What are the most common chronic diseases seen in home health care patients, and how to prepare your staff for them?

Responsible for the most death and disability in America, chronic disease in elderly patients carries a heavy weight on the shoulders of their caretakers at home. Advances in medicine and an aging population combine to create what the World Health Organization identifies as “multimorbidity”, or individuals with more than two chronic diseases. The National Council of Aging reports over 90% of older adults are affected by at least one chronic disease while over two-thirds have two or more coexisting chronic conditions.

Home health agencies can show dedication to their patients no matter their complexity, given the right tools to develop a broader awareness of the populations they care for. By adopting specialized skills and the ability to manage complex patients at home, agencies will have a leading edge in the industry as the population ages.

The Top Ten

Though there is a wide variety of potential chronic illnesses in home health patients, the top ten chronic illnesses reported for those age 65 and older and on Medicare included:

• Alzheimer’s disease and dementia
• Depression
• Heart failure
• Chronic kidney disease
• Diabetes
• Coronary heart/artery disease
• Arthritis
• Obesity
• High Cholesterol
• Hypertension

For patients and staff, it is essential to be able to recognize a chronic disease being managed well or poorly at home. Having a good understanding of the challenges your patients will most likely face as well as their functional baseline of individual definition of wellness will allow the agency to create a more effective and personalized plan of care. The first step agencies can take is to ensure staff are given a strong foundation of understanding the implications of common chronic diseases. In addition to knowing the common profile of a chronic disease, staff need to know the disease’s typical trajectory from early to late stages so even the most novice direct care staff develop insight to provide better care.

Keep in mind, poor health can also occur and continue to worsen due to nonmedical reasons, or social determinants of health (SDoH). Home health is in a unique position, like no other healthcare professional, to get a bird’s eye view of potential contributing negative SDOH.  OASIS-E addresses SDoH such as ethnicity, race, language, transportation, health literacy and social isolation. Quality home care includes targeting interventions to best mitigate negative SDoH. Though home health agencies may not be able to address them all, there is the ability to provide referrals and resources with patients to improve their living situation and/or environment. Utilizing a home health software that is easy for staff to use that can seamlessly organize data and improve organizational workflow will best support the agency in their ability to target SDoH.

Best Practices for Home Health

Since no one chronic disease can be siloed from another, best practices in caring for patients will include a holistic approach and understanding the interconnectedness of illness with presenting or expected findings. For example, ensure your staff understand they are not just doing a visit to perform wound care. They are responsible for evaluating other related aspects of the client’s well-being such as the potential of infection, follow-up appointment attendance, complications related to a decrease in mobility, adherence to medications, side effects of new medications affecting the patient’s ability to eat nutritious meals for healing and strength, and more. When the agency can hardwire a holistic approach as the norm for their staff, patients will feel better cared for and outcomes are sure to improve.

To ensure your agency staff are all able to confidently provide the best care, include education most pertinent to the most common chronic diseases within onboarding or a nurse mentor program. As a bonus, your staff will feel more comfortable with complex patient care which often leads to improved retention and continuity of care for your patients. Focus education on:

• The foundations of each chronic disease
• Common symptoms
• Medications or treatments
• Complications, the impact on other common illnesses or body systems, red flags, and management in the home

Ensure the staff are given clear expectations of their role in caring for the patient and how to best educate their patients and families not only at the start of care visit, but also with each subsequent encounter. Ensure patient education is given at their educational level, in a format they understand and comprehend best. Procedure or skill-based platforms for direct care staff often have access to patient and professional education materials, however, they often are very “cookie-cutter” handouts presenting a one-size-fits-all all approach for patient education. It may be better to use them as an outline and create your own to allow for the addition of patient goals, community resources, use of individualized monitoring equipment, etc.

There are many widely available, free and reliable handouts, webinars, PowerPoint presentations, guidelines for care, and other tools guiding the management of chronic illness online at the public and professional level. Some reputable sources for information include the Centers for Disease Control-Chronic Disease, National Library of Medicine public health information page, Cleveland Clinic, or each specialty organization associations such as the American Heart Association, American Diabetes Association or the Health Resources and Services Administration (HRSA). The HRSA, for example has a variety of training courses, including one particular detailed course surrounding dementia care best practices for professionals. Save your organization time by not trying to reinvent the wheel. Utilize what is available, cite your sources and add your own personal touch.

Encouraging patients and families to get involved with online communities with others who have similar diagnosis can also be a very effective way to influence your patients to become more active participants in their health. Online communities promote sharing of experiences and information, offer support and encouragement from all over the country. The Center for Chronic Illness for example, provides free support groups via Facebook or Twitter. Social support can make positive impacts on mental health for older adults suffering chronic illness which often leads to isolation and depression. In addition, isolation and depression further perpetuate an older adult’s risk for developing stoke, dementia and heart disease.

By working holistically with home health patients experiencing chronic disease, your agency can support the big-picture goal of home healthcare to provide quality care at home, allowing patients to stay in their home. Ensuring your agency staff are well versed on all the facets of the most common chronic diseases occurring in your patient populations allows your agency to proactively manage their plan of care thereby boosting agency, patient and family confidence that your agency is built upon a sustainable foundation.

Author’s Note: Views, information, and guidance in this resource are intended for information only. We are not rendering legal, financial, accounting, medical, or other professional advice. Alora disclaims any liability to any third party and cannot make any guarantee related to the content.

Reference links:

1. Death and disability in America
2. World Health Organization
3. Top common chronic diseases in older adults- National Council of Aging
4. Centers for Disease Control-Chronic Disease
5. National Library of Medicine
6. Cleveland Clinic
7. American Heart Association
8. American Diabetes Association
9. Health Resources and Services Administration

Additional Home Health Agency blogs:

1. Home Health Marketing Strategies
2. Should your home health agency offer a wound care program?
3. Financial Management in home health agencies
4. Tips for charting compliance in home health