Building the bridge. (Home Care).

Is there is a clear public preference for home care services?

de la Haba: My experience has been that people show a definite preference for home care because of the obvious reason that the surroundings are more comfortable. If you have family members who can visit you at home and who can provide care and assistance, most people would prefer to stay at home. While long term care facilities are becoming more like the places the elderly want to come to, if people could stay home, they would certainly prefer it. And today, many of the services previously available only in a health care facility are now available for the home in smaller, lighter-weight versions.

For example, Graham-Field is now involved in home care dialysis. We offer smaller dialysis recliners for the home that are more comfortable and "homelike" in appearance, when compared with the more clinical chair that we also offer, which is intended for 18-hour use in a dialysis clinic. So equipment tends to be nicer looking and more user-friendly because there is more interface between the patient and the equipment. For instance, the chair needs to be smaller because in the home, space is more of a consideration than in a health care facility.

In the home, quality and reliability are paramount because you don't have the professional staff continuously at the patient's side.

Many have established a broad range of services, from postacute and nursing home care through various forms of assisted living and enriched housing that include the naturally occurring retirement community concept. Many AAHSA providers offer services across the entire spectrum. What has worked well?

de la Haba: What I have seen work well are facilities that offer 24-hour professional health care service with a more homelike "look." That might be the stepping stone to a more significant level of care. We've seen more new construction in the past several years, and there is more of a willingness for people to make a transition out of their home when they need more interface with health care professionals.

What about the workforce issue?

de la Haba: Turnover is challenging for everyone.

That has to require more in-service from you, then. How do you cope with having to train new people as frequently as you do?

de la Haba: Leave-behind cassettes are important. We are moving to more informative product guides, which will soon be available on our Web site. Many of our major distributors are in the process of putting more informative and complex education programs on their Web site to provide additional ways for the end users of our products to receive information.

What success plan could you summarize, then, for those wishing to build the bridge from the business of home care to the business of facility-based health care?

de la Haba: I see many facilities expanding their home care agencies to follow a patient from acute care all the way through to home care. That's happening in many areas. Many of our customers either have been acquired or are acquiring other entities, whether it be physical therapy, outpatient, home nursing services, an I.V. therapy company, whatever.

Many of our home care providers are also moving into long term care because they see their customers-- acute-care facilities--for referrals, saying can you help us out on the long term care side. So I see more and more of our customers ... interfacing with a patient (not discharging him out of their system) and maintaining that patient through all facets of their care.

What lessons have been learned over the past few years?

de la Haba: The process is one of educating the patient and the family member on what is available and what the alternatives are: "No, you don't have to be in a nursing home to be taken care of; no, you don't have to go to a dialysis clinic every Tuesday, we can set it up at home, We can now have a health care professional provide a wide array of services at home."

I sense that many people have preconceived ideas of where care takes place. There are all types of new equipment and services available. We communicate these choices via hospitals upon initial registration and discharge, and through insurance companies who can explain the options that are available. As more people require this level of care and want to stay home--and as the technology meets these requirements--there will be an even greater number of options available.

Your particular magazine gets the stories such as what equipment and services are available. The trick is to consolidate and get the information out to the wide variety of people. It's going to require a lot of education on everyone's part!

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Lawrence de la Haba, the senior vice president for Atlanta-based Graham-Field (G-F) Health Products Inc., has been in the industry of home care and long term care since 1982. He recently took time out from his exhibit at Medtrade in New Orleans to speak with Contemporary Long Term Care magazine editor and publisher Mark Zacharia about how forward-thinking manufacturers and facilities are building the bridge between home-based health care and facility-based health care.