Home care doesn't always require a traditional home setting, expert says - MedCity News

Earlier this year, a patient at an Oklahoma hospital was in and out of the emergency room six times in the previous 10 days for treatment of a severe bone infection.

But because he didn’t trust the health care system, he didn’t want to stay in the hospital. He was therefore offered home care. The only problem was that he didn’t have a traditional home; he lived in a caravan in a friend’s yard.

This was not a problem for the hospital it partnered with Medical homean organization that works with providers to offer home care.

“They were able to take in this person who was so distrustful of the system, who was living in circumstances that you might not think of a home and looking after their condition for the first time,” said Pippa Shulman, Chief Medical Officer of Medically Home.

Shulman spoke on a panel last week at Mayo Clinic Platform Conference about how the Boston-based organization works to reach people in underserved communities. Medically Home, founded in 2016, partners with 13 health systems in 14 states, including Mayo Clinic and Kaiser Permanente. The company provides training, protocols, procedures and technology to help health systems deliver the care and manage the goods and services patients need. In return, Medically Home charges a fee to its partners.

Currently, in a public health emergency, Medicare and many state Medicaid programs cover hospital care at home, as do many Medicare Advantage plans and commercial insurers, according to Shulman.

Shulman said not everyone needs a traditional home to receive home care. As long as they are somewhere with a roof, electricity, water and a bathroom, Medically Home can offer its services. There are patients who have received care from their friend’s living room or couch, or from Airbnb. In the event of natural disasters, such as an ice storm, Medically Home can even house patients in a hotel, Shulman added.

For those without a home, Medically Home will ask if there is a family member or friend willing to take them in. In that case, the organization will talk to a family member or friend and explain what the care will look like, and the company tries to keep a relatively small footprint in the home, Shulman said.

Patients themselves do not need any technology to receive home care; Medically Home provides all the necessary equipment that further facilitates patients’ access to care. The company brings patients a tablet, phone and personal emergency response device that they carry, all of which point to the command center. For internet access, Medically Home also offers a tethering device. With these devices, patients can also connect with their care team 24/7, Shulman said.

Like the patient who received care in his friend’s trailer, many patients lack confidence in the health care system. Providing care at home can restore that trust, Shulman said.

“When we think about vulnerable patient groups, the advantage of moving care to a place they call home is that we really put that patient at the center of care. We are guests in their home,” Shulman said. “Although yes, we provide whatever is required at the right time, they know when we’re coming, they know who’s coming … They’re not left wondering, ‘Who am I going to see today?'”

And not only do patients benefit from this setup, so do their caregivers.

“We’re not asking the caregivers to be a nurse or provide the care, but they also have the same transparency about who comes in, what happens next,” Shulman said. “They can participate in the visits with the doctor and the nurse. And that’s often a really big change for caregivers compared to what they see in the physical hospital.”

Although Medically Home offers care to many patients in a non-traditional home setting, some patients are still out of reach. The next frontier is rural communities, where broadband is a challenge, Shulman said. She added that there are several ways the company is exploring to improve this problem, such as using devices that can increase the strength and power of wireless signals or using satellite technology.

“We already work in a number of rural communities, but this is the area where our connectivity challenges are greatest,” Shulman said. “I just want to make sure we’re creating a reliable and robust connection pathway for as many patients as possible, and I think rural areas are where that can be a challenge.”

Photo: selimaksan, Getty Images

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