Patient Engagement Strategies for Home Healthcare Providers

October 11, 2022 - As home healthcare becomes a regular fixture in medicine, it will be key for clinicians delivering home-based care to understand key patient engagement strategies.

Patient engagement strategies for home healthcare don’t stray too far from engagement in other forms of care; patient-centricity and education are essential. But due to the nature of the care setting, patient engagement for home healthcare can look entirely different, according to Bud Langham, the executive vice president of clinical excellence and strategy at Enhabit Home Health & Hospice.

“The patients that we take care of for our home health and our hospice service lines, we encounter them in the most vulnerable location for them—that's their home,” Langham told PatientEngagementHIT in an interview. “So, it can be really, really challenging and it requires a little bit of a different skill set to engage those patients.”

The top patient engagement strategies do have some commonalities across various care sites. Regardless of whether a clinician delivers care in an ambulatory site, a hospital, or in the home, patient-centricity, communication, and education are all important.

But because home healthcare is just that—healthcare delivered in the home—the path to patient-centered care might be different. Home healthcare providers need to utilize unique strategies that allow them to deeply engage with the patient in the home setting, Langham said.

Core home healthcare communication tenets

Patient-centricity and meeting the patient where they’re at are among the core tenets of home healthcare communication.

Fundamentally, Langham said home healthcare providers need to be empathic people with high emotional intelligence. That allows clinicians to navigate the difficult interpersonal situations that may arise when treating very sick patients inside their homes.

“It's scary enough in healthcare to go and see a provider in a clinic. But to have a provider come into your home is really intimidating sometimes,” Langham explained. “And not all homes are the same. A lot of folks are in vulnerable situations. And so, our clinicians really have to be dialed into what's happening with that patient, what's happening in the surroundings.”

In addition to empathy, Langham said home healthcare providers need strong patient-provider communication skills. Providers should discuss medical concepts with patient health literacy in mind, working to meet patients where they are in their own activation.

“As an example, we train all of our clinicians not to tell patients, ‘You need to take your furosemide BID for your hypertension,’” Langham offered. “We would say to patients, ‘It's really important to take your water pill and you need to take that two times a day for your high blood pressure.’ So meeting patients where they are, because they have different levels of health literacy.”

Family engagement addresses the whole care team

Although family engagement is critical at every step along the care continuum, Langham emphasized its importance in a home healthcare setting. Home healthcare patients are individuals who are aging in place—not in an assisted living facility or nursing home—so they are not going to be around a medical professional 24/7.

Looping in family caregivers will be key to ensuring patient safety and reducing the risk for emergency department visits and hospital admissions.

“Inside the home, we not only have to engage the patient but oftentimes their family, their caregivers, their loved ones,” Langham explained. “They're part of the care team too. And so we have to really connect with them as well.”

Even still, family engagement can be a difficult balancing act. While family caregivers are instrumental in helping their loved ones who are aging in place or otherwise receiving home-based care, it is still paramount to balance engagement with the autonomy of the patients themselves.

“Patients have rights in all healthcare settings. And they have the right to restrict or share information with people in their community that they want,” Langham pointed out.

While some patients are unconcerned about the family members included in their care plans, others might want to restrict some of that information sharing. It is important for home healthcare providers to know that and respect that.

“We have to capture that information, share it within our care team so we know who we can talk to, who we shouldn't talk to, and what kind of information we can share,” Langham explained. “It's really critical. If the patient's at the center, then the patient's always in control. We have to maintain their autonomy.”

Enhabit Home Health & Hospice starts collecting that information during the initial patient intake and documents it in the EHR, Langham added.

“Inside our EMR, we have a patient and clinician-facing app called Pointcare,” he explained. “That app allows us, upon admission, to go through and establish all the patient's needs, their wants. We do their assessment and we capture information there about who we're allowed to communicate with and who we're not allowed to communicate with.”

That information is archived in the EHR, but home healthcare providers are also responsible for updating it at every encounter should changes occur, Langham added.

Addressing social determinants of health in home settings

Although rife with unique challenges, home healthcare brings with it the opportunity to get to know patients more intimately than during clinic-based visits.

“That's part of the beauty of taking care of patients in their home is we get to see the actual environment in which they have to survive and thrive,” Langham remarked. “And we get a chance to help them.”

For example, delivering care in the home gives clinicians a front-row seat to the social determinants of health that might be impacting patient well-being.

“Doing an assessment for social determinants of health, it's challenging in a clinic, in a hospital, to ask questions with their food security, their medication needs, their financial needs, their ability to have clean water, power, heating, cooling, support in their environment,” Langham noted.

“It's really challenging to assess when you're just having to take information from the patient or maybe from somebody who's with them. When you walk into a patient's home, you can quickly get a feel for what's really happening with that patient.”

Providers with Enhabit see patients experiencing a litany of social determinants of health. Some providers have visited patients who are hoarders and living in unsafe situations, Langham said; others have all of the resources in the world.

When viewing a new patient living environment, providers need to go back to that core tenet of meeting patients where they’re at.

“We've got all different kinds of patients, and we have to meet them where they are,” Langham asserted. “When we go into a home and do an assessment of a patient, we always assess for the security and safety of their home. Do they have power? Do they have heating/cooling? Do they have clean running water?”

SDOH assessments also include a look inside the fridge, pantry, and medicine cabinet.

But similar to the clinic setting, broaching the topic of SDOH can be tricky, Langham acknowledged. Not every patient will see the connection between the contents of their fridge to their health status, and it can take a good amount of patient trust to let their home healthcare providers in—especially if that patient has numerous SDOH challenges.

Langham said home healthcare providers need to frame SDOH screenings as a part of the holistic patient assessment that happens during home healthcare visits.

“We really tee it up as a comprehensive assessment, to say, ‘We are here to help you and your family,’” he offered as an example. “’We want to help you stay in your home, age in place, not need to go to the emergency room, not go to the hospital. And to do that I've got to do a full assessment of you, not just you but your environment.’”

Enhabit coaches its home healthcare providers to wrap the SDOH assessment into the entire functional and environmental assessment. It’s typical for home healthcare providers to ask patients to demonstrate how they can walk around their homes, how they get in and out of bed or in and out of the shower.

That’s a patient safety assessment, Langham said, and for the emotionally intelligent home healthcare provider, it’s also a chance to check on SDOH.

Even still, not every patient will be readily comfortable with their provider looking through their medicine cabinet.

“But another beauty of home health and hospice is we have multiple opportunities to come into the home,” Langham said. “Sometimes that assessment takes a few days or a few visits.”

“But most of the time, when people know you're there to care for them and they know that you care about them, they'll let you in a little bit and they'll be a little bit more vulnerable and open, which is great.”

Home healthcare and patient engagement technology

Like other areas of healthcare, home healthcare has begun to adopt patient engagement technology into its practices. Home healthcare providers have access to telehealth technologies, Langham noted, and that can be useful for enhancing patient care.

But ultimately, it all comes down to the technology that is best suited to the patient, he added.

“Here at Enhabit, we really embrace an omnichannel or a multichannel approach where we're just trying to meet patients where they are,” Langham stated. “One of the first questions that we ask them when we admit a patient is, ‘What matters most to you?’”

That question opens up the entire trajectory of patient care, letting clinicians make decisions about how they will engage patients and what tools—if any—they’ll use.

Ultimately, it’s that patient-centered approach that defines home healthcare. Although other areas of medicine have begun to embrace patient-centered care models, it’s long been fundamental to home healthcare, Langham said.

“Everything starts with the patient. And everything should revolve around what matters most to them,” he concluded. “How they want to be communicated with, what cadence they want to be communicated with, what technology they want to be engaged with. That's what really matters.”