A Game Plan…

 

A Game Plan for High-Acuity Home Care

One of the clearest conclusions I have come to through years of navigating high-acuity home care is this:

The answer cannot simply be throwing more money at the same structure and hoping it works.

If the framework itself is wrong, increased funding alone will not solve the problem.

Ohio is facing a rapidly growing population of medically complex individuals who are surviving injuries and diagnoses that previously would not have survived due to limitations in medical knowledge, technology, or long-term care understanding.

Today, many of these individuals are living at home for years and even decades.

My son Alex is one of them.

Alex has survived and thrived for more than twenty years following a catastrophic high cervical neurologic injury involving autonomic instability and diaphragm pacing.

What has allowed him not only to survive, but continue progressing, has not been standardized task-based care.

It has been highly individualized, experience-based support developed over years of observation, adaptation, collaboration, setbacks, and learning how to work with his body instead of against it.

That kind of care is difficult to standardize.

But difficult to standardize does not mean impossible to structure.

And that is where the next phase of this conversation must go.

The current system was largely built around:

• generalized support models,

• task-based authorization,

• routine supervision,

• and developmental/cognitive frameworks.

But high-acuity neurologic home care often functions very differently.

Care frequently depends on:

• subtle pattern recognition,

• individualized physiologic understanding,

• rapid interpretation and response,

• continuity of caregivers,

• and deep familiarity with how a specific body behaves.

In many cases, the individual themselves is one of the most important sources of clinical information.

This type of care cannot simply be reduced to checklists or generic staffing assumptions.

And as this population continues growing, systems will increasingly struggle if they continue trying to fit high-acuity cases into frameworks that were not originally designed for them.

Ohio needs a game plan for high-acuity home care.

That includes:

• identifying these cases appropriately,

• developing assessment models that recognize individualized physiology,

• incorporating advanced clinical expertise into decision-making,

• training and retaining providers capable of this level of care,

• and preserving the continuity that is already keeping many individuals stable.

Most importantly, systems need to begin learning from what is already working.

Because families across the country are already building these models out of necessity.

Not because it is easy.
Not because it is ideal.
But because there was no existing structure designed for people like this.

And despite the difficulties, many of these individuals are surviving, thriving, and remaining stable at home for years because highly individualized systems of care have been built around them.

The goal should not be forcing these individuals back into older frameworks that do not fit.

The goal should be recognizing that medicine, survival, and community-based living have evolved—and the systems supporting them now need to evolve as well.

This is not simply “higher-needs caregiving.”

It is a distinct form of high-acuity clinical support that requires a different way of thinking about competency, continuity, risk, and care itself.

The population is growing.

The need is growing.

And the time for a long-term, thoughtful game plan is now.