Home-Based Primary Care information 11-16-04

Thomas Edes, VA Central Office

A.  Definition of VA Home-Based Primary Care (HBPC)

> VA Home-Based Primary Care (HBPC) is a home care program that provides
> comprehensive, interdisciplinary, primary care in the homes of
> veterans with complex medical, social, and behavioral conditions for
> whom routine clinic-based care is not effective. In contrast to other
> systems such as Medicare home care that target patients with
> short-term remediable needs and provide episodic, time-limited and
> focused skilled services, HBPC targets patients with complex, chronic,
> progressive disabling disease and provides comprehensive longitudinal
> home care. HBPC is designed to serve the chronically ill through the
> months and years before death, providing primary care, palliative
> care, rehabilitation, disease management and coordination of care
> services.

B.  Target populations:

    1.  HBPC targets primarily three types of patients in need of home
        care:

        a.  Longitudinal care patients with chronic complex medical,
            social, and behavioral conditions.

        b.  Longitudinal care patients who require palliative care for
            an advanced disease that is life limiting or refractory to
            disease modifying treatment.

        c.  Patients whose home care needs are expected to be of short
            duration or for a single problem not requiring an
            interdisciplinary team, when such services best help the
            facility meet the needs of this population.

C.  The goals of care for HBPC patients include:

    1.  Promote the veteran\'s maximum level of health and independence
        by maintaining optimal physical, cognitive and psychosocial
        functioning.

    2.  Reduce the need for, and provide an acceptable alternative to,
        hospitalization, nursing home care, emergency room and
        outpatient clinic visits, through close monitoring and a
        creating a therapeutic and safe environment in the home.

    3.  Assist in the transition from a health care facility to home by
        providing patient/caregiver education, guiding rehabilitation
        and use of adaptive equipment in the home, adapting the home as
        needed for a safe and therapeutic environment, and arranging and
        coordinating supportive services.

    4.  Enhance quality of life through symptom management and other
        palliative care measures.

    5.  Meet the changing needs and preferences of the veteran and
        family.

    6.  Support the caregiver in the care of the veteran.

    7.  Provide comfort by managing pain and other symptoms.

D.  Differences between HBPC and Medicare home care

    1.  HBPC differs from Medicare home care in target population, in
        process, and in outcomes.

    2.  HBPC targets patients with complex chronic progressive disease;
        Medicare home care targets patients with short-term, focused
        skilled needs

    3.  HBPC provides longitudinal comprehensive care by an
        interdisciplinary team of staff; Medicare home care provides
        episodic focused care by individual staff generally from one but
        sometimes from multiple disciplines working independently.

    4.  HBPC has demonstrated outcomes in substantially reducing
        hospitalizations, hospital bed days of care and total cost of
        care; Medicare home care has not been demonstrated to achieve
        any of these outcomes.