Serving the home health, home care and hospice industry since 1999.

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"Handbook of Home Health Care Administration: Sixth Edition"* is a textbook that should be on the shelf in every branch of every healthcare at home provider. Let's modify that. It should never be on the shelf but should live on the administrator's or branch manager's desk. In the current edition, which is a comprehensive, 1,000-page tour de force, editor Marilyn D. Harris has assembled a team of over 80 authors to cover, in detail, everything a private duty or certified agency administrator needs to know to be compliant and successful.

Ms. Harris has been in home care since before it was called home care. Since entering nursing school in 1954, she has been dedicated to improving the condition of patients and their in-home providers. In this edition, she offers not only the nuts and bolts of agency administration but brings home the importance of this industry to the entire U.S. healthcare system. Through 64 chapters penned by Ms. Harris herself and over 80 other expert authors, she describes in exquisite detail the nuances of an industry from which perfection is constantly being demanded, an industry that rescues the rest of healthcare even when it is not perfect.

Marilyn D. Harris recently celebrated her 60th year in home healthcare. She served 22 years as a director of home health and hospice services where her responsibilities included the administrative overview of a nurse-managed health center, a faith community outreach program, an animal-assisted therapy program, and other community programs. She has worked with colleagues both domestic and international.

From the Introduction:
"There are endless opportunities in the 21st Century to provide high-quality healthcare services to individuals in a compassionate, caring, and cost-effective manner. It is my hope that each reader will find this new edition to be a ready reference for the multi-faceted aspects of home healthcare administration." 

In her eloquent forword, Andrea L. Devoti, President and CEO of Neighborhood Health Home Care and Hospice in West Chester, PA, sets the stage by reminding providers that "Community-based care is now in the limelight, and we need to take advantage of our time in the spotlight...The home care industry is entering a new era, one in which society increasingly defines the industry in terms of its quality-focused processes, cost efficiencies, and industry benchmarks. The most successful home care and hospice agencies will be those who take a proactive approach to adapting to the changes ahead." (emphasis added)

Ms. Devoti describes Ms. Harris' handbook as "an outstanding compendium of experience, advice, and information that every administrator should have at their disposal."

Luminaries in the handbook's list of authors include such names as Tina Marrelli, Barbara Citarella, Joie Glenn, Ann McCaughan, Suzanne Sblendorio, and Mark Baiada. Even Val Halamandaris weighs in on his favorite topic, the history and importance of NAHC. Along with the rest of the cast, these respected writers teach about healthcare at home in ten categories:

  1. Home Health Administration
  2. Standards for Home Health Agencies
  3. Clinical Issues
  4. Quality Assessment and Performance Improvement
  5. Management Issues
  6. Financial Issues
  7. Legal/Ethical/Political Issues
  8. Strategic Planning and Marketing Issues
  9. Other Types of Relationships
  10. Strategies for Success

Home Care: Business or Vocation?
Founded by compassionate nurses more than 100 years ago, healthcare at home has evolved into an endeavor that requires modern business skills. The Handbook opens with a list of job requirements as described by administrators themselves. Ms. Harris identifies a dozen of them. More telling are the comments that compare the rank of importance and percentage of time administrators spend working in each job category now with what they said in 1990.

Resource Management 3.762.25
Organizational Strategy3.722.51
Organizational Behavioral
Risk Management3.062.31
Law and Healthcare Policy2.503.07
Clinical Nursing2.372.26

What Ms. Harris has discovered, based on research conducted at the University of Pennsylvania by Cynthia C. Scalzi, PhD, is that home healthcare administrators are spending much more time today than they used to managing resources and finances, people and computer systems, and risk. For better or for worse, they spend less time on law and healthcare policy. Note that each of the broad categories listed here drills down to ten to twenty specific skill areas each, driving home the point that home care administrator is no easy assignment.

Selected highlights
A thorough review of this book would require more than 100 pages. Here are some articles and concepts that grabbed our attention as we poured through. 

The opening essay by Tina Marrelli presents the status of the industry, now and into the foreseeable future. More than a primer, it details both broadly and in some nuanced detail the basics of running a compliant Medicare agency. From Medicare payment systems to MedPAC's opinion of home care to OASIS-C1 rules to how in-home care helps avoid hospital admissions, Ms. Marrelli expertly lays the framework for the authors who follow.

Skipping ahead to our favorite chapter, Suzanne Sblendorio explores "Management Information Systems and Information Technology" and their benefits to home care. Among the expected points, she clarifies the terminology "MIS" and "IT" by explaining the differences. She offers guidelines for vetting vendors and selecting software solutions and names five specific benefits of technology to a healthcare at home agency:

  1. Maximize Organizational Efficiencies
  2. Compliance with Regulations and Risk Avoidance
  3. Clinical Guidance and Decision Support
  4. Strategic Positioning
  5. Business Intelligence and Business Analytics

After elaborating on each benefit, Ms. Sblendorio adds an argument for the importance of home health data to the entire community.

"Public health agencies and hospitals are required to complete community assessments and establish community health improvement plans. The ability to capture aggregated data from electronic health records systems will provide information on the healthcare needs within these agencies' communities. Home health providers may be asked to provide information during the community assessment process. Aggregate data describing the types of issues being faced by home health patients residing in a community should be incorporated into this assessment and planning process."

No 2nd-tier chapters
Every one of the book's 64 chapters is important but some of the more notable entries explore Medicare Conditions of Participation (Peggie Reid Webb), disaster planning (Barbara Citarella), home care services beyond Medicare (Mark Baiada), marketing strategies (Karen Carney), achieving accreditation (Maryanne Popovich: Joint Commission; Barbara Muntz: CHAP; José Domingos: ACHC), state agencies (Joie Glenn), dealing with insurance companies (William Fonner), and addressing payment denials by contracted auditors (Patricia Hanks). If you buy the book and read nothing else, do not pass up Ms. Harris's closing chapter, titled "Meeting the Present Challenges and Continuing to Thrive in the Future: Tips on How to Be successful as an Administrator in Home Health and Hospice Care."

Lastly, do not be put off by the price tag. This is not beach reading. This is a serious reference that you will turn to again and again. After studying the chapters relevant to your job description, make it required reading for newly appointed branch managers, Directors of Nursing, IT Directors, and Financial Managers. Each will benefit from the full weight of Marilyn Harris's 60 years in our field.

*List price $113.95. Published by Jones & Bartlett Learning, 5 Wall Street, Burlington, MA 01803.
978-443-5000, 800-832-0034.

©2016 by Rowan Consulting Associates, Inc., Colorado Springs, CO. All rights reserved. This article originally appeared in Tim Rowan's Home Care Technology Report. One copy may be printed for personal use; further reproduction by permission only.