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Prakash Chandran (Host): So today we're going to be talking about home care, and the many services that visiting nurses have to offer, and there's actually also compelling evidence that when done properly, at home treatment can be safer and more effective than traditional hospital care. So here to do discuss is Marcia Feldman, the Assistant Vice President of Home Care at South County Health.

Marcia: Well home care is an interesting statement. Home care comprises of an enormous amount of different services provided in a patient's home. So in our environment, a home health agency such as ours, South County Home Health, provides skilled care, meaning care that can only be provided by nurses, physical therapists, occupational therapists, social worker, nutritionists, but there always has to be a skilled need for that care. You also have a service of home care which supports individuals that require housekeeping assistance, cleaning assistance, and supports with activities of daily living. Wounds, medication management, care after surgery, a stroke, an illness, maternal child healthcare. Those are skilled needs, and so there is a big difference.

The other difference that people should be aware of is all home care provided by nurses are considered visiting nurse care, regardless of the name that they have within the community. So South County Home Health is indeed just like your old-fashioned visiting nurse agency, but we have an extremely large array of services that we offer.

Prakash: I see. And I've also heard the term- you talked about the visiting nurse services. I've also heard the term home health before. Is that the same thing as home care? How do you delineate the two?

Marcia: Most of- many of the agencies, I should say, that talk about home care, are actually doing non-skilled services. Home health care is specifically doing services that require a skill. As I said, the wound care, medication management, post-op care, stroke, illnesses, childbirth.

Prakash: Okay, I got it. And tell me a little bit about how it works. Is it typically just one skilled nurse that shows up or staff member that visits? How- what can we expect?

Marcia: So a referral will come to a home health agency, such as ours, either from a hospital, such as our own South County Hospital, or Westerly Hospital, or any other hospital in the state. It will come from a rehab facility or a skilled nursing facility. It will come from a doctor's office. Sometimes patients or families will be in their primary care physician's office, and they'll be talking about some challenges that they have, and that physician can also generate a referral to a home health agency in order for us to go out and take a look at the environment, and see why somebody might be having some different struggles. Perhaps they're having frequent falls, perhaps they're having issues managing their medications, and so there's a lot of reasons why we might be called in.

Now what will happen is that a referral will come into our organization, and we will determine based on the referral if the individual is going to be seen first by a nurse or a physical therapist. Those are the two individuals typically that will go in for the first visit. They will determine with the patient based on the needs of the patient and the request of the physician what the care plan will be. What's the care going forward will be required to help that particular individual get to their optimum state of health and wellness?

So it might be a nurse goes in today, but in reality, all the needs really are physical therapy and occupational therapy. Or the physical therapist goes in today and determines that the majority of the needs are basically going to be nursing needs. And so they will create that plan of care in coordination with the family, and any other family representative, and based on the request of the physician. And they might go in three or four times, or they might go in three, or four, or six weeks, again depending on the individual circumstances of the patient.

Prakash: Okay, and you know, I feel like a lot of us might believe that the term 'home health,' or 'home care,' or these services are meant for senior citizens, but it seems like that's not the case. Like for example, could a younger athlete consider this option as well after an injury?

Marcia: That truly depends. The majority of our insurers require that an individual be what we call homebound. And I don't want the listeners to get nervous and think that means that they're locked in their houses. That's not what homebound means. But homebound means that it takes a tremendously difficult effort to leave the home for a short period of time. Meaning maybe it's something that's only going to be for two weeks, such as a hip replacement or a knee replacement. But that is one of the big caveats.

Now it doesn't mean that they can't go out to their doctor's appointment, it doesn't mean that they can't go out of the home for religious services, or to join a family for a family gathering, but it does mean that they're not leaving the house without the assistance of a device, or multiple people to assist them, and that it's not something they're doing on a regular basis. They can't be going out to lunch every afternoon and consider it homebound, but if their grandchild or child or niece or nephew is graduating and they want to go to the family celebration, they absolutely can do that and still be considered homebound.

Prakash: Right. So I was going to ask you about the difference between outpatient therapy and home care, but it seems like that is the major difference, is that if you are homebound, then you would not be eligible for outpatient therapy. So that is the key difference, isn't it?

Marcia: Correct. Correct, and you know, the goal is always- when you're talking about outpatient therapy, and you're talking about any other therapies, we're basically talking about the realm of physical therapy and rehab medicine. So what we're talking about there is somebody that perhaps has started out needing home care and has graduated, and graduating to an environment where the goal is always to have people cared for in the least restrictive area.

So as they graduate through what we could be doing with them in the home, perhaps they're now able to get out a little bit more, and to take advantage of some of the equipment that we clearly can't bring to them. There's a lot of things we can do in the home without equipment, but at some point many, many patients graduate, and then they're going to a more outpatient environment. I mean, does that help you?

Prakash: So let's talk about the environment. What type of environment is conducive to proper home health? And I'm sure it depends on obviously the type of treatment. But for example, my grandmother-in-law lives in a small one-bedroom.

Marcia: We provide care wherever our patient population lives. We are very creative. Home health nurses and therapists need to be very, very creative. We have provided care in hotel rooms, we have provided care in trailers, mobile homes. Wherever our patients reside is where we go. So it's not really limited by where somebody is at that given moment. If they need our services, we figure out a way to bring the service to them regardless of where they are.

And you mentioned whether or not somebody has pets, and our only request is that whatever pets you have in the home, if it's possible that they get put into another- if it's possible, that they get put into another room. Simply because if you're paying attention to your pet, it might be difficult for you to pay attention to the treatment that you need. It's awkward sometimes to take care of a wound when somebody has got their cat crawling on them. It doesn't make for a good hygienic home care experience.

Prakash: Yeah, that seems to make a lot of sense. You know, I think so many of us didn't realize- or we don't realize how flexible it is. So I guess the question is, is this typically covered by insurance?

Marcia: I would say 98% of what we do is covered by different insurances. And we're very careful. When a patient is referred to us, one of the first things we do is check. We don't want somebody to be caught with a surprise at the end, so we want them to know at the very beginning if perhaps their insurance has a co-pay, or if they need to meet a deductible. But for the vast majority of people, it is a covered service.

You know, we all like to complain about healthcare, and we all like to complain about our health insurance, but really and truly it does provide us with the opportunity in most cases to receive the care we need in the best possible environment. Do you have patients- we're very, very fortunate here at South County. We have patients that are able to go through a continuum of care. So perhaps they've been in their physician's office and referred to us. We are taking care of them, but we determine that they need something a little bit more, we refer them back to their physician. Maybe at that point they need to come into the hospital for the care that they require, and then come right back home with a home care service, or maybe have to make a brief stay in rehab before they circle back out and have home care come into the home, again, to help them through that continuum and get them to their highest level of wellness, which is different for everybody. Your highest level of wellness might be much different than where I can be, and that might be much different than where my ninety-one-year-old mom can get to.

Prakash: Yeah, that makes a lot of sense. So my question is, is this something that patients should be bringing up themselves saying, "I want to have home care be a consideration in my care"? What do you recommend that patients do to receive the proper care in the right environment?

Marcia: I do believe that patients have the opportunity to be their best advocate. So I think that patients that find themselves- and in this particular situation, whereas we're talking about older patients, but it could be that post-op patient, that younger post-op patient as well. If a referral is being made for them to perhaps go to rehab, and they would prefer to be at home, I think they need to speak up and advocate for themselves and say, "Can home care take care of this situation?"

We can have an intravenous going with antibiotics in the home, people don't have to be in the hospital for that, nor do they have to be in a rehab or a skilled nursing facility for that level of care. We can do that at home. We can have drain if that's what's needed with somebody in the post-op wound. We can do all of that with individuals and have them be at home where they're most comfortable surrounded by the people that care about them.

And we cover people- we're lucky. We are very lucky. Our patients range in age from forty-eight hours old, and our oldest patient right now is 101. She's just celebrating 101 years. So literally we have the ability in our organization at South County Home Health to span the entire lifespan, which is really truly very fortunate for our community.

Prakash: That is truly incredible to be around not only the people that you love, but it even sounds like the animals that you love. It seems like you are extremely flexible with the home care that you can provide. And so this has been super informative.

Marcia: We try.

Prakash: Is there anything else that we didn't cover that you'd like us to know?

Marcia: I think I'd want people to know that we care for a diverse group of people with a very, very diverse group of medical concerns- medical and rehab concerns. We work with patients that have chronic diseases, young and old. The newly diagnosed diabetic who's struggling at twenty-eight or thirty years old, we can come out and work with them, and help them learn how to manage their disease better. We work on rehab. Our therapy staff works with Parkinson’s patients, with individuals having swallowing difficulty, perhaps as a result of a cancer diagnosis. We work with individuals with low vision for whatever reason, and vestibular therapy. One of the things that you hear about is people that have serious problems with dizziness that make them not able to truly function or to get around. And we can work with those individuals in their home to help them get those situations under control so that they can lead a better life. We work with wounds, we work with the new ostomy patients, we have a palliative care program for individuals that have- need specialized care minimizing the symptoms that come with serious illness. One of our great new programs is telemedicine where we give to patients that need it the ability to take their own vital signs - their weight, their blood pressure, their pulse, the amount of oxygen circulating in their blood - and it transmits wirelessly to our nurse here in the office, and we can make recommendations, contact physicians, prevent patients from needing to go to the hospital by being able to monitor them remotely. And for that service, they don't even have to be part of- they don't have to be a patient of South County Home Health, so that's a really exciting new technology that we offer.

Prakash: You have such a comprehensive set of services, you're able to be incredible flexible, and I think the one thing that we can all take away from today is to be your own best advocate, and that South County is there to help and support you in any way. So Marcia, I want to thank you so much for your time. For more information, please visit www.SouthCountyHealth.org. That's www.SouthCountyHealth.org. This is South County Health Talks from South County Health. I'm Prakash Chandran, thanks so much for listening.