Home Health Nursing Care Overview

Provides care to people of all ages in their homes. It aims to improve and maintain health, manage illnesses, and help patients recover. It includes skilled nursing, physical/occupational therapy, and more.

A criteria for Medicare-covered home health services. Patients must be unable to leave the home or need extraordinary effort to travel. They need intermittent skilled care.

Patients needing intermittent skilled services, often discharged from hospitals due to conditions like stroke, COPD, or joint replacements, and covered by Medicare for home health services.

A variety of services available, provided in the patient's home, including skilled nursing, physical therapy, occupational therapy, respiratory therapy, medical supplies, wound care, and IV administration.

Licensed Practical/Vocational Nurses are responsible for most of the hands-on care in home health settings.

Registered Nurses provide case management, administration, supervision, and coordinate care in home health.

Home health care has evolved through legislative actions since 1965, involving policies like Medicare, Medicaid, and the Social Security Act to cover care for the elderly and vulnerable populations.

Patients view home health care as individualized, compassionate, and personalized care in a familiar and comfortable environment.

Family members see home health as supporting integrated care, maintaining family structure and wellness, addressing changes, and providing support and connecting families to community resources.

Home health providers use a multidisciplinary approach demanding professional independence, creativity, communication, skill usage, and adaptation.

Medicare's system for paying hospitals a set rate for care based on diagnosis, not costs.

Groups of diagnoses used to determine a set payment rate in Medicare's PPS.

Congress reduced payment limits in home health to control costs, leading to reduced services.

Medicare system that set payment rates for home health services to encourage efficiency.

Home health agencies must get permission from the state to operate.

Home health agencies must be recognized by the government to receive Medicare payments.

Hospices receiving per diem payments instead of fees from Medicare.

Medical equipment, such as beds and respirators, needed at home.

Services provided in the home by nurses who are trained to meet complex medical needs.

Goals focused on returning patients to their previous level of function.

Providing medications directly into a patient's body at home, often without prior hospital admission.

Medicare reimbursement requires agencies to meet federal conditions of participation, has face-to-face visit requirements before and after home care,and is a primary source of income but has decreased reliance in recent years for agencies.

Medicaid is a state-administered program funding home care for low-income people, often requiring Medicare certification, and the services covered vary by state.

Third-party reimbursement covers limited home care services with varying requirements and payment rates. Often tied to post-hospitalization recovery.

Patients pay for services directly.

Discharge planning begins at admission, promotes continuity of care, and involves patients and families. Agencies follow up post-discharge to track progress and satisfaction.

Quality management uses guidelines and techniques to meet client needs, improve care, measured by structural, process, and outcome criteria.

Cultural consideration is crucial in home care. It considers valuing different beliefs and strategies. Adapting communication to meet cultural needs is essential.

Home health assessments consider the patient, family, and their dynamics involving their ability to provide emotional support, cope, and set goals.

Often focuses on the family’s ability to cope with illness, particularly during acute illness, using a family nursing perspective.

Establish clear goals and outcomes collectively with patient and family understanding and agreement.

A plan of care revision is based on the evaluation findings to determine if expected outcomes are met.

Services to meet personal needs after acute or chronic illness, maintaining independence. Applies to all ages and encompasses maintenance, rehabilitation, and ADLs.

Range from simple (ADLs) to complex (IV care). Focuses on rehabilitation, support, and equipment.

Provide various home care services like skilled nursing, physical therapy, social services, nutrition, and durable equipment.

Medicare/Medicaid program; interdisciplinary team providing home, community, and center-based services. 55+ for nursing home-level care who are home-safe.

End-of-life care focusing on comfort and symptom management. Can be at home, inpatient, or in facilities.

Comfort care for those with serious illnesses, extending hospice care principles earlier in the illness.

Community-based programs providing supervised health care, social activities, and stimulation for functionally or cognitively impaired adults.

Understanding of cultural factors (e.g., ethnicity, religion, etc.) impacting health and health behaviors when providing care.

Payment for long-term care services. Changes in reimbursement affect different care settings and costs.

Registered Nurses (RNs) oversee Licensed Practical/Vocational Nurses (LPNs/LVNs).

LPN/LVNs need flexibility, compassion, patience, empathy, and teamwork, in addition to the required skills and knowledge.

LPN/LVNs provide patient education, psychosocial support, and procedural assistance, following the direction of the supervising RN.

Physical therapists work with patients in their homes to restore function, often using treatments like muscle strengthening and ultrasound for conditions like joint replacements.

Speech-language therapists, needing a master's degree, help patients with communication disorders, often after stroke or surgery, focusing on reducing impairments and promoting rehabilitation.

Occupational therapists help restore patients' daily living skills, focusing on tasks, improving independence, and analysing the patient's environment.

Medical social workers focus on the emotional and social aspects of illness, providing short-term services to improve patient well-being.

HHAs provide personal care, physical assistance, and household tasks, following a skilled primary service under RN supervision.

Referrals can come from various sources, such as hospitals, physicians, or direct patient requests. The nurse and other providers do the admission and care planning.

The RN completes the initial evaluation and patient admission within 24-48 hours of referral.

The care plan outlines the patient's physical status, treatments, services, goals, implementation time frame, and must be signed by the physician.

Skilled visits, usually 30-45 minutes, are based on patient needs and healthcare goals. Telemonitoring may be used to cut costs.

Home healthcare documentation is a crucial record of patient care, commonly electronic, legally binding.