Anne Dumbaugh, R.N., Quality Assurance Manager, Olsten Kimberly QualityCare
Speech: "Assuring Continuity from Hospital to Home"
American Association for Continuity of Care
Orlando, FL -- September 23, 1993



Good morning.


(show cartoon on screen)
I think nothing gets to the heart of your job better than this cartoon from the New Yorker. [describe, if not clearly visible to all in room] And it's especially appropriate now that Clinton's health care reform proposal is on the table.


"Quicker and sicker." That just about sums up hospital discharge planning these days. The rapid transition from hospital to home is a challenge to health care providers and receivers alike. There must be planning, coordinating, communicating, referring, and follow-up to achieve the best possible continuity of care.


Of course, the goal of all this is to assure that clients receive the care they need to maintain or regain as normal or productive a role in life as possible -- in the most appropriate environment. Unlike poor Mr. Rheinschreiber here, your clients can't be tossed outside in the cold.


As discharge planners, your goal is to ensure that your clients move successfully to the appropriate next step in the health care system. You work with clients and their families to facilitate this move. You assess their needs and obtain the best community resources available. You make certain your clients can afford these resources. If you work in a hospital setting -- as I assume most of you do -- your bottom line is to provide your clients with maximum assistance in returning them to their pre-hospitalization state.


Obviously, you have a variety of choices in assuring the best possible continuity of care. I'd like to talk with you today about one of these options -- home care -- which is one of the fastest-growing and exciting alternatives in health care today.

And when I say "fast-growing" I mean it! Since 1986, home health care has grown at an incredible 10 percent annually -- taking it from a 6 billion dollar industry to a more than 11 billion dollar industry in 1991. And experts predict an even brighter future, with growth expected to reach 19.5 billion dollars by 1996 -- a whopping 76 percent jump.


There are many reasons for this exponential growth -- among them -- more people living longer, more people surviving illness or disability, more people living alone, and last but not least, an exploding number of services that now can be applied in a home setting.


With this in mind, I'd like each of you to leave here this morning with an understanding of the following:


1. What services are available for patients in their home. You may be surprised to learn how quickly and dramatically technology is changing the face of home care.


2. How home care saves money -- for the patient, for 3rd party payers, and for your hospital. And you'll be pleased to learn that many more services are covered than you may think.


And finally,
3. Where home care is headed, and where you -- the discharge planner and case manager-- fit into the big picture.


Let's take a moment to make sure we all agree on exactly what home care is.



As societal, economic, and political factors continue to shape the health care industry, the future for home care looks brighter than ever. Briefly, some of the trends we're witnessing in the '90s include:


1. Preventive- and self-care, and the emergence of an increasingly health-conscious society. Never has the old saw -- the one about an ounce of prevention being worth a pound of cure -- been more appropriate. In fact, maybe these days we should be saying "A penny of prevention is worth a dollar of cure."


Many of the acute illnesses we treat today may someday be prevented with proper home health care -- and fully reimbursed by insurance. Indeed, it looks like Clinton's health care package calls for coverage of certain preventive services, and possibly expanding that coverage by the year 2000.


2. As you know, health care reform is causing a tidal wave of managed competition. HMOs, PPOs, EPOs -- these are the acronyms of the future. Discharge planners for HMOs must meet the dual challenge of providing quality cost-effective care and maintaining a competitive product in the marketplace. Managed health care greatly depends on discharge planners to guide both members and providers through the system.


In fact, here in Florida, the legislature recently passed the Health Care and Insurance Reform Act of 1993 -- implementing a strategy of managed competition. Community Health Purchasing Alliances will pool groups of small businesses, state employees, and Medicaid recipients to form large health care buying groups. Olsten Kimberly QualityCare is part of one such alliance here in central Florida.


What's happening here is being repeated in states throughout the U.S. -- and will likely mirror what's being proposed in Washington today.

3. Corporations are also getting in on the act. Several companies now provide incentives for employees to keep their health bills down. And they pay more for procedures done outside the hospital and encourage staff to sign up with HMOs.


In fact, one of the more significant new approaches is corporate case management. Employees with serious illnesses are offered the help of a consultant -- usually a nurse -- who discusses options with the family and physician, and who then arranges the best care at the least cost.


Another innovative corporate effort is the "Eldercare" benefit movement. One of the leaders is the Travelers in Connecticut. In what's considered the first comprehensive corporate study of elder-care, Travelers found that one in five employees over age 30, mostly women, was providing some care to an elderly parent. Thirty percent provided financial assistance as well.


As more women enter the workforce, corporations are now attempting to offer employees support programs to assist them in the care of elderly parents. This movement is still in its infancy, but may well become the employee benefit of the '90s.


But, aside from these largely economic trends, I believe that home care will gather strength if for no other reason than because the public wants it.


That definition for home care, which I referred to earlier, also stated that client's find home care the most efficient, effective, and least traumatic form of medical care.


The Olsten Kimberly QualityCare survey I mentioned before bears this out. Of those who had received home care services, more than 90 percent thought they recuperated more quickly, that it was more cost-effective, and that their caregivers were knowledgeable and capable. Indeed, research shows that only 2 percent of home care patients are discharged to nursing homes. I think that says a lot about the value of home health care.


Oh....there's one more trend that will most likely grow in importance in the years ahead. And that is team-work. Teamwork between you--the discharge planner, me--the home care agency, and all those people out there who need us.


I can't stress this enough. Teamwork begins at the time of admission and continues as you assess your clients' needs, plan for continuity of care, implement the discharge plan, and evaluate outcomes.


Discharge planning begins at the time of admission. We need to jointly identify realistic goals. Together we must involve the client and family. We have to join forces to adequately assess the home environment. And we both have to ensure that services can be paid for.


I'd like to leave you with a little story.


A troop of Girl Scouts gathered for a hike in the woods. An hour or so after they set out, they came upon an abandoned section of railroad track stretching about 100 feet. Each girl tried to walk the narrow rails. But after just a few steps, each lost her balance and tumbled off.


Two of the Scouts then said to the rest that they could walk the entire length of the track, without falling off even once. Well, this was met with a chorus of "No way!"


But the two girls were determined to show them it could be done. They each jumped up on opposite rails, reached out and held hands to balance each other, and -- to everyone's surprise -- they steadily walked the entire section of track with no difficulty.


How easy it was by simply working as a team! Remember -- it's when we don't cooperate that the whole system falls apart.


As surely as I stand here, it's teamwork that will account for the successful outcome of the home services you arrange for your clients. Teamwork in utilizing the new technologies....Teamwork in controlling costs...Teamwork in meeting the challenges of the future.


Let's not ever quit holding hands! [Suggestion: show slide with illustration of hands being held.]

Thank you.


Now, I'll be happy to answer your questions.