Home Health Placement

The agency for this paper is Promise Care, LLC. Promise Care, LLC is an organization that assigns various healthcare service providers to individuals who are living in hospital care facilities. As one of the top providers of senior care solutions, they can provide physical therapy, social workers, occupational therapists, home care nurses, and other similar professionals to individuals who are leaving a hospital facility. The company is a private, for-profit company. This means that it is privately held. Specifically, it is not traded on the stock market. Similarly, it is a for-profit organization. This means that the company has investors and it is required to provide a return to the investors. The company is an independent company, which means that it is not part of the major industries. Its primary service is providing home care services to individuals who are leaving hospitals. It does not have a host organization because it is independent and operates independently of any organization. The organization has a budget of approximately half a million dollars annually. It serves Hudson and Essex Counties in New Jersey. According to McKenzie (2013) and the United States Census, the demographics of this area are relatively small. Both of these counties represent approximately 1.5 million individuals. Of these individuals, approximately 12% are living in poverty. The per capita income within these counties is approximately $35,000 annually. The population is approximately 30% white and 41% African-American, with other demographics representing primarily Hispanics or multiracial individuals.

This organization is primarily funded through insurance. For the most part, the organization receives funding from federal sources including Medicare. In addition, the organization receives funding sources from private insurance companies. Thus, the organization is primarily focused on having a fee for service structure (Abendshien, 2018). This means that it charges insurance companies the amount necessary for the organization to function while not relying on grants. This is important because it means that the organization needs to focus primarily on bringing in appropriate funding sources as compared to other organizations that require obtaining grant money in order to continue functioning. Furthermore, this means that the organization needs to spend a significant amount of time negotiating agreements with insurance companies so that they are able to get paid for the services that provide. However, there are some issues related to getting funding for Medicare. Funding from Medicare is highly regulated, which means that the organization has limited ability to negotiate with Medicare in order to receive funding. Medicare provides a specific amount of money for specific services as compared to insurance companies which allow the service provider to bill a certain amount and then will reimburse.

There are a number of regulations and requirements that impact this organization’s freedom of action. First, there are requirements related to Medicare and Medicaid. These requirements are related to providing services, how organizations can provide services, and other regulatory requirements. In addition, the New Jersey Department of Health has a number of regulations that impact how this organization can function. Additionally, this organization is essentially a middleman organization. It is helping individuals obtain home health services. However, it is not actually providing the specific services itself. Instead, the organization serves a matchmaker to help match individuals with the services that they need. As such, the organization is bound by all of the licensing and regulatory requirements associated with specific service providers. For example, if the organization is assigning a social worker, it needs to that the social worker to make sure that they are properly licensed state of New Jersey. This means that the organization cannot simply assign whatever individuals they would like (Yao, Ritchie, Camacho, & Leff, 2016).

In addition, clients for this agency are all voluntary. This has an impact on how the agency is capable of functioning. With other agencies that have mandated clients, they can expect a certain amount of money to come in simply because it is possible to predict what clients will be mandated to participate in. By contrast, because all the clients for this organization are voluntary, it means that the agency has to attract clients. In addition, the clients for the agency are able to choose where they would like to receive services. In circumstances where the organization has mandated clients, they can predict a certain amount of income simply because clients will come in. In this case, because there is some competition with other agencies providing similar services, the organization has to be sure that it is providing services in a way that is both beneficial to the organization and also is keeping clients happy. Some of the agencies providing similar services that are also competitors of this agency include Byada, BVNA, and Amedisys. All of these companies have very similar value propositions and represent competition for this organization. Additionally, some of these organizations have been around longer than Promise Care. As such, they have had more time to build the necessary contacts to develop a referral network. This makes them significant competitors for this organization.

The agency has both the Board of Directors and an advisory board. The Board of Directors is responsible for ensuring that the company is functioning at its best. For example, a Board of Directors is responsible for voting on specific budgetary decisions, employment decisions, and other similar factors (Schiehll, Lewellyn, & Muller-Kahle, 2018). Furthermore, boards also provide oversight to ensure that the company is in compliance with various regulatory and internal policies. The Board of Directors is particularly important because this is a privately held company. Privately held companies are not subject to market forces which can often impact their behavior. Thus, the Board of Directors has a very substantial role in ensuring that the company functions appropriately. It is therefore very important for the Board of Directors to have qualified individuals who are able to provide specific expertise including regulatory expertise, budgeting expertise, and other similar factors. The organization also has an advisory board which is called the professional advisory committee. Advisory boards are incredibly important and valuable because they can provide even more nuanced expertise to the board. For example, in situations where the board may not know how a specific regulation or policy will affect the company as a whole, the advisory board is responsible for providing information and doing research on the specific policies to ensure that the board makes a good decision.

The overall leadership style of the organization is a classic model. They have weekly leadership meetings and the members are responsible for talking about and implementing change. Much of the change within the organization comes from a top-down structure as opposed to a more collaborative structure. The organization does not have any unionized workers or civil servants. Thus, this means that there can be a significant amount of disparity in pay as well as work conditions. When individuals work for unions, it generally means that they can all expect specific treatment (Wallace & Wallace, 2018). Similarly, most civil service jobs have specific requirements and expectations for the job. However, within the context of this organization, all workers are working without the backing of a union or a civil service job.

The agency has a fairly solid relationship with the community. The organization needs to respond to what is happening in the community because this is how it gets the credibility to place and work with clients. With respect to social workers, the primary role of social workers in this organization is to provide counseling to patients in the home. Additionally, social workers are important in this organization because they help coordinate the variety of services that individuals are receiving. In situations where individuals are living hospitals, they often have a variety of new needs. Thus, the social worker is responsible for helping the individual coordinate all of these different needs and also identifying what specific services might be necessary for these individuals (Colby & Dziegielewski, 2016).

One regulation that will have an impact on this agency is the 2017 overhaul of the home health worker regulations. The specific regulation change is that home health workers will now need to take into account primary caregivers’ schedules when deciding how to come up with a specific care plan. This is a significant change. Before, primary caregivers were not part of the care plan. Instead, much of the care was focused on goal-oriented patient care - determining what the patient needed him or herself. Thus, in circumstances where individuals were concerned with money, they might say that they would have a family caregiver at other times (O’Shea, 2018). For example, saying that a daughter, son, spouse, or another family member would be responsible for taking care of them. Now, with this overhaul, it is necessary for individual home health workers to take into consideration the schedules of these individuals. These changes include taking into consideration work schedules, family responsibilities, and any other factor that might have an impact on how well individuals can take care of their family members.

This is a significant policy change with respect to this company because it makes the services that this company provides more relevant. Before, individuals could simply state that they would rely on family members. Now, in circumstances where they cannot rely on family members, it will be important to provide them with services so that they can be taken care of at home. In addition, where cost is a significant factor, an organization such as this one will be in a better position to determine the specific services that the individual might need. These services might be less expensive than a traditional home health nurse. For example, physical therapy might allow an individual to operate in their home more easily such that they do not need a primary caregiver sooner. Because individuals will now start taking these factors into consideration, this new regulation will have a positive impact on this organization.

References

Abendshien, J. (2018). Health care in the next curve: Transforming a dysfunctional industry. Productivity Press.

Colby, I., & Dziegielewski, S. F. (2016). Introduction to social work: The people’s profession. Lyceum Books.

McKenzie, B. (2013). County-to-county commuting flows 2006-10. US Census Bureau.

O’Shea, J. (2018). Patient-centered, value-based health care is incompatible with the current climate of excessive regulation. Health Affairs Blog. Retrieved from https://www.healthaffairs.org/do/10.1377/hblog20180927.405697/full/

Schiehll, E., Lewellyn, K. B., & Muller-Kahle, M. I. (2018). Pilot, pivot and advisory boards: The role of governance configurations in innovation commitment. Organization Studies, 39(10), 1449-1472.

Wallace, D., & Wallace, R. (2018). What unions do for workers. In Right-to-Work Laws and the Crumbling of American Public Health (pp. 15-28). Springer, Cham.

Yao, N., Ritchie, C., Camacho, F., & Leff, B. (2016). Geographic concentration of home-based medical care providers. Health Affairs, 35(8), 1404-1409.