Ensuring Equitable Home-Based Care for Patients

Emma P. Monaco, a seasoned professional in healthcare, boasts more than twenty years of expertise in business development, operations, and clinical strategic growth within the healthcare sector. As the Director of Post-Acute Strategy, Business Development & Marketing at Prime Healthcare for the Garden Grove Hospital Medical Center and Huntington Beach Hospital, she dedicates her efforts to devising growth strategies, enhancing hospital operations, and fostering relationships with physicians. Emma's role extends to providing support to various departments including case management, discharge planning, social work, and finance.

Monaco shares her insights into the successful execution of Post-Acute Care Services, challenges and leadership strategies, enriching the healthcare community with her vast knowledge and proven track record of excellence.

What are some of the challenges in home-based patient care in the healthcare ecosystem and how are new developments expected to address them?

The landscape of healthcare is undergoing significant changes, presenting challenges and opportunities. One major concern is the affordability of home care for elderly patients, especially as the healthcare ecosystem evolves and the economy fluctuates. The fundamental question arises; Can elderly patients who prefer to receive care at home afford it? While I don't have comprehensive census data, my observation suggests that the affordability of home care is gradually diminishing.

Over the past two decades, various sectors of healthcare, including home health, hospice, assisted living, and skilled nursing facilities, have seen a decline in demand. This shift is accompanied by a pressing need to adapt to the changing healthcare landscape, where private pay for home care is increasingly common, without reliance on traditional healthcare insurance like Medicare or Medicaid.

The lack of coverage for home care by managed care entities further exacerbates the issue. However, there are some positive developments, such as a few in-home care providers securing contracts with entities like CalOptima in exchange for reimbursement for home-based patient care services. This indicates a potential avenue for addressing the affordability and access challenges in certain regions like Orange County.

The reality remains that not all elderly patients who require assistance can afford it, highlighting the crucial issues of affordability and access. Despite the challenges, some fortunate individuals have support systems enabling them to age at home comfortably.

Can you provide an example of a recent project or initiative you were involved in, reflecting the challenges faced in ensuring safe discharge for patients?

Let's consider the case of a 75-year-old patient, Jane Doe, admitted to Garden Grove Hospital due to health issues, with traditional Medicare and Medi-Cal as her insurance.

Upon stabilization, the hospital's clinical team initiates the discharge planning process. Despite not getting a necessary nursing facility, Jane Doe, who lives alone and lacks nearby familial support, expresses a desire to return home. Herein lies the dilemma: How do we ensure a safe discharge for a patient who requires ongoing care but lacks financial means and familial assistance?

The first step is to arrange home health services, which provide crucial support. However, these services come with limitations; they aren't round-the-clock and operate on specific criteria. Suppose Jane Doe's condition doesn't warrant prolonged home health care. In that case, the question of affordability arises, as not all elderly patients can bear the cost, which can range from $25 to $35 per hour.

This financial strain is compounded by the absence of family caregivers and the lack of coverage for caregiving assistance in many healthcare insurance plans. Even patients with HMO or PPO coverage find themselves without support when it comes to home care.

In such cases, patients like Jane Doe are caught in a precarious situation. This scenario underscores a critical current challenge in healthcare, where the gap between patient needs and available resources becomes painfully evident.

"Addressing the challenge needs systemic reforms and innovative solutions to ensure equitable access to quality care for all patients, regardless of their financial circumstances or familial support networks."

Addressing the challenge needs systemic reforms and innovative solutions to ensure equitable access to quality care for all patients, regardless of their financial circumstances or familial support networks. It's a complex issue that requires collaborative efforts from healthcare providers, insurers, policymakers, and community stakeholders to navigate.

Within the domain of home-based healthcare, are there specific challenges that persist without the optimal solutions from current services?

In California, numerous managed care organizations play pivotal roles in healthcare coverage. Despite their widespread presence, a fundamental challenge arises concerning their reimbursement rates to various healthcare entities such as hospitals, nursing homes, and home health companies. The discrepancy lies in the fact that these reimbursements often fail to align with the actual costs incurred in providing care to patients, especially those with complex medical needs.

This disparity in reimbursement versus the actual cost of care significantly impacts patient access to essential services. For instance, high-acuity patients with clinical comorbidities often struggle to find suitable placements, particularly in skilled nursing facilities. Despite referrals, these facilities frequently deny admission due to financial constraints stemming from inadequate reimbursement rates. This scenario perpetuates a cycle wherein patients remain in hospitals longer than necessary, straining resources and exacerbating the healthcare burden.

The inadequate reimbursement rates also affect undocumented and unhoused patients, leading to increased hospital stays and further exacerbating the strain on healthcare resources.

A comprehensive overhaul of the healthcare reimbursement system to ensure that reimbursements accurately reflect the costs of care provision is the solution. Only then can healthcare facilities effectively accommodate patients' needs and alleviate the strain on hospital resources. Rectifying these issues requires concerted efforts to create a more equitable and sustainable healthcare ecosystem in California and beyond.

What would be your piece of advice for your fellow peers in the industry?

I find it challenging to provide a definitive answer. However, I hope for significant healthcare reform within the next five years. Specifically, legislators in California, particularly in regions like Orange County, Los Angeles, and San Diego, should conduct a thorough examination of taxpayer money allocation, particularly in healthcare.

This scrutiny should include private sector reimbursements to hospitals, skilled nursing facilities, home health services, and hospices. The focus should also extend to assisted living and in-home care, which often rely on out-of-pocket payments. Policymakers must address the disparity between rising executive compensation in insurance companies and the insufficient funding for healthcare providers, ultimately affecting patient care. Thus, my plea is directed toward governmental intervention to rectify these systemic issues.