The impact of the Prospective Payment System on psychiatric home health care for depressed older adults

The enactment of the Prospective Payment System on October 1, 2000 created a major change in the home care industry. Psychiatric home health care also has been greatly affected by this new health policy. This study examined the influences of the Prospective Payment System (PPS) on psychiatric home health care for depressed older adults. The Quality and Health Outcome Model was the theoretical framework for this study. A mixed method design was used to investigate the influences of the new health policy. A quantitative secondary analysis was used to analyze existing clinical data to describe this patient population and services utilization of depressed older adults in the pre- and post-PPS periods. Qualitative approaches were used to classify nurses\u27 work in their service following the results of quantitative approach. Results. After the enactment of the new policy, this studied agency received sicker and more impaired patients. Service utilization was increased primarily due to the increased admission of patients who were recently discharge from institutional care settings. Facing a sicker population and pressure of daily productivity, nurses expressed that their work still had been patient first. Five categories of work were identified from qualitative work: assessment, management/supervision, communication, interventions, and regulation. Conclusion. Findings suggest that a measurement of financial outcome for this new policy is needed as a goal of future development, especially when the Medicare population will increase with the baby boomers generation. Also, a better mechanism to regulate case-mix level for not-for-profit home care agency is needed. Nurse burn-out is a critical concern and should be carefully examined in the future. Facing a changing Medicare population, it is time to understand and design content of psychiatric home care services to meet patients\u27 needs. Limitation. This study used only one agency for data collection. Even though the data were rich and thorough, it is necessary to compare this agency\u27s experience with other types of home care agency