Getting it Right at Start of Care (SOC): Enhancing Patient Perception of Home Health through SOC Best Practices

Written by Laurie Salmons, Manager, Clinical Consulting, and Carissa McKenna, Director, Clinical Consulting, McBee

In the Home Health environment, we have seen many changes over the past several years. These changes have continued to create varying levels of understanding regarding what home health care is about. This confusion extends to all participants involved in care: physicians, patients, providers and clinical staff as well.

Therefore, it is vital that the Start of Care (SOC) clinician helps the patient/caregiver understand the importance of home health, how home health works and how their home health benefit helps support their care. Home health SOC is an important point in the trajectory of a patient’s satisfaction, as it sets the tone for the remainder of their care period.

Both the patient and the home health care staff must work together to achieve the best clinical outcomes for the patient. Presented here are SOC best practices to help you provide excellent home health care, right from the start.

Home Health SOC Best Practices

• Sit down, relax and make eye contact with the patient, introduce yourself and explain why you are there to see them. It can feel invasive for a patient to invite a medical professional into their home, so be sure to do your best to assuage any concerns the patient may have regarding that.
• Ask the patient what is most important to them regarding the care they are about to receive. “What Matters Most” to them? OR What were they able to do before that they are not able to do now? It’s an SOC best practice to understand the patient’s goals and needs.
• Avoid medical jargon or acronyms, such as CHF, MI, and COPD and frequently check in with the patient to ensure understanding of the information provided and address any questions in order to prevent misunderstandings before they occur. Patients may sometimes not speak up about things they don’t understand or aren’t comfortable with, so it’s crucial to put information in a way that patients can best understand.

Scripts for Exemplary SOC Home Health

Scripting can help! Scripting is not meant to be read to the patient, but rather used as a guide to help staff with alternative phrasing when communicating important points to the patient/caregiver to facilitate better understanding and enhanced recognition of the benefits home health services can provide them. While the script may not be exact, it can help practitioners to better explain things to patients, so the professional in question should understand the script and remember the critical points.

Scripting is relevant for all SOC visits no matter which discipline is involved. Using scripts is an SOC best practice.

Below are some examples of scripting that can be utilized at home health SOC to emphasize the importance and impact of home health services.

Home Health Start of Care Assessment — Sample SOC Script

This first script is meant for the SOC in home health encounters. It covers the initial discussion of the condition being treated, the SOC assessment, and the potential for other treatments if necessary.

“Your doctor has ordered home care services to help you get back to the way you were before (list the patient’s illness/exacerbation/reason for recent hospitalization, etc.). Please stop me at any time to ask questions.

Your doctor ordered home care (list the services ordered – SN, PT, OT, ST, MSW, HHA) because you have (specify the issue/reason the doctor referred the patient). The first step in the process is what I am here to do today. I will perform a full assessment/evaluation of you to determine how we may best help you at home and make sure that you meet Medicare’s specifications for coverage of home health services. This assessment will also help me determine whether you require additional care beyond what your doctor originally requested. If you qualify for services that your doctor did not order, we can call your doctor to get an order to ensure you receive the services that you need.”

Participation Between Patient/Caregiver and Home Health Clinician — Sample SOC Script

Once we’ve established the purpose of the visit and care, we can shift our focus to what the patient wants from treatment. This part of the home health SOC is vital in establishing a metric for success that the caregiver and the patient can share.

“In home health we work in partnership with you, working together to help you reach your goals. Let’s first talk about what matters most to you. This helps us focus on what is most important to you when setting up your plan of care.  Tell me, what matters most to you? OR What is something that has a lot of meaning to you, but you’ve not been able to do lately due to your (specify illness/injury/condition)?

It sounds like (repeat what it is the patient told you matters most to them) is really important to you! How do you think we could best help you work toward achieving that?

You are the most valued member of our care team. Letting us know what is important to you and helping us figure out how we can best help you allows us to truly make strides toward achieving your goals. What I heard you say is that we can best help you by (repeat what the patient said you could help them with).  Would it be OK for me to share with you some recommendations I have based on that? Share your recommendations for the plan of care and connect them to how they will help the patient move toward achieving their goal.

Keep in mind that, at times, we may ask you to do some things when we are not here but rest assured that those things will help you continue to work toward achieving (repeat what matters most to the patient).”

Home Health Plan of Care — Sample SOC Script

“After I complete your evaluation, we can discuss areas where it appears we may be able to help you get better and meet your goals. Medicare expects us to provide these services to you to help you get better faster. I will explain to you the benefit of each of the services that are recommended and what they will contribute to your plan in order to meet your goals.”

Best Practices for Getting it Right at Home Health SOC

1. Engage the patient/caregiver right from the start by identifying “What Matters Most”
2. Ensure the patient/caregiver understand the Medicare home health benefit
3. Evaluate what the doctor ordered, identify any additional needs, and follow up with the doctor timely to obtain orders for additional services
4. Work together to help achieve patient goals – Teamwork is the key to success!
5. Encourage patient/caregiver adherence to the Plan of Care to yield the most successful outcomes.

In summary, getting it right at the home health SOC is a multi-factorial process and requires participation and involvement of the admitting clinician, patient, caregiver, ordering provider and all members of the care team. Scripting is a helpful tool to enhance communication between clinicians and patients/caregivers as well as improve patient/caregiver understanding of the Medicare home health benefit. Identifying “What Matters Most” helps to engage the patient in their care. Patients who are engaged in their care typically have better buy-in to the home health plan of care leading to improved patient satisfaction and more optimal outcomes. Following the start of care home health best practices laid out here can help you deliver exceptional care.

Frequently Asked Questions

1. What is SOC in home health care?

The Start of Care (SOC) in home health care refers to the initial assessment and visit by a clinician when a patient begins receiving home health services. It is crucial for establishing a care plan, setting goals, and ensuring the patient understands their home health benefits.

2. Why is the Start of Care (SOC) important in home health?

SOC is vital in home health as it sets the foundation for the patient’s care journey. It ensures that both the patient and caregiver understand the care plan, and it helps clinicians identify the patient’s needs to provide the most effective care.

3. How can SOC home health visits improve patient outcomes?

SOC home health visits improve patient outcomes by fostering early engagement, identifying patient goals, and ensuring a clear understanding of the care process. This collaborative approach helps patients adhere to their plan of care, leading to better health results.

4. What should clinicians focus on during a home health SOC assessment?

During a SOC assessment, clinicians should focus on understanding the patient’s medical history, current condition, and personal goals. They should also assess the patient’s eligibility for services, develop a care plan, and ensure the patient understands the next steps.

5. How does effective communication during home health SOC visits benefit patients?

Effective communication during SOC visits helps patients understand their care plan, reduces anxiety, and encourages active participation in their care. It also ensures that the patient and caregiver are well-informed, reducing the risk of misunderstandings.

6. How can SOC clinicians ensure patients understand the home health process?

SOC clinicians can ensure patients understand the home health process by using simple, non-medical language, asking open-ended questions, and frequently checking for comprehension. Scripting can also be used to guide discussions and ensure important points are covered.

7. What should be included in a home health SOC plan of care?

A home health SOC plan of care should include the patient’s medical goals, the specific services they will receive (e.g., nursing, physical therapy), and any recommendations from the clinician. It should also outline steps the patient can take to meet their goals and improve their health.

8. How does Medicare play a role in the home health SOC process?

Medicare plays a key role in determining eligibility for home health services during the SOC process. Clinicians must assess the patient’s condition and document their need for care to meet Medicare’s requirements for coverage.

9. What questions should patients ask during their home health SOC?

Patients should ask about the services they will receive, how the care plan will help them achieve their health goals, and what they can do to support their recovery. They should also inquire about any Medicare coverage and what steps are involved in their home health care.

10. What is scripting in healthcare and specifically scripting in SOC?

In healthcare, scripting refers to preparing statements and questions that clinicians can present to patients. Such statements and questions aim to improve the quality of care by better informing patients of their situation and by drawing out concerns that a clinician can address that might otherwise go unspoken. SOC scripting pertains to the particular concerns at the start of care. Across many kinds of care scripts are used to bolster patients’ understanding, to explain why a clinician is pursuing a certain course of treatment, and to improve the reputation of the caregiving institution.