Understanding the changing nature of patient transitions.

Abstract

Home healthcare nurses need to expand their knowledge and skills beyond clinical aspects of providing care for their patients. It is time for nurses in home care to gain knowledge about new financial complexities of healthcare for patients and consumers. It is time to truly understand the price of services patients will incur as they move across the continuum. The VNAA Blueprint for Excellence, an online resource, appropriately states, “home health care is an essential part of the continuum of care, and the nonprofit home health profession represents the essential link between primary and acute care.” Not only are the VNAA and member organizations in the best position to be the “guardians” of this link, but of all transitions that will affect patients and their families in the foreseeable future. As the impact of the Patient Protection and Affordable Care Act continues, patients will experience numerous new transitions that will impact their ability to be engaged in their own care. These transitions range from acute to postacute care, including skilled nursing facilities and home care as well as from primary care practice to home. Simultaneously, coverage can change from uninsured status to exchange coverage and from commercial to Medicare, Medicaid, or both. The Congressional Budget Office (2014) estimates an increase of 16 to 20 million new beneficiaries to Medicaid. Research indicates, in some instances, the extent of this coverage will cause shifts up to a 35% “churn” for individuals from