First person account: HMEs to the rescue

I have provided legal representation to HME suppliers and other homecare companies for 27 years, but, until recently, no one in my family had ever received home health services. So, although my work in the industry as a professional convinced me that homecare providers and the services they rendered were extremely helpful to many patients, I have since learned that there is no substitute for firsthand experience. Last year, my mother experienced a very sudden illness and was hospitalized. She went home from the hospital several days later with a full array of home health services, including private-duty services 2- hours per day, seven days per week; Medicare certified home health services for skilled nursing; home health aide; physical therapy and occupational therapy; and HME. LESSONS LEARNED My lessons about home health services began before she even left the hospital. One of the first lessons was confirmation that all of the difficulties providers have encountered in the referral process for a number of years are still alive and well. After several days in the hospital I knew that my mother would need all of the services she ultimately received. One of my sisters told me that the discharge planner had given her a list of homecare providers. When I reviewed the list, it was clear that the list included private duty homecare agencies only or, as the discharge planner later said to me, "sitters." I knew that my mother qualified for Medicare certified home health services and HME and that they would both be essential for her recovery. I was also aware that the discharge process should begin immediately and was leery of waiting for the discharge planning staff at the hospital to put an appropriate plan in place, especially because they did not seem to know that she qualified for and would need home health and HME services. CALL TO ACTION I immediately telephoned one of our clients and made a self-referral for all of the services that my mother later received. The company immediately sent a liaison to the hospital to begin the process of coordinating home health and HME services. When I telephoned my mother to explain that a liaison would be there shortly, the discharge planner was in her room ready to talk about discharge. My mother announced that she was deferring to me and handed me the telephone so that I could talk to the discharge planner. The discharge planner first indicated that she had provided a list of "sitters." When I explained that my mother surely qualified for home health and HME, she seemed unsure but acquiesced. She then said that she assumed that the hospital's home health and HME company would be OK with us. I emphatically stated that they were not acceptable and that the coordinator from our client's offices was on the way. It was quite clear that if I were less knowledgeable about the way the referral process is supposed to work, my mother's right to freedom of choice of providers would undoubtedly have been ignored. This experience confirms what HME suppliers and home health agencies tell me almost every day. MORE LESSONS There were other lessons, too. One of the most important is that patients and their families should work very hard to anticipate their needs and communicate them to suppliers and agencies before the weekends and holidays. Although representatives of the providers who were rendering services to my mother did not communicate this to us, it became quite clear that doing so was in the best interests of everyone involved. As a result, I urge providers to be more direct and emphatic with patients and their families about communicating needs as far as possible during regular working hours. But perhaps the most important lesson is that home health and HME services are even more wonderful than I ever imagined. We were quite direct with providers that we wanted the goal of our mother's plan of care to be restoration of her excellent health and resumption of all of her previous activities, including walking three miles each day and driving. These goals were accomplished. All three of my sisters and I have very busy lives. It was clearly going to be stressful to decide who would care for our mother. Instead, I was able to say to my sisters that our client would take care of everything and that I would coordinate services with them. I relieved them of any further responsibilities with the promise that I would keep them up to date about our mother's condition. Everyone heaved an audible sign of relief. THINGS TO KEEP IN MIND As I worked with our client to meet my mother's needs, here are some of the things that meant the most: - The lovely, familiar voices of private-duty caregivers who answered the phone in my mother's apartment day after day and gave me updates on her progress and expressed their care for her. - Staff at the agencies and HME company who were extremely responsive to every call. One manager returned my call at 8 p.m. - The assurance that providers truly cared about my mother and would stand by her and our family until she recovered. So, while I know that HME companies in particular are under fire these days, I urge staff at HMEs to keep their eye on the ball, which is to say keep providing wonderful care for patients and their families. When all is said and done, this matters the most and is worth the fight. --- Elizabeth Hogue is a healthcare attorney based in Burtonville, Md.