Emphasis continues toward minimizing the costs of health care and Medicare, Medicaid and private insurers seek to limit costly stays in hospitals and other facilities. Home health care has proven to be a good solution, as physicians tailor treatment planning for care within the patient's home. One potential problem is patients who refuse home health services, neglecting their plan of care.
A recent study showed between 6% and 28% of those suitable for home healthcare refused services. The underlying reasons are broad and include underestimating the severity of their conditions, reluctance to allowing strangers in their home, and financial concerns such as co-payments for in-home care.
Skilled Home Health vs Home Health Aide Services
Patients most likely to refuse home health care are older people being discharged from a hospital. This increases the potential for wrongful medical liability claims against doctors. These patients have twice the likelihood of being back in the hospital in the first 60 days.
Examples of skilled care would be a nurse visiting to change the dressing of a wound, or a physical therapist visit to improve strength and mobility of an injured leg. Many seniors misinterpret “skilled home health care” with assistance conducted by home-health aides. Aide visits may include assistance with bathing, getting dressed, etc. Many seniors are very conscious of remaining independent and thus visualize any home-based care negatively.
A 70-year-old man with a history of high blood pressure and heart disease is hospitalized. The doctor prescribes a blood thinner. The doctor and the hospital discharge nurse educate the patient and his spouse about the dosing instructions, risks, and importance of monthly blood tests. In the first month, the patient misses a test and the office contacts him to reschedule, yet do not hear back.
Two weeks later, the patient arrives in the emergency room after falling, is experiencing severe complications associated with the new medication, and his condition is declining. A few months later the physician learns he has been named in a malpractice claim regarding the care of the patient. The claim cites mismanagement of medication and inadequate monitoring as the cause for his now poor health conditions.
Communication & Documentation
Further transitions from traditional health care settings to the home are likely. Patients who are reluctant to follow-up or rehabilitative aspects of their plan of care create opportunities that can lead to unnecessary and costly claims of malpractice. Important keys to prevention are direct and sensible communication. Kathy Bowles, Home Care Director with the Visiting Nurse Service, says that simplistic language should be used in explaining the need for home care follow-up to patients and their families.
Having doctors use phrases like “a nurse is going to stop by to check the status of your medications” or “a physical therapist will visit to teach you how to exercise after home care concludes” are examples. Having clear and thorough documentation (medical records) is also critical for providers to protect themselves from claims of medical negligence.