New business: Pediatric home care is thriving
Technology, focus on hospital release enlarge market
According to Judith Walden, RN, MHA, director of Castle Home Care in Kaneohe, HI, private duty home care for kids is blooming. Walden, whose home care agency boasts a team of pediatric caregivers, says that she’s getting a lot of respite care cases these days.
"The whole focus today is to get these kids out of the hospital, where many of them have been for years. Parents are primarily responsible for home care for children who have very high-tech needs. What we’re doing, in conjunction with teaching the parents or another primary caregiver, is to provide respite care. We’ll go in for from 20 to 80 hours a week so the can rest or take care of the other children. It’s also a wonderful opportunity to continue teaching and the skills assessment."
A continuum of care
Most pediatric private duty home care is paid for by the state, through the Early Periodic Diagnostic Screening and Treatment (EPSDT) Program of Medicaid. You begin this kind of planning with the parents and siblings — everyone has to be involved.
Walden has chosen to hire pediatric nurses rather than to teach pediatrics to home care nurses. She has also hired some of the same nurses who have worked with the children in the hospital — and who want some extra hours — for private duty home care. Because they already know the children, this provides a good continuum of care — the child, parent, and nurse are all happy.
"There’s a good chance that several of the hospital pediatric nurses will want extra hours, and can cover part of the home care hours. They can still work at the hospital, and with this child at home," Walden says. "We’re helping the hospital because we’re getting a child who is probably consuming a lot of resources out of the hospital and for whom the hospital probably isn’t receiving adequate reimbursement anyway."
Moms as advocates
Walden stresses the need to look carefully at the overall dynamics of pediatric home care before jumping into the market. "It’s very different from taking care of adults. You begin by planning with the patient’s parents and siblings — everyone has to be involved. One thing I’ve noticed about the parents of these children, particularly the mothers, is that they can be extremely demanding and controlling. They know what their kids need and they know how to get it. But these moms are fabulous advocates! Some have actually joined together to approach the legislature to expand community-based care. These moms see each other in the hospital every day and they network. They know where to get the resources."
Technology is available today so you can take kids home who would have had to remain in the hospital five years ago. "We have kids on everything from portable ventilators to tube feedings and IV’s," Walden says. "We’re not talking about children with terminal diseases. These are the tiny little preemies who go home, the older children with cystic fibrosis or other chronic pediatric diseases."
Working with insurance companies on individual benefit management is a major tool in Walden’s financial kit. She often puts together a package of care that is not defined in the patient’s health insurance policy, but can be successfully negotiated with the case manager. As part of her marketing plan, Walden offers to make predischarge home visits to evaluate the home. "You have to evaluate everything from electricity to how much room is available and whether there is a part of the home that is appropriate for the child."
Hospital vs. home
Walden finds her best referrals come from the hospital teams and from EPSDT case managers — people she markets heavily. (See the copy of her initial marketing brochure on p. 142.) "The point is to prove to the insurance company that the care that is being paid for in the hospital can be safely provided at home," she says. "It helps that hospital discharge teams really have begun to look at these children differently — to ask, Can we get them home and what will it take?’"
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