VENUE: American Academy of Pediatrics MN Chapter

DATE: 10/10/10

VENUE: American Academy of Pediatrics – MN Chapter

TOPIC: Pediatric Home Care

AUTHOR: Amy Nelson

There is a lingering misperception amongst some physicians that home care services are meant for seniors. Yet today home care agencies are offering quality medical care for special needs and disabled clients of all ages.

Children who would have years ago been institutionalized, remained in the hospital for long durations or not been given the opportunity to live are now being successfully cared for at home. Chronic patient needs that are being handled by home care nurses include tracheotomy, ventilator, g-tube, IV therapies and many cardiac issues. Cancer and transplant patients are also recuperating at home. Even formerly 23-week premature babies are spending more time with their families thanks to the aid of home care professionals.

Physicians need to be cognizant of the fact that skilled private duty nurses and care managers regularly meet complex medical needs. All such nurse activities are signed off by MDs and patient care plans are recertified at a minimum every 60 days.

States Dr. John McNamara, Director of Children’s Home Care & Hospice Program at Children’s Hospitals and Clinics of Minnesota, Minneapolis, “We have sent over 400 children home with trachs and vents and find home care to be a very good alternative with fewer infections and low readmission rates. Even acute illnesses have been successfully cared for at home.”

Recent advances in medical technologyhave increased the population of pediatric patients now treated at home. Common home medical interventions include: infusion therapies with central and peripheral lines, lab draws, parenteral and enteral nutrition, sleep diagnostic testing, respiratory assistive devices such as ventilators, Bi-level, CPAP, oxygen monitoring, CO2 monitoring, airway clearance equipment and techniques.

Family and professional care providers have demonstrated the ability to administer these medical interventions, in addition to managing the child’s routine medical and developmental needs, as they work in conjunction with pediatricians. According to Rebecca Nielsen, Director of Ancillary Services at Pediatric Home Service, “The value of quality physician, family and professional care provider education and communication is imperative to safely care for children.”

Finding credible and reputable home care agencies to work with is a primary consideration for physicians. To that end, the MN HomeCare Association’s Council for Pediatric Home Care – the first of its kind among state home care associations -- is dedicated to act as a resource not only for physicians and healthcare agencies but also consumers. Its three-fold intent: offer optimal care approaches to meet specific client needs; provide trained and qualified nurses; prepare families to best care for their own children. The Council provides the clinical excellence needed to ensure safety and promote positive outcomes in the home care community.

The Council has established quality measures to raise the standards of the pediatric home care industry. Examples of tools that pediatricians can use to access and implement home care:

• Pediatric Private Duty Nursing Qualification Assessment Tool -- determines a client’s need for private duty nursing hours while accurately considering all conditions which require the intervention of a skilled nurse
• Acuity Tool -- determines reimbursement rates, anticipated outcomes, predictability of hospital re-admissions/ER visits and level of staffing skill/experience needed
• Annual Client Plan – creates a detailed summary of all the factors involved in or influencing home care for the ensuing 12 months

Funding for pediatric home care is increasing as more people recognize its cost effectiveness. While the average tab for hospitalization can be $5,000 per day -- and care for premature infants is often higher -- home care is reasonable by comparison. Many insurance companies now cover extended hour nursing and care visits. A tracheotomy patient, for example, can be approved for 24 hours per day care for one month and then weaned onto family care. Managed care companies such as Medica, Health Partners, UCare and Blue Cross/Blue Shield understand that home care for children is not only safe and efficient but also cost competitive.

Now that state budget cuts are also a factor, it’s all the more important that physicians consider what types of patient care are both cost effective and ultimately necessary. Home care is anywhere from 5 -20 times less expensive than facility care. It also provides one-on-one care, which is very difficult to obtain at hospitals or group facilities.

The bottom line is that home care professionals need physicians, as well as state legislators, to understand the value of pediatric home care in the overall healthcare paradigm. The types of care now being handled at home are drastically different from care models even ten years ago, and they will continue to evolve as technologies advance. So physicians should feel comfortable in trusting and delegating care duties to home care nurses. Home is where families want their children to be, and it’s where a better quality of life for patients can be had.

SIDEBAR

Recommended Communication Steps for Physicians:

1. Talk to home care agencies to understand their array of services

1. Ask for their advice or perspective on certain types of patients
2. Be proactive in communicating about home care with families and nurses
3. Discuss discharge planning, including home care, at a patient’s admission
4. Tell home care providers what you need to optimize patient care

Amy Nelson, President of Accurate Home Care, is the Chairperson for the MN HomeCare Association’s Council for Pediatric Home Care. MN HomeCare Association is the statewide voice for the home care industry. Pediatric home care agencies can be accessed on