When the Nurse Goes Home Apex Home Care Fills a Need for Recently Hospitalized Patients

Hospital stays are a lot shorter than they used to be, says Cheryl Rumley. At the same time, though, the needs of patients haven’t lessened.

When hospitals and rehabilitation centers discharge patients, they often do so into a visiting nurse program — typically a service that offers access to registered nurses and occupational, physical, and speech therapy on a short-term basis.

However, said Rumley, a registered nurse herself, these programs typically do not take into consideration how a client is coping at home in general — including whether or not they are able to do laundry, get groceries, and perform the other tasks necessary to maintain a household and live independently. That, however, is the role of Apex Home Care, Rumley’s Springfield-based agency that helps people in Hampden and Hampshire counties get on with their lives.

“If you don’t manage the care at home, patients are more prone to nutritional problems and depression,” she told The Healthcare News, “and the family is more likely to be overwhelmed.”

A patient discharged into VNA care can expect in-home help for maybe 35 to 45 minutes per day, Rumley said, but they are essentially without help the rest of the time. Home care services, she said, essentially fill some of that gap and ensure that when VNA services end, the patient isn’t left completely without help or resources.

The challenge, said Rumley, is making sure potential clients understand the home care options available to them — especially since patients are spending less time in acute care than ever before, and need greater help outside the hospital setting. That’s even more important for senior citizens, who tend to need the most help in the home and might not have a support net of family members.

This month, The Healthcare News chats with Rumley about her eight-year-old company’s role in helping people maintain the kind of life they desire — without having to leave their homes.

Changing Needs

If there’s one factor that has made the role of agencies like Apex more important in recent years, Rumley said, it’s that Medicare and other cost factors have forced gradually shorter stays in the hospital than in past generations.

That means patients are being discharged with lesser degrees of independence — and less time in the hospital also means less time to educate the patient and family members about outside care options and to coordinate services with home health and other agencies.

That’s a critical shift, Rumley argued. “The impact of discharge planning to meet patient needs after returning home is a crucial part of the patient’s ability to cope in the home setting,” she said.

Discharge planning is a requirement of all hospitals, according to the Joint Commission on the Accreditation of Healthcare Organizations. In theory, discharge planning ensures that patients’ needs will be met after they leave the hospital, enabling them to function at an optimal level when they return home.

The key for hospitals is explaining to patients what options they have for continued care — both in-home nursing care and non-medical care of the sort Apex offers.

“Statistics show that patients who receive home care from nurses have significantly less symptom distress and greater independence than those who do not,” Rumley said. However, certified caregivers on a strict schedule can only do so much.

“Let’s say someone had a hip replacement and he’s at Weldon, and he’s being discharged to Mercy Rehabilitation,” she said. “They’re going to send a physical therapist three times a week, and maybe an occupational therapist, and make sure he understands activities such as bathing. He might get nurses once or twice a week to make sure the wound is healing and he’s taking his medicine. Those are the basic things Medicare pays for. He may or may not get a home health aide.”

However, Rumley continued, “the visiting nurse might not show up at a convenient time. And the VNA is not going to do grocery shopping, clean the house, and transport him back and forth to doctor visits.” And that, she said, is where an agency like Apex proves invaluable.

As a non-certified home care agency, Apex provides a wide range of non-medical services to clients, including hospital-to-home transition, personal care, meal preparation and cleanup, grocery shopping, light housekeeping and laundry, homesitting, assistance with home exercise programs, and respite care.

Providing these services to people making a transition from hospital to home, Rumley said, helps keep them out of nursing homes, improves their quality of life, and reduces the overall cost of care — especially since there are limitations on what hospitals can bill Medicare for when a patient is readmitted for the same diagnosis twice in a short time span.

“You’re dealing with a chronic population that’s already weakened,” she said. “Even after discharge from a visiting nurse agency for treatment of a specific symptom, continued care in the home reduces the rate of hospitalization and lowers stress in the family.”

A Nurse First

Rumley knows about caregiving; her first career was in nursing. While working in a neurological unit at UMass Medical Center in Worcester, she spent much of her time providing home care. After that, she spent a decade working for Olsten Health Care, providing home health services to children.

Her home care work led her to stints at New Medico Head Injury Systems and Pathways, where she served as marketing director. While gaining sales and marketing experience in the field, she started to formulate a plan to combine those skills with her nursing background, and with the help of the Mass. Small Business Development Center, Apex was born in Springfield. Eight years later, the company is still going strong on Main Street.

Rumley recognizes the need for both medical and non-medical services for patients, so Apex works in collaboration with certified agencies, including VNAs, by providing the daily living assistance those companies cannot.

“Nursing needs to be involved,” she said. “Nursing services in the home absolutely reduce rehospitalization rates, and therefore the cost to both hospitals and insurance companies.

“The difference between us and a certified agency is that Medicare pays for the certified agency for a short time due to a disease process, physical therapy, wound care, or something like that,” she continued. “But when the VNA says they’re done, the patient is left with nothing.”

She stressed that Apex is a licensed home care agency with several state contracts, which means it must follow all state and federal guidelines for care — which is not true of all home care companies. And it does make a difference, she claimed.

“We’re able to deal with chronic processes such as Parkinson’s, Alzheimer’s, cancer, stroke, and lung disease,” she said. “We get some very complicated cases, and we are capable of dealing with them.”

Although Medicare doesn’t pay for non-medical home care, Rumley said people have options ranging from long-term care to state assistance. But she maintains that people leaving the hospital setting don’t always comprehend the services available to them, or why they are so important.

“Often,” she noted, “by the time I get into a home, the family caregivers are exhausted and frustrated, and they hadn’t known before about an agency like mine.”
Easing that frustration isn’t just par for the course, Rumley said; it’s the apex for which she’s been striving since she first became a nurse.