Maxim Healthcare Services Homecare Services

Types of Homecare Skilled Care Unskilled Care Non-Medical Care CNA HHA Aid Respite RN LPN PT OT SLP Companion Consumer Direct

Private Duty Nursing Services State regulated program in Alaska One-on-One direct patient care in the home Skilled care preformed by a RN or LPN Providing nursing intervention and judgment to a patient with a chronic medical condition Continuous care for at least 8 hours per day Also referred to as “Shift Care”

Who Qualifies for PDN Services? Patients with a “physical health status that would justify admission to a general acute care hospital or long term- care facility” Patients requiring “continuous care” defined as 8 hours or more per day of care which is “routinely provided by the nursing staff of a hospital” Patients are receiving services for “a life threatening condition” Services needed to assess, administer treatment and monitor/maintain skilled interventions. Meaning a patient must have a chronic condition where nursing judgment is used and nursing interventions are preformed

Common Conditions Where PDN May Be Recommended Disabilities Complex Intravenous Therapy Chronic Illness Cardiovascular Disorders Catastrophic Injury Gastrointestinal Disorders Neurological Disorders Congenital Disorders Renal Disorders Immunological Disorders Blood Disorders Cancer Palliative Care

Admission Criteria The following criteria must be met for admission: Patient is under the care of a physician Patient agrees to homecare Home environment must be adequate for safe & effective clinical care There is a plan in place for medical emergencies Able & willing caregiver to participate in care Adequate funder source to support patient’s healthcare needs Homebound criteria met for Medicare

PDN Care The goal of skilled nursing care is to help improve the patient’s condition or to maintain the patient’s condition Typically looks like Medication Administration Give Injections Wound Care Monitor changes in medical status Enteral feedings Tracheostomy care Manage assisted ventilation

Upon Admission An initial comprehensive assessment is performed by an Internal Clinical Supervisor (RN) Appropriate clinical personnel are assigned based on skill set, experience, and personality as well as scope of service Patient & caregivers are oriented to the services to be provided & administrative policies A Plan of Care is developed collaboratively by the assessing RN, office Clinical Director, ordering physician, patient and family (caregiver)

Plan of Care The PDN provider works with the member’s physician to develop a Plan of Care Plan of Care includes: A Medical Assessment performed by an RN Medication and Treatment Orders Treatment Goals Methods of Care to be used Plan of Care Coordination by Nurses and other Healthcare Professionals The Plan of Care must be re-evaluated and signed by the physician every 60 days

PDN Employment Requirements License/Certification Verification Supporting I-9 Documentation Knowledge Exam/Screening Health Certificate Comprehensive Specialty Screening Evaluation PPD Test Criminal Background Check Reference Checks Prospective Employee Interviews Any Specialty Certificates

PDN Cases Assigned to Nursing Staff by Skill, Education, Training, and Availability of Personnel Patient Acuity Language & Communication Requirements Geographic Location Patient Case Load of Nurse

Readmission Rates in Alaska According to Medicare.gov

National Readmission Rates by Diagnosis

Cost of Pediatric Patients with Medical Complexity Costs of care for Children with Chronic Conditions accounts for 32.7% of all healthcare costs for pediatric patients These patients account for 27.2% of the rehospitalization costs Only 36% of Children with Medical Complexity received home healthcare services Article from American Academy of Pediatrics, entitled Patterns and Costs of Healthcare Use of Children with Medical Complexity

Unmet Needs of Pediatric Ventilator Patients 56.2% of patients surveyed (122) reported an Unmet Need Less than 10% were for preventative or specialty care 40% of those reported their Unmet Need for Home Health Care Study entitled Ventilator-Dependent Children & the Health Services System – Unmet Needs and Coordination of Care by Jennifer L. Hefner and Wan Chong Tsai

Case Management Considerations for PDN Case Managers gather input from hospital staff, nursing agency and primary or specialty physicians to deciding the number of medically necessary hours of skilled nursing care Take into consideration the number of skilled needs the patient has What are the caregiver’s abilities and the nature of the member’s illness The goal is to make the family as independent as possible, with the intention of helping the patient’s condition improve

Other Types of Homecare Intermittent Services Short-term skilled interventions usually involving multiple disciplines including RNs, PTs, SLPs, etc. Unskilled Companion Services ADLs Medication Reminders Transfers Other Hands-On Assistance Non-Medical Companion Services Basic ADLs Custodial Care Meal Prep, Transportation Assistance, etc.