Developing Home Care Services A Global Perspective

Developing Home Care Services A Global Perspective

Developing Home Care Services: A Global Perspective July 9, 2015

Barbara Piskor MPH, BSN, RN, NEA-BC BKP HealthCare Resources Nancy E. Allen BSN, RNC, CMC Solutions for Care, Inc.

Home Health Care Objectives: In this session you will learn: Establishing Home Health Building the Framework Identifying Financial Supports Determining the Operational Structure Delivering Quality Patient Care

The Laws of the Land Research Required Are there any current laws that govern Home Health? Nation-wide? Local? Starting a business may vary from country to country. It is important to be aware of the business registration, laws and licensing requirements.

Determining the Operational Structure

Building the Frame Work What will be the framework for delivering patient care? Laws, Regulations, Policies and Procedures for operations Clinical Procedures provide safeguards and ensure consistency in delivering care to the patient.

Step #1 - Determine the Structure Home Care is a business What will be the framework for delivering patient care? Laws, Regulations, Policies and Procedures for operations, Clinical Procedures provide safeguards and ensure consistency in delivering of care to the patient. Governments, insurance companies and private payers are looking for sound business processes to determine reimbursement and for cost effectiveness.

What type of care is needed by the community? Who are the Patients? Adults, Pediatrics, Geriatrics? What kind of care is needed? Consider the market. Skilled Care Treatment, Palliative, Hospice Non-Skilled Care Who will provide the care? Nurses, Therapists, Home Health Aides, Social Workers, Community Workers, Families?

Identifying Financial Supports Who will pay for services? Consider sufficient financing to cover break even costs and for future planning and strategic goals. Government? Private-Self Pay? Insurance? Grant? Other?

Buy-In from Key Stakeholders Queen of Palau, President chief of staff, Minister of Health, Social Security Administration, Physicians, Faith-Based Organizations, Women s Council

Service Delivery Considerations Complexity of Care Community-at-Large Supports Competition Staff Availability Staff Competencies Market Feasibility Cultural Diversity Multidisciplinary Staff Office and Service Supports Computerization Regulations/Laws/Funding

Business Entity When you choose your business entity, you are describing to the government the type of business you will operate and its corporate structure. Licensing Dependent on governing laws.

The Guiding Principles

Step #3 - Develop Policies and Procedures Written policies and procedures need to clearly define a consistent approach to recurring business, human resource and clinical practices. The policies/procedures outline the standards and practices that your team will implement. Uniform practice ensures safety for your clients as well as legal protections for your organization. It provides guidelines to support reimbursement.

Step #3 - Develop Policies and Procedures A wide variety of policies and procedures should be covered in your manual including: Administrative, HR and Clinical Practices Documentation Administrative and Clinical Client Rights And Responsibilities Intake Procedures Job Descriptions Hiring Practices Risk Management And Quality Assurance

The Foundation for Receipt and Payment of Funds

Step #4 Establish Solid Financial Systems There following are recommended steps to set up your financial systems: Set up a business checking account. Set up a business savings account. Set aside 6 months operating capital to pay your bills while you are getting the business started. Set up a credit card merchant account with your bank. Complete links with 3 rd party payer sources.

Step #4 Establish Solid Financial Systems For Receipt and Payment Set up a pre-paid deposit process for new client accounts. a computerized accounting system if available. a chart of accounts for your financial statements. Payroll systems. Determine your billing rates, gross margins, and expense percentages. systems to ensure accountability in financial systems.

Recruit and Hire

Step #5 - Recruit and Hire Office Staff Your administrative and support staff will become a tightly knit team that will act as the heart of your business. Finding the right mix of talents and personalities is critical to long-term success. Create an organizational chart.

Step #6 - Develop a Recruitment and Retention Plan for Caregivers The Valuable Caregiver The quality of your product is dependent on the quality of people you recruit. Your ability to compete long-term is influenced by your ability to retain the quality caregivers that you ve recruited. Ensuring quality through background checks, education, experience. Qualified to meet physical challenges of the job? Free of Communicable Disease (i.e. Tuberculosis, Ebola)

Concrete or Virtual?

Establish the Office Home Care companies are typically run in a standard office environment for the administrative staff, scheduling staff, clerical support staff and a home base for field supervisors. If the organization is small and the laws allow, home health can be run from a virtual office such as a home office that controls centralization of services. i.e. Staffing, Supplies, Records, Documentation (paper/electronic)

Basic systems may include: Scheduling Billing to clients Billing to government agencies and other payors Bookkeeping Systems Time Keeping Systems Customer Relationship Management Systems Client Record Keeping Payroll Benefits Administration Continuing Education Record Keeping

Scheduling, Billing, and Time Keeping Systems

Step #8 - Scheduling, Billing, and Time Keeping Systems As early as possible, you will want to automate your office operations with computerized scheduling, billing, time keeping and financial software, if possible. If computerized resources are not available, a written documentation system will need to be established.

Inform the public and intended clients and patients about the home care services

Step #9 -Inform the public and intended clients and patients about the home care services There are basic sources of new clients: Consumers - including home care clients, their families, and friends. Healthcare Providers - including hospitals, nursing homes, doctors officers, rehab hospitals, and other providers of healthcare services. Trusted Advisors including elder law attorneys, bank trust officers, geriatric care managers, social workers, clergy, physicians, and financial planners.

Sales And Marketing There are three basic strategies to sales and marketing Networking and Direct Selling Advertising and Consumer Marketing Word-of-Mouth Marketing

Case Management: A Model for Success Susan Chapman RN Director of Clinical Services Brooks Home Care Advantage Jacksonville, Florida USA

Patient Care Delivery Model Determine Staffing Model. Options. Organizational Chart-the framework. BEST PRACTICE: Case Management-taking ownership of the patient care developing a partnership. Accountability of Staff at every level. Orientation Competency Ongoing Training

Palau Nurses Education for Consistency in Patient Care

Ready for Anything Grand Cayman

Measuring Quality of Patient Care

Step #10 Quality Assurance and Improvement How will quality of care to your patients be monitored? Formal tracking systems to monitor: Infection and safety surveillance Incidents to prevent reoccurrence e.g., falls, driving accidents Complaints and consumer satisfaction Clinical, HR and administrative documentation for adherence to regulations and policies.

How will quality improvement be achieved? Aggregate, Summarize, Recommend What have you learned from monitoring? Study the data. Develop a plan. Implement action. Evaluate.

Resources for Best Practice VNAA Blue Print for Home Health and Hospice Educational Materials (no charge) Power Points Webinars Listservs Resources for clinicians and patients http://www.vnaa.org/vnaa-blueprint Pathway to Best Practices http://leadinghomecare.com/

Solutions for Care, Inc. Survey Survivor! Go from fear to confidence and find out what the surveyors are really saying behind those closed doors from one who has been there. Published by Marrelli and Associates http://www.marrelli.com/ Marrelli & Associates, Inc. (941) 697-2900 Nancy E. Allen BSN,RNC,CMC, consultant has over 30 years experience as a clinician, state and accreditation surveyor and is a board certified case manager and specialist in home health by the American Nurses Credentialing Center. 1-904-287-1894 http://www.solutionsforcare.net

BKP HealthCare Resources Barbara Piskor, MPH, BSN, RN, NEA-BC Home Health, Hospice, Home Care Consulting Board certified as Nurse Executive Advanced by American Nurses Credentialing Center Experience in clinical, supervisory, administrative positions and national surveyor in all service lines of in-home care BKP HealthCare Resources Phone/FAX: 412.963.7053 Mobile: 412.512.8270 E-mail: bkpiskor@comcast.net