Healthcare Social Work: Supports Your Organization’s Success, Staff Retention, and Patient Outcomes
March 18, 2019
I can just see the eyes rolling as you read the title, and think “sure, social work”, but, please hear me out.
The emphasis on value-based results and achieving patient outcomes has led much of healthcare to understand that ‘health’ is more than an individual’s physical status. The health of the body is entwined with mental health and psychosocial health- the interrelationship of one’s family, community and a variety of social factors impact health and the ability to achieve outcomes. The emerging emphasis on “social determinants of health” reinforces how our view of health and intervention is ever broadening.
Consider your home health, hospice, private duty or palliative care patients. Few of these individuals are less than very complex. In home and community care no one experiences disease in isolation. Lives are products of family relationships, financial status, and how we define ourselves through our job or our role in the family. The response of caregivers/family either supports an individual’s recovery or comfort or becomes a barrier. The role of the professional discipline of healthcare social work is to intervene when an individual, family, caregivers or a social situation is a barrier to your team effectively delivering care or services to achieve the patient’s desired outcome.
How many visits by your nurses are primarily for psychosocial reasons? Could a social worker help the team more effectively interact or respond to the individual patient or manage a difficult caregiver or family member? Could your nurses be less distracted with patient calls from someone who has one more question who may be lonely or frightened. if a social worker called/reached out to that patient or connected her with community resources how much time could be freed, and stress reduced? How often could your team benefit from a behavioral contract with a difficult patient, or a professional who could help intervene and determine what is behind a patient’s statements of not wanting to live? Suicide ideation or depression that could be managed with medication?
Healthcare social workers can be a positive resource for your nursing or rehabilitation team who face the challenges of home and community care in the home alone. Any of us can benefit from another perspective of what is going on in the home, or the patient or family response that just doesn’t seem right. This interdisciplinary approach is the ‘glue’ of successful hospice and palliative care teams, and now physician practices and health insurance putting together the pieces of improving health.
Think healthcare social workers are just too expensive or you have never heard of them? Check out this bureau of labor statistics information site and the map about healthcare social workers nationwide, just copy and paste the link into your browser: https://www.bls.gov/oes/current/oes211022.htm#st Use the passion and purpose of healthcare social workers.
Barbara McCann, a healthcare social worker.
CHAP Announces NEW Palliative Care Certification
February 14th, 2019
The Community Health Accreditation Program (CHAP) is proud to announce Palliative Care Certification for home and community based providers. The Palliative Care Standards are informed by the latest edition of the Clinical Practice Guidelines for Quality Palliative Care and the experience of clinicians nationwide. “With only a few states with licensure and no national regulations, certification offers public accountability for this important model of care and the patients and families it serves” stated Barbara McCann, President and CEO.
Palliative Care focuses on providing relief from the symptoms and stress of a serious illness. Its goal is to improve quality of life for both the patient and the family. Maureen Spivack, Chair of the CHAP Board of Directors said, “As palliative care increasingly moves from inpatient to home and community settings, CHAP is bringing its 50+ years of experience assessing home and community based care to offer Palliative Care Certification which supports a common threshold for delivery of quality care, and a base for evolving standards of the future.” Eligible organizations include independent providers of palliative care, palliative care programs that are a service of a clinic, physician group, skilled nursing facility (SNF), or of a CHAP accredited home health agency or hospice.
The Palliative Care review includes on-site review and interviews with the palliative care team, as well as patients and families to assess the delivery of care. The certification award is for three (3) years. More information on the CHAP Palliative Care Certification and a copy of the new Palliative Care standards can be found at https://chapinc.org/resources/covid-19-resources/palliative-certification/. CHAP is an independent non-profit organization offering accreditation and certification to providers of home and community-based care nationwide.
Founded in 1965, CHAP offers accreditation to home health agencies, hospices, infusion nursing providers, DMEPOS, public health agencies, pharmacies and certification to palliative care providers. CHAP is a trusted partner of accountable organizations publicly committed to national standards of quality care.
CMS Acknowledges Nursing Shortage in Hospice: What Do Studies Tell All Providers About the Shortage-Not What You May Think!
January 23, 2018
Our most recent newsletter includes an important announcement by the Centers for Medicare and Medicaid (CMS) regarding a more lenient waiver process for hospices to contract for nursing, bringing the anticipated nursing shortage to center stage again – but just, where are we?
The July 2017 study by the HRSA (Health Resources Services Administration), a department of HHS, provides some insight. The study focuses on the non-setting setting prediction of shortage vs. surplus of RNs and LPN/LVNs through 2030 using a statistical model, the HWSM. The model includes several variables such as each state’s demographics and health risk factors, as well as the projected number of nurses to replace those projected as leaving and retiring. A detailed description of the Model can be found at https://bhw.hrsa.gov/national-center-health-workforce-analysis.
The most significant finding in the projected supply and demand for RNs and LPNs by 2030 is that is primarily correlated with variation by state; the shortage is not solely a national phenomenon.
In the 2014 and 2017 HRSA studies, the projected nursing shortage or surplus is state-level and likely reflects local conditions such as the number of new graduates from nursing schools in the state. Research indicates that nurses tend to practice in states where they have trained which is associated with the location of nursing schools, the number of applicants being accepted, and availability of qualified faculty. HRSA results indicate that the nursing shortage is better understood not at a national level, but rather in the inequitable distribution of RNs and LPNs across states.
Key HRSA July 2017 Findings:
Growth in the disease burden primarily attributed to changing patient demographics contributes to an increased demand of about 776,400 RNs by 2030.
The 2017 model also reflects demand associated with increased insurance coverage associated with Medicaid expansion and insurance marketplaces associated created by the Affordable Care Act.
Expanded insurance coverage accounts for a projected demand of an additional 19,300 RNs by 2030.
RNs: Considering each state’s projected 2030 RN supply minus its 2030 demand shows both shortages and surpluses in RN workforce across the United States. Projected differences range from a shortage of 44,500 FTEs in California to a surplus of 53,700 FTEs in Florida. The HRSA model defines an FTE as 40 hrs./week.
If the current level of health care is maintained, 7 states are projected to have a shortage of RNs in 2030; 4 of these states would have a projected deficit of 10,000 or more FTEs, including California (44,500 FTEs), Texas (15,900 FTEs), New Jersey (11,400 FTEs) and South Carolina (10,400 FTEs).
States projected to have the largest excess supply compared to demand for RNs in 2030 include Florida (53,700 FTEs), Ohio (49,100 FTEs), Virginia (22,700 FTEs), and New York (18,200 FTEs).
LPNs: Thirty-three (33) states are projected to experience a shortage of LPN/LVNs due to a projected smaller growth in the supply of LPNs relative to the state-specific demand. States projected to experience the largest shortfalls of LPN/LVNs in 2030 include Texas with the largest projected deficit of 33,500 FTEs, followed by Pennsylvania with a shortage of 18,700 FTEs.
In 17 states where projected LPN/LVN supply exceeds projected demand in 2030, Ohio exhibits the greatest excess supply of 4,100 FTEs, followed by California with 3,600 excess FTEs.
In 2030, many factors will affect demand for and supply of nurses including consideration of specific health care settings. We have no supply or shortage analysis for home or community-based care – the emerging preferred care setting. Insurance reform has expanded the number of people with health insurance coverage, as well as emphasized disease management and prevention increasingly directing care from institutional to community and home-based care with all the related opportunities and roles for nurses. However, a key factor is if home and community-based care can attract the number of nurses needed and know what that will require.
Evolving care delivery models such as Accountable Care Organizations and Palliative Care could also change the role of RNs and LPNs. With the demand for maintaining populations safely at home for require changes in how nurses provide care? A physical visit may be replaced at times by video contact or a broader use of telemonitoring through a variety of devices? Will the growing demand for long term personal care support at home best be met by nurses increasingly delegating functions to aides? How will the scope of nursing practice be challenged with the changing needs of the largest elderly population ever served? As new delivery models evolve we need to anticipate identifying what materially affects the demand for nurses, not only in number but also in qualifications that support the delivery of valued, quality care.
Provider relationships with nursing schools and a variety of nursing associations can be a valued means to understand the challenges where you provide care and introduce more nurses to the scope of home and community care. The AACN (American Association of Colleges of Nursing) is also working to identify strategies, and form collaborations. You may find more information at https://www.aacnnursing.org/News-Information/Nursing-Shortage-Resources/About
The following data is abstracted from the HRSA study, except for the salary information provided by Nurse.org. It is presented as a reference point to again focus on the demand ahead. The state-by-state analysis that follows is solely RNs. The HRSA study does include LPN/LVN data. We hope that you find the data of interest.
CHAP White Paper: Medicare Advantage Plans Expand Home Care Use in 2019/2020 – and the Value of Accreditation for Private Duty and Certification for Palliative Care
October 18th, 2018
The Medicare open enrollment for the 2019 plan year is October 15 through December 7th, 2018. For the first time we may see additional home care benefits offered by Medicare Advantage (MA) Plans. Two (2) recent pieces of legislation led to CMS’ recent approval of expanded MA benefits that can include private duty personal home care in 2019 and palliative care in 2020. These services represent a real opportunity for accredited private duty organizations to pursue contracted Network provider status, as well as palliative care services that earn CHAP certification in 2019.