When a loved one is
discharged from the hospital, but requires additional care to achieve complete
recovery, Tyler Home Health Services can help.
Families
facing this challenge often struggle with the competing demands of providing
appropriate care to the loved one, juggling the needs of other family members
and meeting the responsibilities of a job.
According to Robert (Bob) Cooney, LCSW, and executive director of Tyler Home Health, home health care is defined as an intermittent, in-home, skilled care service that is based on a physician's order.
Sometimes a physician may see a patient in the office and realize that home care is needed; but often patients are referred following a hospital stay. At Tyler, inpatient cases are evaluated by the Utilization Review and Social Services departments, who carefully review patient charts and make recommendations to physicians regarding the need for continued patient care after discharge. Often this care includes a referral to home health.
Tyler Home Health Services,
(THHS) an affiliate of Tyler Memorial Hospital, is a licensed and certified
home health agency that is covered under Medicare, Medicaid and other major
insurances. Located
in the Warner Complex on Kim Avenue, THHS provides quality, compassionate
in-home medical care to people of all ages recovering from an illness or
injury, as well as those challenged by a chronic or terminal illness.
Created
in 1993, THHS grew out of the work of the Rural Health Task Force. William
Milligan, Tyler president and CEO, was a member of that group, and set a
goal of creating a local home health agency to meet the continuity of care
needs of the community.
In July of that same
year, THHS was born, with Bob Cooney as its director and Brenna Evans, RN,
currently Director of Quality Management at Tyler, as its first nurse. By
September, THHS became licensed and certified, and added a second nurse
and physical therapist to the team.
Today, THHS employs
25 licensed professionals and certified aides. Each must possess a valid
driver's license, the ability to work independently, their own liability
insurance, and experience in their respective fields.
The
range of services provided by THHS includes monitoring of vitals, intense
wound care, administering IV antibiotics, occupational and physical therapy,
social services, and nutrition counseling.
To supplement this care, home health aides provide assistance with bathing, exercises, and managing care of the sick room. Combined, these services maximize the patient recovery process.
According to Bob, THHS'
primary area of coverage includes 40,000 people, and stretches from the
Bradford County line, east to Rt. 81, and from the New York border south
to Luzerne County - with a few visits in Lackawanna, Bradford, Luzerne,
and Sullivan counties."Our employees often travel 50 miles to visit
a patient," Bob noted. Visits range from 30 minutes to one hour, and
the average time a patient receives services is 42 days.
Bob
stresses that he and his staff are always conscious of the fact that they
are guests in the patient's home, so the wishes of the patient always prevail.
If a patient doesn't want certain things done, then the staff must abide
by their wishes.
According to Bob, competition
is a challenge in this area. Many out of county agencies try to say they
cover our region, but THHS has a very good relationship with two competitors,
Barnes-Kasson and Towanda Memorial, with which Tyler often refer patients
back and forth.
But the biggest challenge affecting all home health agencies is government
roadblocks. When DRGs were first established in hospitals, home health agencies
flourished, since the care they offered was not affected by the DRG. THHS
itself went from 2000 visits a year in 1993 to 10,000 visits a year in 1997.
Then in 1997, the federal
government implemented the Balanced Budget Act, which instituted the Interim
Payment System (IPS). Prior to 1997, payment was received per visit (with
unlimited visits), allowing a flat rate of $1,500 per patient. Between 1997
and 2000, about 35% of home health agencies nationally went bankrupt, and
another 40% were purchased by hospitals or large corporations. Visits per
year dropped considerably. Luckily, THHS was able to weather the storm.
In 2000, HHRGs came
into effect, which is the home health equivalent of the DRG. The payment
rate was based on multiple factors. An oasis data system was put into effect
by the government that, based on how certain questions were answered, determined
what THHS would be reimbursed for each patient. At that time, THHS growth
began to plateau, with visits averaging between 6,000 - 7,000 a year.
More
government changes came along in the beginning of 2003, when a system called
Home Health Care Compare was launched. Now, THHS is ranked against other
state agencies according to its ability to improve patient care in 15 different
categories. This information can be viewed by the general public by visiting
the CMS website.
Future plans for THHS
include continuation of the same quality of care and patient community education,
and growth of their patient base.
When asked what plans
he had for bringing hospice to our area, Bob answered that he is working
on identifying grants to get a hospice started in this area. However, securing
startup funds and identifying an experienced professional to direct a hospice
agency pose significant challenges.
For now, he said, many
people in our service area use hospice programs from outside the county.
Even with all of these
challenges, THHS' biggest reward is seeing patient improvement and developing
close, positive relationships with patients and their families."Seeing
a patient recover and enjoy life again is really our best reward,"
Bob added.
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