Caregivers Case Study Essay

1. My understanding of the business problem: There are two problems in this business that combine to make one big issue. First, we have a major shortage of caregivers. This is not specific to the VNA, it’s happening all over the country. But it’s a big problem for all agencies right now. People just don’t want to do this job because it’s hard and low-paying. Second, we are shortly going to be “graded” on our clients who have potentially avoidable events. All home health agencies are facing this challenge. This includes readmission to the hospital, use of the emergency room or relapses due to lack of care, so it’s in our very best interest to keep clients home and healthy.
2. How I will measure the business impact: As we are going to be graded (by the government) about our percentage of readmissions within a 30-day length of time following a hospital or nursing home stay, this will impact us on our Medicaid reimbursements. There will be a decrease in percentage of payments based on these numbers. Our clients “are risk-adjusted using a predictive model
that incorporates five categories of risk factors, including the patients' prior care setting, age and sex interactions, health status, Medicare enrollment status and other interaction terms (e.g., a patient with chronic heart failure and chronic obstructive pulmonary disease)”. (Quality Measures) So we can measure the impact here in dollars and cents. How much do we have subtracted from our Medicaid payments due to client readmission to the hospital? We want the answer to be none, we need to do everything we can to keep our clients home, uninjured and healthy.
3.
What data is available: We have data on past readmissions as well as the current state of our client’s health. We know the number of hours clients are allowed by the government, and what caregivers are available and when and where. Also we have data on clients that are currently in the hospital or a nursing home and when they are expected to come home. We have data on previous client’s state of health and when and why they were readmitted to the hospital as well as length of stay. We also know how long our clients are able to stay at home before they have to go to a nursing home for good and for what health reasons, or to the hospital where some of them die.
4. The initial solution hypothesis: Throw more caregivers at the problem – do what we can to immediately recruit more people. This is a short term solution; turnover is tremendous in this industry. We are always going to be looking for more
employees.
5. The solution: There are some things we can do, after some careful investigation and thought. We can install telemonitoring in some homes – only the clients who do not have dementia or mobility issues will benefit from this method. We can monitor 100 clients with 4 RNs in this manner. Monitoring temperature, blood pressure, weight and a host of other data, overseen by a qualified person who can interpret and act on potential problems will help the client and our caregiver shortage. As Glaser discusses in Solving Big Problems with Big Data, with predictive analysis we can use the results from telemonitoring to understand which clients may be candidates for re-admittance to the hospital. This will alleviate the caregiver shortage so that we can send caregivers to other homes that require a more hands-on approach. Clients who cannot get out of bed, shower or toilet themselves are prime candidates for injury when left to fend for themselves. Pinpointing clients who have the greatest potential for re-admittance or injury should be one of our biggest concerns. We will want to make sure that we are doing all we can to help them. We will still need to recruit for caregivers however. Finding out where our current caregivers heard about the VNA may help us to pinpoint certain avenues to advertise.
6. The business impact of the solution: Implementing these changes will not be inexpensive. We will have to pay to install the monitors in each client’s home and then track all the information. We are going to have to work to recruit more caregivers and this can be time consuming and expensive. However, these changes will help us to improve our grade with Medicaid. This will prevent us from losing money in the long run since our payments will be performance based. We will be able to use the data collected from the monitoring for future clients as well. This will also improve our client care which will lead more clients our way and increase business. There are at least 5 other agencies in the area and we are all in competition with each other. The changes proposed will be good for business on a number of levels.