Refuah Home Health: Strengthening the Continuum of Care

As the American population ages, living longer with more acute and chronic conditions, home health providers are becoming invaluable components in the delivery of patient-centered coordinated care.

In September of 2017, Refuah Home Health began offering in-home health aides for the elderly and persons with disabilities who are homebound. Home Health Aides (HHA) provide traditional in-home health services such as assistance with bathing, dressing, grooming, skincare and wound prevention, and feeding. Other offered services include assistance such as medical reminders and escorts to and from doctor visits. Additionally, Refuah HHAs provide companionship, personalized exercise programs, shopping and errand management, and communal meal preparations.

A recent study completed by the Alliance for Home Health Quality and Innovation reported that an overwhelming majority of Medicare patients wish to stay in their own homes. The study further concluded that the majority of patients utilizing home healthcare services are older, suffer from multiple chronic conditions, and live alone. These high-needs patients are often dependent on family to bridge the gap between home and the doctor’s office, placing an increasing financial and emotional burden on younger generations.

Refuah Home Health seeks to fill this gap as an active partner in coordinated care. “We aim to support the efforts of our patients and their families to keep loved ones living at home in a comfortable and familiar environment,” says Home Health Director, Esther Lowenstein. To this end, Lowenstein underscores the importance of incorporating home health into a patient’s provider team: “We will work in-step with our patients’ primary care physicians, to provide clinically appropriate and cost-effective practices, allowing more patients to avoid hospitalization and become active members of community life.” This team-based approach allows Refuah to better manage patient care and bolsters the organization’s ability to achieve Medicare’s Triple Aim goals: improve patient experience of care, increase the health of populations, and reduce the per capita cost of healthcare.

According to Lowenstein, Refuah Home Health evolved out of the pronounced and growing needs of the clinic’s aging population. “We want to help patients improve or remain as healthy as possible,” she says.

“The Home Health Aide is a connector from the clinic to home,” says Lowenstein. “This seamless approach allows us to identify and report health issues before they become urgent, and provide immediate intervention within the comfort of our patients’ own homes.” Lowenstein continues, “This will have a direct effect on a patient’s health outcomes. We can now give our older patients what they crave—independence through responsive and respectful quality care.”

With this approach, Refuah Home Health goes beyond traditional post-acute care management, making home health a key partner in improving health outcomes, reducing access barriers, and lowering healthcare costs.

“Our patients’ health is at the core of what we do,” Lowenstein concludes. “We believe the addition of home health services will allow us to provide increasingly effective and responsive treatment that has a material impact on our patient health and overall quality of life.”


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