Home health care in Arizona

Arizona Nurse, Mar 2000 by Long, Carol O

The services of home health care agencies have made a profound impact on the lives of many Arizonans not only on the patients that they serve, but also on the livelihood of many employed in these agencies and on the market within the health care system. Home health care is the delivery of technical and professional health care services in the home to those who are ill and under a physician's care. Home health care is an integral part of the health care delivery system today with over 20,000 agencies nationally, and providing care to over 8 million patients (National Association for Home Care, 1999). Yet a comprehensive national picture of home health care is lacking, except for survey samples and rough estimates of service delivery by patient demographics.

Like the national picture, very little is known about home health care in the state of Arizona, other than the number of agencies and whether they are licensed or certified. It has been 10 years since a survey was completed about home health care agencies and their services in the state. The Arizona Department of Health Services (ADHS) license home health care agencies, but collects no detailed statistics about home health care or hospice care in the state, as this is not required by state or federal law.

Home health care has grown significantly in this decade, yet the contributions or magnitude of home health care in Arizona has been poorly understood. This article presents a brief synopsis of the changes in the home health care industry and recent and relevant survey findings in Arizona, within the context of an everchanging picture of home health care nationally. Implications for the future are addressed.

External Forces in Home Health Care

There is a growing concern nationally regarding the increasing expansion and expenditures in home health care. Efforts in controlling this growth in recent years included moratoriums (now overturned) on licensing new agencies, the implementation of Operation Restore Trust, targeting Arizona and other states by investigating fraud and abuse, the requirement for surety bonds, and the execution of the Interim Payment System (IPS). The most recent activity is the use of Outcome Assessment Information Set (OASIS) and the proposed rules on a Prospective Payment System for home health care.

Current data from the National Association for Home Care (NAHC) estimates that close to 2,500 Medicare certified home health care agencies have closed in the past year, succumbing to some of these government pressures. New Mexico recently reported increasing number of home health care agencies closing, threatening access to patients in rural areas (Home Health Line, 1999). Amid stories of access concerns occurring with increasing frequency, the U.S. General Accounting Office is investigating these closures.

In addition, there is little information on the characteristics of these agencies. Unfortunately, even NAHC can only secure data from 50% of the states per a recent conversation with Mary St. Pierre (NAEC, 1999) and no data exist for Arizona. Thus, through funding by Arizona State University Faculty-InAid program, the Arizona Home Health Care and Hospice Survey (AHHCHS) was developed to gather information about the status of home health care and hospice in Arizona.

The Arizona Home Health Care Survey

The construction of the AHHCHS was completed with the assistance of an Information System Task Force, a statewide forum with representation from home health care agencies and hospices, the ADHS, health care consultants, the State Board of Nursing, and the executive directors from the Arizona Association for Home Care and Arizona Hospice and Palliative Care Organization. The data collection tool included five major sections (agency, patient, personnel, financial, and clinical monitoring characteristics) and was separated into two distinct surveys: the 64 item Home Health Care Survey and 80 item Hospice Survey. All licensed and certified home health care agencies and hospices in the state were contacted to complete the survey. The current survey of home care agencies, initiated in July 1998, was completed in January 1999 and provided a long overdue look at home health care in the state of Arizona. Results are presented for the Arizona Home Health Care Survey.

Results

Several key findings are reported. A mailing in July of 1998 to 146 agencies revealed a considerable number of obstacles in obtaining this vital information. D4ta collection spanned 6 months due to a 65% turnover rate in administrators employed at the agencies.

Following the national trend, it also became apparent that many agencies were either out of business or in some other business transformation which made data collection more difficult. Yet, considerable information was obtained, due to the persistence of many, in determining the status of home health care agencies in Arizona. A response rate of 44% was obtained (n=43).

Agency Closures

Like the national trend, Arizona is undergoing considerable change in the home health care market. In December 1998, it was determined that 42 agencies had either closed, were no longer Medicare certified, or were no longer in existence due to merger/ acquisition. Another eight agencies closed soon after the survey was over. In the end, over 34% of the home health care agencies had closed or were remarkably reconfigured demonstrating considerable unrest and instability in the industry in a very short period of time.