Concord Monitor – Opinion: Home-based solutions to a healthcare crisis

Julie Stone, Vice President of Strategy for Granite VNA in Concord, Laconia & Wolfeboro.

Our healthcare system is strained. While this is not breaking news, the impact that it continues to have on patient care is critical. At a time when hospital capacity is challenged, alternative post-acute in-patient care options face similar issues.

But have we fully explored home healthcare as a viable and cost-effective option?

Prior to the COVID-19 pandemic, our hospitals, clinics and other healthcare facilities faced a number of challenges that impacted their ability to provide appropriate levels of care to patients when and where they needed it. Today, post-pandemic, those issues continue to be front and center.

One of the leading drivers of the healthcare crisis in New Hampshire is the inability of hospitals to discharge patients to safe, appropriate post-acute care facilities like nursing homes or skilled nursing facilities. In many cases, it means simply going home. Discharges are an important metric in determining the success of our healthcare system, and for hospitals it also means having beds available to care for more patients.

The reasons for the discharge logjams are many and complex, and are outlined in a June report from the New Hampshire Hospital Association. Among the “barriers to discharge” noted in the NHHA report, insurance was the leading impediment to hospital discharge: long waits for Medicaid determination, insurers who don’t provide coverage for post-acute care, denial of requests for authorization from insurers or inadequate post-acute care networks are some of the causes.

Housing concerns, staffing constraints at nursing homes and skilled nursing facilities and lack of access to necessary community services are also among the leading causes of delays in discharge.

And when those patients can’t be safely and appropriately discharged, where do they go? They stay right where they are, in hospital beds; beds that are in demand by so many waiting patients. In the worst cases, some of those patients continue to be “boarded” in hospital emergency rooms, placing additional, and unnecessary, stress on beleaguered emergency department doctors, nurses and staff.

In the first six months of 2024, according to the NHHA, the number of medically cleared patients waiting for discharge actually declined, from a high of 130 in September 2023, to 79 in June 2024. Of those 79 patients, 15 were boarded in emergency departments, waiting for an inpatient bed. A greater concern, though, is the staggering number of medically unnecessary “extra days” those patients spent waiting for discharge: 7,455 days of beds occupied by patients with no other place to go. One of those patients has spent more than 400 days in a hospital, waiting for discharge.

Studies have found that, when appropriate, home health care can provide better outcomes than institutional settings. That’s where home health agencies around the state are ready and willing to help. They provide skilled nursing, physical and occupational therapy, wound care and other clinical services at lower cost, in patients’ homes, where they are most comfortable.

There is substantial work being done at the state level here in New Hampshire: in its DHHS Roadmap 2024-2025 released in June, the NH Department of Health and Human Services has highlighted increasing the percentage of people receiving home and community based services (HCBS) instead of care in a nursing facility.

Programs like NH Choices for Independence provide services to people with disabilities and senior citizens with medical needs to return to their homes, without having to wait for placement in a nursing home or skilled nursing facility.

Home health agencies also help patients and caregivers manage health issues before they develop into urgent or emergent needs that require hospitalizations, and prevent re-hospitalizations with wellness and education programs, immunization clinics and other helpful services. The cost of these programs is small compared to the costs of hospitalizations and high-acuity care.

All of us in healthcare – from hospitals, to post-acute care facilities, to home and community based healthcare providers – have a stake in overcoming the challenges facing us here in the Granite State and across the nation. Organizations like Granite VNA can be part of the solution to this vexing and costly problem; delivering quality health care and promoting wellness in homes and communities through all stages of life is our mission.