UCSF Receives Grant to Establish New Nursing Specialty.

SAN FRANCISCO--(BUSINESS WIRE)--Sept. 3, 1996--The UCSF School of Nursing has received a three-year, $400,000 grant from the US Department of Health and Human Services, to develop a new nursing specialty to improve the quality of care for the growing number of patients who receive health care at home.

The grant will be used to establish a master's of science program in advanced practice home care nursing. It comes during an unprecedented growth in home care services and products due to the aging population and the changing health care environment, says the grant's principal investigator Carmen Portillo, RN, PhD, assistant professor in the UCSF Department of Community Health Systems.

"More people are being cared for in the home for a number of reasons," Portillo said. "As the population ages, more people are experiencing chronic illnesses and disabilities that require home care services. In addition, chronic disease, such as HIV infection among the younger population, has increased the need for home care services."

Approximately 9.5 million people in the United States need assistance with activities of daily living, such as eating, dressing and bathing, according to Portillo.

New advanced practice nurses will be able to provide clinical and managerial leadership for home health agencies faced with dramatic changes in funding and in the health care market, according to Portillo.

In addition, advances in home care technology now allow dozens of complex illnesses once treated almost exclusively in the hospital to be treated more cost-effectively at home.

The UCSF grant will be used in part to train graduates for a highly technological environment, helping them gain the knowledge and skills necessary to use and monitor advanced medical devices in the home, as well as computer-based systems to manage patient care.

"Advanced practice in home care will enhance the health of clients and families by bringing together technological expertise and excellence in clinical decision making and care delivery," Portillo said.

The UCSF grant will prepare graduates to conduct comprehensive health assessments, to diagnose and treat complex responses of individuals, families and communities to actual or potential health problems, to manage acute and chronic illness, and to promote wellness. In addition, the graduates will be prepared to integrate education, research, care management, leadership and consultation into their clinical role.

Spending for home care reached $8.5 billion in 1990, an increase of more than 400 percent since 1980. Medicare and Medicaid now pay almost 75 percent of the nation's home care bill, Portillo says.

Managed care has become a major factor in the availability of home care services. Since the 1980s, enrollment in Medicare health maintenance organizations has increased at a very high rate, resulting in an economic advantage for the payer to place its members in the least costly care environment.

"This continued growth has increased market competition as well as the potential for profit motives to negatively affect the quality of care," Portillo said.

At the same time, capitation--in which an HMO pays a fixed monthly fee in advance of services--is complicating the fee structure of home health agencies. While most agencies operate under a traditional Medicare "fee-for-service" pay system, in which home visits are viewed as revenue generators for the HMO, under capitation, home visits cost the HMO money.

On the other hand, HMOs view home health agencies as "cost-avoidance centers," meaning that the HMO uses home health services instead of more costly health care strategies, like hospitalization or emergency room visits, according to Portillo.

To remain competitive in the managed care environment, home health agencies must change their service delivery patterns to care for patients 24 hours a day, seven days a week. "This causes problems for most home care organizations," Portillo said, "because these agencies lack up-to-date information systems to assess the cost of care that can be translated into a 'per person per month' cost, preventing them from negotiating appropriate capitated contracts."

Graduate nursing students enrolled in the UCSF advanced practice home care nursing program will work with licensed home health agencies in San Francisco.

"The City and County of San Francisco have made a significant commitment to the provision of home care services and will provide a rich training ground for this program," Portillo said.

As of July 1994, there were more than 54 home care providers serving San Francisco, including licensed and Medicare certified home health agencies, infusion therapy companies, private care/extended hour agencies, companion and homemaker services, and home repair agencies. In 1993, licensed home health agencies in San Francisco reported approximately 336,000 home visits, including 20,000 visits to AIDS patients and 41,000 visits to hospice sites.

The UCSF School of Nursing will work with the UCSF/Mount Zion Home Care Agency, placing students into the homes of AIDS patients or disabled elderly to deliver care. At the same time, UCSF will develop relationships with other home care agencies for student placements.

The UCSF/Mount Zion Home Care Agency will provide a rich educational experience for future advanced practice home care nurses, says Marjorie Flores, RN, MPA, executive director of the agency. "Our agency serves clients that represent the ethnic, social and cultural diversity of the San Francisco Bay area," she said.

The UCSF Department of Community Health Systems offers graduate study in five other specialty areas: adult nurse practitioner, community health, nursing administration, occupational health, and psychiatric/mental health. All programs require two years to complete and prepare students for advanced practice.

CONTACT: UCSF

Rebecca Higbee, 415/476-2557