Psychiatric home care visits reduce costs
Program avoids inpatient care
Children and adolescents suffer from the same serious psychiatric illnesses as adults. These young patients frequently require long-term care, including residential treatment, and the cost is high. However, a quality alternative to high-cost residential treatment exists. A recent study conducted by Western New York Staff Builders in Buffalo found that psychiatric home care successfully stabilized young psychiatric patients in an average of 35 days at a total cost of about $700 compared to about $500 daily for an inpatient stay.
"Psychiatric home care is a bargain," says Verna Carson, PhD, RN, CSP, national director of behavioral health for Staff Builders in Lake Success, NY. "A home health nurse visit costs between $65 and $115 and is an intense hour to two hours of one-to-one interaction between the nurse and patient," she explains. "Unfortunately, most psychiatric inpatient stays are more for containment than therapy. The patient gets very little personal one-to-one attention. The focus is simply on stabilizing the patient to insure that the patient is no longer a threat to self or others."
In any given year, almost 4% of children and adolescents ages 9 through 17 are diagnosed with a severe psychiatric disorder. An estimated 7.5 million youths under the age of 18 have psychiatric, behavioral, or developmental disorders. Yet only about 20% or 1.5 million of these youths receive the treatment they need, says Carson.
Even among those youths who receive treatment for their psychiatric disorders the interventions offered often fall into the "too little, too late" category, says Carson. "These young people are often socially isolated, fail in school and in relationships, and come to the attention of the juvenile system. Their parents often feel hopeless," she notes. "In addition, the stress of raising a troubled child often rips apart the fabric of family life. Psychiatric home care offers a viable treatment option which addresses the needs of both the patient and the family."
Seven outcomes for seven elements
Staff Builders designed an outcome study to demonstrate that psychiatric home care is an effective treatment model for youths with mental illness. (For further discussion of behavioral health outcomes, see article on p. 205.) The company’s RESTORE, family behavioral health, program provides a broad scope of interventions including the following:
• crisis stabilization;
• medication management;
• community linkages;
• family support and education;
• long-term management for the seriously and persistently mentally ill.
RESTORE delivers care using a proprietary model called PIECESS. (Please refer to box on p. 207 for seven components of the PIECESS model.) The model’s seven components provide a theoretical and philosophical framework for the program.
Previous Staff Builders studies of adult populations suggested that psychiatric home care decreased the need for inpatient hospitalization, decreased utilization of emergency services, and resulted in overall increases in treatment compliance. (For more information on psych home health, see CM primer article, p. 207.)
Staff Builders conducted a study of 54 children and adolescents who received mental health home care from Western New York Staff Builders between January 1995 and December 1996. Researchers collected information on the following seven outcomes:
• treatment compliance;
• rehospitalization rates;
• emergency room admissions;
• functional ability;
• length of stay;
• number of home care visits;
• cost of care.
Chart reviews; central intake; field nurse interviews; mental health providers, such as psychiatrists, case managers, psychologists, and social workers; family members; and patients themselves were the sources for the information gathered.
The findings were encouraging, says Carson. Roughly 90% of patients referred to the program required nursing assistance with medication management. Nurses assessed compliance at each visit through direct observation of medication consumption and through questioning the patient, caregiver, or home health aide. Nurses rated compliance from 0% to 100% at each visit. The overall average medication compliance rate for this sample was 89%.
However, compliance with other treatment modalities is also essential to recovery in psychiatric illness, Carson notes. Nurses also assessed the patient’s attendance to physician, clinic, case manager, and counselor appointments. Patients had a 60% compliance rate for other treatment modalities.
Education prevents suspensions
Of the 54 patients in the sample, 43, or 80%, were on a behavioral plan. Plans required nurses to educate the patient and the primary caregiver about implementing the plan in the home. In some cases, nurses also educated school staff about specific behavioral plans. These interventions maintained children in school and prevented suspensions or expulsions for inappropriate behaviors.
Other findings include:
• 65% of patients were stable at discharge and met goals designed in their treatment plan;
• 35% of patients were discharged for a variety of reasons, including persistent oncompliance;
• 11% of patients were rehospitalized for psychiatric reasons;
• 4% of patients were arrested and removed from their homes.
• 17% of patients used emergency services while in the RESTORE program.
"The cost savings with psychiatric home care are tremendous," says Carson. "Children were stabilized in an average of 35 to 36 days with between 10 and 11 nursing visits. The average costs of those visits ranged from $650 to $710.
"Compared to $500 for one day of inpatient care, the study clearly demonstrates both the clinical and cost effectiveness of psychiatric home care for young patients."
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