Parts of the Affordable Care Act focus on keeping people out of hospitals as a way to cut costs and to focus on patient care. That shift is putting more emphasis on areas like home-based care and transitional care.
"The main goal is to have people prepared when they go home," said Lisa Hopp, professor of nursing at Purdue University Calumet in Hammond and director of the Indiana Center for Evidence Based Nursing Practice.
Before, some patients sought hospitals for revolving door care. But that is costly.
"Hospitals are very expensive to operate," said Pat Bankston, associate dean at Indiana University School of Medicine Northwest and dean of the College of Health and Human Services at Indiana University Northwest in Gary.
If home health care providers can do the work instead, it cuts down on the expense, he said.
A large degree of pressure on hospitals now comes from the Affordable Care Act, demanding them to do better, Hopp said.
"Besides getting people insured, the Affordable Care Act has a legislative focus on patient-centeredness," she said. "Nurses have always felt that's what we do. We're patient-centered. It's written in our code of ethics."
Because of that, the Patient-Centered Outcomes Research Institute, or PCORI, has been welcomed as a huge resource, Hopp said.
"In the brouhaha when legislation (for the Affordable Care Act) was being debated, PCORI was what the strident people were calling the death panel," she said.
In reality, the institute focuses on patient-centered care. Its mission statement states the organization, "helps people make informed health care decisions and improves health care delivery and outcomes by producing and promoting high integrity, evidence-based information that comes from research guided by patients, caregivers and the broader health care community."
It emphasizes the role of patients in their own health.
"They have to be integrated from the very beginning," Hopp said.
With lengths of hospital stays being appropriately shortened, people go home with their illnesses, such as heart failure and pulmonary disease. They need to know how to manage their health, and that often means relying on people who specialize in transitional care, Hopp said.
"You need a team of people," she said.
Home health care agencies are playing a bigger role, especially with technology allowing care that can be provided in home instead of in a hospital setting, said Linda Delunas, associate dean in the College of Health and Human Services at IUN, associate professor in the School of Nursing and adjunct associate professor of medicine at the IU School of Medicine-Northwest.
One example is hospice care.
"Given the choice, people would rather die in their own home," Delunas said. "Hospice care provides support to do that."
And, it is a much less expensive option for patients who do not require high-tech hospital equipment, she said.
Hopp said many families who have used hospice for their dying loved ones are grateful.
"Hospice continues to be one of our bright spots in the health care system," she said. "Most people say, 'We should have done it earlier.'"
Another emphasis is on palliative care, which is different than hospice, Hopp said.
Palliative care is for patients who are seriously ill. The care uses a team approach to focus on relieving patients of symptoms and pain of serious illness.