New Way to Approach Care at Home

by Kristin Rowan | Nov 21, 2024 | Caring for the Caregiver, Clinical

by Kristin Rowan, Editor

Care For Lives: Empowered Homecare with a Holistic Approach

It’s a familiar story that you’ve heard countless times. A licensed practical nurse (LPN) takes a job in a healthcare setting and continues her education to become a registered nurse (RN). She works tirelessly for two years both at her job and in school with no days off. Moves into the hospital setting, then the clinic setting and suffers from burnout. She sees how much there is to do in healthcare that isn’t being done in the hospitals and clinics. Frustrated with the lack of care, too many patients, and too much stress, she tries her hand at home health. And she falls in love…

The Start of Something New

This is the story of Vanessa Chambers, CEO of Care For Lives PLLC. Her first reaction to home health was “Where has this been all my life?” Although she loved home health care, she felt she didn’t get to spend enough time with her patients. So much of her day was spent on paperwork and running from case to case. Sound familiar?

Vanessa also found herself unable to recommend treatments that she believed could help her patients. Bound by the script her agency created, she felt as though her opinions were unwanted and her critical thinking skills as an experienced nurse were disregarded. And so the all too familiar tale continues. Vanessa started treating patients on her own and created a business based on how she wanted to treat patients.

In addition to standard patient care, Vanessa implemented patient education. Her patients weren’t taught what they needed to know and it terrified them. Their fear, as much as their illness, was a threat to their recovery. Their mistrust of the healthcare system and hospitals left them without care. When Vanessa realized how much work there was to be done, she started to build an army of caregivers. This was the beginning of Care For Lives.

Building the Care For Lives Army

“Let’s cultivate something!” This was the siren call Vanessa sent out to people she knew and trusted. She wanted to foster a community where nurses felt valued and could bring that energy to the people in New York. With the help of a business consultant, Vanessa began cultivating her army. At first, she reached out to nurses that she had worked with or for in the past. Those nurses recruited other nurses that they new and trusted.

A new realization came to Vanessa when she saw how much help her patients needed in areas outside of nursing. Mental and physical well-being and a holistic approach offers better results than treating a condition in a vacuum. As she did more research on treating other areas of a patient’s life, she was introduced to Cognitive Behavioral Therapy.

CBT

Cognitive Behavioral Therapy (CBT) is talk therapy that looks into a patient’s trauma to see how it correlates both physically and mentally and how they connect to each other. Vanessa traveled to England to experience CBT first hand. “I’ve had therapy before,” explains Vanessa, “But, with him I solved problems I didn’t even know were there.” Mark Semple, CBT, Traumatologist, was next to join her army, followed by Sharon Semple, CBT, Traumatologist, and Hanna Commodore, CBT. Along with the therapy, her team will recommend psychiatry and/or medication if needed.

Nutrition

As part of the holistic approach, Vanessa contacted Shawn M. Nisbet, Holistic Group Nutritionist. With a different approach than traditional nutritionist who focus on getting a patient to a desired weight and moving on, Nisbet delves into each portion of a patient’s lifestyle. She assesses the need for supplements like Vitamin D, skin care regiments, as well as issues with a patient’s relationship with food. She offers individual and group therapy for nutrition and wellness.

An Unlikely Addition

The last addition to Vanessa’s Army is not one you would likely think of as a matter of course. But, Vanessa recognized that when patients feel good about the way they look, they are more optimistic about their health. So Vanessa found a hair care therapist. Danni Antenor is a licensed cosmetologist who is more than just a hairdresser. Hair can become matted and tangled after surgery or a hospital stay. Antenor works with all types of hair and comes to the home to clean out any matting or residue from the hospital. She will also find a look that is simple for the patient to maintain, flattering to the patient, and one that prevents hair loss. More than this, Antenor prevents the loss of dignity.

Armed and Ready

With her team in place, and feeling confident that she could provide not only health and healing, but education to keep patients home and out of facilities, Vanessa official launched Care For Lives PLLC on October 19th. She is still wading through the noise in New York to get word of her business out to the community. She is planning a pop-up clinic event before the end of the year. Care For Lives nurses will provide education to patients and to their families and caregivers.

Operations

Care For Lives is currently a private pay agency. They are looking to start accepting insurance by Q2 of 2025, starting with private payers. They will consider Medicare and Medicaid patients when they feel equipped to do so.

Care For Lives operates under a concierge service model, with patients paying a monthly flat rate for different tiers of service. Depending on the level of membership, patients get a nursing visit and cosultation, CBT, hair therapy, direct or group nutrition counseling, and weekly or bi-weekly virtual visits. They plan to at physical therapy and additional services over time.

Longer term goals for Vanessa include hiring a medical director, having a 24/7 call center that is fully staffed, setting up a messaging system to provide patients with access to their care team, and to expand Care For Lives with new locations.

About Care For Lives

Care for Lives provides empowered homecare. We provide patients, and their support system, with the education needed to ensure patients may enjoy the freedom and peace of mind that comes only from living in the comfort of your own home. We are dedicated to increasing quality care knowledge, and support services, for treatment, prevention, and total wellness where you feel most comfortable. Our services are available in homes, communities, and places of work.

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Kristin Rowan has been working at Healthcare at Home: The Rowan Report since 2008. She has a master’s degree in business administration and marketing and runs Girard Marketing Group, a multi-faceted boutique marketing firm specializing in event planning, sales, and marketing strategy. She has recently taken on the role of Editor of The Rowan Report and will add her voice to current Home Care topics as well as marketing tips for home care agencies. Connect with Kristin directly kristin@girardmarketinggroup.com or www.girardmarketinggroup.com

©2024 by The Rowan Report, Peoria, AZ. All rights reserved. This article originally appeared in Healthcare at Home: The Rowan Report. One copy may be printed for personal use: further reproduction by permission only. editor@therowanreport.com

Healthcare is Heading Home

by Rowan Report | Nov 21, 2024 | Advocacy, Editorial, Other Sites

Web Golinkin, Forbes Books Author

Healthcare is Heading Home, and That's a Good Thing!

As the Baby Boomer generation ages, the home healthcare market is expanding. GETTY

During my long career in healthcare, one of the biggest trends in healthcare delivery has been the shift from hospital / inpatient to outpatient care. The compound annual growth rate (CAGR) of outpatient services was roughly 8 percent from 2017 to 2022, while inpatient services grew 1-3 percent during the same period. Outpatient services now represent more than 50 percent of total U.S. healthcare spending.

Particularly during the past 20 years, there has been significant growth in new outpatient facilities and channels, including retail-based and urgent care clinics, freestanding ERs, imaging centers, dialysis centers, ambulatory surgery centers, rehabilitation clinics, behavioral health clinics, and telehealth / virtual care.

The shift towards outpatient care has been driven by multiple factors, including patient desire for convenience, the need to reduce costs, and rapid advances in medical science and technology. Now, however, a new trend in healthcare is pushing the boundaries of outpatient care increasingly into the home.

This article explores the rapid expansion of home healthcare, the factors driving its growth, and the important distinctions between home care, home health care, and hospital-at-home models.

Macro Growth Drivers

The U.S. home healthcare market has experienced exponential growth, projected to reach nearly $510 billion by 2027 (roughly equaling the projected size of the outpatient market), according to various industry reports. This represents a CAGR of approximately 8 percent from 2020 to 2027. Several factors contribute to this rapid expansion:

Aging Population: One of the primary drivers of growth in home health care is the aging population. As the Baby Boomer generation reaches retirement age, there is a significant increase in the need for healthcare services tailored to older adults, many of whom prefer receiving care in the comfort of their homes.

Rising Chronic Conditions: The prevalence of chronic diseases such as diabetes, heart disease, and respiratory illnesses is increasing. Home healthcare services, including skilled nursing and rehabilitation therapies, provide essential support for managing these conditions.

Technological Advancements: Innovations in telehealth and remote monitoring technologies have transformed healthcare delivery. Patients can now receive real-time consultations and monitoring from healthcare professionals, reducing the need for in-person visits and enhancing the appeal of home healthcare .

Cost-Effectiveness: Home healthcare is often more cost effective than traditional hospital care. By providing services at home, patients can avoid expensive hospital stays, and insurance providers are increasingly recognizing the value of home-based care, offering incentives for its use.

Patient Preference: There is a growing preference among patients for receiving care in their own homes. This trend is driven by the desire for comfort, familiarity, and independence, as well as the recognition that home care can lead to better health outcomes.

Main Types of Service

Three basic types of home healthcare have emerged. It is important to understand the differences between them, as each type serves different needs and patient populations and requires different kinds of providers and support:

Home Care: This term typically refers to non-medical assistance provided in a patient’s home. Services may include personal care (such as bathing and grooming), companionship, meal preparation, housekeeping, and transportation. Home Care is often used by individuals who need assistance with daily living activities but do not require regular medical intervention.

Home Health Care: In contrast, Home Health Care involves medical services provided by licensed healthcare professionals. This may include skilled nursing, physical, occupational, and speech therapy, as well as home health aide services. Home Health Care is typically prescribed by a physician and is intended for patients recovering from illness, surgery, or managing chronic health conditions.

Hospital-at-Home: This model represents a more recent innovation in home healthcare, allowing patients to receive acute-level care in their homes instead of in a hospital setting. Hospital-at-home programs provide comprehensive medical services, including monitoring and treatment for serious conditions, under the supervision of healthcare providers. This model aims to reduce hospital congestion, lower healthcare costs, and improve patient satisfaction by delivering hospital-level care in a familiar environment. In addition, there is growing evidence that it improves clinical outcomes and reduces hospital readmissions.

Future Growth Drivers

Several key drivers will underpin further growth of home healthcare:

- Policy Changes and Regulations: Government policies have increasingly supported home health care. Centers for Medicare & Medicaid Services (CMS) and other government programs incentivize home-based care, reflecting a broader strategy to reduce healthcare costs and improve care quality.
- Healthcare Provider Initiatives: Many providers are expanding their services to include home healthcare options as part of their overall care continuum. This integrated approach helps streamline patient transitions from hospital to home, improving coordination and outcomes.
- Market Competition: The growing number of home health care agencies and providers has fostered competition, driving innovation and improvements in service delivery. This competition encourages providers to adopt new technologies and practices that enhance patient care.
- Public Awareness and Education: Increasing awareness of home health care options has led to more patients and families opting for these services. Educational campaigns and outreach initiatives have helped to demystify home health care, making it a more accepted alternative to traditional care settings.

Obstacles to Growth

Despite its rapid growth, the home healthcare sector faces several challenges:

- Workforce Shortages: The demand for qualified home health care professionals exceeds supply, leading to staffing shortages. This is exacerbated by the demanding nature of home health work and competitive wages offered by hospitals and other healthcare and non-healthcare settings.
- Regulatory Hurdles: Navigating the regulatory landscape can be complex and burdensome for home healthcare providers. Compliance with Medicare and Medicaid requirements, as well as with state regulations, often demands significant administrative resources. This can restrict the ability of smaller agencies to scale and compete effectively.
- Insurance Reimbursement Issues: While insurance providers increasingly cover home health services, reimbursement policies can be inconsistent. Challenges related to payment models, including delays and denials, may hinder access to necessary care for patients and impact the financial viability of home health agencies.
- Technology Adoption: Although technology is a key growth driver, some providers and patients resist adopting new tools. Ensuring that healthcare professionals are adequately trained in using telehealth platforms and remote monitoring devices is critical for successful implementation.

Positive Future Outlook

The outlook for home health care remains positive, as the sector adapts to evolving consumer needs and preferences. Several trends are expected to shape its future:

Integration of Technology: The continued integration of telehealth and artificial intelligence (AI) into home healthcare will enhance service delivery and patient monitoring. Wearable devices and remote patient monitoring systems will likely become standard tools for managing chronic conditions at home.

Focus on Value-Based Care: As healthcare systems shift toward value-based care models, home healthcare will play a pivotal role in managing patient outcomes and costs. Providers will increasingly be held accountable for the quality of care delivered at home, leading to a greater emphasis on patient engagement and satisfaction.

Expanding Service Lines: Home healthcare providers and agencies will likely expand their service offerings to include mental health support, palliative care, and specialized rehabilitation services. This diversification will cater to the broader needs of patients, particularly those with complex medical conditions.

Enhanced Collaboration: There will be a growing emphasis on interdisciplinary collaboration among healthcare providers, including hospitals, primary care providers, and home health agencies. This collaboration will facilitate smoother transitions of care and improve overall patient outcomes.

Increased Investment: As the demand for home health services continues to escalate, investment in the sector is expected to grow. Venture capital and private equity firms are increasingly recognizing the potential of home healthcare, leading to innovations and improvements in service delivery.

The growth of home healthcare is a testament to the changing landscape of healthcare delivery. Driven by demographic shifts, technological advancements, and evolving consumer preferences, this sector is poised for continued expansion.

As challenges such as workforce shortages and regulatory hurdles persist, the future of home health care will depend on the ability of providers to innovate and adapt.

Nevertheless, healthcare is moving inexorably towards the home. That is good news for millions of patients who need acute, transitional or long-term care in the most comfortable environment, and for providers and third-party payers who are seeking to maximize the value of care being delivered.

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Marcylle Combs Care at Home Worker Safety

Web Golinkin has focused his career on making health information and care more accessible and affordable. He has done this as CEO of five companies over the past 35 years, including three he co-founded.

These companies include the largest cable TV network devoted to health (America’s Health Network), one of the nation’s largest operators of retail-based clinics (RediClinic), a leading population health management company (Health Dialog), and one of the nation’s largest operators of urgent care clinics (FastMed). Web also co- founded the Convenient Care Association and served as its Chair for many years. He has been widely covered in the national media and has spoken at numerous healthcare conferences.

A magna cum laude graduate of Harvard, Web grew up in New York City and Long Island but has lived in Houston since 1988, so he is almost a Texan. A longtime runner and fitness enthusiast, Web enjoys tennis and golf—as long as he can walk and carry his bag. Web has been married to the same extraordinary woman for 39 years, and they have two amazing sons who make him proud every day.

Medicare Advantage Stock Prices After Trump Elected

by Kristin Rowan | Nov 15, 2024 | Clinical

by Kristin Rowan, Editor

Will the Change in Leadership Usher in a Change in Reimbursement Rates?

As in any election year, we have been bombarded with promises, predictions, and pandering from senate and house hopefuls as well as presidential candidates from every party. Each of them found platform issues that resonated with their followers. In turn, they have accused their opponents of all manner of sin.

Now that the election has passed and the lame duck session of congress has begun, analysts have started looking to January and how election results may impact different industries. Analysts believe Trump, along with congressional Republicans, will aggressively push Medicare Advantage. One researcher predicts that traditional Medicare will “wither on the vine.”

Privatization

Opposition to our current health care and insurance system often advocate for a single-payer system that is seen in places like England and Canada. Naysayers refer to this as the “socialization” of medicine, referring to socialist and communist governments. Privatization, on the other hand, moves healthcare out of the hands of the government and into the hands of privately held, usually for-profit, health insurance companies. Medicare Advantage has quietly moved more than 50% of all Medicare eligible patients to a privatized system. Senior policy analyst at Paragon Health Institute, Joe Alabanese believes that the Trump administration and a republican Congress would be “more friendly” to the idea of privatized health care.

Insurer Stock Prices

Whether the stock prices just before and after election day are predictive of things to come remains to be seen. For now, the information before us is this:

- Between Nov 1 and Nov 7, Humana Inc. had the largest increase in stock prices at 10.7%
- UnitedHealth Group Inc. rose 5.1% in the same time period
- Both companies had greater stock increases than the average across S&P
- Elevance Health was in keeping with the rest of the S&P with an increase of 3.6%
- Molina Healthcare, Inc. and The Cigna Group dropped 0.2% and 0.4%, respectively

Analysts say the jumps are in keeping with expectations that Republican control in Congress and in the White House will be beneficial for Medicare Advantage

Final Thoughts

It’s no secret that The Rowan Report is not a fan of Medicare Advantage. Specifically, the sales tactics used on the elderly and infirmed are predatory and the denial rate is criminal. The more eligible patients sign up for Medicare Advantage the less they will receive the care they need. Further, the more Medicaid has to supplement the cost of Medicare Advantage, the more home care agencies will suffer. Nationally, the more CMS regulates payment rates, pre-authorizations, and denial rates by privatizing Medicaid, the worse off our entire healthcare system will be.

With the state and national associations, we will continue to advocate on behalf of care at home agencies and their patients. And we hope you will too, regardless of who is in office. We have support at the federal level and we will continue to fight the good fight.

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Safeguarding Home Care Heroes Part 2

by Rowan Report | Nov 8, 2024 | Clinical

by Marcylle Combs, BS, MS, RN, CHCE

This article is part 2 of 2-part series. Read part 1 here.

Protecting our Care at Home Heroes

Preventive Measures and Safety Protocols

To deal with these dangers, several preventive steps have been recommended.

Personal Protection

Personal Protective Equipment (PPE) and hand hygiene are basic but important ways to prevent disease spread. Making sure workers are up to date on vaccinations, following cleaning protocols, and safely handling sharp objects and hazardous materials can also significantly reduce risks.

Beyond PPE

Safety policies personal protective equipment

But safety isn’t just about using PPE. There’s also a need for ergonomic tools to prevent injuries, regular safety checks of patient homes, and ensuring safe driving practices for workers who spend a lot of time on the road. Just as important are communication and conflict de-escalation strategies to help healthcare workers manage tense situations with patients or their families.

Training

Training home health workers to spot signs of potential violence or aggression, whether from patients or their families, is vital. They should also have strategies to defuse conflicts and a clear plan to exit safely if a situation turns dangerous. Since hazardous chemicals in the home can be a real threat, agencies should train workers to recognize unsafe conditions and take the necessary steps, like reporting the problem or moving the patient to a safer environment.

Emotional Resilience

A Must-Have for Care at Home Workers

Physical safety is important, but emotional well-being is just as crucial. Feeling emotionally secure—valued, supported, and heard at work—is key to keeping employees engaged and satisfied with their jobs. It helps reduce burnout, absenteeism, and turnover.

Creating a culture of psychological safety starts with good leadership. Managers need to actively listen to their employees’ concerns and encourage open communication. When workers feel that their voices are heard and their opinions matter, they’re more likely to stay proactive and engaged.

Real-Life Examples and the Importance of Strong Policies

The dangers faced by home health workers aren’t just theoretical—they’re very real. I’ve seen this firsthand. As both an owner, administrator, and nurse, there were times we felt unsafe.

One instance that sticks out happened a few years ago

A nurse on a routine visit encountered the patient’s grandson breaking into the house, clearly high on some kind of drug. She and the patient managed to block the bedroom door while she called 911, and thankfully, the police arrived before the grandson could get to them. He was carrying a gun, though she didn’t know that at the time.

Putting Comprehensive Policies in Place

A solid safety program that meets the unique needs of home health workers is a must. This includes having zero-tolerance policies for workplace violence, infection control measures, and clear guidelines for handling dangerous materials. Ongoing education and training are essential to make sure staff follow these protocols.

In addition, there should be regular assessments to gauge how effective safety policies are. Gathering feedback from workers on the ground is crucial to making sure these policies address real-world challenges.

Final Thoughts: Safety is a Mindset

Workplace safety isn’t just about following rules or checking boxes. It’s something that should be part of the culture of every organization. By putting in place measures that protect both the physical and emotional well-being of home health workers, we can ensure that these “home care heroes” continue to provide the critical care that so many people rely on. As Eleanor Everet wisely said, “Safety is not a gadget, but a state of mind.”

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Marcylle has faithfully served and advocated on behalf of home health and hospice patients for over 30 years. She started her career as a nurse, worked diligently to strengthen her leadership skills and ultimately became the owner/president of a successful home health and hospice company. She has served the home care industry in Texas and nationally throughout her years on multiple committees, boards, associations and dedicated lobbying efforts. Currently, Marcylle serves on the board of directors for The National Association for Home Care & Hospice (NAHC), the Home Care and Hospice Financial Managers Association (HHFMA) and the Industry Advisory Board. Additionally, she serves on NAHC’s Governance and Nominating Committee, the HHFMA workgroup, Innovations Committee and chairs the Women in Leadership Committee for HHFMA.

As a wife, mother of 5 adult children and as a female in the workplace she aspires to grow and lead others until her last breath on this earth. She continues this quest through three new business ventures she has founded: MAC Legacy, MAC Legacy Investments and The Marcylle Combs Company.

The Great Hospital/Home Health Divorce Movement

by Tim Rowan | Nov 8, 2024 | Admin, Editorial, M&A, Regulatory

by Tim Rowan, Editor Emeritus

Hospitals Divesting Home Health Departments

Is this an early omen of two related trends? A number of hospitals are divesting their home health departments, while large health insurance companies are swallowing up large home health companies.

Beckers reported on October 23 that Providence Health plans to spin off its home-health services along with hospice and palliative care into a new joint venture that will be managed by Compassus, a for-profit, Tennessee-based provider of home care services in 30 states. The move will affect about 700 patients receiving care every day in Spokane County.

The Catholic not-for-profit health system’s agreement with Compassus will be known as “Providence at Home with Compassus.”

After a regulatory review, the deal is expected to close in early 2025. Providence and Compassus will each own a 50% stake. The new venture is part of a strategy to expand and improve home-based services, but also to cut costs. Providence, which operates Sacred Heart Medical Center and Holy Family Hospital in Spokane, declined to disclose the financial details of the joint venture.

LHC Group Was Not Enough

A news release that surfaced on October 25 said that UnitedHealth Group representatives are set to meet with Justice Department officials to make the case for the insurance giant’s acquisition of Amedisys to be approved. The meeting is often the last step before the Justice Department decides whether to file a lawsuit challenging an acquisition, according to the news outlet.

Amedisys operates more than 500 facilities in 37 states. Shareholders approved the acquisition in September 2023, but the deal has been held up by regulatory scrutiny. Justice Department officials are concerned the deal could increase prices for home health, according to Bloomberg.

If approved, this would be phase two of UnitedHealth’s historic foray into our sector. United acquired LHC Group, a home health provider with more than 900 locations, in February 2023. If UnitedHealth’s acquisition of Amedisys is approved, the company would own 10% of the entire home health market, with significant overlap between Amedisys and LHC acquisitions in some Southern states, according to Bloomberg.

Regulators could approve the deal with some changes to address competition concerns, Bloomberg reported. In August, Amedisys and UnitedHealth agreed to sell a reported 100 home health and hospice care centers to VitalCaring Group if the merger is approved.

Three or More is a Trend

UnitedHealth is not the only insurance company interested in owning home health agencies and hospices:

Humana acquired Kindred, one of the nation’s largest HHAs, and rebranded it CenterWell Home Health. Today it operates more than 360 home health locations in 38 states. In 2023, the company said it would expand into in-home primary care in several states.
In 2023, CVS Health acquired home health provider Signify Health for $8 billion. The company won a bidding war for Signify over UnitedHealth Group, Amazon and Option Care Health. Signify Health has more than 10,000 clinicians.
Evernorth, Cigna’s health services arm, offers home health services with a staff of more than 430. In January, Cigna CEO David Cordani said home health was one area where it would focus on future acquisitions.
In 2021, Centene sold its majority stake in home-based primary care provider U.S. Medical Management. Centene retained a minority stake in the company.

Our healthcare sector is changing as the entire U.S. healthcare scene changes. Next week we will delve further into the ramifications of the CMS 2025 final rule and of course the political events of this week.

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Tim Rowan is a 30-year home care technology consultant who co-founded and served as Editor and principal writer of this publication for 25 years. He continues to occasionally contribute news and analysis articles under The Rowan Report’s new ownership. He also continues to work part-time as a Home Care recruiting and retention consultant. More information: RowanResources.com
Tim@RowanResources.com

Fraud Soup

by Elizabeth E. Hogue, Esq. | Oct 31, 2024 | Clinical, Regulatory

by Elizabeth E. Hogue, Esq.

Everyone in the "Fraud Soup" Together

Perhaps you remember the CEO of a hospice in the Dallas area, Novus Health Care Services, who texted staff members urging them to administer drugs to patients to avoid exceeding per patient spending caps. He then sent texts praising them when patients passed away from the drugs he had urged them to administer: “Good job!” There were also accusations of recruiting ineligible patients and falsifying documentation. Ever wonder what happened to him and other staff members?

Well...Here's the Scoop!

Sixteen individuals from the hospice were indicted and at least eleven of them pled guilty.
Thirteen individuals involved in these activities were sentenced to a combined eighty-four years in prison.
The most recent sentence of four years in prison was imposed on the hospice’s marketing director.
The CEO of the Hospice was sentenced to thirteen years in prison.
Two Medical Directors decided to go to trial instead of pleading guilty. They were sentenced to thirteen years and ten years in prison.
A nurse involved in these activities was sentenced to eight and a half years in prison.
An LVN who received a text from the CEO saying “good job” after she administered drugs to a patient who then passed away was sentenced to eight years in prison.

A triage nurse was sentenced to seven years in prison.
The Director of Operations was sentenced to five and a half years in prison.
A Medical Director who pleaded guilty received a sentence of four years and nine months.
The VP of Patient Services was sentenced to three years in prison.
The VP of Marketing was sentenced to two years and nine months in jail.
A nurse was also sentenced to two years and nine months in prison.
An owner of a lab and home health agency was also sent to jail for eighteen months because she allowed the CEO to access potential patients’ confidential medical information in exchange for using services provided by her companies.

Far-Reaching Effects

Can you imagine the effect on professionals who surely also lost their licenses and their families? Not to mention patients and their families!

The lesson in this heartbreaking story is that fraud enforcement is not limited to owners and upper management. Enforcers will dump everyone who engaged in inappropriate conduct into the “fraud soup.” Therefore, when providers refuse to engage in fraudulent conduct, they are not only protecting themselves, but everyone else involved.

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Elizabeth Hogue is an attorney in private practice with extensive experience in health care. She represents clients across the U.S., including professional associations, managed care providers, hospitals, long-term care facilities, home health agencies, durable medical equipment companies, and hospices.

No portion of this material may be reproduced in any form without the advance written permission of the author.

New EVP for Talent Acquisition

by Rowan Report | Oct 31, 2024 | Partner News

FOR IMMEDIATE RELEASE

Contact: Johnathan Eaves
(903) 445-6969
jeaves@axxess.com

Axxess Names Tim Ingram Executive Vice President for Talent Acquisition

His Appointment Will Ensure New Hires Reinforce Its Award-Winning Culture As Company Grows Worldwide

DALLAS, October 21, 2024 – Longtime Axxess leader Tim Ingram has been named Executive Vice President for Talent Acquisition to work closely with company leaders around the world to ensure new hires continue to reinforce the award-winning culture known as The Axxess Way.

A Message from Axxess CEO

“Beyond our industry-leading solutions, our foundational strength has always been and will always continue to be our unique culture,” said John Olajide, founder and CEO of Axxess, the industry leader in care at home technology solutions. “Tim’s demonstrated commitment to excellence and his collaborative and cooperative nature make him the perfect choice to represent our unique culture and work with our team to ensure new hires also embody The Axxess Way as we continue to grow around the world.”

Tim Ingram, in His Own Words

“Axxess is easily the most dynamic and collaborative culture I have ever been part of, and it’s an honor to be responsible for ensuring we find only the smartest, highest-quality team players who can help take Axxess to the next level,” said Ingram, who joined Axxess in 2016 and will continue to serve as Executive Vice President for Interoperability, partnering with industry-changing technology companies to enhance Axxess’ solutions. “Our vision is to be the global home healthcare technology leader, and most admired for our people, partnerships and solutions. Ensuring we achieve our vision starts at the interview.”

Tim's Background

Ingram has more than 20 years of experience in healthcare, including working in software, as well as regulatory and mergers and acquisitions environments. He serves as an ambassador for the National Hospice and Palliative Care Organization’s My Hospice Ambassador program; a member of several committees and councils for both NHPCO and National Association for Home Care and Hospice and is a past board member for the California Hospice and Palliative Care Association. He was named one of DirectTrust’s Interoperability Heroes in 2022.

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About Axxess

Axxess is the leading global technology platform for healthcare at home. The company offers a robust ecosystem that empowers healthcare organizations and professionals to deliver the highest quality care. By integrating with partners and payers from across the healthcare continuum, more than 9,000 organizations trust the Axxess network to care for more than 5 million patients worldwide. Multiple independent certifications have confirmed that Axxess has the most secure and industry-compliant software solutions. The company’s collaborative culture focused on innovation and excellence is recognized nationally as a “Best Place to Work.”

This press release was originally published by Axxess and is reprinted with permission. For more information or for permission to use this material, please use the media contact above.

Safeguarding Home Care Heroes

by Rowan Report | Oct 31, 2024 | Admin, Caring for the Caregiver, Clinical

by Marcylle Combs, BS, MS, RN, CHCE

This article is part 1 of a 2-part series. Check back for part 2 on November 7th.

Protecting our Care at Home Heroes

Building Emotional Strength & Ensuring Workplace Safety

In the fast-paced, ever-changing world of home health and hospice care, paying attention to care at home worker safety—both physically and emotionally—is critical. These “care at home heroes” offer life-saving care to people in need. The environments they work in, including patients’ homes and their surrounding neighborhoods, can be unpredictable and uniquely risky.

Agencies must put more focus on their caregivers’s emotional well-being and physical safety to help them provide the best care possible. Developing strong safety policies and creating a supportive work atmosphere are key strategies to ensure they can focus on what matters most: caring for their patients.

Care at Home Worker Safety Hidden Dangers

Understanding the Risks

Care at home workers face a wide range of hazards, many of which are heightened by the fact that they’re working in spaces they can’t fully control. These dangers range from exposure to bloodborne pathogens and other biological risks to dealing with physical strains, like lifting patients in cramped spaces. There’s also the issue of unclean home conditions, aggressive pets, crime-ridden neighborhoods, and the risks involved in driving between homes.

By the Numbers

Statistics show that care at home workers are five times more likely to experience nonfatal workplace violence compared to people in other industries. More than 60% of these workers have reported experiencing at least one incident of violence in the past year. Registered nurses (RNs) specifically have reported high levels of verbal abuse (up to 65%), physical assault (44%), and sexual harassment (41%) on the job. In addition, these caregivers often deal with musculoskeletal injuries, with injury rates being 50% higher than those in hospitals due to patient handling tasks.

Common Incidents and the Problem of Underreporting

Many of these incidents go unreported, which only adds to the dangers care at home workers face. Since they’re constantly on the move, it’s tough to track these events. Still, reports clearly show that violence, harassment, and injuries occur more frequently and are more severe in care at home than in many other fields.

Threats Aren't Always From the Patient

On top of dealing with violent patients, care at home workers may also face threats from family members. Tensions and emotional stress in the home—often tied to a patient’s declining health—can sometimes escalate into verbal or physical threats toward caregivers. These situations can make workers feel unsafe, even if no direct threat is made.

Real-World Relevance

For example, I once had a patient’s family member follow me to my car while talking about his pet venomous snakes. He didn’t threaten me directly. I definitely felt uneasy, though, but I didn’t report it. As I look back on this encounter, I believe I truly should have reported this and recorded it for future review. It just highlights what we should teach our employees on how and when to report incidents.

Hidden Threats

Chemical exposure is another issue. Care at home workers often encounter dangerous cleaning or other chemicals that aren’t stored or used properly. Sadly, there was a tragic case where a home health nurse in Los Angeles died after being exposed to hazardous chemicals stored incorrectly in a patient’s home. Other in-home hazards include fall risks, aggressive animals, weapons hidden in the home, and illegal substances. These hidden risks make it crucial for workers to follow safety protocols when entering patient homes.

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National Alliance for Care at Home: An Interview with Dr. Steve Landers Part 1

by Kristin Rowan | Oct 25, 2024 | Admin, Advocacy, Regulatory

by Kristin Rowan, Editor

Alliance CEO Landers

For more than a year now, The Rowan Report has been providing updates on the merger between the National Hospice and Palliative Care Organization (NHPCO) and the National Association for Home Care & Hospice (NAHC). This week, we attended the first National Alliance for Care at Home (The Alliance) Annual Home Care and Hospice Conference and Expo. We had the opportunity to sit down with Dr. Steve Landers, inaugural Chief Executive Officer of The Alliance.

Dr. Steven "Steve" Landers

Dr. Steven Landers brings his almost 20 years of experience to The Alliance as its first CEO. Dr. Landers is a board-certified physician in family medicine, geriatric medicine, and hospice and palliative medicine. He has dedicated his career to seeking home- and community-based solution to traditional healthcare. His focus is on providing compassionate, dignified, and cost-effective care to patients.

Dr. Landers graduated from Case Western Reserve University School of Medicine, where he completed a geriatric medicine fellowship at the Cleveland Clinic.

Dr. Landers is no stranger to NAHC and NHPCO, having previously served on the board of directors for NAHC. He has met with Congress, state legislatures, CMS, and PAC officials, providing testimonies, discussing home care policy and regulation, and advocating for care at home.

Steve lives in Little Silver, New Jersey, with his wife, Allison, and their three sons. His hobbies include golfing, fishing, hiking, traveling, enjoying good food and watching horse racing. When he is not taking part in these activities, you can find him cheering on his sports teams — the Browns, Cavaliers, Guardians and Indiana Hoosiers.

Dr. Steven Landers: On the Record

The Rowan Report:

What do you know about the status of the ongoing lawsuits, going back to the 2024 final rule?

Dr. Steven Landers:

One, we should probably bring Bill [Dombi] into it because he’s truly a technical expert on it and I’m still getting up to speed on it. My understanding is there is no active lawsuit at the moment. We were asked to go back and take some additional administrative steps, which we’re doing. Then we’ll be able to evaluate what further legal paths are possible.

RR:

That leads me to, not a question, but an observation I’d like you to comment on, Steve. For 45 years, the organization has been run by attorneys and the emphasis in lobbying and advocacy has been ‘you need to stop this cut because it’s hurting businesses and also it’s hurting patients.’ The way you’re talking, you emphasize as you begin with how it’s hurting patients. And so I’m wondering if the organization being run by a physician and not an attorney indicates that different emphasis going forward.

Steve:

I certainly am going to do everything I can to tell the story of how policies impact patients and families. That will be part of what I try to do every single day using my experiences as a physician to do that.

RR:

Would it be exaggerating to say “new day, new emphasis” at The Alliance?

Steve:

Well, The Alliance is new in and of itself, so The Alliance is a new day for the industry, a hundred percent. We brought together two legacy organizations. The opportunity to have a stronger voice is very real and certainly I am going to bring a clinical perspective. I’m also a family caregiver. I have my own personal experiences with home care and hospice that have instructed how I think about these things.

And there is every opportunity here to get stronger, to try to make a bigger impact. I would not diminish the truly heroic work that’s been done by advocates within our associations in the past. There’s a lot of love and care that’s happening out in our country because of the leadership that’s been in place. But as you can see by some of the things that we’re talking about, we need to do better. We need to find another way to tell these stories to somehow get somebody to listen.

RR:

You recently released a statement about your position as CEO of The Alliance and your vision going forward. There was a commitment attached to that. Can you speak to that?

Steve:

Yeah, so that’s one of the things that I’m really happy we’re doing very early in our work with the Alliance. For membership, whether to join or to renew membership, we are requiring an attestation from our members around their commitment to quality and to compliance. We’re requiring any provider member to attest to having a program in place for quality and compliance. And we’re requiring that they attest that they monitor the OIG exclusion list and don’t take referrals for employees that are people that are on that list. Also for home health and hospice providers, we’re asking that they attest that they do their level best to participate in the Medicare Home Health and the Medicare Hospice Quality Reporting program.

In order to make a difference on behalf of our members and make a difference on behalf of the people that need care at home, we have to have as credible and high integrity of a voice as possible. And so this is just one simple step of additional things that we’ll consider going forward. We want to make sure that our alliance, our coalition is high integrity and has a deep commitment to quality and compliance.

RR:

It’s one thing to ask people to sign an attestation. It’s another to find the bad players and help CMS to get rid of them.

Steve:

And we’re right there as a partner in that. I think you’ll see more announcements from us in the future about what we’re doing to help with that. I mean, on one hand, we’ve made many proposals around fighting fraud and hospice in particular. If you followed the hospice policymaking, both Legacy NAHC and Legacy NHPCO over the last year have made many policy recommendations. And you’ll definitely see us both advocating for anti-fraud measures as well as having resources within our association to focus on those topics.

Interviewer 1:

Just to clarify, did either of the legacy organizations have this same kind of attestation?

Steve:

No, this is new. The impact of the legacy organizations cannot be questioned. It’s been amazing. But, it’s a new day and we are looking at ways to increase our impact. So, this is a new part of our membership process that we feel strongly about to just take another step to ensure that our coalition, our membership, is of the highest integrity possible. We are walking the walk and talking the talk with respect to quality and compliance.

RR:

Thank you, Dr. Landers

This article is part 1 of 2 interviewing Dr. Steven Landers. Read the rest of the interview here.

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Home Care Patient Dies in Care: Aide Arrested

by Kristin Rowan | Oct 10, 2024 | Clinical, Regulatory

by Kristin Rowan, Editor

Elderly Patient Needs 24-hour Care

In Polk County, FL, an 86-year old man, identified only as Mr. Anderson, was hopsitalized and diagnosed with congestive heart failure. In addition to receiving care from Good Shepherd Hospice, his family hired round-the-clock care through Assisting Hands. The home health aides were caring for Mr. Anderson in 12-hour shifts.

Night Shift

Beatrice Taylor arrived for her night shift at 9 p.m. She noted that Mr. Anderson and his wife were already in bed, but not sleeping. Shortly after the day aide left, Taylor fell asleep on the couch in the living room of the patient’s home. Company policy states she was responsible for the patient’s care and should not have been sleeping.

An Avoidable Tragedy

Taylor was awakened by a “thump” coming from the bedroom. She entered the bedroom to investigate and found Mr. Anderson lying on his side, on the floor, with his head wedged between the nightstand and the bed. Taylor told investigators that she tried to help him back into the bed. He told her not to touch him, so she left him there and went back to sleep on the couch. She did not call 911, as was the policy of Assisting Hands in the event of an emergency. Nor did she call her agency or anyone else to assist.

Four Hours Later

Taylor woke up somewhere between 3:45 a.m. and 4:53 a.m. that morning. At some point, she called her parents and had a 36 minute conversation. During that conversation, she decided to check on the patient and found him still on the floor, but now unresponsive. It was her parents who suggested she call 911.

Contrary to both her parents’ urging and her employer’s policy, Taylor still did not call 911. Instead, she called Assisting Hands and left a message through the company portal. Taylor finally called 911 at 5:37 a.m., more than four and a half hours after Mr. Anderson fell.

The implanted pacemaker found during autopsy showed that Mr. Anderson was still allive at 1:oo a.m. when Taylor initially found him. The autopsy also concluded that he would have survived if Taylor had called 911 right away. His official cause of death was positional asphyxia with pre-existing health conditions listed as contributory causes.

Not actual image from story

Company Policies Broken

During the course of their investigation, detectives reviewed the Assisting Hands employee policies. That investigation uncovered several policies that Taylor violated:

If a patient falls, home aides are required to seek help which may entail calling 9-1-1. Home aides must notify the company as soon as the patient is safe
Home aides are not permitted to sleep during their assigned shift unless it is a “live in” shift
Home aides are required to submit care notes using the company portal throughout their shift to ensure assigned services are being followed appropriately.

The 911 call that Taylor placed at 5:37 a.m. should have been placed at 1:00 a.m.
Assisting Hands confirmed to detectives that this was not a “live in” shift
No information was provided as to whether Taylor submitted care notes during the shift.

Arrested Development

Taylor worked for Assisting Hands for eight months, but did not show up for her shift following the incident with Mr. Anderson. Assisting Hands has since terminated her employment. She was a licensed home health aide, but does not have a medical license, nor is she a nurse.

Taylor was arrested by detectives and made several statements about her innocence. She insisted she had done nothing wrong saying she, “didn’t kill that man.” A paramedic who responded to her 911 call overheard Taylor on the phone say, “he was old anyway so what does it matter.” Taylor remains in custody at the Polk County Jail and is being held without bond.

Polk County Sheriff

“The complete disregard for Mr. Anderson’s life by the person who was employed by his family is completely outrageous, and egregious. I believe someone who was not even being paid to look after this elderly man would have immediately dialed 9-1-1 under these circumstances. Her behavior and attitude are simply deplorable. Mr. Anderson’s family members are in our prayers.”

Grady Judd

Sheriff, Polk County Sheriff's Office

Risk Fall

In 2021, more than 38,000 older adults died from falls. This is the leading cause of injury death for adults aged 65 and older. The death rate increased 41% between 2012 and 2021. You can read more about the risk of falling and what one company is doing to help prevent falls in our accompanying article this week, an interview with Dr. Ann Wells of InnovAge.

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