Setting the Course for New Horizons in Home Health

There is an undeniable comfort when healing in your own home, and according to Danielle Flynn, director of Penn Medicine’s Home Health program, recovering outside of a hospital is the way of the future. A second-generation nurse, Flynn intentionally pivoted to home health when presented with the opportunity.

“It’s really been quite impressive to watch how things have grown in the home setting over the last 10 years,” Flynn says. “Care delivery has really shifted from brick-and-mortar settings, such as clinics or hospitals, to a patient’s home, which, for many, is truly the best environment for a successful recovery.”

A Leader in At-Home Care

Driven by her passion for at-home care, Flynn assumed the role of director for Penn Medicine’s Home Health program. While her responsibilities are numerous, her primary focus is ensuring quality of care.

“I have direct oversight for daily operations, and at the moment we have over 3,500 patients on our service and more than 400 staff members,” Flynn says. “Beyond that oversight, I find the greatest joy and excitement in working directly with our partners across Penn Medicine to build new programs that stand to improve the kinds of care we deliver in the home.”

The patients within the Home Health program typically come directly from a recent hospital admission, Flynn says, and could potentially benefit from home nursing or therapy services. Contrary to long-term care specialists, professionals within the Home Health program serve in short stints.

“We have, for example, post-op patients that receive physical therapy in their homes and will have a nurse that comes by to check their incision and help with pain management,” Flynn says. “We’re there for about an hour or two a few days a week versus a private duty nurse who may be there for 10-12 hours at a time.”

Building on Success

Although the concept of home health has been around for several decades, the practice of care delivery outside of hospitals and rehabilitation facilities is constantly evolving.

“What I think has shifted in the industry in the last three to five years is the realization that a patient can immediately receive care at home after a hospital admission rather than having to go to a long-term care facility or rehab setting,” Flynn says.

Flynn says that Penn Medicine’s Home Health program has demonstrated that patients have improved outcomes when they immediately go home to recover following a surgical procedure. Although there have been massive successes in the program, there still exist reservations around moving more complex care types out of hospitals and rehab facilities and into homes.

“One of the programs that I’ve led and worked very closely with involves patients who have a breast cancer diagnosis, and they have undergone mastectomies,” Flynn says. “Typically, patients who have mastectomies would not receive home care services, and they would have to return to the provider’s office four to five times to have their surgical drains removed.”

Home care not only provides an additional level of comfort throughout the patient’s recovery process, but it saves them needless stresses that are involved with paying a visit to a direct provider.

“If we’re talking about breast cancer patients, many of them are younger women with children,” Flynn says. “So, for a visit to get their drains removed, they have to find childcare, drive long distances to reach the provider, pay to park, and then sit in a waiting room—all for what is usually a 60-second procedure.”

To help alleviate these stresses, Flynn is an advocate for conducting these types of procedures at home so that the patient can fully recover without having to step foot back in a hospital. To Flynn, these types of procedures are just the beginning of what is possible in home care.

Reimagining Possibilities

In addition to at-home drain removal, Penn Medicine is focused on finding an end-to-end solution for patients who have heart failure. According to Flynn, heart failure patients experience a high rate of readmission to the hospital; allowing them to recover at home is a major breakthrough.

“Our heart failure patients that receive home health services are given a telehealth monitor, which is essentially an iPad, along with Bluetooth peripherals of a blood pressure cuff, a scale, and a pulse oximeter,” Flynn says. “Every day, the patient sends their vital signs to a remote team of nurses who are also readily available to answer questions submitted by the patient.”

Should a patient need more intensive care, a team of nurses called the “Calvary” visits the patient and can report their findings back to the cardiologist. These nurses are equipped with monitors, oxygen tanks, and an arsenal of medications to deal with myriad situations while keeping the patient in their home.

“These are the types of things that we were unable to do in home health 10 years ago,” Flynn says. “Before, we would check vital signs and teach the patient about their medications. Now, we’re really shifting the type of care that could only be safely and effectively delivered in a hospital to the home setting.”

Experts in the Home

Given the advanced nature of care and inherent autonomy associated with home care, nurses and therapists must be clinically expert. Outside of hospitals and other traditional practice settings where a direct provider is present, top-tier critical thinking and assessment skills are essential, especially since, in many cases, the patients are still battling an illness.

“These home health clinicians are really the eyes and ears of providers, and they are truly some of the brightest experts we have on the team,” Flynn says. “There’s also no other practice where the nurses or therapists are also tasked with billing. So, on top of their clinical duties, they are also responsible for the organization’s bottom line.”

In many cases, these clinicians are akin to social workers insomuch as they meet the patient in their home and become immersed in how the patient lives. Having a comprehensive understanding of the patient’s world only stands to improve the type of care they receive.

“So often, I immediately thought I completely understood a patient’s situation. I would teach them everything they needed to know about their medications and their diagnosis, but then they’d be back in the hospital two days later,” Flynn says. “As a clinician in a hospital, I don’t have a window of view into what helps patients be successful at managing their acute and chronic conditions at home. When you start to really peel back the layers and understand the challenges that patients face in the home setting, you’re able to help them overcome those challenges.”

Expanding Accessibility

Although Flynn and her team continue to push the boundaries of innovation in home health, rules and regulations still prevent ubiquitous access to this type of care. Medicare and Medicaid patients who are not deemed homebound, meaning they cannot leave their home without suffering physically, do not currently qualify for home care services.

“These archaic regulations truly limit the number of people who could benefit from receiving care in the home setting, whether it be for the ability to create greater access at our hospitals throughout the country, or whether it be to enhance the patient’s recovery experience,” Flynn says. “Nobody likes to go back to the hospital, and it’s proven that there are better outcomes when a patient can recover in their own home.”

Flynn believes that a thorough re-examination of these regulations will occur over the next five to 10 years. This re-evaluation would allow for a wider cast net among patients who would benefit from home care and alleviate overflow in brick-and-mortar settings.

“I really think that there is a huge opportunity for homecare,” Flynn says. “Maybe I’m being wishful, but I think this change would make a huge difference in healthcare.”

Lauren Liacouras (lliacouras@ahima.org) is an editor with the Journal of AHIMA.