January/February 2009

New Twist on Home Healthcare
By Nicci Kobritz, RN, NP
Aging Well
Vol. 2 No. 1

The word boutique generally conjures thoughts of shoes, clothing, or handbags. But home healthcare—the not-so-glamorous but all-too-necessary field of caring for older adults in their own homes—has created a unique niche for the boutique concept.

Developing the concept enables its use as a catalyst to reinvent the basic premise of home healthcare. Most home healthcare companies maintain similar operations with a number of minor differences. They provide clients with planning and caring based on the idea that the traditional responsibilities of home care lie in taking charge of the client’s needs.

But a modified business model takes home healthcare to a new level. Its focus centers on maximizing clients’ potential to do for themselves. Youthful Aging Home Health Care is one company that embraces the boutique concept for the in-home care of older adults. Its revised model has been in operation for two years following research and development and a three-year transition, and it operates on a different premise.

The emerging market prompted the need for a change in home healthcare. Increasing numbers of older adults contribute to the current marketplace. For years, home care remained static—certified nursing assistants provided services for the client. The retooled model builds on the same care but recognizes that most older adults cherish their independence.

Construction of the boutique model involved developing a system based on older adults remaining independent and, importantly, putting the components in place to wrap around that service. A complete menu of services enables adjustments in care to suit each client’s needs.

For example, one older woman’s goal was to get into her wheelchair to watch the sunset each night. Sometimes, it can be as simple as that. For others, goal realization emerges through a program of individualized care designed specficially for that client. That’s the boutique concept. The core difference is that the program enables clients to reach their maximum physical capacity. It makes them independent by allowing them to do more for themselves. One success story focuses on an older woman with Parkinson’s disease who left her wheelchair behind and walked after 10 specialized sessions.

The first step in such a program involves a complete nursing assessment to determine the necessary services for a personalized plan of care. It’s essential to establish a relationship with a client’s primary physician. Stabilizing chronic conditions is a necessity before accomplishing goals of greater independence. A matchmaking process enables the selection of the right caregiver.

The next step includes discussing the rehabilitation program. A physical therapist’s evaluation lays the groundwork for an aggressive plan. Then, if the client is capable, a personal trainer may be used. Dietitians should make dietary adjustments based on levels of activity, possibly adding fluids that older adults frequently overlook. Other options include art and massage therapy.

When a plan is in place following the assessments, a program representative visits the client to determine whether the caregiver is a good fit. Efforts continue until the client is completely satisfied. Backing up the certified nursing assistant are home health aides, companions, nurses, physical therapists, geriatric care managers, and social workers. Care varies depending on the individual’s desires and capabilities. The range of services can extend from a few hours per week to 24/7 live-in care.

The fitness routine extends beyond the body. Each client receives brain fitness software for use on a company-provided laptop, with results measured before and after each use. Clients with dementia and Alzheimer’s disease work with special Montessori-based programs.

Based on this contemporary model, the program provides more care but takes on fewer clients. It works because it provides a more personal level of care. The basis for success lies in providing continuity with skilled professionals and emphasizing strong rehabilitation programs. Another integral part of the equation is improving communication among doctors, clients, and family members, a lofty but necessary goal in a setting where many older adults become overwhelmed with managing multiple medications and treatments. And, of course, stablizing medical conditions is the greatest support in maintaining independence.

It’s critical to maintain medical records for each client, updating them 48 to 72 hours following a treatment. Client updates are available 24/7 for family members, providing important peace of mind. Family members comprise the second part of the equation. Often, client care includes caring for family members as well, as they recognize and accept that a parent or loved one’s health has changed or deteriorated. Communicating changes and updates to family members is key. Teleconferencing and e-mail allow sharing information with family members across the country and around the world. Positive feedback indicates that the new care model is working successfully.

— Nicci Kobritz, RN, NP, is president and CEO of Youthful Aging Home Health Care in Sarasota, FL.