Children suffer from feeding disorders for a range of reasons. Feeding and/or swallowing disorders may require a feeding tube in place of oral food intake to ensure that a patient receives adequate nutrition. Physical health problems, behavioral/sensory food aversions and other disorders can be severe, life threatening and dangerous at a time — early childhood — when nutrition is especially vital for brain and body development, as well as social and emotional growth.
Skilled nursing and therapy services to treat these serious conditions are being pioneered by home care providers with long-standing expertise and specialization in this type of care. These services keep patients healthy and safe. They also allow children to receive care at home with family, which is also vital to a child’s social and emotional health.
New York-City and Long Island-based St. Mary’s Home Care is advancing this work using innovative technologies and a comprehensive program of skilled services.
St. Mary’s is also working to integrate these practices more widely, in coordination with hospitals, under the Delivery System Reform Incentive Payment (DSRIP) program, using advanced technologies like telehealth remote monitoring.
Design and Outcomes
Initial outcomes from the St. Mary’s Home Care Telehealth Feeding Program show universal patient and caregiver satisfaction, with three out of 11 patients successfully treated and weaned off feeding tubes, and nearly all steadily gaining weight.
“Carry-over” is a key tenet of therapy — to ensure that patients are able to sustain skills, techniques and practices to apply them in all situations. For children with feeding disorders, this involves a parent or other household caregiver maintaining continuity of therapies to help children get the nutrition they need and to progress, which is where remote-monitoring technologies can be a powerful tool.
Through St. Mary’s program, speech therapies and other skilled services are provided in the home under a comprehensive care plan. But St. Mary’s also uses remote patient monitoring to extend the reach of these therapies and ensure carry-over as these technologies allow therapists to remotely observe parents feeding their children in real-time using techniques learned in therapy. Parents can also receive automated reminders to report on changes in a patient’s status.
This technology is paired with specialized feeding supports and clinical interventions: comprehensive evaluations, an RN review of the patient’s medications and side effects, environmental assessments by home care speech therapists to reduce distractions or improve seating or positioning at feedings, diet assessments and emergency management to ensure that patients and caregivers recognize signs and symptoms of aspiration or other emergencies that require immediate action.
DSRIP, First 1,000 Days
DSRIP’s pediatric quality indicators and project measures are an important way to support this kind of work directly and on a broader scale, along with critically needed state investment and program supports at a time when funding inequities exist for pediatric home care services, as previously reported in HCA’s Capitol Report.
Meanwhile, the state has launched a “First 1,000 Days” initiative recognizing that a child’s first three years are the most crucial years of development, calling for an all-encompassing pediatric health care model.
These and other opportunities must recognize the role of pediatric home care specialty programs, like the St. Mary’s program, which are innovating to improve lives and children’s health.