Wednesday, Nov. 5, 2003 | 11:20 a.m.
To check the ratings on home health agencies by state, county or ZIP code, go to welfare.gov on the web or call 1-800-633-4227. The site compares agencies based on how patients improved in areas of mobility, daily living and mental health as well as the occurrence rate of patient medical emergencies.
Las Vegan Rosemary Stack, like many seniors, is a walking paradox of frailness and strength who guards her independence like a badge of honor.
The 81-year-old, who retired here from Mount Prospect, Ill., has spent the past several years as the main caretaker for her 84-year-old husband, Hank, who suffers from polio-related complications and is now wheelchair-bound. Although their four children have said they are willing to help the couple at any time, they are out of state and Stack hates to interrupt their lives.
So when Stack herself got sick and had to be hospitalized, she was more concerned with who would take care of her husband than with who would take care of her.
A home health agency helped Stack regain her independence and return home following two surgeries.
"I'd never be able to manage if they did not come in and tell me what to do, show me what to do," Stack said, tearing up. "I don't ask for help, but help has come for me."
Like many seniors, Stack relied on a hospital social worker, Terri Melquist of Summerlin Medical Hospital's Acute Rehabilitation Center, for advice on finding home health care.
This week a new federal health initiative was launched to give seniors and others in need of home health care the resources they need to choose the agency that best meets their needs.
Under the new federal Home Health Quality Initiative, launched by the U.S. Department of Health and Human Services, patients can compare agencies in their area based on how patients improved in areas of mobility, daily living and mental health as well as the occurrence rate of patient medical emergencies.
It follows a year after a similar initiative was launched for nursing homes.
The initiative evaluated 40 agencies that serve Clark County and found that 18 surpassed the national average on eight of 11 quality measurements. Seven agencies did not have enough patients to give reliable results. The remaining 15 all exceeded national averages on at least three measurements and were within a few percentage points of the national averages on all measurements.
Melquist sees the initiative as a "great resource" to help patients select a home health agency.
Jody Olson, spokeswoman for the American Association of Retired Person, said the focus is in the right place. "The focus on outcomes of care shows the number of people that it helps, who gets better, who thrives with the quality of care ... this will allow people to say, 'This program works; this program doesn't."'
The initiative, through the Health and Human Services Department's Centers for Medicare and Medicaid Services, also contracts with a quality improvement organization, HealthInsight, to work with each agency to identify and improve specific aspects of care.
"It gives (agencies) an important ally in their constant quest to improve patient care," Cecilia Anderson, director of professional services for Valley Home Health, said.
Home health services help home-bound individuals who still need ongoing medical care make the transition from the hospital or the rehabilitation center back to their own homes.
Stack receives visits in her Care Free Apartment in Summerlin two to three times a week from Valley Home Health registered nurse Rosie Garrett to check her vital signs and the intravenous tubing Stack needs for her medication. Garrett said she also continues to monitor Stack's condition, counsels her on nutrition and is available if she has any concerns.
Many home health patients need wound care, physical rehabilitation or regular, skilled surveillance because of chronic illnesses, health-care providers said. The key is to help patients become stable in their daily living and as self-sufficient as possible, Garrett said.
"We do a lot of teaching so they can still become independent," said Garrett, who has 10 years of experience working in home health care and 28 years experience as a registered nurse.
Stack, for instance, has learned to flush her own IV lines and administer her medication herself.
"This last surgery kind of knocked me for a loop, but I'm trying one day at a time," Stack said during a home visit Tuesday. "She taught me how do this and now I can do it myself. I am so grateful for all she has done."
In addition to providing patients with consumer resources on home health agencies, the federal initiative will help nurses like Garrett improve their care by identifying and focusing on areas where patient outcomes may not be improving as well as they could.
The initiative also identifies areas where an agency is "getting extremely high or good outcomes," said Jean Green, director of professional services at Southern Nevada Home Health Care, Inc.
"You want to look at that and see what they are doing that is leading to that (good outcome)," Green said.
Charles Perry, executive director of the Nevada Health Care Association, said the initiative has transformed once adversarial relations between nursing home providers and federal regulators into cooperative interactions.
"Under the new initiative, CMS not only helps to identify where improvement could be made or should be made, but also puts an organization into place that can help you achieve the goal you are looking for," Perry said.
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