2012 Conference Preview: Quality Home Care, What is it and Who Defines It?

BY GLENDA BURKE, ALTERNATIVES

Join Glenda Burke at conference for “Private Duty Insights” on July 23, “Creating Super Management Strategies for Home Care Success” on July 25, and “And Then There Were 3: An Objective Comparison of Accreditation Options” on July 26. Click here to check out session summaries in the conference brochure!

“Quality Care” is just one of many buzzwords being bantered about in the home care industry today – practically every logo, brochure or marketing presentation promises “quality”. In this critical time for home care, we as an industry need to ask ourselves first: “what is quality care?” and second and most critical: “who or what defines it?” We must step away from past practices and embrace the reality that opinions are not true indicators of quality. In the final analysis, quality is not a popularity contest, but it is clear evidence of positive patient outcomes.

Those of us who have been in home care for a few years have seen “quality measures” come and go. We have never actually fit into any of the quality improvement plans that were designed for hospitals and passed on in second-hand form for home care. In the determination of quality services, one size does not fit all; the issues encountered in home care practice are certainly far different from the hospital setting.

As seasoned home care practitioners, we must move beyond the days where supervisory visits revealed that the patient “loves” the aide and definitely would “choose our agency again” for future services – to actually being able to determine that we made a difference in the physical and mental condition of the patient. We know they love us, but are we making a difference in their lives? As much as we might hesitate to admit it, the use of the OASIS data assessment brought that change. With the emergence of OASIS, we were able to look at a slice of real time with regard to the patient’s condition and then using the same assessment data, look at them at a future time to compare accomplishments or declines during a course of care. This gives us the opportunity to go forward with our plan or recognize the need to revise plans, care, and in some cases, goals. We may have gone into OASIS kicking and screaming, but it forever changed the concept of “quality”.

Finally, even though we are competitors, we cannot limit the quest for quality to our individual businesses. This is an issue that affects the industry as a whole. “Negative publicity” for one home care agency influences public opinion about all of us.

Let’s consider some indicators that individual agencies can use that might improve the public’s view of quality for the entire industry:

  • The beginning: owners and license holders, background screening, financial history and history of previous sanctions by regulatory entries must be identified.
  • Policies and procedures: Development and implementation of adequate policies and procedures that establish expectations of quality practice in all aspects of the operation.
  • Hiring practices: careful screening and validation of credentials; past employment history and experience; and competency testing for all staff.
  • Orientation of staff: Focus on provision of outcome-based care and appropriate patient goal setting.
  • Continuing education for staff to ensure that current best practices are in place.
  • Actual meaningful positive patient outcomes measured against appropriate goal setting, treatment orders, documented improvements in condition and compliance with treatment requirements.
  • Patient satisfaction/referral source satisfaction: utilizing an objective meaningful data collection tool regarding satisfaction that uses pertinent questions designed to identify problem areas and do not limit statements to bland “feel good” affirmations of satisfaction. Collect patient satisfaction data at established points during the course of care, not just after discharge.
  • Maintaining a “clean” operation free of any hint of fraudulent practices.

There are many other aspects of your business that can be used to measure the quality of the services being provided; so many in fact, this short article could not begin to capture them all. But one thing I can promise, is if you take that feeling of accomplishment that you had upon hearing your patients utter these words “we love your agency” and add to it actual documented evidence that the patient has achieved the ability to provide self care, or some other equally important accomplishment — you will then truly possess a sense of accomplishment that is more than just a feeling. In addition, you will catch a glimpse of quality in its purest form, and that’s what it’s all about in the world of home care. The answer to what defines quality is simple: quality defines itself and the old adage “I’ll know it when I see it” actually holds true.

Glenda A. Burke, RN, BS is the founder, owner and primary nurse consultant for Alternatives, a consulting and education service. Glenda recently developed the Florida-specific regulations portions of HCAF’s newly released Home Care Manager Certificate Program. This online certification preparation program will allow leaders from all over Florida to participate from the comfort of their office/home and can proceed at their own pace. It is accessible 24 hours a day, 7 days a week and from anywhere there is internet connection. Please see www.homecarefla.org for details. Glenda may be reached at altconedu@aol.com.

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