Healthcare Management for Eldercare Advocacy Organization

Planned change in the eldercare advocacy organization

In the coming years, many countries will experience a dramatic shift in healthcare infrastructure due to an expanding elderly population size. However, the changes may vary across countries depending on many factors such as the kind of social welfare available in each country, the political environment which determine policies, the level of healthcare available and individual expectations in each country. Due to this wide variance, the innovations within this space will also vary greatly. What this means to the healthcare manager is that managing innovations becomes very hard (Shlutz, Andre & Sjovold, 2015 p 42). This also impacts on performance management which is fast gaining popularity in the public sector as a means to improve on accountability. Unfortunately, it has been cumbered by a series of challenges in its implementation; this is in spite of the frameworks developed over the last couple of years (Nistor, Stefanescu & Crisan 2017, p.32).

Healthcare is a strong indicator for how people experience quality of life. Just like economical issues, healthcare is a topic for debate in many countries. The healthcare delivery system is reflective of the government’s performance in most countries, hence being integral to the identity of the nation as a whole. With the execution of the planned change in the eldercare advocacy organization, the patient will receive focused care at home. This is a shift from the disease centered approach of care offered in hospitals. The patient centered medical home (PCMH) favors the delivery of care at home, seeing this as the most attractive option for the patient. This allows the patient to be a stakeholder in their own care plan. The care delivery will make use of information technology. It will also help in linking care across the community and delivering care to the patient at home. Using IT, it will be possible to track the patient in real time as a standard of clinical practice. What this means is that hospital stay will be minimized, because patients can be monitored at home and interventions carried out away from the hospital (CGI GROPU, 2014, p5)

The delivery of healthcare services is fast moving into the home and it involves a number of people, devices and technologies. It cuts across different residential environments. Spearheading this shift are a number of factors such as; the ever-increasing cost of healthcare, increasing elderly population size, prevailing rates of chronic conditions, better disease outcomes, injuries, childhood conditions and technological advancements. These together with a host of other reasons have made it necessary to move the focus of care away from the hospital setup to the home setup. The healthcare that results however still varies in terms of how safe it is, how well and how fast it is administered and how much it costs (National research council, 2011, p167).
Leveraging the power of organizational committees and teamwork

The role of the committee is to evaluate this trend in healthcare delivery and trouble shoot for problems in its implementation by analyzing human factors. Having established that this shift presents opportunities as well as threats in the delivery of services, the committee is tasked with inventing solutions to address the challenges. The approach taken by the committee is biased towards evaluating the impact of human factors that can offer solutions that will ensure safety, quality care and mutual benefit for both the patient and caregiver (National Research Council, p.167). It is the prerogative of the committee to look into these four key areas that will improve on delivery of care at home: (1) technology which includes both devices and information technology applications (2) the patient and caregiver (3) the home environment (4) existing gaps in knowledge that should be looked into. Although there are a number of issues that may not be resolved, use of human factors principles will go a long way in ensuring that delivery of healthcare at home is safe, effective and affordable. It is not the role of the committee to prioritize recommendations, but to focus on how healthcare is delivered in the home and the different constituencies affected by it (National Research Council, 2011, p.168)

For this change to be implemented successfully, team skills such as relationship building and team dynamics will have to come into play. This will help in the realization of patient centered care that is of high quality and is equitable. Bearing in mind that effective information sharing is key; the team must build on inter professional communication skills. The potential impact of a breakdown in communication could be detrimental.

Impact on human resource needs

Direct care workers such as certified nurse assistants (CNAs), home health aides and personal care aides provide an estimated 70%-80% of hands on care in geriatric homes and other community-based settings (Rowe, Fulmer &Fried, 2016, p.4). When this change is implemented, it will call for a mass recruitment of trained and competent workers from around the globe. These workers need to be equipped to meet the demands of the administration of healthcare in the home environment.

Change impact on the organization care

Programs geared towards the delivery of home-based care for people with advancing chronic conditions have been shown to be very effective by the department of Veteran Affairs and in a Medicare demonstration (Independence at Home) (Rowe, Fulmer &Fried, 2016 p.3). Evidence suggests that primary care administered in the home environment is necessary for good patient outcomes and family member satisfaction. The use of an interdisciplinary approach is essential for proper handling of complex challenges encountered when caring for a homebound patient with limited functional capabilities. This means that the team apart from having clinicians also has to incorporate other teams such as behavioral therapists, dieticians, occupational therapists and psychologists. The teams will collaborate in providing a wide array of services which include administering medications, symptom management, creating awareness, patient education, offering support to the caregiver and averting crises that may arise from chronic conditions. Home based care plays a vital role in managing hospital readmissions and long hospitalizations where it can be avoided. This helps in reducing cost and it also prevents detrimental effects associated with long hospital stays. As opposed to dialing 911 family members can rely on this system to offer help at home. The role of the home – based care provider is also to enhance communication between the hospital and the patient/family. Home – based primary care offers hope and a channel to maximize care for the sickest and frailest of patients- those who are confined to their homes with functional limitations that may not allow them to access hospitals or physicians’ offices (Klein, Hostetter &McCarthy, 2017, p.4).

Categories of people who require care at home include: frail elders, people living with disabilities and chronic conditions, war veterans with incapacitating injuries and children with special needs. Offering effective home-based care requires a lot of coordination between the teams involved such as health workers, financial service providers and other support services. When proper coordination is achieved, it leads to better patient outcomes and reduced cost of care. When successful, coordinated care ensures smooth communication between caregivers, it also ensures that the care recipients receive the best care with the best resources available (National Research Council, 2011, p176). To achieve success, every team member must collaborate and be a part of implementing the shared objectives. Coordinated care entails coming up with a customized plan of care that will be executed. The importance of effective communication cannot be over emphasized. The team needs to focus on shared goals and objectives, have a good understanding of the resources at their disposal and work well to coordinate tasks and functions of each team member. Techniques such as system analysis are useful in pointing out problems in care coordination and also pointing out intervention solutions that may work to address these pitfalls. Adequate research into areas of communication, cognitive aiding and decision support and high-fidelity simulation training techniques can also be used to guide suggestions for care coordination (National Research Council, 2011, p.177).

Joint commission guidance on the change

There is mounting pressure on organizations to keep up with the latest advances in administering quality care to patients. This is due to an increasing need to provide better patient outcomes while utilizing the best technology. Anticipating the drastic change, the Joint Commission is working hard to offer support to health organizations. Accreditation allows for a direct linkage between all care providers, starting from the hospital down to the home-based health care worker. With this in place and functioning, it is important to assess the cost versus quality of care along the continuum to know if objectives are being met. Through accreditation, organizations can introspect and evaluate their services with an aim of addressing their weak points. Some of the organizations that can enlist for accreditation by Joint Commission include home healthcare, home medical equipment, hospice, pharmacy, personal care and support services (Joint Commission, 2011, p 3-4).

Quality assurance mechanism

To achieve the best possible outcomes for patients receiving care in this setup, there needs to be maximum collaboration between all parties involved. This includes the hospitals, doctors, nursing homes and any other party that handles the patient in this continuum. When there is free flow of communication from all these points, better patient outcomes are realized. Also, with the use of modern technologies such as electronic medical records and telehealth, it is easy to offer patient centric care that is cheaper. Finally, when a home care organization earns the Joint Commission seal of approval, they are free to partner with health systems, physician groups, on care transition teams, accountable care organizations and pay for performance initiatives that may be of benefit to them (Joint Commission, 2011, p5-6).

Information technology support for the change

Perhaps caregivers play the most important role when it comes to offering care to the elderly at home. That said, technology plays a vital role in ensuring that the care is delivered at a reasonable cost to the patient. A host of technological applications help the caregiver to easily deliver quality care without incurring a lot of expenses. Telehealth for example utilizes high-tech technologies to allow clinicians to monitor and offer care to patients remotely. This monitoring allows the nurse to attend to patients at different sites without having to be physically there. This makes it cheaper to administer care and the nurse can also track changes in real time. Measurements such as electrocardiogram readings, pulse oximetry, blood pressure, respirations weight, blood glucose etc can all be taken and assessed remotely.

Chronic conditions such as diabetes, asthma, hypertension and arthritis can also be monitored remotely. Through telemedicine, the care giver and patient can communicate remotely and come up with a care plan that is updated in real time. The health sector in the US, just like many other countries, is beset BY many challenges such as; a shortage in supply of health workers, tight healthcare budgets, inaccessible health insurance and an increasing aging population, there is increasing need for the adoption of home-based care. This will help the elderly to receive the best care while at home, which is what they prefer (Tao, &McRoy, 2015, p.33)

Impact of the change on operation

Across the globe, the application of home-based care strategies has help to decongest hospitals and provide affordable and customer centric care to patients with chronic illnesses. Elderly patients all over the world prefer to be cared for in a familiar home environment (Netshandama & Mudau, 2016, p1). Both families and governments are feeling the strain of caring for an increasing aging population and an increasing burden of chronic diseases. It is therefore important to focus the care on cheaper alternatives of offering care at home with the support of a myriad of care givers. Extra effort needs to be put to bridge the gaps in administering care at home including the use of software systems, health monitoring devices and telephony (Tao, &McRoy, 2015, p.34).

To meet this objective, organizations need to develop some key character traits (four pillars) to help them address “three critical roles” that they need to play in the delivery of home-based health care services.

The four pillars:
Patient and person centered: provide individualized care for every patient and taking into consideration the unique values of each patient when making clinical decisions (Landers et al, 2016, p. 272).
Seamlessly connected and coordinated: there should be a seamless flow in care delivery at all points of the home-based care continuum. This starts right from the primary care service delivery point (Landers et al, 2016 p272).
High quality: care delivery to patients must be of the highest quality at all times (Landers et al, 2016, p273).
Technology enabled: by use of appropriate technology, patient’s and caregivers can connect and receive more intensive services remotely. This will improve access to care for many patients and change how chronic conditions are managed (Landers et al, 2016, p.273)

Three critical roles of the organization

Acute care and post–acute care Support: Home health agencies play a key role in helping the patient transition from the hospital setting to the home setting where they will continue to receive care. They also serve the role of a post hospital and acute service provider for the patient when deemed clinically necessary (Landers et al, 2016, p.273).

Primary care partners: Home health organizations often partner with primary care providers including outpatient primary care as well as home-centered primary care, together with responsive and highly-skilled nurses, coordination of care, therapy, as well as other linked services all through time-limited occurrences where care recipients demand an increase in home-centered care so as to avoid re-hospitalization or other unforeseen results (Landers et al, 2016, p.273).

Home-centered long-term care partners: Home health agencies additionally partner with home-centered long-term healthcare as well as social support agencies (i.e., informal and formal individual care givers) with responsive and highly-skilled nurses, therapy, as well as other linked services all through occurrences where patient needs a slight increase of home-centered care so as to avoid re-hospitalization (Landers et al, 2016, p.273). 

References

Landers, S., Madigan, E., Leff, B., Rosati, R. J., McCann, B. A., Hornbake, R., ... & Lee, T. (2016). The future of home health care: a strategic framework for optimizing value. Home health care management & practice, 28(4), 262-278.

Klein, S., Hostetter, M., & McCarthy, D. (2017). An Overview of Home-Based Primary Care: Learning from the Field. Issue brief (Commonwealth Fund), 15, 1-20.

Mashau, N. S., Netshandama, V. O., & Mudau, M. J. (2016). Self-reported impact of caregiving on voluntary home-based caregivers in Mutale Municipality, South Africa. African Journal of Primary Health Care and Family Medicine, 8(2), 1-5.

Schultz, J. S., André, B., & Sjøvold, E. (2015). Demystifying eldercare: managing and innovating from a public-entity's perspective. International Journal of Healthcare Management, 8(1), 42-57.

Nistor, C. S., ?tef?nescu, C. A., & Cri?an, A. R. (2017). Performance Through Efficiency in the Public Healthcare System–A DEA Approach in an Emergent Country. Studia Universitatis Babes-Bolyai Oeconomica, 62(1), 31-49.

Tao, H., & McRoy, S. (2015). Caring for and keeping the elderly in their homes. Chinese Nursing Research, 2(2-3), 31-34.

Joint Commission. (2011). Home—the best place for health care: A positioning statement from The Joint Commission on the state of the home care industry. Retrieved from https://www.johnahartford.org/images/uploads/resources/Home_Care_position_paper_4_5_111.pdf

CGI GROUP (2014). Healthcare Challenges and Trends: The Patient at the Heart of Care. Retrieved 30 March 30, 2018 from https://www.cgi.com/sites/default/files/white-papers/cgi-health-challenges-white-paper.pdf

National Research Council. (2011). Health care comes home: the human factors. National Academies Press.

Rowe, J. W., Fulmer, T., & Fried, L. (2016). Preparing for better health and health care for an aging population. Jama, 316(16), 1643-1644.