Home Health - David Allen, MD

Ask A Doctor - Union Democrat
David Allen, MD
Home Health

Q: When is a patient referred for home health services?
A: A patient is referred for home health services when they need a licensed nurse, therapist, or other caregiver to provide care such as administering complicated medications, dressing wounds, monitoring symptoms of diabetes, or providing physical, occupational, or speech therapy.

Patients are referred by their doctor, who can be their primary care physician, specialist or hospitalist. A social worker or discharge planner may also help arrange for home health care.

Medicare regulations require patients to have a face-to-face visit within 90 days prior of receiving the referral from their doctor. In a few cases, patients may begin home health services prior to receiving a referral but must attain a face-to-face visit with their physician within 30 days.

Q: What is the role of a medical director with a home health agency?
A: As the medical director of Sonora Regional Home Health, I review cases, provide consultation on difficult cases, and attend annual meetings. My role is not to interfere with the patient’s primary physician, who is ultimately responsible for the patient, or with the care plan established by the home health team. However, there are times when I do intervene, perhaps if there are unsafe conditions for a patient or home health employee.

November is National Home Care and Hospice Month and I would like to congratulate everyone for the work they do in Home Health. They all provide excellent care for our community. During a recent audit, a California state surveyor complimented the home health team on their outstanding work. It’s the people who make this service so good.

Q: What are some common conditions that require home health services and are there any specific requirements that patients must meet?
A: A few of the common conditions for home health care patients are diabetes, heart disease and congestive heart failure, chronic obstructive pulmonary disease (COPD), stroke, and patients requiring post-surgical care.

In order to receive home health care, patients must be homebound, meaning there is a “considerable and taxing effort” to leave home. Patients are allowed to leave home for medical treatment or for short outings such as going to church or the hairdresser but otherwise must require skilled care at home.

Q: Who provides home health services? Can friends and family participate in the care of a home health patient?
A: Home health care is provided by licensed nurses, therapists and home health aides. Nurses provide specialized care that requires a licensed caregiver, such as IV therapy, feeding tubes, and complicated medication or wound care. The nurses also do a lot of teaching, enabling the family to care for the patient. Physical, occupational and speech therapists provide rehabilitation and techniques to keep the patient safe at home. Home health aides assist in the care of the patient with tasks such as bathing, dressing, light meals and transfers – such as moving the patient from bed to chair.

Friends and family play in integral role in the care of patients at home. Because home health care is provided intermittently, the goal is to empower the patient and his or her family so that the patient can remain safely and comfortably at home and avoid hospitalization.
 

Q: When is a patient released from home health?
A: When a patient is first evaluated, the home health team establishes a specific care plan and outlines goals for the patient. A patient is released when those goals are met and the patient or family has gained the independence required to keep the patient safely at home.

Q: Who pays for home health services?
A: All major payors, including Medicare, will pay for home health services as long as the homebound and physician referral requirements are met. There are some difficulties with health maintenance organizations (HMOs) many of which do not cover home health services in our service area. In a few instances a letter of agreement between the home health provider and HMO may allow for a patient to receive home health coverage.

Bio:
David Allen, MD, is board certified with the American Board of Internal Medicine and has been practicing in Sonora since 2004. Dr. Allen grew up in Turlock, Calif., and graduated from Loma Linda University School of Medicine. He has 30 years of experience in internal medicine, having also practiced in Redlands, Calif., DeQueen, Ark., and Oroville, Calif.

Dr. Allen’s family is quite involved in health care. His wife and daughter are both nurses and his daughter works part time for Sonora Regional Home Health. His son is just finishing his residency in physical medicine and rehabilitation and his father is an anesthesiologist.