National Nurses United and the California Nurses Association released a joint statement this past week criticizing Kaiser Permanente’s aims to expand advanced hospital services into patients’ homes.
The unions accused the health system of trying to maximize profits and endangering patients, along with undermining the role of registered nurses in providing care.
“Nurses, more than any other healthcare staff, spend the most time with patients,” said the unions in the statement.
“We reject Kaiser’s assertion that iPads, cameras, monitors, and the occasional visit by likely lesser-skilled and unlicensed personnel are in any way comparable to the skilled, expert nursing care and social emotional support we RNs provide every moment of every shift,” they added.
“Nurses have always and will continue to play a critically important and highly valued role at Kaiser Permanente,” said Kaiser representatives in response to a request for comment. “The Advanced Care at Home Program does not limit the role of nurses in hospitals.”
“The Kaiser Permanente Advanced Care at Home is an innovative person centered program rooted in quality, safety and patient satisfaction. Patients enrolled in the program must meet established clinical and safety criteria,” the representatives continued.
“Regardless of whether the patients are receiving care in the comfort of their own home or in a hospital we hold ourselves to the same high standard of care. The program empowers multidisciplinary care teams to provide the right care at the right time while meeting our patients where they want to be,” they added.
WHY IT MATTERS
In October, Kaiser – along with the Mayo Clinic and Medically Home – announced that it had launched a coalition aimed at creating a pathway to access at-home hospital-level services.
The systems noted the advantages of the model, saying it can be a safe, effective way to provide care to patients where they are. Patient satisfaction levels were high, said representatives in an interview with Healthcare IT News.
Mayo Clinic’s Dr. Michael Maniaci also pointed to lower readmission rates and equivalent fall and infection rates among advanced care at home patients.
Kaiser is currently piloting the program at two sites in California but intends to expand it system-wide, the NNU and CNA noted.
According to the unions, bringing hospital-level services outside a facility’s walls robs patients of the benefits of being physically close to other specialized departments, units and equipment.
“Nurses know that our patients can be fragile and their condition can deteriorate quickly and unexpectedly. We are appalled by the idea that our patients could be stranded at home in case of an emergency or adverse event, with no way to get immediate help or medical intervention and treatment,” said the statement.
The unions also said they were skeptical of reported patient outcomes given the size of the pilot programs and the studies, and accused Kaiser and other hospital systems of treating the model as a “gold mine.”
They flagged the danger of shifting care onto laypeople, especially women, and raised concerns about the potential of such initiatives to exacerbate racial disparities.
“The industry will accuse registered nurses of opposing this and similar programs because we simply want to ‘keep our jobs,'” read the statement.
“That’s exactly right. Hospital nurses do want to keep our jobs because we know our profession serves a critical role in our society: We are highly educated, knowledgeable, and skilled professionals who care for the sickest of the sick with our healing touch. We practice the art and science of nursing and all patients must have equal access to our care,” it continued.
THE LARGER TREND
Amidst the COVID-19 pandemic, Kaiser has shifted more resources and strategy toward expanding beyond a brick-and-mortar health system model.
In addition to its investment in Medically Home Group, the health system also launched a “virtual-first” health plan in Washington this past year aimed at centering telehealth as a foundational modality of care.
But the system, and other stakeholders wishing to expand virtual services, face potential hurdles in Congress and at federal agencies. When the public health emergency ends, so too will many telehealth regulatory flexibilities – which has advocates concerned.
ON THE RECORD
“Registered nurses are demanding that the hospital industry, the public, and private and government payers such as the Centers for Medicare and Medicaid Services abandon these plans to send home patients who should be admitted to hospitals,” said the unions’ statement.
“As a country, we need to invest in the proven health care infrastructure and RN workforce we know we need – and that our current COVID-19 pandemic painfully reconfirms we must have – to care for the nation’s patients,” it continued.
Kat Jercich is senior editor of Healthcare IT News.
Twitter: @kjercich
Email: [email protected]
Healthcare IT News is a HIMSS Media publication.
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