Home-based healthcare services have a long history in the United States, starting with visiting nurses providing safe milk for infants and improving the health of immigrant populations. Over time, as reimbursement strategies and regulations changed, so has the delivery of home healthcare. Healthcare is currently at a tipping point, transitioning from an episodic orientation to promoting health for individuals and populations, and focused on improving outcomes while reducing costs. The National Research Council (2011) recently declared that healthcare is coming home.
Bundled payments, major technology advances, the aging of the population, an "experience-oriented society," and the push to reduce costly inpatient care have combined to promote creative home-based healthcare. As a result, both the complexity and the intensity of these services are increasing. In order to improve the experience of care and reduce costs, home healthcare of the future must be patient-centered, seamlessly connected and coordinated, assure high-quality care, and be technology-enabled.
A recent white paper commissioned by the Robert Wood Johnson Foundation identified three critical roles for future home healthcare organizations: 1) postacute care and acute care support, 2) primary care, and 3) long-term care. Key attributes for success include having a holistic approach (considering an individual's physical, mental, social, and spiritual aspects in the context of their environment); coordinating care across providers and sites of care; collaboration (partnering with other professionals and community resources); and advocacy on the part of the individual, family, and community (Storfjell et al., 2017).
Home healthcare providers have a unique opportunity to improve the health of their communities. They see firsthand the impact the environment and social supports have on the health of an individual. They are intimately aware of resource gaps and fragmentation. Thus, they are in a perfect position to identify trends mobilize needed resources to improve the health of a community or population.
As 1% to 5% of the U.S. population accounts for the majority of healthcare costs, collaborating with acute care providers to reduce inpatient utilization is critical. Multiple studies have shown that nursing care management that includes in-home contact is the most effective strategy for improving outcomes and reducing costs for this high-risk group. Because of their knowledge of resources and their relationship with patients, home healthcare nurses are in a unique position to coordinate care across the continuum for these complex care, high-utilizers. Delivering primary and long-term care in the home offers a promising and cost-effective solution for millions of frail, vulnerable older adults living with chronic conditions and functional impairment. The advances in telehealth and related technologies support increased access to home-based primary care and specialty consultation.
To accomplish these changes, home healthcare providers need to look to the past to reinvent the future. According to Florence Nightingale, "Nurses are about keeping people well, safe, comfortable, informed and whole; building the capacity to manage their health in every stage of life." And Lillian Wald (1915, p. 65) said that "the call to the nurse is not only for the bedside care of the sick, but to help in seeking out the deep-lying basic cause of illness and misery." The words of these healthcare pioneers are even more important today. To be successful in the future, home healthcare professionals need to be about creating health, as well as treating disease.
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