Home-based Care: Recognizing a Time and Place
The Regence Health Policy Center (RHPC) strongly supports policies to increase patient access to home-based care (HBC) services, and we have highlighted the numerous positive impacts that HBC can have on patients. However, we also recognize that there are circumstances where home-based care may not be the best choice and it is more appropriate to treat a patient in a facility-based setting.
Providing HBC to unsuitable patients does not serve the patient’s interests and could lead to worse outcomes and higher medical spending. As the home-based care model continues to evolve, there are several considerations to ensure the patient is receiving the right care, in the right place, at the right time.
A Suitable Home Environment
Providing care in a patient’s home environment allows medical teams a unique glimpse into a patient’s living situation including housing, family relationships, and other factors that influence a person’s health. Additionally, since homes are often not constructed with the provision of medical care in mind, certain infrastructure may be required to be installed before HBC can be initiated.
This perspective enables physicians to deliver person-focused care tailored to individual needs. Ensuring the home has appropriate infrastructure in place as well as connections to additional social support such as meals and/or transportation are key to successfully and safely providing care in this model.
Effective Care Coordination and Communications
Scheduling and coordinating clinician home visits and virtual check-in visits are essential to ensure that HBC is being delivered efficiently with safety as a top priority. Since 24-hour on-site nursing care is not a component of many HBC models, this means the patient or their caregiver will need to perform some treatment related tasks such as providing wound care, administering injections, or managing multiple medications.
Depending on the severity of the patient’s condition, a patient or their caregiver’s ability to complete these tasks without assistance may be limited. Open and consistent communication between the patient and their care team allow for these needs to be addressed and plans put in place to assist the patient and ensure they are receiving high quality care. If a patient or their caregiver are unable to provide safe and consistent care when staff is not onsite, or if the burden of providing care in this setting is not feasible for the patient and their caregivers, HBC is likely not a viable option.
Stable and Reliable Infrastructure
There are structural barriers that present challenges for patients in accessing HBC services. First, many rural communities lack high-speed broadband internet access. While broadband is not a prerequisite for the delivery of all HBC services, certain commonly used tools such as telehealth and remote patient monitoring, may require broadband to operate effectively.
Without reliable broadband access, rural patients are not able to utilize the full scope of services capable of being delivered in the home, limiting patients to facility-based care. Second, patients without adequate health coverage may be unable to utilize HBC services due to the prohibitive cost. Finally, the ability to provide HBC is reliant on the availability of clinicians and staff to administer these services. If a particular area does not have the workforce to support HBC, it will not be an option for patients, leaving them to rely on facility-based care as their only option.
There will be circumstances in which treating one patient in their home is the optimal care path whereas another patient may require facility-based care to address their needs. It is important that all patients have access to the care that is indicated for their specific conditions. Facility-based care and home-based care are complementary and allow providers and patients to work together to provide the best care and improve outcomes. Regence Health Policy Center recognizes the value of each care model as we continue to work to implement policy changes to increase access to and adoption of home-based care.