SONOMA – Sonoma Valley Hospital is expanding its Skilled Home Health Care service into Marin and Napa counties, rebranding it as Healing at Home as part of an effort to keep hospital readmissions at a minimum while delving further into offerings outside of the hospital setting.

While the hospital has offered its skilled home health service since 1989, officials said the program has seen a steady increase in demand in Sonoma Valley, particularly given the high percentage of seniors in the region. Now, the 83-bed hospital hopes to capitalize on similar demographics elsewhere in the North Bay, according to Barbara Lee, director of Healing at Home.

The further push into skilled home care is also in response to lessening inpatient visits at the hospital, a theme felt throughout the industry as small hospitals and big systems alike contend with reduced Medicare payments and potential penalties for preventable re-admissions.

“Inpatient volume is declining, so our hospital has seen the opportunity to advance our outpatient services, and that’s a general trend,” Ms. Lee said.  “There is a growing population of seniors. In the past two to three years, we’ve been expanding into Santa Rosa, Napa and little into Marin. This has been a gradual, planned expansion.”

The Healing at Home program currently provides about 1,000 home visits per month and has increased by 28 percent over the past five years, Ms. Lee said. The program is measured by visits, not the number of patients, given the differing medical needs of each individual.

The average patient of the service is in their 80s, Ms. Lee said. As such, skilled home care can be a key part of making sure elderly patients remain cared for at the appropriate level, including tracking medication compliance, with the hopes of keeping them out of the emergency room.

Ms. Lee said the shift to skilled home health has been increasing slowly over the last 20 years or so, but the Affordable Care Act and its emphasis on bending the health care cost curve by stemming re-admission rates is accelerating the trend.

“It is accelerating with health care reform, and that’s an exciting opportunity for our field,” she said.

On a national level, the senior population is expected to grow to 21 percent by 2040, while the 85-plus population is expected to reach 14.1 million people, according to Stephen Steady, M.D. and president of the Sonoma County Medical Association, writing in Sonoma Medicine.

But North Bay counties are already nearing that figure with its senior population. In Marin County, 18.2 percent of the population is 65 years or older as of 2012, according to the U.S. Census Bureau. In Sonoma County, the number is 15.2 percent of 65 and older, and in Napa County, 16 percent of the population is 65 or older. The statewide average is 12.1 percent.

That speaks to the growing need and general shift toward home health services, officials said, noting that in addition to the motivation spurred by health care reform, patients themselves want to be treated at home if possible.

 “We’ve paid close attention that for a number of years,” Ms. Lee said. Sonoma Valley Hospital is “well positioned to take advantage of the opportunity that that presents,” she said. “The population is getting older, and people want to get taken care of in their homes.”

Dr. Steady wrote that payment restrictions and the 30-day readmission rule following hospitalizations “are causing a scramble to keep patients out of the hospital. For hospital to be in the black with Medicare reimbursements, it is no longer profitable to simply fill the beds.”

Accordingly, there will be significant demand for skilled nursing facilities and that type of care, Dr. Steady said.

Sonoma Valley’s Health at Home involves skilled nursing, intravenous therapy, enterostomal therapy, wound care, medication management, pain management and physical and speech therapy, among other areas, according to the hospital.

It differs significantly from home care agencies, as caregivers work directly under physician orders, Ms. Lee said.

“We’re held to very high standards under Medicare," she said. The bulk of payment for Sonoma Valley’s home health comes from Medicare and private insurance.  

Sonoma Valley Hospital will hire additional nurses in both Marin and Napa counties as part of the expansion, but the hospital didn’t yet know exactly how many, nor did it say how many additional monthly visits it anticipates.