Trinity, VNA Home Care Forge Collaboration to Overcome State Regulatory Hurdles

With state regulations limiting access to home health for people living on the border of Indiana and Michigan, two agencies managed to find a creative solution to deliver care in those markets. The collaboration involves a Trinity Health At Home agency in west Michigan and Saint Joseph Health System’s VNA Home Care in Indiana.

The home-based providers announced earlier this month they had formed a creative alliance to bypass Indiana regulations effectively blocking VNA Home Care from serving a nearby community in the Great Lakes State.

“When I came on board, it had been about two years that the southern area of Michigan, which had historically been served by the Saint Joseph VNA office, had stopped receiving services,” Erin Denholm, president and CEO of Trinity Health At Home, told Home Health Care News. “Basically, surveyors came in back in 2013—new surveyors for the state of Indiana—and their interpretation of the conditions of participations meant that the VNA in Mishawaka, Indiana, could no longer serve southern Michigan because it was outside their jurisdiction.”


Trinity Health At Home—part of the larger not-for-profit Trinity Health system, a conglomeration of hospitals, physician groups and continuing care organizations—provides skilled home health, hospice and palliative care services to patients in nine states.

Trinity Health operates in 22 states as an entire system.

VNA Home Care provides skilled nursing, occupational, physical and speech language therapy services. Overall, the Saint Joseph Health System, a regional health ministry of Trinity Health, provides health care services to more than 200,000 individuals living near the border of Indiana and Michigan annually.


“In other parts of the country, there are certain states that give reciprocity to one another and allow that seamlessness in providing care,” Denholm, who will have served in her positions with Trinity Health At Home for three years come October, said. “That was not that case [between Indiana and Michigan], so we had to get into some serious problem solving.”

A community struggles with gaps in care

Under current Indiana state regulations, home care agencies in Indiana are limited to providing services solely within their state’s borders. As a result of that policy stance, patients in parts of southern Michigan, many of whom use the services of Saint Joseph Health System, had limited and fragmented home care options.

“That is the hospital that they go to, though some of their primary care physicians might be in southern Michigan still,” Denholm said. “Upon discharge, if they need home care, we had basically been unable to provide that seamless service as part of an integrated delivery system.”

Niles, Buchanan, Edwardsburg and Cassopolis were among the counties that had been affected by the Indiana policy.

To work around the Indiana policy, the care team at VNA Home Care had to join the Michigan Trinity Health At Home agency and become dually certified in both states. That means patients can now technically choose the Trinity Health At Home agency in west Michigan, but receive care from the visiting nurses, therapists and social workers from the VNA Home Care in Indiana.

The collaborative effort officially launched on Aug. 20.

The providers had initially tried reaching an agreement with the two states to allow for cross-border care. Allowing for cross-border care is relatively common and an issue that does not appear in any of Trinity Health At Home’s other coverage areas, according to Denholm. Its Iowa office, for example, is free to provide services to Nebraska, she said.

“We actually tried through advocacy to plea to state legislators in Indiana and in Michigan,” Denholm said. “Frankly, there wasn’t interest in having reciprocity.”

Indiana’s policy was challenging for patients and VNA Home Care alike, as the affected communities accounted for a significant portion of the agency’s patient population, Karen Joyce, west region executive director for Trinity Health At Home, told HHCN. At one point, patients form the Michigan area made up about one-quarter of VNA Home Care’s caseload and census, she said.

Trinity Health At Home and VNA Home Care have access to the same electronic medical record platform and same remote monitoring platform, allowing for a smooth collaboration.

“I’m sure there will be bumps in the road, but I think we have a lot of really intelligent, problem-solving people on our team,” Joyce said. “We’ll get the work done and provide the care that patients really need.”

Written by Robert Holly

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