Androscoggin Home Care & Hospice: Julie Shackley, President/CEO

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With the aging population increasing in numbers throughout the United States, the need for healthcare groups that provide services to older patients is rapidly growing within the industry. As patients age, they often face more comorbidities, leading to more hospital visits and higher costs of care. Ways to manage these costs is a priority issue for the healthcare industry going forward.

Home care and hospice are services that have long been part of the healthcare industry, but these services have often been overlooked.

“Home-care services are key to some of the successes that government is talking about, yet our voice is small within the industry,” said Julie Shackley, president and chief executive officer of Androscoggin Home Care and Hospice, headquartered in Lewiston, Maine. “We already have programs that manage chronic conditions and help reduce hospital readmissions, saving money for the entire healthcare system.”

Shackley hopes that home care and hospice can gain more recognition for the services it provides not only to patients, but also to the healthcare system as a whole. Androscoggin has been working with physicians, hospitals, and other healthcare organizations in Maine to help collect data on outcomes and cost.

“We are already planning for the future of accountable care organizations (ACOs),” she said. “The health system and physicians in our area see us as a critical element of the team. We work with them to develop care plans for common diagnoses so that the message and education is consistent across the continuum of care. We all have a goal of improving healthcare from a patient-outcomes perspective and a cost perspective.”

Doing more with less

Trying to do more with less is a common theme at all healthcare organizations. The home-care and hospice industry faced huge cuts recently with the passage of the Patient Protection and Affordable Care Act. In preparation, Shackley said Androscoggin began streamlining processes and increasing efficiency to help budget available dollars.

Shackley said the staff was given small laptops and cell phones to maintain real-time communication and be able to document in patients’ homes. The organization also set up a physician portal to share care plans and send orders electronically.

“In 2010, we were able to shave off about $1 million in expenses,” Shackley said. “We decreased office spaces, invested in technology, and streamlined our systems and processes. We still have more work to do and are looking at ways to increase volumes and expand services.”

Even in light of budget cuts, Androscoggin always puts patient needs first. Shackley said the company began offering telehealth, which is a small box in a patient’s home that cues the patient to take blood pressure, weight, glucose, or other measures. It then transmits that data to a central station in the office where a nurse looks for abnormalities.

The nurse can then notify a physician or make medication changes, ultimately keeping the patient out of the hospital. Shackley said this service has greatly improved patient care and saves healthcare dollars overall, but as of now, it is not reimbursed.

Providing quality care for patients

Androscoggin offers the following three primary programs: home care that provides care for individuals just out of the hospital for congestive heart failure, wound care, orthopedic injuries, and other issues; hospice that visits individuals in their homes, nursing facilities, or at the company’s hospice house; and palliative care for patients who want some treatment options above comfort care, yet still want to benefit from the skills of the agency and staff.

Because care is given in patients’ homes, home care and hospice has typically been a silent part of the healthcare system. Androscoggin has increased visibility and services through a 14-bed acute hospice-care facility. This facility serves patients who are at the end of life and are unable to be managed at home or at a nursing home.

Shackley said the organization faced some skepticism early on for the hospice house, but after being open for five years, it has been completely embraced by the community. It has provided a great service to patients who are still able to fulfill their end-of-life wishes.

“Many of our patients are discharged home from the hospice house,” she said. “They are able to get their symptoms and pain management under control enough to return home and pass peacefully where most individuals prefer.”

A community of support

Shackley feels that a large part of Androscoggin’s success is the support it receives from the community. The organization cares for about 7800 patients and families in about seven counties. It has about 350 employees and close to 400 volunteers. She said staff, leadership, and volunteers are included in decision-making for the company, particularly in the development of the company’s mission and values.

“We are fortunate to be trusted in the community,” Shackley said.

For the coming year, Androscoggin is looking to increase efficiency, expand services, and promote their existing services.

“We have a lot to share,” she said. “We have significant experience and the same passion and goal that many in the healthcare industry do.”

-by Patricia Chaney

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