Chp.34 Home health and hospice nursing

what is home health?

• Homebound individual

• Under physician care

• Requires medically necessary skilled nursing care or therapy

what are the hospice qualifications?

• Any individual with a terminal illness

• Certified by physician or nurse practitioner to be terminally ill with life expectancy of 6 months or less; eligible to receive Medicare Hospice Benefit

What are the requirement for medicare to pay for home health?

• Home bound 

• services must be intermittent and provided by nurse, physical therapist, or speech and language pathologist 

• Medicare forms, physical orders, and client  records must be completed on time 

• Heath care  provider must have a face-to-face visit with the client before initiating  orders.

Conducting a home visit considerations?

• initial telephone contact 

• referral 

• visit preparation 

• Environment assessment  

Distractions in the home environment?

• •Environmental distraction:

  •Behavioral distractions: arguing

  • Nurse-initiated distractions: phone use

Home safety concerns

• medications: not sorted, being used by others

• medical supplies: reusing supplies inappropriately 

• home safety check: rugs, gun, wires 

• safe environment: violence 

Hospice home care

• Improves end-of-life care for the terminally ill

• Relieves suffering throughout the illness

• Supports the patient and family/caregiver through the dying process

• Provides grief support to the family after the patient has died

Goal of hospice care?

• to humanize the end-of-life experience

four types of hospice care?

⚬Routine home care with intermittent visits

⚬Continuous home care

⚬General hospital care

⚬Respite care in skilled nursing home

Medications are given to? Family education?

• reduce pain

• manage symptoms

• allow pt to rest

• ED: nurses follow providers’ orders, patient wishes

Documentation of home care

• 1.Assessment

  2.Diagnosis and planning

  3.Outline the client and family roles

  4.Intervention

  5.Referral for community services

  a.Immunizations

  b.Meals on wheels

  6.Terminate the visit

  7.Evaluation

• document to avoid law suits

Formal vs Informal caregivers

• FORMAL

  • Professionals and paraprofessionals who provide in-home health care and personal services

  • Compensated for the services they provide

•INFORMAL

• Family members who are caring for the client

• Education provided by home health nurse

• Skills of the caregiver also assessed by home health nurse

• Volunteers, adult day health centers, or senior service centers 

caring for the caregiver?

• respite care services