(800) dscc.uic.edu

Transcription

1

2 DSCC Helps Transition Children with Complex Medical Needs from Hospital to Home Cynthia Booth, MS, RN, APN & Amy Cunningham, RN, BSN Home Care Program

3 Educational Objectives Understand DSCC s mission and programmatic structure Understand the role of DSCC in transition from hospital to home Describe home care eligibility and the referral process Discuss barriers and common concerns; strategies for resolution

4 Disclosure We declare that neither we, nor our immediate families, have a financial interest or other relationship with any manufacturer/s of a commercial product/s or service/s which may be discussed at the conference.

5 Who We Are Illinois Title V organization since 1937 We partner with Illinois families and communities to help children and youth with special healthcare needs connect to services and resources. We help children with special needs Nurses Social Workers Speech & Language Pathologists Audiologists Advanced Practice Nurses Respiratory Therapists Medical Insurance Specialists

6 Core Program Orthopedic bone, joint, muscle Neurologic nerve, brain, spinal cord Heart Defect External body impairment cleft lip/palate & severe burn scars Hearing loss Speech condition require medical/dental treatment Eye impairment cataracts, strabismus, and certain retinal conditions Cystic fibrosis Hemophilia Certain inborn metabolic problems PKU, galactosemia Urinary impairment kidney, ureter, bladder

7 Home Care History Program enables certain children with special health care needs to live in their home 1983: program initiated to provide care coordination to a medically fragile/technology dependent population Joint state/federal funding for child health programs (Title XIX-Medicaid)

8 Home Care Program Administered by Department of Healthcare and Family Services (HFS) Operated by DSCC, through an intergovernmental agreement Eligibility for waiver and nursing services is determined by HFS

9 Home Care Services Care coordination Environmental & vehicle modifications* In-home shift nursing Specialized training of nurses* Special equipment & supplies Respite care* Family/caregiver training* *waiver services

10 Waiver & Non-Waiver Nursing for all children is provided through Medicaid s Early Screening, Diagnosis, and Treatment program Waiver children at risk for institutional level of care Non-waiver children generally lower level of medical fragility and technology dependence Any child who requires home nursing, including families with higher incomes, can apply for Home Care

11 Over 21 Age 21 years and older Had to be a participant in the MFTD waiver program and age out at 21 years Not eligible if they left the waiver program before age 21

12 Eligibility Technology dependence, care requirement Technology examples: Tracheostomy Ventilator Complex tube feeding TPN Oxygen, Bipap/CPAP Peritoneal Dialysis

13 Eligibility Illinois Residency Safe home Caregiver willing to learn and provide care

14 Referrals are Easy Call us caregiver s name phone number child s address county or zip code Visit our website fill in family information submit web form

15 Website & Facebook

16 Intake Process Complete application Comprehensive medical reports Authorizations Verification of insurance Physician letter of medical necessity Must include statement of need for nursing Description of medical and nursing care needs Include diagnoses

17

18 Intake Process Home and community evaluation Nursing agency selection Determination of DME provider Parents complete training Complete application submitted to HFS Evaluation by quality improvement organization Approval and allocation

19 Barriers: Housing Lack of safe home Overwhelming infestation Home in foreclosure Homelessness Lack of utilities Space limitation Landlord refuses home modifications Delay related to home modification needs Head of household refuses nursing Accessibility

20 Solutions to Housing Reorganization of space Referral to housing resources Referral to financial resources Working with landlord Extermination services provided by waiver Home modifications provided by waiver Transitional facility

21 Barriers: Family Family hasn t completed required training Lack of a secondary caregiver Transportation Caregiver health issues Social issues such as mental health, domestic violence, substance abuse, cognitive limitations Denial of need for care

22 Solutions: Family Structured training plan Explore other sources of family support Refer to core program and community resources Refer for counseling, support groups, outside agencies, palliative care Transitional care facility Refer to DHS Division of Rehab Services and Division of Developmental Disabilities

23 Barriers: Medical Instability Surgeries postponed Change in medical needs Prolonged hospitalization Progressive, deteriorating conditions Lack of predictability of medical course Stable medical status required prior to application review

24 Solutions to Medical Instability Referral at appropriate time Work closely with case manager for documentation and discharge planning Work closely with nursing agency on discharge planning Good communication with all parties Care coordination with all parties Transitional care

25 Barriers: Nursing Geographical location Lack of qualified nurses for specialty care Safety of neighborhood/condition of home Personality conflict with family Fluctuating discharge dates Frequent readmissions Difficulty in staffing weekends and nights

26 Solutions: Nursing Supplement care with CNA Use two agencies Contact agencies in other counties regarding expansion Mediation between family and nursing agency Family pursue recruitment efforts Creative scheduling

27 Care Coordination DSCC Care Coordinators work with hospitals, nursing agencies, insurance providers, DME companies, transitional facilities, families and community partners to assure medically complex, technology dependent children are safely transitioned home.

28 Connect with Us www. UIC Specialized Care for Children

29 THE FUTURE OF PEDIATRIC HOMECARE What are the necessary updated care and mindset for quality care to be maintained

30 ADVANCED TECHNOLOGY FOR MEDICALLY COMPLEX CHILDREN More medically fragile children are able to sustain a quality of life longer and in the comfort of their home This care was not available 25 years ago; in 1990 Pediatric Home Services opened up this possibility The demand continues grow as does services, providers, and technology

31 ADVANCED TECHNOLOGY FOR MEDICALLY COMPLEX CHILDREN Equipment is now available specifically for in home care and/or treatment Physicians and healthcare facilities are supporting and endorsing this transition to home care Complete communication and defined rolls in this is essential

32 INCREASED NEED FOR CARE Pediatric population with special health care ranges from.07% to 18% These increasing numbers along with the baby boomers increasing need for home care is developing into challenging issues This is affecting providers, skilled professionals, patients, and caregivers

33 FUTURE CHALLENGES Lack of fair payment for services Restrictive Coverage Benefit Exclusion

34 FUTURE CHALLENGES Lengthy Approval Process Shortage of Home Health Nursing Pediatric Skilled High acuity skill with current technology

35 HOW THE INDUSTRY CAN HELP EDUCATION OF ALL PROVIDERS AND CARETAKERS Comprehensive Care Plans More accessible and on-going care-giver training

36 HOW OUR INDUSTRY CAN HELP Collaboratively determining the services needed and appropriate providers Improved and constant communication with all service providers Continuing education for home health care providers as well as clinical professionals Training at a hospital level

37 REIMBURSMENT CHALLENGES Payment is not adequate for they level of care required from nursing professionals. This jeopardizes the quality of care and the lack of a timely turn around to get these fragile children home and safe. No differential in skill level or shift reimbursements

38 REIMBURSMENT CHALLENGES Awareness of policy makers of the intricacy and high demand Transparency and education on the true costs of all providers to keep medically needed cared for in the home. Compared costs to hospital/facility stay to home care.

39 REIMBURSMENT CHALLENGES Additional state training requirements that are unbillable increase costs that are unmanageable Disparity between hospital/healthcare Facility compensation deters highly skilled nurses from home care Budget cut for these services are limiting providers and current providers ability to continue this care

40 ESSENTIAL REIMBURSMENT Payment to be adequate to allow providers to provide care with in medical standard for pediatrics Equalizing reimbursement among all pediatric healthcare facilities and providers Customary narrative of medically necessary requirements for all insurance and state Medicaid programs

41 RECRUITING EFFORTS Nursing school-bridge programs only Too expensive to employee Registered Nurses Activism to policy makers for pay/reimbursement

42 CONCLUSION Pediatric Home Care Services face many challenges to keep up with increasing technology and nursing professionals Reimbursement is insufficient in comparison to the skill and quality care provided in hospitals and healthcare facilities Need advocacy and education for state policy makers

43 PATIENTS AT A GLANCE

44 PATIENTS AT A GLANCE