Safe At Home After Work Injury
Provider shortages in home health are concerning, but partnering with the right provider can make a difference
When injured employees are struggling with a difficult transition home, they need compassionate health care professionals who are highly skilled and trained in caring for those who may have experienced a severe or life-altering work injury.
Unfortunately, finding qualified individuals to provide that care is becoming a bigger challenge. An important issue impacting all areas of health care is the provider shortage. Having skilled providers available is particularly important in home health, which has become a bigger player in the recovery process for injured individuals.
A survey by the Pennsylvania Homecare Association found that 93% of Medicare-certified home health and hospice agencies and 98% of licensed agencies said they had refused referrals during the past year. One area where the shortage is having its biggest impact is nursing. When shortages exist, nurses need to be enticed to take shifts, and when they can’t, vendors are forced to go outside their network to look for replacements.
In addition, staffers who schedule shifts have to make dozens of calls to vendors only to be told over and over there are no available nurses for a request. This adds up to valuable time lost that could have been spent handling other patients. To combat delays, financial incentives are becoming part of the solution to draw a balance between higher prices, staff, patient, and employer impacts. When the average cost of a 3-day hospital stay is around $30,000 offering an extra dollar an hour for home health services post-surgery may be cheaper overall and lead to a better outcome for the injured employee.
And an influx of new graduates won’t solve the issue for home health, initially. To gain experience, many new nursing grads first seek out opportunities in acute care settings, where they can develop skills to later work in specialty areas of their choice. Therefore, it takes a few years for this youth movement to occur in home health.
So, what can payers and adjusters do to ensure that their injured employees receive home health services that will keep them on track for a successful return to work? Here are some factors to look for when pairing with the right specialty provider.
Education and Training
Over the last decade or so, Americans have been experiencing shorter stays in acute care facilities as technology and advanced skills has facilitated better treatment at home. This requires today’s home health care professional to have higher level training to treat injured individuals in the early stages of their recovery. For instance, 10 years ago, patients needing advanced wound care would require a longer acute care stay. Today, given the appropriate wound care provider and equipment in place, those services can be delivered at home. The same is true with more advanced respiratory services.
For this reason, make sure to partner with a program that hires experienced providers and trains them to confidently deliver these services.
Creative Solutions
Effective cost containment in the face of provider shortages requires innovative solutions that include evaluating the actual needs of injured employees to ensure they receive the proper level of care. For example, companies may receive a request for a registered nurse (RN) for 24 hours a day for three weeks after a surgery, when an experienced specialty program might determine that 12 hours with a licensed practical nurse (LPN) and 12 hours with an RN could open the pool of available nurse resources with similar outcomes.
Good specialty programs assist in matching the injured individual’s medical needs to the appropriate skill level required. If necessary, home care coordinators will speak to the treating physician or case manager to get clarification on patient needs. They will assess and facilitate total home care, as well as specialty service requirements, in a comprehensive plan. If possible, they will also speak to the injured employee and family members to assess social, lifestyle, and environmental factors that can affect the match. These agencies also have a track record of dependability and consistency, and appropriate policies in place.
Over time, care coordinators may consult with the treating physician and case manager to see whether the caregiver skill level can be reduced — perhaps from a nurse to a home health aide which can help save significant costs, especially over the life of a claim requiring 24/7 care.
Collaborations and Connections
One of the most important factors in partnering with a home health service is how well it partners with its network vendors. This includes listening to payers’ needs so they recruit the right staff members and retain the ones who provide the services they need.
Look for companies who have made significant investments on behalf of their clients, ensuring they’re attracting the best talent and retaining it. Established specialty services are better prepared to fill a payer’s needs due to the volume of business and favorable terms it can provide agency partners. These networks can obtain prioritized handling of cases, allowing adjusters to avoid the scenario where they receive a frantic call from a family member, saying a nurse or home health aide has not shown up. Instead, gaps and disruptions in home care can be avoided.
Also, consider home health programs bundled with case management service to facilitate better transition of care. Case managers have a greater understanding of the individual’s physical and psychosocial needs and can help the home health professional seamlessly execute the care plan, while avoiding an additional provider service for the payer.
While the provider shortage will continue to be a challenge for workers’ comp leaders, partnering with companies that have solutions in place will help ensure your injured employees are always safe at home.
Nicole Usher is Senior Director of Operations at Apricus, an Enlyte company. With nearly 20 years of experience in the workers’ comp industry, Usher has held multiple leadership positions including roles in finance, quality, and operations. With a longstanding knowledge of quality service delivery, she instills these values within her team, partners, and clients. As an operational leader, Usher promotes innovative ways to provide superior client experiences that adhere to the complex nature of the industry, state regulations, and the needs of claims professionals.