Trends in Health Care

Since VNSNY’s founding in 1893, medical knowledge has changed dramatically. As new discoveries and advances are made, patients live longer, and diseases and conditions that were once uncommon are now major causes of discomfort, disability and use of health care services. Monitoring developments in research and tracking changes in patient demographics are critical to ensuring that patients are receiving proper treatment and care in the setting they prefer–at home in their community.

Reducing repeat hospital admissions and rehospitalization.

Returning to the hospital soon after discharge is often a setback in a patient’s recovery, and it’s costly—but the good news is that it’s often preventable. Many institutions and agencies are working to reduce repeat hospital admissions. The Center for Home Care Policy & Research has contributed to these efforts through spearheading projects like the ReACH Collaborative, a partnership with 65 home care agencies across the U.S. to implement home care improvement initiatives, improve hospital to home transitions, and focus appropriate resources on high-risk patients. Many of the successful strategies implemented by ReACH agencies were first implemented at VNSNY. 

Retooling the health care workforce for an aging America.

Americans are living longer, and an aging population will place demands on the health care system. Having enough home health aides, nurses, therapists, and doctors to meet future needs is important. The Center is studying workforce issues, including the causes for the high rate of home health aide turnover and what factors contribute to nursing and home health aide job satisfaction as well as the retention of nurses. With a workforce of 16,000 employees, VNSNY is in a prime position to inform policy makers on how the health care system can prepare for an aging America. VNSNY's Chief Executive Officer, Carol Raphael, was one of 15 national experts who served on the Institute of Medicine’s (IOM) Committee on the Future Health Care Workforce for Older Americans. Penny Hollander Feldman, the Center’s director, served on the IOM Committee on Improving the Quality of Long-term Care, which also emphasized that an adequate, well-trained and satisfied workforce is key to delivering high-quality services.

Increasing evidence-based practice.

People who receive home health care are typically older, and often have more than one disease or diagnosis that requires multiple medications and changes in diet or physical activity. As a result, elderly adults often have complex health care needs that require a high degree of self-management, as well care by a team of skilled home care clinicians. Caring for older people with multiple chronic conditions is challenging—in part because there are no well-established guidelines for home health care that address the conditions and risks that change with advanced age.

After receiving a grant from The John A. Hartford Foundation, the Center launched the National Framework for Geriatric Home Care Excellence, a project that assessed how existing knowledge of geriatrics can be adapted to home care. The Framework and practice recommendations developed by the project’s expert panel of geriatric specialists and home care leaders are now being used to guide the e-learning courses and online community of the CHAMP Program (Collaboration for Homecare Advances in Management and Practice).