Q&A: Integrating Home Health in Senior Living

As the only continuing care retirement community (CCRC) organization in Washington state that will soon offer senior living, home health and hospice care, Wesley Homes understands the need to be ready for shifting health system dynamics.

Wesley Homes currently has two senior living campuses in the state that offer assisted living, independent living, dementia care and skilled nursing. The Des Moines, Washington-based organization is also working on a third community, which will likely break ground in mid-2016, and has taken on home health, private duty home care and has plans to open up a hospice division to serve nearby communities.

To continue its growth and strategy, Wesley Homes adopted an integrated software system from Brightree to use across its businesses. Home Health Care News sat down with Melinda Moore, executive director of Wesley Homes, to hear more about the organization’s plans and business integration.

As an organization that has seen 50% growth in the number of patients in your home health business in a little over a year, do you expect to see more senior living communities take on home health services?

As more seniors move into retirement communities, they want to stay in their apartment. Whereas retirement communities need to have a continuum of care, from independent living to assisted living to skilled nursing, both short-term and long-term. Those skilled nursing facilities can partner with hospitals and ACOs along the post-acute continuum. It’s unusual for a CCRC to have its own home health continuum of care. Once we get hospice up and rolling, Wesley will be the only CCRC in Washington state that has all three components.

The CCRC community sees home health as being increasingly important, although financially difficult to sustain off the ground. There’s more affiliations rather than ownership. Wesley as a whole negotiates with ACOs and versions of ACOs where it’s a practice group. We call it a “small A.” It’s more of a community-based relationship, a contractual relationship to partner with them in post-acute care. Our parent organization is skilled nursing, it’s assisted living, independent living and home care. It’s a nice package, and home health is very much a part of that.

Wesley has been a retirement community for decades. Wesley is faith-based. It’s affiliated with the Methodist church. In that vein, they are committed to providing the elderly services in their communities and providing those residents all the services that they may need as they age in place including moving to other levels of care so they can stay in their chosen apartment.

Walk me through your integration strategy across the different businesses.

My charge as executive director was to implement a point of care solution. One is to bring us up to standards with the HIPAA requirements and electronic records, but also to facilitate the revenue cycle. To do that, we needed a good software system. We needed to bring more staff on board and we needed to recruit in a very tight market.

Washington state has one of the lowest unemployment rates, for better or for worse. It’s a tight market. There are only 70-plus home health agencies in the whole state. They are competing for the same nurses. So we needed to build the business, and we needed the staff to build the business. We needed to have a revenue cycle improvement so that we were optimizing the revenue we were bringing in and minimizing denials or rejections or not being able to collect on the business that we do.

Those were the main reasons we were looking for a point-of-care solution. [We needed] one that would manage home health and home care that would be appropriate for hospice because that was in the works. [We needed] one that would provide the data that needed to be reported through the system for management reports.

What’s the process like for bringing your staff on board with EHRs and software transitions?

I can hand an iPad to an occupational therapist that is new to our company, because maybe we contract with them and I have a new IT who comes into work. I can hand it to them, and in 20 minutes get them the forms and they are good to go. That’s pretty phenomenal. For our other staff who are doing site visits, it’s very user friendly. I set a tone where every visit is going to be documented on the iPad. No paper is allowed and they are all going to be completed and synced to the office by the next day so that we can start processing. We’re almost there. We’ve come a long ways from being on paper where it could take three, four, five days or longer to get something into the office to process.

What is the industry standard?

Some point-of-care device is going to have to be everywhere. We need to get the information from in the home as quickly and as accurately as possible into an office system where it can then start the process—the quality process for OASIS and the revenue cycle process to keep the bills down so management has what they need. It’s actionable data. It’s all there. It’s the business intelligence we’ve been talking about for years.

Performance improvement is how we measure quality outcomes. Our quality outcomes are based on the quality of the tool we use to capture the data and the quality of the data that is input into that tool, which is our point-of-care documentation. it relates to the case mix, the type of patients you’re providing care to. The older patients are going to respond differently than your younger patients, and we need to carefully capture that information. And then also the type of care and services that you provide.

The key factors are your measurement tools, the quality of the data that’s going into that, the type of services that are being provided and your patient population. They will all drive what your outcomes are. You can’t so much control your patients, you can’t control the tool itself. We have to produce OASIS, it is what it is. But we certainly can manage how we are training clinicians to enter data to the software and then have that software guide to what type of care is appropriate for that patient and is it being effective. There are some key pieces in the quality of the software to make the patient’s outcome and the agency’s outcome be accurate and appropriately reflect the care provided.

What’s next?

Some of the blind spots are that in a small market, we’re relatively small and trying to grow. We’re accepting patients that may be different than the bulk of what we’ve seen in the past six months or so. So, our case mix is changing. We may start getting more surgical patients, more of a specific disease maybe. And we want to get good at it.

The staff are looking for reference tools, some educational tools that are built into the software where they don’t have to go off out of the app and google search this disease, but they’d like to tap on an info button to find out more. They’d also like for more prompts for moving along a continuum of care or suggesting different levels of care. But, at the same time, they don’t want to be forced into any care. It’s both opening doors to other care models, but also understanding that a specific patient may only choose to go down a narrower path and not have a system force them to do more than they are allowed to do. But that’s always been the struggle.

Written by Amy Baxter