SBL Home Care Acceptance-To-Service/Care
Purpose:
The purpose of the policy is to inform the public of the availability of home health services, and to assure prospective patients and referral sources have sufficient information to select an agency that can provide timely, safe, and high-quality home health services. Patients are accepted only when this home care agency can adequately meet your medical, nursing, and social needs. SBL Home Care has established clear criteria and guidelines for accepting patients into services, ensuring compliance with federal regulations, specifically 42 CFR 484.105(i).
Scope:
Sarah Bush Lincoln Health Systems adopts the following policy and procedure for all areas of Sarah Bush Lincoln Home Care.
Statement of Policy:
SBL Home Care will accept patients for home health services based upon a reasonable expectation that the agency can adequately and safely met each patient's medical, nursing, therapeutic, and social needs in their place of residence based on new Condition of Participation by CMS New COP 484.105(I) is a new standard set forth requirement for Home Health Agency (HHAs) to establish an "acceptance-to-service policy to develop, implement, and maintain through and annual review that addresses criteria related to HHAs capacity to provide patient care, including, but not limited to anticipated needs of the referred prospective patient, case load, case mix of HHA, staffing levels, competencies and skills of HHA staff, services offered, and HHA limitations in care, specialty services, service durations and frequencies.
Definitions:
Primary Provider Certification: All admission require a primary provider order and certification of medical necessity for home health care.
Assessment of Needs: A registered nurse or qualified therapist will complete a comprehensive assessment (OASIS-E, if applicable) to determine the patient's medical, functional, psychosocial, and environmental needs. An objective evaluation or appraisal of an individual's health status, including acute and chronic conditions. The assessment gathers information through collection of data, observation, interview, and physical examination.
Agency Capability: Acceptance will occur only if the agency has adequate staffing, resources, and capability to meet the patient's identified needs effectively and safely.
Geographical Coverage: Patients must reside within the agency's defined licensed geographical service area.
Insurance Verification: Insurance coverage of payment source will be verified prior to admission.
Non-Discrimination: SBL Home Care accepts and provides services without regard to race, color, age, sex, religion, national origin, disability, or sexual orientation.
Plan of Care: All patient care will be provided based on a written, primary-provider-approved plan of care, reviewed and updated regularly in collaboration with the primary provider and interdisciplinary team.
Case-Mix: refers to types of health conditions patients have in the agency. This is used to determine insurance payment. It utilizes the CMS Oasis Data Assessment collection tool at the Start of care, Resumption of care, Recertification, and Discharge Assessment utilized by SBL Home Care.
Healthcare Compare: Centers for Medicare and Medicaid Services (CMS) public website where information about agency quality is located.
Timeliness of Care: Current home health regulations require patients referred to home health from a facility stay be admitted to the agency within 48 hours of discharge. However, the certifying provider may order an alternate day, or the patient may request a preferred admission date. The decision to admit a patient is made after the initial home evaluation visit is made by a nurse or therapist to establish criteria is met per CMS regulations. These regulations require that the patient has a skilled need, requires intermittent services, has a primary provider to oversee the plan of care, and patient is homebound. The purpose of the initial visit is to establish a individualize plan of care that meets the patients physical and nonphysical needs.
Functional Score: patient specific and refers to a person's physical limitations and includes an assessment of ambulation, transfer, toileting, bathing, dressing, grooming and risk of hospitalization. Each patients functional score is uniques to him/her based on their Oasis assessment.
Public Accessibility: This policy is publicly available and accessible via; the agency's website, admission and referral packets, and agency office display area, and will be reviewed annually or more frequently if regulatory or operation changes require updates.
Policy:
Sarah Bush Lincoln Home Care is a department of Sarah Bush Lincoln Health Center who operates in East Central Illinois providing Home Health Care. The Home Care Administrator, and Clinical Manager is responsible for assuring that patients are accepted for services only if the needs of the patient can be met. Every effort is made to accommodate new patients with timely admission. This policy will be applied consistently to all patient referrals in a manner that is neutral to the sources of payment for a referral.
Every Referral for home health services is reviewed by a registered nurse to determine if appropriate orders have been provided and any anticipated needs of the patient can be met by this organization. If required services are not available, the referral source, patient, and ordering provider are notified.
Patients have the right to select the agency of their choice. Quality data allowing consumers to compare agency performance is available at Find a Healthcare Providers: Compare Care Near You/Medicare. Home Health Compare.
A: Services Offered
Sarah Bush Lincoln Home Care is considered a full-serive Home Care agency providing skilled nursing, rehabilitation therapies including physical, occupational, and speech language pathology services. Medical social worker, and home health aids are considered non-skilled services for bath and personal care are provided only in conjunction with skilled services.
Specialty services offered include infusion therapy, pediatrics, wound, and ostomy specialty.
B: Licensed Counties & Service Area East Central Illinois
SBL Home Care services 15 Counties in East Central Illinois Clark, Coles, Cumberland, Douglas, Edgar, Moultrie, Shelby, Fayette, Effingham, Jasper, Crawford, Clay, Richland, Piatt, and Christian.
C: Staffing and Patient Volumes
All types of services are provided directly by agency staff. On rare occasions less then 1% yearly. Contractors are used in instances of unplanned staff absence, vacancies, and periods of high patient volume. Contract staff is used for physical, and occupational therapy.
Current Staffing:
| Staffing: FT/PT | Number of Employees: |
| Registered Nurses in Field | 29 |
| Licensed Practice Nurse in Field | 4 |
| Physical Therapist & PTA In Field | 17 |
| Occupational Therapist & OTA In Field | 8 |
| Speech-Language Therapist In Field | 8 |
| LCSW Social Worker In Field | 1 |
| Supervisor Registered Nurses & Other office Staff | 16 |
| Home Health Aide | 3 |
Assigning staff to patients is done by zone (North, South, East, West). If discipline is not available in a particular zone, the ordering provider, referral source and patient is notified. A decision is made to delay the service until they are available, or another agency is selected by the patient. SBL Home Care does everything in its power to reassign staff to cover that zone during absence or unexpected illness of staff to meet the needs of the community.
The following is a 12 month count of home health patients admissions, re-admissions, recertification, and discharged patients:
| Type of Assessment (OASIS): | Total Number of Patients in last 12 Months Serviced: |
| Admission | 1871 |
| Re-admission | 169 |
| Recertification | 371 |
| Discharges | 2008 |
Total Number of Patients and Duplicate Patients by Service:
| Type of Service: | Total Number of Patients and Duplicated Patients by Service | Total Number of Visits |
| Skilled Nursing | 1871 | 15713 |
| Physical Therapy | 1561 | 9113 |
| Speech Therapy | 70 | 284 |
| Occupational Therapy | 1229 | 3897 |
| Medical Social Worker | 68 | 69 |
| Home Health Aide | 158 | 1897 |
| Other | 877 | 2434 |
| Total | 5834 | 33407 |
D: Skills and Competencies
All staff complete an orientation to the agency and are assigned a preceptor to facilitate individual training. Standardized skills and competency evaluations are required by all staff on hire. Annually, staff complete assigned competencies based on their discipline and may include clinical updates, regulatory changes, changes in technology new procedures, and products. All staff complete training and competency on infection control technique, emergency management, and patient safety.
Nursing: Complex wound care including negative-pressure-wound therapy, Surgical after-care, Ostomy management, Intravenous Infusions, Drain management, Urinary catheter management, Gasterestional-Tube management, Enteral feeding, Tracheotomy care, chronic disease management, Case management and Care Coordination, Medication management.
Physical Therapy: Assessment/improve functional mobility in the home, Fall assessment and training, Home safety modification and education, Balance training, Orthopedic rehabilitation, neurological rehabilitation, Chronic disease management, medication review, care coordination.
Occupational Therapy: Assessment/Improve ADL/IADLs in the home, fall assessment, home safety modifications and education, Activity modification, neurological rehabilitation, Orthopedic rehabilitation, Chronic disease management, medication review, care coordination.
Speech-Language Therapy: Assessment/Improve communication and swallowing issues, Cognitive rehabilitation, Voice treatment, Apraxia, Dysarthria, medication review, care coordination.
Home Health Aide: Personal hygiene such as showers, bed bath, tub bath, sponge bath, shampooing, nail care, skin care, oral care, toileting and elimination, safe transfers and ambulation, normal range of motion and positions, communication, teamwork, reporting of skin conditions to nursing.
Social Worker: Assessing social and emotional factors related to the patient's illness, need for care, response to treatment, and adjustment to care, Assessing relationships of patient's medical/nursing requirement to their home situation, financial resources, and availability of community resources. Patient advocacy. Goals of care discussions and advanced care planning documents.
E: Patient Case Mix
Most often the patients admitted to home health have just been discharged from a hospital or skilled facility for rehabilitation stay.
We care for patients with a variety of illnesses and injuries. Many patients may have several different conditions that require care by nursing and rehabilitation therapists to manage at home. The most common patients cared for in or organization is: Musculoskeletal Rehabilitation, Wound Care, Cardiac/Circulatory Disorders (Heart Failure), Neurological/Stroke Rehabilitation, Respiratory Illness (COPD, Flu A, B, RSV, COVID), Infectious Disease, Surgical Aftercare, Gastrointestional/Genitourinary, Endocrine (diabetes), and many others.
Functional Score: patient specific and refers to a person's physical limitations and includes an assessment of ambulation, transfer, toileting, bathing, dressing, grooming, and risk of hospitalization. The typical patient in the agencies has a score of 68.7 which is considered a higher limitation in function. The goal is to maintain that functional score or improve it at discharge from the organization. SBL Home Care Case Mix Score average is: 1.0570 Functional score average is unable to be determined due to the complexity of each patients Oasis assessment and their functional limitations it varies at each time point of Oasis Assessment per patient.
On average, patients receive 10 to 13 home in person visits during a stay. Virtual visits can be provided by home care agencies if needed to include (audio, audio-visual, and biometric monitoring) to perform patient assessment. SBL Home Care currently does not provide Tellahealth visits.
F: Service Limitations & Special Considerations
Each Patient referral is screened to assure the patient meets coverage criteria and includes insurance verification.
Some patients may not be accepted to service if the agency is not included in a particular insurance network or the patient lives outside our service area.
If during the referral process, patient safety or environmental safety is a concern, the referral may be considered high risk, and steps to mitigate risk and maintain safety for both patients and staff will be considered prior to acceptance to service.
Our agency staff have the right to request a second staff member or local law enforcement officer to accompany them on visits if environmental safety, patient or family member threats, is a concern.
Geographic limitations. Infusion nurses and pediatric nurses are very limited in our service area due to a small populations of our RNs who do not do pediatric care. Limitations in high risk medications in outer geographic area due to concern of patient safety and staff limitation of meeting their needs in a timely manner. (60 minutes or less from Coles county)
Daily wound care or infusion is very limited due to large service location, and less staff living in our outer geographic locations to provide daily visits. It is the agency expectations and goal to teach someone in the household to provide daily care or IVs for the patient/client.
SBL Home Care does not provide Custodial care for extended hours or 24 hour care.
G: Procedure/Guidelines
None; SBL Home Care does not perform any point of care testing (gulcose testing, INR testing)
H: Cross Reference
(15459099) Admission Criteria for Home Health Services Policy and (14759767) Patient Discharge & Transfer Process for Home Health Services Policy
References:
Federal Register: Medicare and Medicaid Program: Conditions of Participation for Home Health Agencies 484.105(i)
Home Health Conditions of Participation (COPs) updates CMS finilized updates to the HHA to reduce a voidable care delays by helping ensure the referring entities and prospective patients can select the most appropriate HHA based on their care needs. CMS fnilized the new standard that reqires HHA to develop, implement, and maintain, through and annual review, a patient acceptance-to service policy that is applied consistently to each prospective patient referred for home health care. The policy must address at minimum, the following criteria related to the HHA's capacity to provide patient care: the anticipated needs of the referred prospective patient, the HHA's caseload and case mix, the HHA's staffing levels, and the skills and competencies of the HHA staff. CMS finalized that HHAs must make available to the public accurate information regarding the services offered by the HHA and any service limitations related to types of specialty service, service duration, and service frequency. The HHA must review this information as frequently as the services are changed but no less than annually.