The Nurse in Home Health: module 3

home care

• Nurses have provided care in the home for more than a century in the United States

• Home care gives clients and families a chance to receive health care in their usual environment, where they may feel more comfortable and where it may be easier to learn and practice how to make health-related lifestyle changes

• For clients who are homebound, home care may be a necessity

home care includes?

disease prevention, health promotion, and episodic illness–related services provided to people in their places of residence

Is an approach to care provided in people’s homes because theory or research suggests this is the optimum location for certain health and nursing services

Home care is part of a?

• continuum of care where clients have the opportunity to live and move through the experiences of subacute, chronic, and end-of-life care.

• The care given in home care settings is often managed and directed by a registered nurse.

• The care given in home care settings is interdisciplinary in nature.

caregiving

• It is essential to work with the family in the provision of care to an individual client

• Family is defined by the individual and includes any caregiver or significant person who assists the client in need of care at home

Family caregiving includes…

assisting clients to meet their basic needs and providing direct care such as personal hygiene, meal preparation, medication administration, and necessary treatments 

Working in the Client’s Home

• Nurses practice autonomously with little structure in the home setting; therefore competence and creativity are essential

• The home environment lacks many resources typically found in institutions, so it is essential that nurses have good organizational skills, be able to adapt to different settings, and demonstrate interpersonal savvy for working with the diverse needs of people in their homes

• When working in a client’s home, the nurse is a guest and, to be effective, must earn the trust of the family and establish a partnership with client and family

• Client safety is of utmost concern in home care just as in other health care settings

Role and Scope of Home Health Practice

• Assessment by collecting data about home care clients

• Diagnosis through the analysis of these data

• Outcome identification that helps home care nurses identify nurse-sensitive measures

• Planning  in the form of nurse-sensitive interventions directed to the identified outcomes

• Implementation-identified nurse-centered actions in collaboration with clients and families

• Evaluation outcome accomplishment through nurse-sensitive interventions

direct care

• refers to the actual physical aspects of nursing care – anything requiring physical contact and face-to-face interaction:

  • Performing a physical assessment on the client

  • Changing a dressing on a wound

  • Giving medication by injection

  • Inserting an indwelling catheter

  • Providing intravenous therapy

  • Teaching clients/family how to perform a task

indirect care

• activities a nurse does on behalf of client to improve or coordinate care:

  • Consulting with other nurses and health providers in a multidisciplinary approach to care

  • Organizing and participating in client care team conferences

  • Advocating for clients with the health care system and insurers

  • Supervising home health aides

  • Obtaining results of diagnostic tests

  • Documenting care 

Nursing roles in home care:

• Clinician

• Case manager

• Client advocate

• Educator

• Mentor

• Researcher

• Administrator

• Consultant

home visit steps:

• Initiating the visit

• Preparation

  • Equipment

  • Directions

  • Personal safety

• The actual visit

  • Assessment

• Post-visit planning

Reimbursement mechanisms of home care

• Medicare and Medicaid are the principal funding sources for home health care, with third-party health insurance providing another major source

• Budgeted funds for public health from taxes cover preventive home care visits to the clients of public health agencies

• Other home care services (health education, risk reduction, case management, primary care) may be reimbursed from a variety of sources: program funds, grants, contracts, or third-party billing

Cost-effectiveness

• Based on increased number of agencies and rising costs, federal government instituted a prospective payment system on October 1, 2000 

• Prevents fraudulent use of Medicare funding

• Evaluation results show that the prospective payment system has increased efficiencies and reduced certain costs and that it has generally not been associated with declines in quality