Wound care appears to be on the radar for many in health and healthcare, partly due to the addition of wound care to publicly reported measures and the increases of national costs for the care of patients with wounds. In 2005, Medicare spent more than $2 billion on hospital stays for infections of surgical and traumatic wounds and disruption of surgical wounds-twice the number reported for 2000 (Lang & Erickson, 2008).
As hospital costs have increased, the trend of hospitals discharging patients to home healthcare also has increased. In 2000, less than 25% of patients were discharged to home health treatment for wound care. However, by 2005, the number had increased to almost 33% (Lang & Erickson, 2008).
Clearly, home health offers an efficient and cost-effective alternative to hospital care. This became evermore clear during a recent shadowing experience with a visiting nurse professional. I had the opportunity to accompany a visiting nurse on home visits to 2 patients residing in an urban environment. Both patients were African American men in need of wound care, yet both had very different circumstances and living conditions.
One gentleman was elderly and lived in his family home along with his daughter and grown granddaughter who took excellent care of him, offering great psychosocial support. The other gentleman, in his 40's, lived in what appeared to be public housing. He lived alone, was obese, and had some mental health challenges.
Typical of the visiting nurses I have met, this nurse knew her profession. She was skilled, talented, and driven to deliver high-quality compassionate care to her patients. During our visits, she demonstrated a strong command of her environment and balanced the needs of her patients with a schedule that allowed for driving, traffic, and other challenges of urban settings (i.e., parking and safety). During the transportation time, she also provided consultation with other nurses treating patients in wound care. This particular nurse had specialty training in wound care and was certified in wound, ostomy, and continence nursing (WOCN).
On these visits, while learning about wound care in the home environment, I also gained great respect for the compassionate uncompensated care provided to patients in the Medicaid and Medicare systems. For example, on the average, reimbursement or coverage for supplies under Medicare is about $150 a month. Supplies for one of the patients was approximately $100 for the 1 treatment, and his wound required a total bandage change every 2 days. His chronic venous disease had caused deep and horrific wounds completely covering the lower part of his leg, and because of his obesity, he was unable to reach, clean, or treat the wounds adequately on his own. The severity of the wounds also required extensive treatment for assistance in healing that allowed adequate circulation and protection from additional injury. Covering the true cost of supplies was not an option for this patient. His wounds needed professional treatment to avoid infection.
In addition to supply costs, had it not been for home care, the patient would have had to navigate his neighborhood via wheelchair seeking public transportation to the closest hospital or healthcare clinic. How are these costs captured? How is lifestyle or other social determinants built into the healthcare cost equation? The reality of this experience, the visualization of this wound, the care and treatment by the nurse, the skills required to navigate the home environment for supplemental support, and the additional care and compassion shown to the patient will remain in my mind forever. In addition, I have a heightened sense of respect for our member agencies and a recognition for the importance and value of providing uncompensated care through the charitable donations of generous sponsors and donors of nonprofit organizations. It is the combination of public and private resources that truly contributes to patient well-being.
The cry for support and the story to be told by both provider and patient are profound. Medicare needs to cover home healthcare and at adequate levels for every patient. Patients need care in the home. This care not only addresses their well-being. It also reduces the cost and the logjam of patients seeking care in emergency rooms. The large numbers of uninsured patients have some health coverage through Medicaid or Medicare; yet they do not have adequate supply or access to that care.
As a nation, we need to recognize the complexities of our healthcare system and support systems of care that meet patients where they need treatment and where they are best able to listen and learn-at home. Home care addresses the needs of patients who struggle with transportation issues, safety issues, and the logistics of getting to and from care, especially when they lack family support. Yet, the true costs of these additional challenges in healthcare are not part of the formula. Policymakers need to understand this additional complexity in service delivery and recognize the solutions to many of the challenges facing patients.
Home healthcare can and does positively affect the quality of healthcare and reduces the costs associated with that care, financial, emotional, and professional. Our elected officials need to do the right thing-preserve home healthcare benefits in Medicare. We cannot allow policy decisions to have a negative effect on patients, nurses, and families of the ill and infirmed.
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