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Wednesday, April 1, 2020  

Re-thinking home-health carePublished 11/4/2003

Home Health Nursing is not for the timid or faint of heart. One must possess the ability to juggle the appropriate amount of visits the patient requires and still profit from it. Since the introduction of the Prospective Payment System (similar to DRGs), agencies have had to re-think their approach to home care. The idea is to accomplish the entire patient’s needs in half the time. This is not a bad thing though, however it is tougher to accomplish. Time management skills are a must for the field nurse.

A home health nurse must have a broad range of experience to survive home health. When you think of how fast patients are being discharged from an acute-care setting, it becomes obvious that home health is needed during that transition. More and more is being done in the home — chemotherapy, infusions and transfusions. Home care is quickly becoming like a mobile hospital. Here is what it is like in the day of a home health nurse.

We begin with the admission process. The admitting nurse must review the referral for possible needs before she ever enters the home. For example, wound supplies. If the patient is a diabetic, she must bring her glucose monitor. The diagnosis is all she has to go on most of the time.

An experienced home health nurse already will be planning patient’s needs and putting together a tentative plan of care. She then would call the patient and give an approximate time she will be there. On arrival to the home, the observation skills come into play. Did the patient open the door? Does the patient get short of breath with this activity? How is the house laid out? Does it appear safe? There is a 12-page OASIS (outcome assessment information set) assessment required by Medicare, which is used for comparison to national agencies to establish a standard of care among agencies. There is a safety assessment, activities of daily living assessment and a complete head-to-toe assessment.

The patient interview is extensive. This is where the nurse gets to know the patient and decide to what extent home health will be involved.

The nurse must develop a plan of care, calculate exactly how many visits will be made and what other disciplines need to be involved and the frequency of visits for them, as well. She also must start her discharge planning with the first visit. After that is established, it becomes part of the 485, which are the physician orders. Any deviation following this must have a new physician’s order.

Nursing goals are set with interventions, and documentation must reflect those interventions. Sometimes collaboration with the physician is needed to establish the patient’s needs, such as a particular type of wound care.

After all of this is done, the nurse must decide on a diagnosis code for the primary diagnosis. This can get tricky, but a correct diagnosis is a must for reimbursement purposes.

The concept of home health is to teach patients to care for themselves. Teaching is the largest aspect of home-health nursing. When patients know when to call the doctor and how to take their medications, they avoid complications and further hospitalizations.

Home health nurses play many roles. They must be the infection-control person. They are a social worker for the patient needing connection to community resources, assist in obtaining medical equipment and is the patient’s advocate. It is through her professionalism that the patient has his/her needs met. The nurse becomes a friend and relied on for care and direction.

The work is hard, but the rewards are great. Where else can you actually find the time to teach one-on-one and take the time needed to assure the patient understands? The autonomy in home care is remarkable. The relationships developed and the bonds created make it all worthwhile.

When you are about to give up, a patient says to you "Thank you, I am so glad you are my nurse," then you are ready to try it yet another day.

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