home-based care

A transcript is available online

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We all know how the classic 1939 film "The Wizard of Oz" ends: Dorothy taps her heals together and reminds herself that 'there's no place like home.' And that's true for many people in need of long-term care.

On today's program, two conversations about some of the challenges faced by two different groups of people wanting to stay in their homes and receive needed services there: people with a disability and the elderly. Both groups often find that living in their homes and in communities they're familiar with benefits them in multiple ways.

But the cost of long-term assistance from caregivers can make staying at home difficult, if not impossible.

Dr. Maureen Nash is a geriatric psychiatrist. She talks with host Se��n Collins about the many psychological benefits of receiving care in a familiar setting for those who choose "aging in place."

And we hear from Dr. Lisa Iezzoni from the Harvard Medical School about the many barriers that exist for people with a disability, regardless of their age, remaining in their own home.

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Dr. Nash has recently been named a Distinguished Fellow of the American Association for Geriatric Psychiatry. She previously was a guest on this podcast's episodes that focused on Dementia and memory care and Family Caregiving.

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Maureen Nash, M.D., FACP, FAPA, DFAAGP

Medical Director��

Providence ElderPlace ��� PACE Oregon

Portland, Ore.

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Dr. Iezzoni is the author of Making Their Days Happen: Paid Personal Assistance Services Supporting People with Disability Living in Their Homes and Communities. ��She previously was a guest on this podcast's episode that focused on Doctors & Disabilities.

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Lisa Iezzoni, M.D., MSc.

Professor of Medicine

Harvard Medical School

Health Policy Research Center���The Mongan Institute

Massachusetts General Hospital

Boston, Mass.

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FOR MORE INFORMATIION:��

Aging in Place: Growing Older at Home ��National Institute on Aging

Book review of Making Their Days Happen ����Disability and Health Journal

Dignity of risk and living at home despite severe disability ����Perspectives in Biology and Medicine

Informal and formal home care for older adults with disabilities �� ��Health Affairs

Remaining at home with a severe disability ����Health Affairs

Historical mismatch between home-based care policies and laws governing home care ��Health Affairs

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Healthcare leaders are entering the new year with an unusually high number of short-term crises – things like rising costs, increased competition, and staffing shortages. So where should you be focusing your attention in 2023? In this episode host Rachel (Rae) Woods talks with executive strategy experts Natalie Trebes and Aaron Mauck about the complexities of today’s market and what should be on a leaders' radar for 2023.

This episode is the first of a two-part series. Tune in next week when Rae brings Natalie and Aaron back to discuss what leaders can do today to shape the future of healthcare beyond 2023.

Links:

• Ep. 142: The dire state of hospital finances (Part 1: Hospital of the Future series)
• Ep. 143: A new path for a sustainable financial future (Part 2: Hospital of the Future series)
• The outlook for healthcare in 2023
• Build a winning workforce strategy

Learn how healthcare competition is transforming (www.advisory.com/healthcarecompetition)

(New/bonus content starts at 22:09. First part of episode originally aired November 2, 2021.)

There's been plenty of talk about companies being disruptive in the healthcare industry, from Amazon to Walmart, but a company you might not be thinking about is also making moves into the healthcare world—Best Buy. In this episode, host Rachel Woods sits down with Advisory Board's Miriam Sznycer-Taub to talk about how Best Buy is moving its way into the healthcare world and what that might mean for the healthcare industry.

Bonus links:

• Ep. 131: Healthcare disruptors: Why Walgreens wants to partner—not compete
• Ep. 130: Healthcare disruptors: Don't discount retailers
• FDA's new final rule opens up hearing aids to millions of Americans

Links:

• Why you shouldn't rush into home-based care (and what to consider before entering)
• Home-based care market scan

The confluence of several key trends in U.S. healthcare, including an aging population, shifts away from inpatient care, and a rise in healthcare consumerism has led to an increased emphasis on post-acute care, particularly care that permits aging in place.

In this episode, we’ll get insights regarding opportunities for health systems and investors within post-acute and end-of-life care from both Kevin Grabenstatter, Managing Director and Partner in L.E.K. Consulting’s San Francisco office and Rozy Vig, Principal in L.E.K.'s Healthcare Practice.

Visit L.E.K. Consulting at https://www.lek.com/

Our guests this week bring tremendous expertise to the constellation of issues that surround family caregiving: from managing the expense of caregiving, to strategies for finding respite care, to enjoying the psycho-social benefits of being present and accompanying a loved one in a time of need.��

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In addition, we hear excerpts from interviews with two family caregivers who talk with producer Scott Acord about the family dynamics of providing care at home. To hear extended versions of these conversations, follow the links to Linda's Story and Marti's Story or look for these bonus episodes being published along with this podcast.

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Robin Henderson, Psy.D.

Chief Executive, Behavioral Health

Providence Health & Services, Oregon

Chief Clinical Officer

WORK2BEWELL

Portland, Ore.

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Nicholas Kockler, Ph.D.

VP System Ethics Services

Chair, Applied Health Care Ethics

Providence Center for Health Care Ethics

Portland, Ore.

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Maureen Nash, M.D.

Geriatric Psychiatrist

Medical Director

Providence ElderPlace

Portland, Ore.

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Linda's parents were both active long into their lives, but as they began to age, they began to need more and more help. Linda lived near them and initially was able to check in on them daily. But soon after her father died, a decision was made for Linda and her husband to move into her parents' home so she could provide more constant care of her mother. Linda talks about the importance of asking for help in caregiving and making changes in the physical layout of the home to remove potential obstacles and to improve safety.��

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This extended conversation is a bonus episode that accompanies a podcast on Family Caregiving. ��

There's been plenty of talk about companies being disruptive in the health care industry, from Amazon to Walmart, but a company you might not be thinking about is also making moves into the health care world—Best Buy. In this episode, host Rachel Woods sits down with Advisory Board's Miriam Sznycer-Taub to talk about how Best Buy is moving its way into the health care world and what that might mean for the health care industry.

Links:

• Why you shouldn't rush into home-based care (and what to consider before entering)
• Home-based care market scan

It’s no secret that most seniors in America want to maintain their independence for as long as possible. In fact, according to the Disabled Living Foundation, the majority of seniors say they fear losing their independence more than they fear death.

For many, a main hallmark of independence is being able to age in place. A survey by AARP revealed that 90% of Americans age 65 and over want to stay in their home and 80% believe their current residence is where they will live until they die.

Other statistics show 27% of seniors currently live alone – and that number is projected to keep growing as Baby Boomers age. So, a crucial key to empowering seniors to maintain their independence, especially if they live alone, is the use of technology to monitor their health and well-being.

Ryan Herd – founder of Caregiver Smart Solutions and CEO of 1 Sound Choice (a company specializing in smart home automation) – joins host Stan Massey of Transcend Strategy Group in this engaging discussion on remote monitoring technology and its increasingly important role in caregiving.

Whether you’re a professional provider of home-based care or a concerned family member wanting to keep tabs on a senior loved one, existing and emerging technologies are making remote monitoring easier and more effective. Ryan and Stan cover a variety of significant factors for remote monitoring, including fall detection, looking for changes in living habits, tracking clinical vital signs and much more.

With 30 years of experience in smart home technology, Ryan consults with the home building and healthcare industries and is a sought-after speaker. Because of his expertise, he was selected by the National Kitchen & Bath Association to be a 2019 NKBA Insider to assist in educating its members about the importance of collaboration between technology integrators and the design community.

Ryan offers unique insight into smart home technology, the Internet of Things (IoT), and the significance of technology in the home today. He also is the author of “Join the Smart Home Revolution,” Amazon’s #1 best-selling smart home book.

COVID-19 ushered in an overwhelmingly stronger preference for patients to receive care at home rather than in a facility. A national survey by Transcend Strategy Group revealed that 60 percent of family healthcare decision makers are now more confident that quality care can be provided at home versus 33 percent feeling more confident in the quality of care at a facility. 

This preference, along with the growing demand for care as the huge demographic of Baby Boomers continues to age, is opening new opportunities and challenges for providers of home-based care.

In response, Bill Dombi – Doctor of Law and President of the National Association for Home Care & Hospice (NAHC) – has said that providers of home-based care must demonstrate “a willingness to not only embrace change, but to lead it.”  

Through this important discussion with host Stan Massey of Transcend, Bill offers his insights to three key areas of necessary change: 1) Widening the understanding of what home-based care can provide; 2) The role of technology and other innovations in meeting the demands of home-based care; and 3) Developing a bigger and better workforce to handle the growing volume of home-based patients.

Bill has served at NAHC for more than 30 years, including his role as president since 2017. He also serves as executive director for the Home Care & Hospice Financial Managers Association. Bill specializes in legal, legislative and regulatory advocacy on behalf of patients and providers of home health, private duty home care and hospice care.

With nearly 40 years of experience in healthcare law and policy, Bill has been involved in virtually all legislative and regulatory efforts affecting home care and hospice since 1975.

When most people think of “home care” or “home health,” they think of clinical or skilled therapy services at home. However, as the “Silver Tsunami” of Baby Boomers continue to age, there’s an exponential need for nonclinical home care. By helping with activities of daily living, providing personal monitoring and supervision, serving as a companion, running errands and much more, nonclinical caregivers help seniors age in place with greater independence.

Jeff Salter – founder and CEO of Caring Senior Service – has been leading his company for 30 years to meet these needs. In this discussion with host Stan Massey of Transcend Strategy Group, Jeff delves into the lack of awareness and understanding about the availability of nonclinical home care, as well as key opportunities and challenges of this important service.

The conversation covers the details of the crucial role nonclinical home care serves. Jeff and Stan also talk about the gaps custodial care can help fill in partnership with clinical providers, the current lack of reimbursement or tax breaks for nonclinical care at home, the impact technology will have on home care innovations, and the career opportunities for home caregivers – including workers being displaced by technology in retail and food service.

Jeff began his career in home health and quickly saw a glaring need for greater custodial home care. He started Caring Senior Service in 1991, launching the company in Odessa, Texas. After expanding across the state for 12 years, the company began offering franchises in 2003 and today has 45 locations in 20 states.

To celebrate Caring Senior Service’s 30th anniversary – and to bring national attention to the outstanding needs in senior care – Jeff is embarking on a 9,000-mile electric bike journey starting April 1, 2021 (no foolin’!). He will ride to each of his franchise’s 45 locations and begin a dialogue with each community on how they can join him to Close the Gap in Senior Care.

Whatever your opinion of the BLM movement, it has thrust the topic of true equality into a searing national spotlight – and has prompted many of us to reflect more deeply on the issue.

In addition to risk factors regarding COVID-19 and minority populations, equality considerations have sparked renewed discussions on glaring disparities in healthcare across key demographics. Hospice and palliative care professionals have recognized for decades that minority populations greatly underutilize their valuable services. Recent Medicare data shows that of their members who died on hospice care, only 37.1% of African Americans received the service, 38.8% of Hispanic/Latino descent and 34.5% of Asian descent (compared to 51.2% of Caucasians). 

In this special podcast episode, Ronit Elk, PhD – Professor in the School of Medicine, Division of Geriatrics, Gerontology and Palliative Care at University of Alabama-Birmingham (UAB) – talks with host Stan Massey about an important research project and pilot program she has been leading. The subject is developing culturally based protocols for palliative care and hospice, with the goal of better engagement and access for minority populations.

Dr. Elk and Stan discuss why the origins of traditional hospice care in America may not be an ideal fit with minority populations, the disconnect that can happen between the medical world and cultural beliefs, the influence of community in minority populations – and how such factors informed her process to develop protocols based on individual cultures. Protocols developed from her research currently are being applied through a pilot program in Beaufort, South Carolina, a rural area with a significant African American population.

In addition to her position at UAB, Dr. Elk is associate director of the Southeast Institute for Innovation in Palliative Care and Supportive Care. She also served as guest editor on “Palliative and End of Life Care for African Americans” in a special issue of Journal of Palliative Medicine.

Dr. Elk was born in Israel (but moved to many countries during her youth because her father was an Israeli Ambassador to Turkey, India, Uganda, Kenya and South Africa). She has been a U.S. resident for more than 30 years yet maintains a global perspective on serious illness, death and dying.

Providers of home health services, palliative care and hospice care often express disappointment and confusion regarding referral patterns by physicians. Many providers feel physicians don’t refer to them as early as they should or may be missing the full benefits they can provide to patients and families alike.

What are common key barriers that get in the way of physicians making referrals to home-based care providers? How can providers better educate and communicate with physicians to break down those barriers and enhance the care patients receive?

Special guest Michael Paletta, MD, FAAHPM, is Chief Medical Officer and Senior Vice President for Hospice of Michigan – the largest provider of hospice and palliative care services in that state. As a physician with a background in a wider range of healthcare, Dr. Paletta has decades of experience in collaborating with other physicians and understanding their mindset.  Dr. Paletta joins host Stan Massey (lead consultant of Transcend) to discuss physicians’ perspective on supportive care versus curative care and how to overcome barriers in gaining physician referrals.

Their conversation covers intriguing topics, including Dr. Paletta’s view on “buyer’s remorse” in today’s healthcare environment, the challenges of accurately predicting life expectancy with the interventions of modern medical, educating physicians on the full truth about palliative care and hospice services, and his hope for the new generation of physicians in seeing palliative medicine as the specialty it is – with referrals being the norm rather than the exception. 

COVID-19’s lockdowns and quarantines magnified America’s awareness of social isolation – especially among our seriously ill and elderly populations.

Yet social isolation has been a challenge for many seniors long before this pandemic. One valuable tool in overcoming isolation among seniors is adult day care – if it’s available and affordable.

In this conversation with host Stan Massey of Transcend, Kara Harvey, co-founder and CEO of Elder-Well® Adult Day Program, talks about the positive impact of adult day care on participants and their families.

Along with the discussion on combating social isolation, topics include the benefits of cognitive engagement, music therapy, emotional well-being, the advantages of respite for family caregivers and other issues.

Kara co-founded the franchise-based Elder-Well® Adult Day Program with her husband, Ken Harvey. Together, they have a long history of providing services in the elder care industry.  Starting in 1998, they began an independent home care agency serving local seniors. To expand that company, they purchased a national home care franchise and continued to provide home care and hospice services. Then, in 2014, they developed a unique social-supportive adult day program to fill a need in their community. 

 This innovative program quickly became a trusted resource for families and senior care professionals seeking day care services. Now, they are offering these services in communities across the country under the name Elder-Well®.

With the no-contact demands of COVID-19, telehealth and other remote care tools were thrust into the national spotlight. CMS started to relax certain restrictions regarding telehealth, and the use of video conferences skyrocketed for remote care and communications among clinical teams, patients and their families.

A common perception, however, is that telehealth mostly consists of video chats – and remote care technology has the existing performance and future potential to offer many more functions to elevate overall care, as well as the patient/family experience.

In this conversation with host Stan Massey of Transcend, Robin Stawasz, LMSW and program development executive for Acclivity Health Solutions, provides a range of exciting considerations for the emerging use of telehealth and other remote care tools. 

Starting as a Hospice Social Worker in 1990 and dedicating her professional life to hospice, Robin has held a variety of clinical, leadership and administrative positions within hospice and palliative care, often specializing in innovation and program design. She has served on many regional, state and national Boards and hospice related organizations, and has written and presented on a wide variety of topics focusing on serious illness care.  

Robin’s work with Acclivity Healthcare Solutions helps deliver the technology providers need to ensure patients with advanced illness receive the right care at the right time in the right setting – while honoring the patient’s dignity, goals and values. The company’s Connected Care platform utilizes analytics, machine learning and workflow management to uncover insights needed to avoid unnecessary emergency department and hospital stays. By further empowering home-based care’s effectiveness and efficiency, such technologies help improve quality and reduce spending for America’s sickest and most costly patient populations.

Physicians are trained to cure, or at least treat illnesses to stabilize patients and help them enjoy the highest quality of life possible. Perhaps that’s why many physicians struggle with difficult conversations when the prognosis isn’t good … especially a terminal condition. 

Timothy Short, MD, has been a practicing physician for 33 years – 21 years as a family doctor and a palliative/hospice specialist for the past 12 years. During that time, Dr. Short has developed a deep passion – and compassion – for communicating effectively with patients and families despite situations that are difficult to process. 

In this conversation with host Stan Massey of Transcend Strategy Group, Dr. Short shares very practical yet profound advice on turning difficult discussions into productive goals-of-care conversations. His explanations of tactics and techniques to focus on the person first and their medical condition second may transform your approach to “having the hospice talk” with patients and their families – all while supporting a new definition of hope for them.

Dr. Short is Associate Professor of Palliative Care at University of Virginia Medical Center. In 2019, he was honored with the Leonard Tow Humanism in Medicine Award – an annual recognition of one University of Virginia faculty member chosen by the students for exemplary humanistic and compassionate care. Well-deserved, Tim!

When a loved one is afflicted with a serious illness or a debilitating chronic condition, the family is often thrust into a new role of caregiver at their loved one’s home. Although a labor of love, the job can be very demanding, emotionally draining and physically exhausting. And many family members begin without the knowledge of where to turn for help.

According to Nicole Clagett, founder of Transitions GuidingLights – a nonprofit agency dedicated solely to supporting family and professional caregivers – the confusion begins with the very definition of “caregiver” and when the duties begin.

In this conversation with host Stan Massey of Transcend Strategy Group, Nicole discusses several important facets of family caregiving. Topics include navigating resources for assistance, family dynamics as different members pitch in to help, the impact of caregiving on the caregivers’ personal lives, and the changing face of family caregiving as younger generations assume the mantle of caring for their elders.

Nicole’s vast experience in caregiver support and her candid approach in talking about the challenges of caregiving make for an intriguing conversation. 

A basic requirement for any organization granted 501(c)3 not-for-profit status by the government is having an active Board of Directors. Traditionally, many organizations have built their boards by going down a checklist of desirable skills board members will have based on their careers. An attorney? Check. Financial guru? Check. Marketing professional? Check.

But is this the best way to build a Board? Bill Musick, founder of Integriti3D – a company focused on improving hospice care across the country – offers a different perspective. With decades of experience in the entire continuum of health services, Bill has a passion for working with CEOs and Boards of Directors to achieve new levels of effectiveness. In fact, Bill has even earned Certified Governance Trainer credentials from BoardSource.

In this conversation with host Stan Massey of Transcend, Bill explores the desirable traits of high-performing Boards. He shares insights about taking Boards of Directors beyond being partners in problem-solving with an organization’s executive team. In addition, Bill encourages Boards to be highly involved in setting an aspirational vision for their organization, championing the agency’s culture, modeling behaviors of integrity, connecting to the community in meaningful ways and other impactful activities.  

Most providers of home health are worried about the impact PDGM will have on their operations, staffing and reimbursement. There’s been a lot of discussion about the challenges … but not so much about the opportunities PDGM may bring.

Mark Hunt – vice president of the home health division of Covenant Care and a veteran of some of the biggest national brands in home health – explores the upside of PDGM, including better outcomes for patients.

In this conversation with host Stan Massey of Transcend, Mark talks about the importance of upfront communications with staff and referral sources. Details include the implications of accurate and thorough coding, the new thresholds on therapy visits, avoiding LUPAs and other adjustments to help smart providers thrive under PDGM.