Some Background Information

When someone with Medicare or a Medicare Advantage plan (usually those 65 and older) gets sick and they have difficulty leaving the home, Medicare has a Home Care benefit that fully covers skilled professional home visits.  Of course Medicare sets strict guidelines and limitations to this amazing benefit, notably in the current context, you can only get it if you are "homebound" (or really struggling physically to get out of the house) or not at your baseline health (it is not preventative, but *surprise* quite reactive).  My current job is with a Home Health agency providing skilled nursing under this benefit (I am a RN case manager).  

I see so many patients feeling so very overwhelmed with managing their health at home.  This program is made from the items I educate about on repeat to my patients. Is what I teach ground breaking or revolutionary? Not particularly, however, my patients and their caregivers are in such a state of overwhelm with their recent health event that they just really need that little bit of extra help - and it makes all the difference.  Often I am surprised that my patients don't already know what I am educating about, and also often, my patients are thankful for the knowledge and if I ask them, they will tell me they wish they'd known it earlier.

So why haven't they learned these key self-care habits earlier?  Unfortunately, right now in the United States health care is a fee for service system.  More services provided, the more an agency can bill for.  Additionally, much (but not all) of patient education and preventative care is not a billable service.  Doctors are given time slots that are 15-20 minutes per patient and have caseloads of hundreds of patients.  What brings the money in is more appointments. What about if a patient needs a little extra time to learn about their diagnosis and how to care for themselves? Well, 1) the insurance expects a LOT to be "patient responsibility", meaning, each individual needs to take responsibility for their own health and with that advocating for and finding the education they need to care for themselves, and 2) if the education is going to take more than 15 minutes, make another appointment because there isn't much flexibility there.  Though, I have heard of some clinics coding an appointment a certain way to allow more time.  Another kink in the system is that if a patient calls in with a concern or question and the doctor takes time to look into it and respond, it is not billable.  It's just "part of the job", which means working for free.  Obviously it's a game of making enough elsewhere to cover those non-billable responsibilities but it is a tricky thing.  In our system everything hinges around the insurance, what's covered, what's not, because that's what pays the bills.  It's what pays my bills.  But let me tell you, it's not working for anyone but some wealthy shareholders or CEOs.  Working in this way has health care providers over-worked and quite stressed, leading some to leave the field all together, I can think of two fellow nurses right now off the top of my head that have left the profession completely.  So those left in nursing are on a time crunch, and often there just isn't the time for them to truly sit down and take the time to understand a patient's educational needs or limitations at home or priorities of care.