How We’ve Changed! 
Or Not?

by Carolyn J. Humphrey, RN, MS, FAAN

It was 1987 and what a year it was.

• The top movie was Dirty Dancing.
  
• The first heart-lung transplant took place in Baltimore.
  
• Proprietary and hospital-based agencies were only 25% of providers.
  
• The “Staggers lawsuit” was filed which resulted in a landmark ruling.  Medicare homecare payments are controlled by what care the patient needs, not what Medicare is willing to pay.
  
• Fiscal intermediaries questioned everything!  Agencies had to buy copiers and rent trucks to respond.
  
• Beacon Health was founded.
  
• I was 40 and pregnant!
  
• Prozac® was released for use in the US.
  

And now... it’s 2007!  I’ve been reflecting on the last two decades in homecare — where we’ve been and where we are now.  In those 20 years, we’ve had quite the experiences.  It’s been exciting.

• There’s increased recognition of the value of homecare and hospice and an increasing demand for those services.
  
• Clinicians still find gratification working with patients and families.
  
• Pay for Performance could result in increased clinician education and use of evidence-based practice.
  

It’s been frightening:

• There has been no change in clinician productivity standards while clinicians experience tremendous pressure to do more with less time.
  
• The current nursing shortage is here to stay, yet clinicians in the field do more non-clinical work than ever — even with technology. 
  
• There is decreasing recognition of homecare nursing as a specialty by the profession, agencies, and state and national associations. 
  
• And there are more stories of fraud and abuse.
  

And it’s been exhausting:

• Paperwork was bad in 1987 and it’s worse today.
  
• A field staff’s challenges include driving, getting lost, parking, freezing, being soaked in the rain, encountering animals and small creepy insects, finding clean restrooms, talking in private, paying higher gas prices, and walking into a home with 30 pounds of equipment!
  
• We’ve endured Interim and Prospective Payment, OASIS, HIPAA, Home Health Compare, coding, managed care, HHABN, and 10 terms of Congress!
  

What I remember most about homecare in the 80s and 90s is the active role we all played in shaping regulations that had an impact on clinicians and patients.  We constantly told regulators and legislators how their changes were expensive and hampered patient care.  With the 2007 political changes, I’m hoping we increase this dialog beyond just reimbursement.

One constant over the last two decades has been Beacon Health.  Diane and Rich Omdahl have created a company committed to helping agencies be compliant, provide quality care and support their mission.  Now more than ever, homecare needs quality education, efficient and compliant policies and systems, and clinicians who provide appropriate, covered care.  Thanks to Beacon for being our homecare partners for two decades, now on to the next one!