NUR1010 chapter12

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NUR1010 chapter12
2014-02-04 06:55:10
Home Healthcare Nursing

Home Healthcare Nursing
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  1. Home care nurses must be competent...
    Communicators, teachers, managers, physical caregivers
  2. Historical perspective
    • Nightingale 1860: Concept of nursing providing services at patients home
    • late 1800: Lillian Wald and Mary Brewster established nurse home visits
    • 1900 vast growth in home health care+ Visiting Nurse Association VNA
    • Services for women and infants before and after birth + tuberculosis patients.
    • After WWII shortage of physicians
    • 1940: hospital based home care agencies
    • 1965: change Medicare and Medicaid: payment for some home care services
    • 1963 1,100 home health agencies, today more than 10,500
    • 1980: diagnosis related groups (DRG's) in Medicare-> cost containment measure-> home care vital aspect of health care system
  3. What are some reasons for increase of home health care
    • Rising demand for improved end-of-life care at home
    • Individuals over 65 living longer with multiple chronic. conditions
    • Technological development
    • Reimbursement for home health care by Medicare
  4. Significance of home health care
    • Promote, maintain, and restore health
    • Short term direct care in home
    • Assist with ADL, teach about self-care, enhance continuity of care
    • Governmental, private and hospital based
    • Needs skilled nurses
  5. Agencies that provide home care
    • Major industry:
    • Home care agencies
    • Home care equipment vendors
    • Home infusion therapy companies

    Official, hospital-based, proprietary
  6. Medicare does NOT pay for ...
    • 24 hour home care
    • Homemaker services e.g. shopping, cleaning ...
    • Medicare is the largest single payer of home care services
  7. Who is eligible for Medicare covered home health care
    • Clients who are homebound and under the care of a physician (some states have lifted homebound restriction)
    • Many insurances follow Medicare guidelines
  8. How has the role of homecare changed over time?
    • froom broad public health nursing model characterized in the role of the VNA
    • To medical care in the home addressing special needs, directed by physician, with a limited amount of time
  9. Acute care nursing vs. home care nursing
    • Main difference: location
    • Home care: flexible, experienced, adaptable, self reliant and autonomous decision maker, efficient teaching skills
    • Closer Nurse client relationship
    • Client and family part of decision making process
  10. Advantages of home health care
    • Lower cost
    • Less threatening environment
    • Easier access to loved ones
    • No traveling
    • restoration of family control
    • Lower level of stress for client and family
  11. Challenges regarding home health care
    • Loss of privacy/control
    • interruption of family routine
    • Concerns about competency of nurses
    • Personality conflicts...
  12. Behavior of home health nurse
    • On time, perform consistent with families's desires, not too pushy, not try to control everything,
    • Nurse should listen, expenses may cause stress -> inform about resources available, respect ,
    • Lots of paperwork,
  13. Health teaching
    • Learner: client, family, caregiver
    • ... teaching outcome has to ne assessed
  14. The home visit (steps)
    • Preparation: client contact per phone, identification, purpose of visit, cost of service, eligibility, alternative sources of support, insurance card or evidence of coverage
    • Beginning the visit: casual social conversation, build trust
    • Assessment: physical (appropriate for home care, who will pay, how long service will be needed) , family (structure, stage of illness, developmental stage...), financial (info abvout cost of service, insurance payment, options to reduce costs, which exact coverage,...)
    • Determination of needs and planning care: discuss nursing needs and develop a plan of care, who is responsible for what, expected outcomes are developed, loans for follow up visit
    • Home health agencies have to demonstrate client's progress-> Medicare does not reimburse if quality improvement and goals are not achieved following OASIS-C format
    • Implementation: focus on physical care, teaching, counseling, referrals according to plan, observing progress
    • Termination of visit: review of purpose of visit, what was learned at assessment, reviews plan, time and purpose of next visit discussed, eventually little conversation
    • Follow-up visits and evaluation: check if goals are met, build relationship,
    • Documentation: usually follows OASIS to ensure qualification of payment
  15. What has to be. Documented to ensure Payment for services?
    • Client is homebound:
    • absence from home are infrequent for receiving medical treatment
    • Leaving home requires considerable and taxing effort
    • Not able to drive
    • Client leaves home how often, for how long, for what reason, effort and assistive devices
  16. Caregiver assessment
    • Presence, availability, type of assistance, knowledge, physical and psychological status, caregiver needs,
    • Caregiver at increased risk for health problems
    • ->understanding of needs and training interests
  17. 3 critical components regarding successful family caregiving
    • communication (prognostic information, alternative levels of care, respite care)
    • Decision making
    • reciprocity (caregiver and patient, empathy, listening and partnership)
  18. Future of home care
    • More focus on practice (client care, best practices, pharmacology,...)
    • Agencies are improving standards
    • Changes that emphasize care to accentuate family and client empowerment
    • Increasing important role in community-based care
    • Welcome increased use of technology
  19. Medicare reimbursement
    • The client must need skilled care: there won't be payment for bathing and dressing, if this is all the patient needs
    • 2 The client must be homebound: condition that restricts ability to leave home
    • Leaving home requires special assistance, transportation, devices
    • 3 need of nursing care that is part-time and intermittent'
    • 4 plan care must be authorized by physician
    • 5 Care must be medically reasonable and necessary
    • 6 Pay only for interventions on treatment plan
    • 7 Home health agency must be approved by Medicare