Private Duty, Home Health and Hospice Owners: Want to grow your agency? Then Change your delivery model!

Right now, many owners have their agencies operating in what I call “a silo.”  Patient referrals come in, we create a plan of care and provide services, and we think we are doing a pretty amazing job. But…let’s meet Sam!  Sam is an 84-year-old male, lives with Daughter who still works full time. This patient (Sam) had history of falls, is a diabetic, and has very poor vision. Recently Sam has started to become more demented and forgetful and he locked himself out of the house several times. Now Sam needs a caregiver on-site when daughter goes to work.

Good news: The Doctor refers to home care agency!  Yes folks, we have taught home care agencies to get referrals directly from physician offices using our 52-week road map to referrals.

Let me get back to the story… Next, the home Care agency visits the patient and sets up the patient with service 10 hours a day, Monday through Friday for 10 months. During that time Sam has several falls. One of those falls leads to a wound that developed on his shin and his diabetes makes it difficult to heal. The daughter and the aide keep it bandaged, as it’s is too hard to get Sam out of the house to go see the doctor anymore.

Does this sound familiar? Yes, we all have probably serviced a Sam or two. The aide continues to support Sam and his daughter until the patient dies with the daughter and caregiver at the bedside. Sounds great, right? He received help at home.  The doctor referred the patient for home care!  Yeah!  However, the Daughter was exhausted and overwhelmed with the care of her father and ultimately, left feeling alone, guilty, and extremely depressed.

The patient dies with pressure ulcers and in pain with daughter and the aide at the bedside, because he refuses transport to the hospital.

Where did this go wrong? Failure is the key to success! You see, you can learn from these patient stories. I’m sure my hospice folks feel terrible that they couldn’t jump in and save the day! My home health friends reading this are saying hey we could have helped with those wounds.

Now, imagine it went this way:

Imagine if the home care agency had developed a working relationship with a home health agency and a hospice.  Each week, leadership would meet to review current patient census to see if any of the other service lines are needed on a patient’s plan of care. Hospice could get additional aide hours provided by the private duty company. Home health agencies can refer a patient to the hospice organization to do an evaluation to see if hospice is appropriate.  Hospice can discharge patients that aren’t deteriorating back to the home health agency and the home health can subcontract aide services with the private duty company.

Let’s look at another example:

Sam has Alzheimer’s Disease. He lives with his wife Barbara. Barbara and her daughter take Sam to the physician’s office because Sam has a fever and a bad cough. The doctor does a chest x-ray and Sam is diagnosed with Pneumonia. Following these findings, the doctor does a swallowing test, and Sam ends up with a peg tube for feedings. The hospital orders home health on discharge to home.

Home health comes in and teaches the patient’s wife Barbara how to use Peg Tube. The wife asks for someone to sit with Sam 3 days a week for 4 hours so she can go food shopping, visit the hair dresser, and possibly meet up with some of her friends. The home health nurse explains that Medicare won’t cover that type of service. Sam dies 4 weeks later with an exhausted wife and daughter at the bedside.

Why does this happen? Home Health Nurse never made recommendations to add home care to the plan of care.  Hospice Was Not Referred to Support Patient And Family. Why? Well, it is because we assume everyone out there knows what private duty, home health, and what hospice do and the truth is unfortunate. We each build a plan of care knowing only what we know. This leaves the patient receiving subpar treatment and we find ourselves under-servicing the patients that we know and love. It is time that we understand what each of us can do to make a total patient care delivery experience!

Next week I will share with you my vision of the Total Patient Care Delivery Model. If you want to get a jump start on training yourself or your team, go check out and look for our orientation training products.  They will help you to get a better understanding on what makes a patient qualify for services. Don’t miss my blog post next week! Until then, keep learning how you can service more patients by being a better patient advocate because you are constantly evolving your knowledge about post acute care services.

Cheryl Peltekis, RN “The Solutionist”