Re-Imagining Patient/Family Advisory Councils for H@H
PFACs were never easy to build and manage even in traditional specialty/departmental segments. But the new infatuation with moving the patient from the brick-and-mortar provider setting to safe and reliable care at home has created the need for a new form of patient council that represents this more decentralized model of critical care delivery.
In a way Hospital at Home (H@H) is the epitome of social determinants of health in the actual locus of care delivery. Sure visiting nurses have always been in the home in lieu of doctors making house calls. And yes, physical and occupational therapy has been delivered in the home on an outpatient level.
But hospital at home is a different experience and because of its relative newness at scale, providers are still learning. Because hospital at home is a model that “the whole family can play”, the number of insights that can be gathered increases exponentially given the number of interactions the family has with the patient, and more importantly with each other.
This is not like being in a room on a hospital ward with friends and family coming in periodically. This is like a room in a hospital ward coming into your living room! Along with it come all the sanitization, technology, nutritional, therapeutic, entertainment, and clinical elements one needs to heal. Add to that whatever number of family members the patient has along with a dog, cat, and a fish tank.
The great thing about a recovered H@H patient on PFACs is that it's not hard to find members (and their families) who can communicate virtually given the remote nature of their care.
Add to that the fact that there is still a very close association with the hospital brand since this is technically an extension of the provider enterprise. Were it simply an outsourced home care company the dynamics would be quite different. But in this case, the same trust that needs to be established on-premises must be met or exceeded in the home.
Some of the factors H@H patients love the most are also the ones the family is most responsible for.
Depending on the severity of the ailment family members can be responsible for in-patient equivalents of:
· Dispensing medication/pharmacy services
· Food services
· Housekeeping & Sanitization
· Mental health
· Call bell
· Mobility and accessibility
· Medical and monitoring devices
This means that the patient could not only depend on their family for these services but also report on their performance. This alone makes the PFAC aspect of H@H incredibly important in regard to outcomes and patient satisfaction. This also raises some interesting questions about HCAHPS scores in a H@H setting and the reimbursement implication if scores are low.
The H@H PFAC will share many of the same recruitment, retention, and equity issues as the traditional PFAC but the diversity of its insights will be much different.
Consider that there will be few better opportunities for providers to truly experience the social determinants by having complicated healthcare delivered in the home of those living in multi-generational housing with limited bi-lingual skills or in lower-income rural settings. This is in many cases only done in Medicaid-funded inpatient or outpatient settings where the home setting is a mystery.
Needless to say, some additional SDOH insights will be generated by those receiving sophisticated care at home in affluent and upper-middle-class settings.
Finally, there will be a new dynamic among the H@H council participants in that they will be sharing experiences about a setting that none of them physically shared. Perhaps more fascinating, they will be able to share the plusses and negatives of the home experience versus the brick-and-mortar hospital where they were originally admitted.
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