Home healthcare, also referred to as formal or skilled care, is the support and care service that healthcare professionals provide at the patient’s own home. These care services include respiratory therapy, home infusion therapy, home medication, skilled nursing or medical care. The global home care and self care market is the aggregate of the markets for home healthcare equipment and home healthcare services.
The most important trend in healthcare witnessed in the recent times has been a shift of patient’s focus from hospitals to home care. The move from treatment to proactive monitoring has opened up new opportunities in the home healthcare market. Patients prefer home healthcare over hospitals mainly for the latter’s cost and convenience benefits; and are thus increasingly opting for third-party medical professionals and care-givers.
The home healthcare market generates approximately 70% of revenues from the people aged 65 years and above; mainly because of the declining ‘elderly support ratio’, or the ratio of the number of people caring for the elderly, to the number of older people above 65 years. This factor highlights the growth potential of the market for third-party care in the coming years.
With a major push toward healthcare reform and the appropriation of nearly $20 billion in federal stimulus funds as part of ARRA (The American Reinvestment and Recovery Act), 2009 was an action-packed year for the healthcare industry, particularly healthcare IT. 2010 promises to be even more dynamic as healthcare organizations prepare for upcoming industry changes and position themselves to take advantage of government incentives. The following are 10 trends I feel will drive the healthcare IT market this year:
1. EMR Adoption Gains Momentum — According to the latest statistics from HIMSS (Healthcare Information and Management Systems Society), only 0.5% of U.S. hospitals currently have a complete EMR (electronic medical record) system that provides data continuity throughout the institution. Hospitals and healthcare systems will install, integrate, and enhance EMR systems at an accelerated pace in an effort to demonstrate "meaningful use" and capitalize on ARRA incentives.
2. PHRs Earn Legitimacy — PHRs (personal health records), once rejected by providers and academics, will become recognized as a viable method in which to transport patient data and will complement EMRs and EHRs (electronic health records). Advances in secure personal storage, smart card, and software technology will help drive this trend.
1. Recession. Though conditions have improved in some areas, hospitals are still feeling the lasting effects of the recession.
"This recession seems to be a two-step process that we are only halfway through," says Michael Rowan, COO and executive vice president of Catholic Health Initiatives in Denver. "The markets are improving but there are still a large number of unemployed out there, and that will affect hospitals' bottom lines." The recession has revealed itself in a variety of ways that are mapped out in numbers 2-7 below.
2. More non-paying patients. "Growth in unemployment has translated into growth of the uninsured," says Nancy M. Schlichting, president & CEO of Henry Ford Health System in Detroit. Michigan has had a longer and deeper drop in unemployment than any other state, with the jobless rate at 15 percent for the state and at 30 percent for Detroit alone. Ms. Schlichting says Henry Ford has seen a 20 percent growth in uncompensated care each year for the past two years.
Ms. Schlichting has been trying to find ways to cope with the influx of non-paying patients. Henry Ford is partnering with a federally qualified health center in Detroit to direct patients needing primary care from its EDs to the center. Even as the economy improves, Ms. Schlichting says the challenge of non-paying patients won't go away because unemployment will remain high. Washington has been trying to soften the blow. Dick Clarke, president of the Healthcare Financial Management Association, hopes that Congress' extension of COBRA eligibility for group insurance coverage for laid-off workers could markedly raise the number of paying patients.
Marilyn Pattillo, RN, Ph.D., is an associate professor of clinical nursing and co-chair of the Disaster Nursing Committee, and Trish O’Day, MSN, RN, CNS, is an instructor in clinical nursing in the School of Nursing.
What was your initial reaction when you heard about the earthquake in Haiti?
MP: Sadness…. Sadness for those whose lives have been disrupted. Sadness because I know that many groups from countries all over the world are sending help. Unfortunately there is probably no command and control in Haiti to organize the response efforts. As usual, politics, influence and power will come into play.
TO: My initial reaction was how different this disaster is from a disaster in the United States. Even with the many challenges of Katrina in our country, the aftereffects of this earthquake in Haiti will not be remedied in five or 10 years. After Katrina, there was housing (imperfect, perhaps) for evacuees to transition to. That is not the case in Haiti, with no resources to rebuild. Where will survivors live?
How important is it for nurses to be mobilized into Haiti to help with triage and providing care?
MP: There are trauma and emergency room nurses who are trained to work in triage teams and assist in search and rescue efforts. Most nurses, however, will be needed to stabilize injured patients and to keep epidemics from happening. In addition, nurses can also help by:
o Mobilizing and keeping the families resourceful and intact to help with caring for injured family members.
o Preventing a “second disaster” by conducting good health assessment and disease surveillance.
o Organizing immunization and vaccination efforts.
o Identifying people at high risk for malnutrition and sickness.
o Identifying areas that need immediate assistance because of poor sanitation, lack of water, lack of good food, grief and psychological trauma.
o Setting up shelters that are safe and can provide respite.
o Training local nurses and physicians.
o Collecting data so resources can be appropriately allocated.
PS. This is a good article because we can use it not only in Haiti but also wherever disaster strikes
The elderly will outnumber children for the first time in 2045, ratcheting demand on nursing homes and increasing the burden on working-age people to support retirees, a United Nations report found.
The proportion of the world’s population older than 60 years will reach 22 percent over the next four decades from 11 percent in 2009 and 8 percent in 1950, the UN’s Department of Economic and Social Affairs said in the report, titled World Population Ageing 2009.
The ranks of the elderly are expanding 2.6 percent a year, three times faster than humanity as a whole, mostly because people are living longer and having fewer children. The trend will affect economic growth, savings, investment, consumption, labor markets, pensions and taxation, the UN found. It will also influence living arrangements, housing demand, migration trends and the need for health-care services.
“As children account for a declining proportion of the population, there may be a reduction in the number of schools just as the increasing share of the older population begins to require more long-term care facilities,” the authors said. “In the political arena, population aging may shape voting patterns and political representation.”
The number of people older than 60 surpassed 700 million worldwide last year and is projected to swell to 2 billion by 2050, or triple the level in 2000. In most countries, the population over 80 is growing faster than any other age group and will continue growing rapidly until at least 2050, indicating “a growing demand for long-term care,” the authors said.
Today, the median age for the world is 28 years. The north central African nation of Niger has the youngest population with a median age of 15; Japan has the oldest, with a median age of 44, according to the report. Worldwide, the median age will likely increase by 10 years over the next four decades.
As revelers celebrated the start of a new year and a new decade, little Miya Tanni was welcomed into the world as Chicago's first baby born in 2010 -- arriving 10 seconds after midnight, according to St. Joseph Hospital on the North Side.
Weighing in at 7 pounds, 6 ounces, Miya was born to West Rogers Park residents Linda and Azin Tanni, both registered nurses. Azin Tanni also is an Iraqi war veteran, having done two tours of duty over four years.
Patients at risk for falls at Northern Westchester Hospital Center in Mount Kisco, N.Y., are easily identifiable. They wear yellow socks. It is part of a new way of doing things at the facility, an innovative falls prevention initiative designed and carried out largely by nurses.
Unofficially called the Four P’s, the evidence-based practice model incorporates pain, position, potty, and placement markers into two-hour rounding. Because the program is only 3 months old, official falls data isn’t available. But the nurses, who round in the units where falls traditionally occur, report fewer occurrences.
“Within the last month and half, at least on this unit, I don’t remember hearing of a fall taking place,” says Cristina Fata, RN, BSN, staff nurse on the mixed medical unit. “That rates really well with a year ago. Obviously our goal is to have no falls, but realistically sometimes something happens we can’t account for. This has definitely reduced the number of falls and call bells.”
The idea behind the Four P’s arose from Northern Westchester’s evidence-based practice council, says Chief Nursing Officer Lauraine Szekely, RN, MBA, who also is the senior vice president for patient care services at the 235-bed facility.
“The nurses who are involved in the evidence-based practice council through our shared governance model were interested in looking at falls and pressure ulcers to see what evidence was out there to ensure our practice was the best and meeting industry standards,” Szekely says.
To that end, the evidence-based practice team reviewed existing literature on falls prevention and examined internal data on when and where falls occurred in the facility, says nurse educator Fay Wright, RN, MS, SPRN-BC, coordinator of evidence-based practice and clinical instructor at Northern Westchester.
“Most of the falls at Northern Westchester were because people needed to go to the bathroom, and if you think about it, that makes sense because you wake up in the morning and you have to go,” Wright says. “So we looked at the evidence, and people were looking at toileting every one to two hours as a way to prevent falls. It’s almost like taking tiny steps — called small tests of change — in the change process.
The next step in creating the program was developing a fall risk assessment tool that not only incorporated toileting with falls-prevention strategies done during rounding, but also continually measured a patient’s fall risk.
“This is the beauty of the small tests of change,” Wright adds. “We identified procedural issues. For example, someone goes in and turns a patient, but they don’t potty before turning and a few minutes later the patient needs to go to the bathroom, so it’s almost double the work and uncomfortable for the patient because they’re getting moved a couple of times. [We’ve] developed a system that helps people work together.”
Four P’s Primer
Nursing professionals saw how the elements of the tool fit together in April during a comprehensive training. Close to 150 RNs, LPNs, technicians, chart coordinators, and respiratory therapists received education designed and administered by Wright on the new program.
“We had a bed set up with a mannequin, and everyone role played what they needed to do during rounding and used the key words to assess pain, potty, position, and placement,” Wright says. “At first people were like, ‘We can’t do this,’ but once they started doing it they got really engaged and played with it.”
While the enhanced rounding intrinsic to the Four P’s initially seemed like more work for bedside nurses, that perception quickly was dismissed.
“It’s less work in a way because when you’re frequently checking on patients you’re anticipating their needs and decreasing the call bells,” says Katerina Langer, RN, staff nurse in the orthopedic and neurology units. “But safety is the biggest concern, so whether it’s more or less work we’ll do whatever’s necessary to improve safety and prevent falls.”
The assessment component of the Four P’s provides another layer of prevention. Upon admittance and each ensuing day, patients are evaluated for risk. Not only do high-risk individuals receive yellow socks, they are charted with yellow stars and identified as fall risks to the call-bell intercom operators.
“One day a patient may be OK, but the next day have a procedure and become a risk, and this encourages us to assess our patients’ fall risks on a daily basis,” says Annmarie Tietjan, RN, BA, PCCN, staff nurse in psychology and cardiopulmonary units. “This is a tool that is more specific to each patient — it’s in tune to their individual needs.”
Patient Acceptance
High-risk patients generally have been receptive to the new tool, Tietjan says.
“The funniest thing happened. The first day it went live I went into a patient’s room — it was an elderly man — and told him about the new rounding, and he said, ‘That’s the best damn thing I heard all week. That makes so much sense,’ and I told him he was absolutely right,” Tietjan says. “It really gives us an opportunity to talk to the patients and see what they need.”
The additional time with patients is a boon to nurses stretched by the fast-paced hospital environment, Fata adds.
“Even if it’s just a few minutes to toilet and turn the patient, it gives you that time and allows you to assess and pick up on cues if the patient is in distress,” Fata says. “I don’t think it makes you a better nurse, but it brings out top-notch nursing; it’s more about personal nursing. With turning and positioning and being about the patient more, it makes it more personal and patients see the difference.”
