1. Home Health, Medical Equipment and Hospice

2.  Environmental Analysis  Internal Environment  External Environment  Long Term Objectives

3.  The industry  Continues to change and evolve  Greatest current changes are technological  The next decade will bring greater change, and in other areas:  Aging baby boomers  Obesity and diabetes epidemics are expanding  Technology will continue to advance  Every field of health care will be affected

4.  Rising Costs  Demand for home health care will increase  The ongoing nursing shortage continues to inflate costs of salaries and recruiting  Uninsured Patients  46 million Americans currently uninsured, up from 20 million in 2004  Increase in service jobs indicates that the number will continue to increase  Government funds and VA budgets face increasing stresses

5.  Rising Costs  Health care spending currently 16.2% of GDP  Expected to increase to 20% by 2015  Will be more difficult to secure third-party payments (insurance and Medicare)  Aging Population  >60% of home health patients are over 65  Demand will increase as baby boomers enter retirement

6. Coming changes will reverse former trends Home Health Care Patients, 1992 – 2000 (National Home and Hospice Care Data, 2004)

7.  Diabetes Epidemic  CDC: diabetes now a general epidemic, no longer localized to specific areas  One-third of Americans born in 2000 can expect to develop diabetes  Blindness, kidney disease and amputations are common complications  Diabetics are poor healers and can require home health care for months  Obesity – the leading risk factor – also is epidemic in the US

8.  Two major changes:  Increased numbers of people reaching retirement age  Changes in Medicare, VA and private insurers’ willingness to pay for home health care  Home care is more cost effective for insurers than hospital care  TCB Caring Hands must be prepared to meet future demand for home care, medical equipment and hospice services within the veterans groups it serves

9. Home Health, Medical Equipment and Hospice Services

10.  Home Health  Routine in-home assistance at the nurse’s aide, CNA and LPN levels, with oversight by an RN  Contracted home health services in the veteran’s local community  Medical Equipment  This is for equipment and support not provided by other sources. Example: the ramp that VA does not include with the wheelchair it provides  Hospice  Contracted licensed care and volunteer visits within the veteran’s local community

11. Home Health and Hospice Benefits  Home is important, especially when other aspects of life are uncertain  Home health patients need assistance, not institutionalization  Home healthcare encourages individuals to do as much for themselves as they can  Home healthcare promotes faster return to health  Home hospice supports both the patient and the family

12. Physical ServicesHelper Services  Companionship and conversations  Monitor diet and eating  Assist with evening tasks, preparing for bed  Help with morning tasks  Prepare medications  Assist with transportations to and from appointments  Assist with walking  Assist with clothing  Provide light housekeeping  Assist with laundry  Change linens  Plan, prepare and clean up after meals  Pick up prescriptions  Assist with any pets  Care for Alzheimer’s and dementia patients  Attend appointments with the patient  Outings

14.  Eligibility extends to any veteran who has been honorably discharged  Home healthcare, medical equipment and hospice care must be ordered by a physician  Home health proceeds according to physician orders  TCB Caring Hands’ involvement in medical equipment applies to filling in the gaps left by government agencies and insurance companies  Hospice care is provided for those expected to live six months or less

15. Program Costs Program Expansion

16.  Costs vary relative to geographical region  Services will be contracted with local home health and hospice agencies  Costs increase with increased requirements  Average costs nationwide are:  Assisted living: $2073 per month in rural Arkansas to $5231 in Washington, DC. “Average is under $2500 in many non-metro markets” (Nursing Home, Home Health, Assisted Living, 2011).  Home health aides: national average is $21/hour, with broad geographical differences. Hourly rates are $25 in Rochester, MN; $18 in New York City, $23 in Chicago, and $13 in Shreveport, LA (Nursing Home, Home Health, Assisted Living, 2011).

17.  This service can be operational in any city at any time:  Contracted with local agencies  Dependent on veteran presence and request in specific geographical areas  Most cities have home health and hospice readily available  Now favored by federal government, including VA, Medicare and Medicaid  Services generally must be ordered by a physician

18.  Economic changes may change local costs  Market changes are underway and will be more dramatic in the future  Federal budget changes can affect local supply  A survey of veterans using the site can guide program development and expansion plans

19. Nursing Home, Home Health, Assisted Living - General Average Cost. (2011). ConsumerHealthRatings.com. Retrieved August 5, 2011 from http://www.consumerhealthratings.com/inde x.php?action=showSubCats&cat_id=208. http://www.consumerhealthratings.com/inde x.php?action=showSubCats&cat_id=208