NBC News and Lester Holt highlight care at home

From Leading Age: It’s not every day that a study from the Journal of General Internal Medicine makes it on to the evening news. But the story I saw on NBC Nightly News this week must have resonated with anchor Lester Holt because he knew it would resonate with his viewers.

Dr. John Torres, the show’s medical correspondent, reported on the results of a small, randomized, controlled trial showing that patients receiving care at home for serious conditions like infections, heart failure, and chronic obstructive pulmonary disease, experienced just as good outcomes, at a lower cost, than similar patients treated in the hospital. Most important, community-dwelling patients were happy to be recovering in their own homes.

At LeadingAge, we’ve known for a long time that consumers prefer home care to care in a hospital or nursing home. Back in 2008, we developed a guide called Doctor at Your Door to educate senior housing communities about the benefits associated with bringing doctors to older adults, rather than the other way around.

The publicity around this latest study reinforces the fact that we were on to something big almost a decade ago. But it also raises important issues that we cannot ignore as we continue to move health care to the home.

AFTER THE DOCTOR LEAVES

It was reassuring to see Dr. David Levine, a clinician-investigator at Brigham and Women’s Hospital in Boston, ministering to one home-based patient in front of NBC’s cameras. And it was downright heartwarming to see the genuine relief and gratitude on the face of the older woman featured in the piece. She obviously was very glad to be at home and not in a hospital.

But one thing struck me as I watched the scene: Who would be there for the older woman after Dr. Levine went on to his next patient?

Many community-dwelling older people with serious illness depend on at least 2 people to be there for them, day in and day out: a family member and a home care worker.

I’ve been thinking quite a lot lately about that home care worker. Fortunately, I’m not the only one who is.

BUILDING HOME-BASED TEAMS

I’ve just returned from a meeting, funded by the Gordon and Betty Moore Foundation, which focused on this very subject. Researchers, nurses, social workers, psychologists, funders, policy makers, payers, educators, and home care worker organizations came together to talk about how we can ensure an adequate workforce to support the care of people with serious illness in the community. In a few weeks, I’ll be taking part in a similar workshop on Integrating Health Care and Social Services for People with Serious Illness at the National Academies of Sciences, Engineering, and Medicine.

It’s important that we’re having these discussions at a time when, as NBC obviously knows, older people are voicing their preference to stay at home, even when they are dealing with serious health conditions. We owe it to these older Americans to do what we can to respect this preference. But we also owe it to them to ensure that community-based care is the best it can be.

There are many things we can do to ensure good outcomes at home, but one stands out for me. We need to build coordinated teams to provide care to older people living in the community. We need to include the home care worker on that team, and we must give that worker the same respect we give to the team’s primary care physician, nurse practitioner, social worker, specialist, and pharmacist.

HOME CARE WORKERS ARE KEY

Home care workers spend more time in a care recipient’s home than any other service provider, and that makes them essential to the success of the care team. Because they have a personal relationship with the care recipient, these workers can provide important knowledge and insights about that person to other team members. The home care worker also has the advantage of seeing the person often enough to be able to quickly detect changes in condition before they escalate into medical emergencies. And, of course, the home care worker provides more hands-on care to the individual than any other team member.

Clearly, it makes no sense to design a home-based care team without the home care worker. But how?

The first step is difficult, but fundamental. We need to adopt a coordinated approach to home care. This means teaching community-based doctors, nurses, social workers, pharmacists, and home care aides how to work together, make care decisions collaboratively, and delegate care tasks. It means being intentional about recognizing and acknowledging the value of home care workers, providing them with appropriate training and education, and then trusting in their ability to fulfill their potential.

MOVING FORWARD WITH YOUR HELP

I’m hoping the recent interest in hospital-at-home programs will foster serious efforts to create more home-based care teams that value and hone the skills of home care workers.

I believe LeadingAge members can play a role in speeding up this process as they expand their home care services, work with health care partners to develop integrated models of care, or seek ways to better support residents of affordable housing and retirement communities who want to remain in their apartments for as long as possible. Here are a few basic, and necessary, steps:

• Pay attention to this emerging trend. It’s not going away.
• Train your home care workers so they have the skills they need to participate fully in home-based care teams.
• Advocate for those workers to ensure that they will be accepted as full-fledged members of those teams.

We will never have a high-quality home care sector without well-trained and well-respected home care workers. Invest in that worker today. Residents, clients, and workers will thank you tomorrow.