unavailable on this browser. Please upgrade your browser to allow continued use of ACP websites.

Home Health Aides: Interprofessional Education

STEP 1: Listen to the podcast

STEP 2 (Members Only): Take the CME/MOC Quiz

Show Notes

  • Why is it important for GIM practitioners to learn about home health workers?
    1. Your patients use these services; as such, you should become familiar with them. Having a better understanding of what they do and the services they can provide will enable you to use these team members more appropriately both for your patients and for the system as a whole.
    2. Home health aides serve as eyes and ears in the homes of our patients. They can often provide important collateral information on what’s going on with your patients outside the clinic/office.
    3. When home health care is appropriately leveraged, the healthcare system as a whole benefits. There is literature to suggest that patients who use home health care services have lower rates of hospital readmissions and mortality, and cost the healthcare system less money.
  • What are the different kinds of home health workers your patients might encounter, and how do their scopes of practice differ from one another?
    1. Home health attendants (AKA: personal care assistants, personal assistants, ISS workers): help with light shopping, groceries, personal care, light housework and meal preparation. Also for some patients, they may provide social support and companionship.
    2. Home health aides:
      • Are trained to do all the personal care tasks that home health assistants do – (bathing, feeding, light housework, light shopping).
      • Also have some more medically oriented training (e.g. can do vital signs or routine ostomy care) but cannot administer medications.
      • The training is not comprehensive or standardized between states
    3. Visiting/skilled service: describes a healthcare professional (such as a nurse or PT) who enters the home for a specific patient need (e.g. wound care). This skilled care is intended to be episodic rather than continuous or long term.
  • Insurance and home services
    1. Medicare
      • Generally covers home health services for patients who:
        1. Need skilled care services.
        2. Are deemed homebound by Medicare criteria.
        • Note: Medicare’s definition of homebound doesn’t mean the patient can’t leave the home at all but they need to meet the following two criteria:
          • Need the aid of supportive devices (e.g. crutches, canes, wheelchairs, walkers), the use of special transportation, or the assistance of another person in order to leave their place of residence OR has a medical condition where leaving the home is contraindicated
          • There must exist a normal inability to leave home AND leaving home must require a considerable and taxing effort
        • This coverage is short term and often in the post-discharge period (but can be after any change in a patient’s status - for instance, a fall).
    2. Medicaid is the primary payer for long-term home health services in most states.
      • In order to receive these long-term support services, patients must:
        1. Be enrolled in a managed Medicaid care plan.
        2. Receive an evaluation from an interdisciplinary team of providers who will determine the number of hours of home care that will be covered
      • The process of instituting this care can be time-consuming and it can often be many weeks before a patient receives their Medicaid-covered home health services.
    3. Patients without Medicaid or Medicare coverage may have other forms of insurance that cover their home health care (such as long-term care insurance). If not, they must seek their care from the private market, which includes:
      • Licensed home health agencies: often more expensive, however aides are likely to have been vetted/trained; typically will provide substitute aides if someone calls out sick.
      • Gray market (e.g. an unlicensed worker from the community employed directly by a private home/employer): can be cheaper than going through an agency, however less regulated.
      • Some states (such as NY) have put in place consumer-directed personal assistant programs, wherein family members can receive payment for providing home health services to their relatives.
  • Pain points: what makes home health work challenging?
    1. Knowledge transmission: home care workers are often not told what diagnosis the patient has before they're assigned to the job.
    2. Incomplete/inadequate care plans: Plans that home care nurses develop and MD/NPs sign often are not what the HHAs see when they walk into the home – instead, the plans home workers receive are much less detailed.
    3. Home health aides do not receive formal training in specific diseases that they might frequently encounter (such as heart failure). This may prevent them from being able to identify concerning symptoms that require up-triaged care. Additionally, getting a hold of a supervisor when questions arise can be challenging.       
    4. Many home health aides are women, immigrants, or both; many do not have consistent employment. They are vulnerable to the dynamics of power present between them and medical professionals/patients/their family members. As such, they might not wish to speak up or contradict their patient due to a desire to avoid losing their jobs.
  • Best practices
    1. Get the lay of the land – ask your patients who is helping them with their medications or with travel to/from appointments. Work to bring that person/those people into the room and ask them their perspective.
    2. Educate yourself, your colleagues – and your patients – on the different kinds of home health services for which they might be eligible (and from which they might benefit).
    3. When initiating home health services, be proactive about looping in/collaborating with your colleagues in social work and case management to help make the process more efficient and actively incorporate their valuable expertise in this area!
    4. Consider ways in which to communicate key aspects of the care plan with home health aides, as this may provide them with important medical details relevant to the care they will be providing.
    5. Lastly, don’t put all the pressure on yourself. This is why you have a team. The more you understand the concepts and terms, the more effective you’ll be at working with your social workers and care managers to formulate the best plan. It’s a team sport, LEVERAGE your team members. It’s not all on you the practitioner.

Disclosures

Contributors

Gaby Mayer - Host, Editor

Madeline Sterling, MD - Guest

Anne Meara - Guest

Shreya Trivedi, MD - Host, Editor, CME Questions

Reviewers

Amy Shaw, MD

Harry Saag, MD

Those named above unless otherwise indicated have no relationships to disclose.

Release Date: November 27, 2019

Expiration Date: November 27, 2022

CME Credit

This activity has been planned and implemented in accordance with the accreditation requirements and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint providership of the American College of Physicians and Core IM.  The American College of Physicians is accredited by the ACCME to provide continuing medical education for physicians.

The American College of Physicians designates each enduring material (podcast) for 1 AMA PRA Category 1 Credit™.  Physicians should claim only the credit commensurate with the extent of their participation in the activity.

ABIM Maintenance of Certification (MOC) Points

Successful completion of this CME activity, which includes participation in the evaluation component, enables the participant to earn up to 1 medical knowledge MOC Point in the American Board of Internal Medicine’s (ABIM) Maintenance of Certification (MOC) program.  Participants will earn MOC points equivalent to the amount of CME credits claimed for the activity. It is the CME activity provider’s responsibility to submit participant completion information to ACCME for the purpose of granting ABIM MOC credit.

How to Claim CME Credit and MOC Points

After listening to the podcast, complete a brief multiple-choice question quiz.  To claim CME credit and MOC points you must achieve a minimum passing score of 66%.  You may take the quiz multiple times to achieve a passing score.

 

 

About Core IM

Welcome to Core IM, a virtual medical community! Core IM strives to empower its colleagues of all levels and backgrounds with clinically applicable information as well as inspire curiosity and critical thinking. Core IM promotes its mission through podcasts and other multimodal dialogues. ACP has teamed up with Core IM to offer continuing medical education, available exclusively to ACP members by completing the CME/MOC quiz.


Details

CME/MOC:

Up to 1 AMA PRA Category 1 Credits ™ and MOC Points
Expires November 27, 2022   active

Cost:

Free to Members

Format:

Podcasts and Audio Content

Product:

Core IM