COVID-19 and Home Health
There have been minor policy changes to home health due to the pandemic. Legislation like the CARES Act slightly promotes the usage of home health. Findings from current research suggest home health can significantly improve post-discharged COVID-19 patient outcomes. Home health can create a full continuum of care for these recovering patients.
How COVID-19 Changed Home Health
The CARES Act
On March 23, 2020, Congress passed The Coronavirus Aid, Relief, and Economic Security (CARES) Act. The $3 trillion COVID-19 stimulus plan allocated $100 billion to health care providers. $50 billion has been distributed to hospitals and long term services and support (LTSS), which includes home health agencies that contract with Medicare. The most profound change The CARES Act has on home health is the ability for nurse practitioners (NPs), clinical nurse specialists, and physician assistants (PAs) to certify and recertify a Medicare beneficiary’s eligibility for home health services—(states must approve this measure, however; currently 30 states allow NPs to perform certification) (Famikinwa 2020). Before the CARES Act, only physicians were allowed to make this judgement. The policy change is particularly helpful in areas that are hospital professional shortage areas (HPSA)—most of which are rural communities.
Current Usage of Home Health for COVID-19 Recovery Post-Hospitalization
This is a positive step for home health becoming a firm pillar in the continuum of care, especially for vulnerable individuals with complex cases. However, the use of home health as a form of rehabilitative care for hospitalized COVID-19 patients is not the same as it is for stroke survivors. The Centers of Medicare and Medicaid report that only one in ten patients hospitalized with COVID-19 are discharged home with home health services (Holly 2020).
How Home Health Can Help Recovering COVID-19 Patients
New York, New York was the epicenter of COVID-19. The first case was reported on March 1, 2020. New York State has reported 2.14 million cases, and New York City has reported 973,000 cases (“Statistics: New Cases And Deaths” 2021). There have been 53,250 and 33,521 deaths respectively (“Statistics: New Cases And Deaths” 2021).
Two researchers from the Visiting Nurses Service of New York (VNSNY)—Kathryn Bowles and Margaret McDonald—have studied how home health services bring value to the recovery of post-discharged COVID-19 patients (Holly 2020).
Their findings are in the article “Surviving COVID-19 After Hospital Discharge: Symptom, Functional, and Adverse Outcomes of Home Health Recipients”, which was published in The Annals of Internal Medicine®. The study is a “retrospective, observational cohort study, analyzing medical information from 1,409 COVID-19 patients admitted to VNSNY’s home health services between April 1 and June 15 following a hospitalization” (Holly 2020). Their organization received referrals from 64 hospitals. Their typical patient profile is Medicare eligible individuals who are well over the age of 65. However, for the COVID-19 study, the average age of patients was 67. They concluded that the reason this cohort had such a drop in age was most likely due to, “COVID-19 devastating impact on older populations…(they) were meeting with hospital survivors,” (Holly 2020).
The patient referrals typically had multiple comorbidities—(the most common being hypertension, diabetes, and chronic pulmonary disease)—and were utterly exhausted (Bowles et al. 2021). They also noticed an increased risk of non-adherence to medical instruction (Bowles et al. 2021)—most likely due exhaustion, cognitive fatigue, and trauma. Patients were suffering from ever-present and/or chronic pain, anxiety, and difficulty breathing with any exertion. 85% of the patient cohort also needed help with four or more activities of daily living (ADLs) (Bowles et al. 2021)
The findings on patient recovery outcomes are much more positive. Patients had an average of 32 days of care, in which “88% of the overall sample were discharged without any adverse health events, such as re-hospitalization or death” (Holly 2020). In short, most of their patients that received home health as part of their post-discharged COVID-19 care had significant improvements in pain, ability to breathe, cognition, and anxiety (Bowles et al. 2021).
Bowles, Kathryn H., Margaret McDonald, Yolanda Barrón, Erin Kennedy, Melissa O’Connor, and Mark Mikkelsen. 2021. “Surviving COVID-19 After Hospital Discharge: Symptom, Functional, And Adverse Outcomes Of Home Health Recipients”. Annals Of Internal Medicine 174 (3): 316-325. doi:10.7326/m20-5206.
Famikinwa, Joyce. 2020. “Non-Physician Certification In Home Health Care Blocked By State-Level Barriers”. Home Health Care News. https://homehealthcarenews.com/2020/11/non-physician-certification-in-home-health-care-blocked-by-state-level-barriers/.
Holly, Robert. 2020. “COVID-19 Patients Discharged From Home Health Care Often Have ‘Excellent’ Symptom Improvement, Functional Outcomes”. Home Health Care News. https://homehealthcarenews.com/2020/11/covid-19-patients-discharged-from-home-health-care-often-have-excellent-symptom-improvement-functional-outcomes/.
“Statistics: New Cases And Deaths”. 2021. Google. https://www.google.com/search?q=how+many+covid-19+cases+has+new+york+had&rlz=1C5CHFA_enUS939US939&oq=how+many+covid-19+cases+has+new+york+had&aqs=chrome..69i57j0i390l2.6489j0j7&sourceid=chrome&ie=UTF-8.