Los Angeles County government, often criticized for being behind the curve in health care trends, was way ahead of private industry when it comes to home health care it first started offering such services nearly 40 years ago.
But even though the county’s Home Care Services program was discovered in the late ’50s to be an effective way of avoiding costly hospitalization, the program currently is so small that many people in the home care industry as well as in county government have never heard of it.
Officials within the county’s Department of Health Services are in disagreement about the amount of home health care that should be provided. Some consider it an efficient cost-saver for the county and that the budget for it should be increased but others counter that the typical county patient is not likely to need home care.
In the 1996-97 fiscal year, the county spent more than $3.3 million on the program down from the previous year’s $4.3 million.
“We’re really looking at some important needs here,” said Doreen Young, director of the Home Care Services program at Los Angeles County-USC Medical Center. “We really need more money spent on home health care.”
The more the county spends on home health care, the less it has to spend on hospital care, Young said, because treatments in the home are between 10 percent and 30 percent of what they would cost in the hospital. Patients who receive home care also are less likely to require expensive re-hospitalization, she added.
But other county officials say there is a good reason why little money is devoted to the home care program: Most patients do not need it.
“We tend to do a lot of 911 business, where people come to us physiologically unstable, and once they come out of it they don’t need more treatment,” said Ray Schultze, director of re-engineering for the county Department of Health Services.
Schultze said many patients come to county hospitals because of such problems as heart failure and broken limbs conditions that must be treated at a hospital, but either need no follow-up or follow-up care that can be done on an outpatient basis.
The number of patients seen through the county’s Home Care Services program is relatively small. Last year, about 4,000 patients were served, while a single private hospital, Cedars-Sinai Medical Center, served roughly the same number through its home health program.
Schultze said most of those who use home health care are elderly people on Medicare, and the county has few patients who fit that description.
“The county’s Medicare population is only about 4 or 5 percent,” Schultze said. “At Cedars, it is about 55 percent.”
There are other reasons why county patients are less likely to need home care than patients in HMOs and at private hospitals. The county does very little elective surgery something that can require follow-up home care, he said.
“The population that gets into the hospital is younger. It is more in the direction of medicine than surgery relative to other hospitals in the community, and it is less in need of home care,” he said.
A visit from a Home Care Services nurse costs the county between $80 and $130 a fraction of how much hospital treatment would cost.
More than 40 percent of home care patients served last year 1,683 patients were referred from County-USC, the largest hospital in the Department of Health Services system. County-USC is the only one among the county’s six hospitals that has nurses devoted to home health care but even that hospital has only two nurses who do home health work.
County-USC and the other five hospitals in the system mostly rely on private contractors. The county has 15 private companies to which it contracts its home health services up from 11 providers in 1993.
“Some of that is based on need, but it’s based on geographic need as well,” said Richard Espinosa, a contract administrator with the Department of Health Services. “This time around, when we chose the 15 (providers), we found there were certain pockets in the county that needed more providers.”
About 40 percent of the cost of care is reimbursed by Medi-Cal, and another 8 percent is reimbursed by Medicare.
One of the 15 companies that provide home health care for the county is Inglewood-based Tri-Med Home Care Inc. Administrator Margaret Lanam said the firm does most of its county work in County-USC’s neighborhood, South Central Los Angeles, as well as the greater L.A. area and the San Fernando Valley. It sees about 20 county patients a month.
The difference between Tri-Med’s county patients and its HMO patients, Lanam said, is that county patients tend to need more services.
“The county patients need a bit more care because they tend to be indigent patients,” she said. “They don’t have a lot available to them in terms of caregivers.”
Although Schultze said that most county patients do not need home health care, he added that there is a chance that the amount of money the Department of Health services devotes to home care could increase in coming years.
The department as part of the re-engineering of its hospitals will be looking at whether to increase the amount of home care it provides. The Clinical Resource Management Group, which was formed a month ago, is looking at a variety of ways to reduce the length of expensive hospital stays, he said.
“One of the solutions certainly could be (more) home care,” Schultze said.
