Nurse Practitioners and Home Care
The authors of this article used Medicare payment data to: a) analyze the role of nurse practitioners in the care of homebound frail older adults; b) determine the number of visits made by nurse practitioners in comparison to those made by physicians; and c) compare the service areas of those who care for patients in their homes versus residential facilities. The authors cited the tremendous number of older adults with three or more deficits in activities of daily living—an estimated four million—as well as approximately one million homebound patients who are confined to bed. According to Yao et al. (2016), “Frail homebound older adults account for about half of the costs generated by the top 5% of Medicare beneficiaries and for 29% of all Part A and B costs, 46% of Medicare 30-day readmissions, 24% of Medicare hospitalizations, 38% of all long-term institutional care, and have a 23% annual mortality.”
The researchers found that 3,300 nurse practitioners had become the largest group providing care to residents in their homes, with 1.1 million residential visits in 2013! Visits tend to cluster along the coasts (New England, Southern California, and Florida, as well as the Great Lakes region). This may reflect population density, but may also be due to work environment in various states. Although numerous models reflected cost savings, the model that was exclusively composed of nurse practitioners was the most successful at cost reduction. Despite these findings, only 21 states and Washington, DC, fully recognize the full scope and capabilities of nurse practitioners. Frail older adults will continue to increase in numbers as healthcare becomes more and more successful at treating chronic disease and other comorbidities. Providing care coordination from the home is a new reality. Nurse practitioners do more than just make an isolated visit—they are uniquely qualified to provide primary care, chronic disease management, health education, and referrals when indicated. Does your state recognize the potential contribution of advanced practice nurses to the care and well-being of the homebound community dwelling patients? Can advanced practice nurses work to the full extent of their education and training? Visit: https://nursinglicensemap.com/advanced-practice-nursing/nurse-practitioner/nurse-practitioner-prescriptive-authority/.