patient safety hospital and home health care

We are pleased to share information from an article by Elizabeth Hogue, Esq.* below about patient safety and discharge planning as related to home health care. This is necessary information for all case managers to know, but also important for patients and anyone who is a patient advocate.

Patient Safety: Case Managers Informing Patients About Private Duty Home Health Care Options

In order to be appropriate for home health or hospice services paid for by any payor, including the Medicare Program, patients must either be able to care for themselves or they must have a primary caregiver.  Patients’ family members or others may be willing to fulfill this role on a voluntary basis.  If not, discharge planners/case managers should offer patients and/or their family members the option to pay privately for a primary caregiver who can meet patients’ needs in between visits from professional staff from home health agencies and hospices.  These types of services may be referred to by post-acute providers as private duty home care services**.

**Private duty home care services are the services provided by agencies like EasyLiving. You will also hear these referred to as home health care (easily confused with skilled/Medicare home health care), home care, home caregivers, and in home care or various other names. Companies offering such home health services are regulated in different ways depending on the state. Families sometimes hire private caregivers as well, but should be aware of the patient safety issues that may arise with unsupervised caregivers.

The option to pay for private duty home care services should be offered to all patients who cannot care for themselves and who have no voluntary primary caregivers.  Patients who can care for themselves or have voluntary primary caregivers may also wish to contract for additional assistance, so discharge planners/case managers should offer this option to all patients who may benefit from these services.

Discharge planners/case managers may be reluctant to offer these services to patients and their families because of the cost of such services.  They may also erroneously conclude that patients and their families cannot afford these services.  Discharge planners/case managers should not jump to conclusions about who can afford these services.  Instead, private duty home care services should be offered to every patient and family who may benefit from them.  This conclusion is consistent with legal and ethical requirements that govern the practice of case management.

This is a very important point and one which we have often encountered over the years. With well-meaning intentions, many professionals hesitate to refer to services that cost money (“out of pocket”), while the elder and family often experience great relief when they know what is available. They can make the decision themselves when presented with the options, and there may be affordable ways to structure home health care services to fit the patient’s budget. When patient safety issues are at stake, costs can be even greater in the long run without much needed services.

The Duty to Ensure Patient Safety through Choice

As advocates for patients, discharge planners/case managers have an obligation to make sure that patients understand all of the options available to them, including the option to pay privately for home care services. Case managers/discharge planners also have an ethical obligation to inform patients about the availability of private duty services.  Autonomy is an important ethical principle applicable to the practice of case management/discharge planning.  This ethical principle generally requires case managers to provide information to patients so that they can make informed choices. 

Patients cannot make choices about the care they wish to receive unless they have information about all services available, including private duty services.  Discharge planners/case managers, therefore, have a clear ethical obligation to provide information about private duty home care services to all patients who may benefit from them. 

Read more about patient safety upon hospital discharge (tips and checklist) and contact us if you need help!

*Italicized portions excerpted from: “What Case Managers/Discharge Planners Need to Know about Private Duty Home Care Services”, ©2015 Elizabeth E. Hogue, Esq.  All rights reserved.