Insights on Chronic Disease Management in Home Health - High Touch Care Through Technology
By Carol Emmerthal, Hospice and Palliative Care Director, Day Kimball Hospital
The population served by Home Health Clinicians is mostly Medicare-aged persons with multiple chronic diseases. All areas in healthcare strive to battle chronic disease with a specific recipe of high touch care that is person-centered, evidence based and coordinated. However, caring for people where they live affords the clinician a clear view into how an individual’s environment and lifestyle influences their health and allows for the development of an individualized plan to meet the specific challenges faced by the person. There are many factors that bring people back to the acute care settings but none more prominent than problems with medications, injuries, and safety issues, and lack of knowledge of when and how to seek timely advanced care. Communication issues amongst health care providers also contribute to readmissions to acute care settings.
In the twenty plus years of working in Home Health, I have seen the positive outcomes of coupling human care with that of technology. With the increase in demand for care, affecting human resources for providers, and family caregivers with more on their plates to manage, technology has become a viable option in obtaining positive outcomes for the people cared for in their home. We must keep in mind that chronic disease is not just diabetes, heart disease, and other medical issues, but also diseases such as Alzheimer’s and other related major neurocognitive disorders.
Electronic medication dispensers are an optimal tool to enhance medication adherence and safety. These devices all function by securing medications with a locking mechanism and then dispensing the medication at pre-programmed times including a notification that it is time to take the medication. Pre-filling of the device occurs at a regular interval by a nurse or family member, and bulk medication can be secured to prevent tampering and potential medication safety issues. Some electronic medication boxes are connected to call centers that add an additional prompting to the person through human contact. If the individual does not take their medications within the predetermined time, the call center connects with the patient or family member. The type of device used and the need for a connection to a call center is a choice made through clinical assessment and coordination with the patient and family or caregiver. One of my first experiences with an electronic medication box was a man with Alzheimer’s disease. His daughter lived out of state and she received a call from her father that “God had told him to take his medications.” Knowing the call center had spoken to him over the intercom; she went with it and used the contact to illustrate the importance of his medication. Having medication safety for this man meant years as opposed to months where he remained at home and not in a nursing facility.
"We must keep in mind that chronic disease is not just diabetes, heart disease, and other medical issues, but also diseases such as Alzheimer’s and other related major neurocognitive disorders"
As with medications safety, timely alerting of injuries, safety issues, and knowing when to seek care can be difficult to manage. A good number of the Medicare population lives in their own homes and may have limited family supports due to work schedules and families residing a great distance from the person. Tele Monitoring is a valuable tool in supporting self-management and safety in the Home Health Setting. Tele Monitoring covers a broad spectrum of care needs, including biometrics reporting, safety and falls monitoring, and location tracking.
Vital signs and clinical monitoring is what comes to mind with the term telemonitoring. The patient monitors vital signs and other biometric in their home, and the results are transmitted to a centralized location where results are assessed, usually by a nurse. In some cases, direct communication occurs through the monitoring device with the person. The value of this modality is that the patient learns self-management of their disease process through regular biometric feedback and clinician contact and education. Tele Monitoring can provide cause and effect data for the person to learn from, including strategies to prevent adverse medical events. Another benefit is early detection and intervention based on changes in status. Clinical indications for telemonitoring are many including, diabetes, heart failure, respiratory diseases, and psychiatric illness and wound management.
Telemonitoring as a tool in the management of safety has a new definition. Many think of an elderly person wearing a pendant or wrist alert button that triggers either by the person or automatically with a fall. Though these are the vast majority of systems seen in the home and are valuable in their own right, today’s seniors and their families have other highly technological options. Systems are available that allow real-time monitoring of the elderly person and their home environment. Discrete monitors worn by the person, such as in insoles of shoes and monitors in attached to appliances, allows for the real-timelong-distance supervision of the person. I was recently told by a patient’s daughter, who lives on the opposite coast from her mother, that this type of system is a godsend. “I can tell how many times she goes to the refrigerator, uses the bathroom, and see any changes in how she is getting around her home.” On one occasion, she was able to identify that the stove had been left on and called her mother to have it turned off.
Electronic Medical Records (EMRs) in the Home Health setting has enhanced clinician practice; especially in the area of chronic care management, by improved communication and care standardization. Every Home Health discipline involved in the patient’s care plan has access to all information about the patient. Information is no longer compartmentalized in a file drawer, within the office. Having the same information allows for consistent sharing of information and education with patients who are dealing with complex care needs, and fosters patient engagement in their own care. Patient and Clinician Portals allows for access to the patient’s Home Health record by the patient, family and other care providers. EMR portals support coordination of care and allow a patient and family member access to their clinical information. EMRs assist with decision supports through evidence based care being translated into standards of practice that can assist in guiding the care of a specific disease process. The ability to standardize practice ensures that the care needs and metrics are met to prevent exacerbations of illness.
The battle against the management of chronic disease can be won in the home. Today’s technological environment has significant potential of continuing to meet the needs of the aging and chronically ill individuals, whose goal is remaining in their homes. Many barriers to meeting this goal can be overcome using technology, coupled with the human care provided by Home Health clinicians and families.