We hear a homecare and hospice nurse’s perspective on healthcare from Rachel Hammon on this episode of the Perspectives on Healthcare Podcast with Rob Oliver. Rachel is a member of Generation X. She joined the podcast from Texas where she is the Executive Director of the Texas Association of Homecare and Hospice. Previously, she was a nurse within the hospital setting as well as the home care setting. As you will hear in the interview, she is also a passionate advocate for patients and their right to receive care in the environment of their choosing.
Here are 3 things that stood out as Rachel Hammon gave us a homecare and hospice nurse’s perspective on healthcare:
- Homecare is extremely diverse. It represents a variety of care options, differing time lengths of treatment, and serves individuals of all ages, from children to seniors.
- Quality healthcare means timely access to care in an environment of the patient’s choosing, including the option to receive services within the home.
- The ability to provide quality care throughout the healthcare system has been challenged by the current labor market. Additionally, wages for homecare workers and nurses can present a challenge.
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Here is the text of Rachel Hammon presenting a hospice and homecare nurse’s perspective on healthcare:
Introduction to Rachel Hammon
Rob Oliver: Thank you and welcome to another episode of Perspectives on Healthcare. Today’s perspective comes from Rachel Hammon. She is from down in Texas. She is a registered nurse and the executive director of the Texas Association of Home Care and Hospice. She is a member of Generation X. And Rachel, welcome to the podcast.
Rachel Hammon: Oh, well, thank you for having me. I really appreciate the opportunity today.
Rob Oliver: Absolutely. Tell me a little bit about yourself and your role in healthcare, please.
Rachel Hammon: Absolutely. As you mentioned, Generation X, and I, by way of background, am a nurse. So I have practiced in healthcare in a number of settings, and I’ve spent the large majority of my practice time actually in homecare. Started out, of course, in the hospital and the ICU and ER and some of those places and then decided I really wanted to go into homecare. A passion of mine was taking care of children, and I had the opportunity to take care of children who had gone home from the hospital and really needed some nursing care in the home. They are medically complex children who needed nursing care so that they could stay and live with their families at home.
Rob Oliver: Okay.
Rachel Hammon: That’s how I got into home care.
Rob Oliver: Right. So is that like temporary nursing care or is that ongoing nursing care or how does the home care work? So I’ll just give you personal background for me. I get a lot of urinary tract infections, and I am so delighted to be able to do the IV antibiotics at home and the visiting nurse, and it’s a temporary thing. Is that kind of what you were doing? Are there more permanent or more long-term opportunities in home care as well?
Rachel Hammon: So that’s what’s so wonderful about home care. It’s very diverse. Pretty much anything that you can do in the hospital minus a few things, obviously we can’t do surgery at home, but we can do in the homecare setting. So it can be visit-based. It might be for a short-term need. Maybe somebody fell, broke their hip, they need some temporary therapy. It could be a temporary need for a child, let’s say they were born with a cleft palate and lip and need some help, the mom and the baby need some help learning how to eat, right? After that can be very short-term, but then we might have people that have more long-term care needs where they might need ongoing assistance in the home long-term. That can be for a child, it can be for an individual who’s a senior or a young disabled who needs ongoing help maybe to be independent in the home and participate in life in their community. So homecare is a very diverse form of healthcare. It’s really based on that individual and what that individual needs in order to stay independent and integrated in their community and with their family.
Rob Oliver: Got it. Your association represents homecare and hospice. What’s the difference between home care and hospice? And can you talk a little bit about that hospice concept as well, please?
Rachel Hammon: Absolutely. So as I mentioned, it’s very diverse. We take care of individuals from birth all the way through end of life and hospice really focuses on healthcare in the home at the end of life. So it’s really helping someone pass away with dignity and comfort in the comfort of their own home rather than in the sterile environment, for instance, of a hospital or alone, let’s say in a nursing home. So it really gives people that opportunity to choose how they want to live the last days of their life. And I would say that’s very personal for me. My mother-in-law just recently passed away in July at home on hospice. And it was a choice that we as a family made together. And she really wanted to be with my husband and I at home in the last days of her life. And so we were able to be with her in those last days at home because of hospice.
Rob Oliver: My understanding is that hospice is, sometimes hospice is viewed as more of a shorter term thing like you’re looking at somebody who has a month or two months or something like that. Am I properly understanding that sometimes it is a much longer process than just to say, okay, we’re waiting until somebody is nearing that end of life situation? What are the other options that might be extended a little bit?
Rachel Hammon: Right. So it’s really based on the individual’s diagnosis, number one, and their choice of when they want to go onto hospice. So for instance, when we found out that the cancer that my mother-in-law had came back and it was non-treatable, we decided right then to start hospice. And her diagnosis, I mean, was somewhere between two and six months. She stayed a little over six months on hospice. Some people choose to postpone hospice and decide, you know, I really want to try some curative measures first. And then if all of those fail, then I might be ready for hospice and some people don’t choose hospice at all. So it really is, the length of time is based on an individual’s diagnosis and really a lot on their choices.
Your definition of healthcare quality
Rob Oliver: Got it. Okay. What does quality healthcare mean to you?
Rachel Hammon: Well, that’s a really good segue into what I consider quality, because as I just said, a lot about homecare and hospice is based on those individual choices. So first and foremost, you know, quality healthcare in my mind is that people have that choice of where they receive their care. And, you know, obviously it’s more than that, but that’s a huge component is that people have the opportunity to make the choice, where do I want to receive healthcare? And like I said, home care is healthcare in the home. It can be very, very complex. We take care of individuals who are on ventilators and to your point, who receive IV therapy services in the home complex, wound care, and individuals who need long-term care and assistance with activities of daily living to remain independent in their home and community. So, you know, choice is a really big factor in where you receive your home care because it has a huge impact on your outcomes and your state of mind. And that truly does have a huge impact, I think, on the quality of care. Likewise, a quality workforce is extremely important. And home care has been struggling a little bit on that end only because the funding for home care really has not or has been somewhat neglected over the years, both at the state level and what we’re seeing are cuts at the federal level. And we want to attract and maintain those quality individuals and those individuals who provide high-quality care. And in order to do that, we need to ensure that we’re paying them appropriately. And so, for instance, a nurse, we want to attract those nurses who provide quality services, but if they can get better pay, better benefits in a hospital setting, then we’re not getting those individuals providing services in the home. Same thing with what we call direct service professionals or direct service workers or certified nurse aides. There’s a number of ways or names that we can use to describe individuals who provide services under the supervision of a nurse for individuals who might need help with their activities of daily living, for instance. And seniors who might need assistance with bathing and dressing and their medication administration. And on the state side, individuals who provide those services, their rates right now are set through Medicaid, and they are exceedingly low. As we’ve seen and heard on the national news workforce and the cost of work, the workforce is going up. And in home care, the starting wage is $8.11 an hour. Now, I’m sure you have seen the Help Wanted signs, even in restaurants, Chick-fil-A, Buc-E’s, Burger King, starting salaries at $16 to $18 to $20 even an hour. And so yet we’re asking individuals that provide complex, very personal, very important care to individuals in their home to accept a starting salary of $8.11 an hour. So as you can imagine, that presents a huge challenge for finding a quality workforce and ensuring that people have access to home care.
Rob Oliver: It’s so interesting because you have this dichotomy where the value of the work and the impact of the work when it comes to the individuals that are served is so important and high, and yet the financial remuneration for that is not being… It’s set not by you because you obviously see the value in what’s being done there, but it’s being set by external organizations who, whether or not they say they value the work that’s being done, the money that’s being put to it gives the exact description to say, we value it, but we only value it at this level.
An example of quality healthcare
Rob Oliver: So can you give me an example of quality health care?
Rachel Hammon: Well, absolutely. So in the home care environment, when somebody needs home care, at whatever level that might be, that they’re able to receive it in a timely manner. So for instance, if you’re in hospice care, something I recently experienced, as you know, and let’s say that individual is getting closer to the end of life and the family needs relief, they need crisis care intervention, meaning that they need a nurse to be there for a longer period of time to give them a break during the active dying process, quality means that that hospice agency is able to find that nurse and get that nurse there that day. And it is important when let’s say an individual is in the active dying process and the family might be exhausted from providing some of the care that that individual might need, that they get that relief right then and there. That’s a huge indicator of quality. Likewise, when an individual is discharged from the hospital, for instance, and they need to go home, and they need some complex wound care, quality means that you’re able to get a person there in a timely manner so that they don’t get re hospitalized. So those things matter. It matters that an individual, for instance, who provides long term services and supports to a senior in the home is paid appropriately in those rates are set again by the state and by our state legislature. So that when that individual who needs let’s say 20 hours of attendance in the home that they get those 20 hours because you have access to a workforce to provide that because what happens if if they don’t get that is that maybe they were set up on medication reminders that attendance not there that day, they don’t remember to take their medications, the leading cause for seniors going in the hospital is not just falls, but incorrect medications, either they forget to take their medications, or maybe they forgotten they’ve taken it and they take too many, and then they end up at the hospital. So there are a number of consequences to not having staff available staff to provide the care needed in the home.
Rob Oliver: One of the things I want to highlight in what you said is that there is the emphasis on making sure the patient is cared for. But you’re viewing the patient as a larger as larger than just an individual, you’re looking at the family, and the way that the family is, is being maybe taxed isn’t the right word, but that that the way that the dynamics are handled there, and the impact that it’s having. And so, you know, as, as a speaker talking about quality, it’s a reminder that it’s about patient and family centered care. It’s more than just the individual. So I think that’s very well said.
Understanding homecare and hospice better
Rob Oliver: What do you wish people understood about your role in healthcare?
Rachel Hammon: Well, that we’re fighting every day, on behalf of Texans, and, you know, individuals that need care in the home, and, you know, that it’s exceptionally important that people again, have that choice to receive those services in the, in the home are not forced if they’re an individual, let’s say being discharged from a hospital, instead of going home to receive care being forced into a nursing facility. Every day that let’s say an elderly individual stays away from their home, it becomes that much more difficult for them to go home. And so it is not appropriate to force an individual who wants to go home to a nursing facility when they can receive care, the same level of care in the home, one, it’s inhumane to it is much more costly to divert individuals from hospital to a nursing facility when they can get that same level of care in the home. And if we’re talking about children, children should never grow up in facility ever. And so every family has the right to ensure that their child, if that child was born with a disability, or born prematurely and needs nursing care, has that ability to take their baby home, and to and to raise that child at home. And the only way sometimes families can do that is with nursing in the home. So that is what we’re fighting for every single day. And something I’m extraordinarily passionate about.
Rob Oliver: So you’re preaching to the choir on this, listen, I’m nursing facility clinically eligible, okay, I, the state of Pennsylvania would pay for me to live in a nursing facility. And I’m fighting for my freedom every day. And I receive services in my home to help make sure that I’m independent in the community. And I remember, I mean, my statistics are probably five or six years old. But there were 3000 people in the state of Pennsylvania under the age of 21 who were living in nursing facilities. And I completely agree with you that that is not an acceptable figure. So thank you for the work that you do and the advocacy that allows people to be in their home instead of in a nursing facility. We’ve got two questions left, and I’ve only got like, two or three minutes. So move through these.
Looking into the future of homecare
Rob Oliver: What excites you about the future of healthcare?
Rachel Hammon: Well, what excites me is that there are more and more people that know about home care and hospice, and know that they, they have the right to home care and hospice. That’s exciting. What was troubling, obviously, we went through a huge pandemic, hopefully, we’re coming to the tail end of that pandemic, it is something that you know, COVID is something that we are going to have to learn to live with, I believe, however, the most acute phase is over. But what it did do is it highlighted the the necessity for home care and the impact home care has on the entire healthcare continuum, when hospitals were over run with individuals, and they were needing to get people out, who did they call? They called home care agencies, when they knew when they were trying to again, discharge people, they could not send them to nursing homes, because nursing homes were closed. And so they were trying to, they they were able to send them to home care, we were able to keep people safe in their home out of those congregate settings as well. So I’m excited to see that home care is getting some more attention. But what we need is that with that attention, we need appropriate funding, bottom line, we have two issues on Medicare, they are trying to take $18 billion out of the home care benefit right now. So what does that mean? That means seniors right now, starting next year, are going to have limited access to home care through a rule that they just passed. So we’re trying to pass the Preserving to Access to Home Care Act of 2022, so that we can reevaluate what we need in terms of payment for home care on the Medicare side. And then on the state law side, we need our state legislators to step up and appropriately fund home care services and ensure that the health care workers are recognized for the very hard frontline work that they provide to individuals across the community. And we serve roughly about 500,000 individuals across the state of Texas alone in the community.
Rob Oliver: And the thing that I will reiterate that you pointed out earlier is the cost factor. You can serve people in the home. And again, you know, with my passion about home and community based services, you can serve two people in their home for the cost of serving one person in a facility. And when you when they’re looking at making cuts to home care, the issue is that it actually is there’s a financial incentive to treat people in their homes because it is more cost effective.
Improving healthcare quality for patients
Rob Oliver: All right. Last question. What is one thing medical professionals can start doing today to improve the quality of health care?
Rachel Hammon: Get involved. You know, I know, you know, it is so busy in health care. Every health care provider is stretched, truly stretched to the brink. We are so short staffed in the home care world. We have a huge nursing shortage that was exacerbated by the pandemic. Nurses are tired. They were worked very hard during the pandemic. And so to make substantive changes, you really have to get involved. And so if you want to see health care improve, get involved. Be a voice for home care or hospice or any of the services that you might provide, whether it be in hospitals or nursing facilities, because health care is so important to so many. So, again, if you are in the health care worker in the home care industry, get involved. Be a voice. Talk to people. And we have a website that is there for the public. It’s called savehomecare.org. And I would encourage people to go there to find out a little bit more about home care. What are the challenges in home care? And to find out how they can be an advocate and a voice for individuals, their patients, their families that deserve that kind of care.
Rob Oliver: Absolutely. And I’ll make sure to put that link in the show notes so that people can visit that and learn more. Listen, Rachel Hammon, thank you so much for being with me today. I appreciate you taking the time. I appreciate you sharing your viewpoint and I respect your perspective on health care.
Disclaimer: All opinions expressed by guests on the Perspectives on Healthcare Podcast are solely the opinion of the guest. They are not to be misconstrued as medical diagnoses or medical advice. Please consult with a licensed medical professional before attempting any of the treatments suggested.