On Oct. 11, home care and hospice organization VNA Care of Rhode Island announced it will close Dec. 20, and would work to transfer patients to Visiting Nurse Home & Hospice in Portsmouth in the meantime.
VNA of Care New England, however, remains open, though the subject of some confusion over where the remaining VNA programs in the state stand. Providence Business news asked Kathleen Peirce, vice president of clinical operations, executive director, and chief nursing officer at VNA of Care New England, a few questions about what the loss of VNA Care of Rhode Island means to local VNA services.
PBN: With VNA of Rhode Island closing, what does the home care landscape look like in Rhode Island?
PEIRCE: The home care industry in Rhode Island has a very long history, but it is unfortunately not immune to the changes occurring across health care.
It’s very sad personally and professionally to see the closure of the VNA of Rhode Island, which is one of the oldest visiting nurse associations in our state. However, I don’t anticipate this will dramatically change the landscape, as their home care and hospice census had shrunk over time, and other home health agencies, such as our VNA of Care New England, will be able to pick up that patient population as needed. Patients still have a choice in home care agencies.
PBN: What set the two organizations apart? Will VNA Care of N.E. be able to take up the slack left by VNA of R.I.’s closure?
PEIRCE: The VNA of Care New England and the VNA of Rhode Island have similar missions in that we are both nonprofit, Medicare- and Medicaid-certified agencies, and we both serve the home health and hospice populations.
What sets us apart is our relationships with patients, families, hospitals, other health care facilities and providers. As a 4-Star Agency for Patient Satisfaction and for Patient Quality, as defined by CMS [Centers for Medicare], we have a strong commitment to providing services that enhance the patient experience and improve outcomes, even those that offer little reimbursement.
For example, our nurse practitioner advanced illness management program has helped us identify patients at increased risk for hospitalization, allowing us to build in safety nets for these patients and to work with them based on their ultimate goals for care; our Conversation Project nurses work alongside the Care New England palliative team to assist patients and families at difficult crossroads to make crucial decisions that fit their goals and desires; our hospice program has grown and we have added the necessary resources to support staff, patients, families, physicians and facilities. With this growth and enhancement of services, we are here to help patients and families who have been affected by the closure of the VNA of Rhode Island or need home health or hospice care.
PBN: Please explain the most common misconception about home health care.
PEIRCE: Because so many home care agencies are similarly named, many people think we are all somehow connected and the same. We are not connected at all. Somehow when you say VNA, people connect you in their head as one connected system.
I don’t think people realize how integral home care and hospice care are to the entire health care environment and to our communities. We help keep patients where they want to be – at home.
Our patient population is very much at-risk to need hospitalization or long-term care placement, and that is why they benefit from home health care services like nursing, physical therapy, occupational therapy, speech therapy, nutrition services and the assistance of home health aides.
Many people also think of hospice as a “place.” Hospice is not a place, it is a philosophy of care that focuses on caring and comfort. Providing care at the place the patient calls home is the basic philosophy of hospice, whether it is at home, in a family member’s home, a nursing home, an assisted living, or a residential care facility. Helping patients and families at their end of life is a privilege and one we work very hard on.
PBN: How does home care fit into the changing health care landscape with a focus on keeping patients healthy and out of the hospital?
PEIRCE: Health care costs in this country are unaffordable. Home health care is the least expensive option for health care for a patient. It is crucial that we focus our resources and reimbursements toward these essential services. We are all being challenged to manage with less, to keep our patients healthier, and to provide care in the right place, at the right time. Care New England does this successfully through our ACO [accountable care organization], Integra.
The VNA of Care New England does this by helping our frail patients to remain safely in their home. To help them increase their strength and balance, for example, our agency has a comprehensive fall-risk program called Steady Strides.
This program is rigorous and helps patients regain their balance, strength and confidence to avoid falls and resulting injuries. We also work diligently to ensure that patients understand the medications that they are taking. Most patients see a number of different physicians and it is not unusual for a patient to be on 25 to 30 daily medications. Not only is this unaffordable for many, it is confusing and may lead to medication errors that result in hospitalization.
PBN: What is your opinion on the criticism of Nicholas Oliver, executive director of the Rhode Island Partnership for Home Care, who in April 2016 objected to Raimondo’s fiscal 2017 budget proposal, which included a 7 percent increase in Medicaid funds to increase care workers’ compensation but did not include reimbursements for health care services in the homes of the state’s Medicaid population?
PEIRCE: Home health care is challenged by decreasing reimbursement almost every year. In Rhode Island, it has been a decade since the last increase in reimbursement services for Medicaid patients, which is a significant population for which home care services are provided.
That creates a significant financial challenge. In addition, Medicare for the first time in 30 years has issued new conditions of participation (COPs). What I love about these new COPs is that they are patient-centered. What I struggle with is that they are costing the industry approximately $293 million in year one and $234 million each year following.
These costs are not offset by any reimbursement. The people who choose to work in home health care are incredibly talented and committed to providing the best care to patients. Home health workers travel to patients’ homes – no matter the weather. In order to recruit and retain the best and brightest, we need to be able to pay competitive wages and offer incentives for a job well done.
That has become increasingly challenging as reimbursements decline. At the end of the day, we remain focused on the patients, the clinical outcomes we are trying to achieve, providing care in the most efficient and economical way, and employing creative solutions to all the challenges we are faced with.
Rob Borkowski is a PBN staff writer. Email him at Borkowski@PBN.com.
