Home Health Nursing

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Home Health Nursing

• Home Health Nursing-What is it?
• History of Home Health Nursing
• Who pays for care in the home? Medicare Vs
  Medicaid Vs other insurers
• Home Care Eligibility Requirements
• Trends in Home Care
• Roles in Home Care

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What are we talking about when we say Home
Health Nursing?

• The provision coordination of
• Acute
• Restorative
• Rehabilitative
• Maintenance.
• Preventative or
• Health Promotion
• Services.

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• By.a professional nurse or other health care
  providers of therapeutic services such as
• PT/OT/Speech Therapy
• Medical Social Work
• Personal Care , Home Health Aide services.
• Setting is usually the home or some other
  non-institutional setting.

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A wee bit of history.

• 1700s- Religious orders went out into peoples
  homes to care for sick
• Early 1800s- Boston Dispensary then District
  Nurses across country
• Late 1800s- Visiting Nurses Associations
• 1900s -VNAs, Public Health Departments

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Some key players.

• Florence Nightingale
• Lillian Weld
• Mary Brewster
• Mary Breckenridge

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History.

• 1965- Medicare/ Medicaid Legislation
• HUGE Impact--payors for services
• To date MEDICARE is 1 Payor of Home Care
  Services
• 1982-DRGs- Limited the for Hospitilized Care,
  so patients were discharged from hospitals
  Quicker and Sicker
• Huge ? the use of Home Health Care
• 1990s- Influences of Managed Care
• Use of Guidelines/Pathways
• Contracting for Services
• Captitation of payment

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2000s...

• Introduction of HHRGs PPS
• Home Health Related Groupings PPS
• In place as of October 1, 2000
• High impact on the way Home Health Agencies are
  functioning
• The way agencies are paid effects the way the
  function
• high component

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CHANGE.....
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Medicare/Medicaid

• Medicare
• Federally funded as part of Social Security
• Provision of care for anyone in the U. S. Age
  65 or older
• Managed by HCFA and Intermediaries
• 2 Parts
• Part A-Reimburses for hospital and post- hospital
  care ( including Home Health Care)
• Funded totally from SS
• Part B- Reimburses physician charges, Lab fees,
  therapies, supplies
• Funded from premiums

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Medicaid

• State funded
• MediCal
• Designed to cover
• Children
• Low income adults in need of health care
• Disabled
• Medically indigent
• Varies state-state
• Colorado Vs Utah

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Medicare Will pay the Agency For Home Care
Services if.

• 1. Patient is Homebound ( Unable for health
  reasons to leave the home)
• 2. Be in Part-Time or Intermittent need of
  skilled , non-duplicative care from one of the
  following care providers
• Nursing and/or PT/OT/Speech
• 3. Have a documentable medical necessity
• 4. Be under the care of a physician
• 5. Have a Plan of Care

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Home Care Today..TRENDS

• Rapidly Growing Field
• 1963-1000 agencies
• 1997-21,000 agencies
• Sicker and sicker patients
• ? Technology in the home setting
• ? Variety in Home Health
• not all the elderly, also
• Pediatrics, Neonate Care
• Mental Health Care
• ? Cost Savings Home Vs Hospital
• Example Vent Dependent--22,000 month in Hosp,
  7,000 month at home

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TRENDS Cont...

• Increase in regulations
• Importance of documentation
• Increased emphasis on QUALITY of CARE, how to
  prove its there
• ? Computerization--Transfer of Information
• ? Influence of Managed Care
• ? Concern over Safety Issues
• Growth of Hospice services

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Nursing in the Home Vs in the Hospital

• Healing Environment for Patients, Families
• Patients and Families have feeling of more
  control
• Same Nursing Process
• A D P I E
• Emphasis on Family The Primary
• Caregiver
• Education is Critical
• Multidisciplinary Team, NURSE is key coordinator,
  ROLES..

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Home Health Treatment Plans

• Diagnosis
• Functional limitations
• Anticipated length of care
• Type and frequency of services needed
• Medications

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Treatment plans (cont)

• Diet
• Activities permitted
• Medical supplies and appliances
• Safety measures in home environment
• Mental status
• Orders and treatments
• Goals/Rehab potential/ DC plans

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Treatment plans

• Must be reviewed and updated every 60 days.
• Assessment visit okay without Dr. order

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Some Case Examples

• ???

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Case Study 1

• A 28-year-old female was admitted to your
  med-surg unit after suffering a hip fracture in a
  bad skiing accident, You anticipate this patient
  being sent home in a large cast. She works
  part-time for a local manufacturing firm and
  states she is married with two children.

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Case Study 2
Help

• A 78-year-old male, Harold P., was admitted to
  your telemetry unit from CCU after undergoing
  open-heart surgery for 3-vessel bypass. His wife
  states that she has severe rheumatoid arthritis
  and that because of her disabilities, Harold
  prepares most of the meals and performs the
  housework. They have a 50-year-old daughter who
  lives in Grand Junction. Harold and his wife live
  in Meeker on the family ranch. Harold develops a
  post-op infection of the sternal incision
  requiring involved dressing changes BID and IV
  therapy with Amphotericin B. As Harolds primary
  nurse, you are actively involved in his discharge
  planning.

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Case Study 3

• Mrs. Whelan, who is 76, is sent home from St.
  Elsewhere hospital with a new colostomy after
  bowel surgery to remove an obstruction. Mrs.
  Whelan is weak, lives alone and has a history of
  depression

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Case Study 4

• Mr. Colson, who is 86, recently moved in with his
  daughter. Two months ago he was admitted to the
  hospital with urinary problems and pain. In the
  hospital he was diagnosed with cancer of the
  prostate. Mr. Colson has a catheter, is
  essentially bedridden and is teary as he misses
  his own home and friends. Mr. Colsons daughter
  is in her mid sixties, had arthritis and is
  raising her 12-year-old granddaughter.

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Case Study 5

• Greg is a 19-year-old who was referred to your
  home care program from St. Nowhere Medical Center
  after a lengthy hospitalization due to a
  motorcycle accident. The history states that Greg
  went over an embankment and had significant
  trauma to his right leg some six months prior to
  this referral. He recently had surgical removal
  of the hardware placed during the extensive
  trauma surgery which immediately followed the
  accident. He is newly diagnosed with osteomylitis
  of the right knee. He has a methicillin resistant
  staph infection and is to receive Vancomycin per
  the physician orders. Greg has an immobilizer and
  is non-weight bearing on admission to home care.