Chapter 12: Home Health
Care Nursing
Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins
Growth in Number of Home Care Agencies
• 1967: 1,753
• 1975: 2,242
• 1985: 5,983
• 1995: 9,120
• 2000: 7,152
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Question
What event in the early 1980s contributed to the growth in
the home care industry?
A.
The implementation of diagnosis-related groups
(DRGs) for Medicare
B.
The establishment of HMOs
C.
Medicare and Medicaid legislation that allowed
payment for home care services for qualified
recipients
D.
A shortage of physicians
Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins
Answer
A. The implementation of diagnosis-related groups (DRGs)
for Medicare
In the early 1980s, the implementation of DRGs for
Medicare contributed to the growth in the home care
industry. This legislation was intended as a cost
containment measure.
Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins
Source of Payment for Home Care
Services
• Medicare
31.9%
• Medicaid
13.3%
• State and local government
15.7%
• Private insurance
18.0%
• Out of pocket
18.0%
• Other
2.9%
(Adapted from National Association for Home Care [NAHC], 2006.)
Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins
Cost of Home Health Care
• Hospital charges per day
1998
2003
$2,370
$3,838
$498
$499
$93
$109
• Skilled nursing facility
charges per day
• Home health charges
per visit
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Question
What would describe a “typical” individual receiving home care
nursing services?
A.
Over 65 years old; recently hospitalized
B.
Over 85 years old; has a disease of the circulatory
system
C.
Over 65 years old; recently hospitalized; has a disease of
the circulatory system; requires high-technology medical
interventions
D.
Over 85 years old; recently hospitalized; has a disease of
the circulatory system; requires high-technology medical
interventions
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Answer
C. Over 65 years old; recently hospitalized; has a disease of the
circulatory system; requires high-technology medical
interventions
More than 69% of clients served in home care are older than 65
years, and 17% are over 85 years of age. Recently hospitalized
individuals (within 30 days of discharge) make up a large
proportion of home care clients. Clients with diseases of the
circulatory system account for almost 31% of those receiving
home care services with Medicare reimbursement (NAHC,
2006). There are also an increasing number of clients requiring
high-technology medical interventions (e.g., intravenous
therapy, mechanical ventilation, parenteral nutrition).
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The Home Visit
• How do you begin the home visit?
• What assessment is essential for a home visit?
• How is the home visit documented?
• What place does confidentiality have in home care?
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Question
How do you begin the home visit?
A.
By immediately beginning the OASIS assessment
B.
With introductions and a short period of casual,
social conversation to put the client and family
at ease
C.
With a genogram
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Answer
B. With introductions and a short period of casual, social
conversation to put the client and family at ease
In some cultures, the family will place a great deal of
weight on getting to know the nurse before they will
allow the admission assessment to commence. One
nurse who specializes in transcultural home visiting
stated, “I know that the family is ready to begin the
admission interview when they offer me tea and food.” It
is important to begin building a trusting relationship from
the first greeting. A friendly, warm manner helps as the
nurse begins to ask the client questions about specific
health care needs.
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Personal Safety
• Get to know the neighborhood.
• Dress in sensible shoes and simple clothes.
• Know your client. Always note a history of violence.
• Keep your supervisor informed of potential violent
situations.
• Have safety accessories in your car (cell phone,
flashlight), and keep it well-maintained.
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Support of the Lay Caregiver
• Family and lay caregivers are important members of the
client's health care team.
• The stress and demands of caring for a loved one 24
hours a day, 365 days a year, takes a toll on family
caregivers.
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Support of the Lay Caregiver (cont’d)
• Leonard, Brust, and Nelson (1993) found that more than
half of parents caring for children dependent on hightechnology equipment had psychological symptoms great
enough to merit psychiatric intervention.
• An important role for the home care nurse is assessment
and support of lay caregivers.
Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins
Question
A 50-year-old retired government employee is caring for
his 50-year-old wife, who has advanced dementia. What
public health nursing interventions could you use to
address the needs of the client and his wife in this
situation?
A.
Health teaching
B.
Screening
C.
Counseling
D.
Outreach
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Answer
C. Counseling
Counseling establishes interpersonal relationships with
families or individuals to increase or enhance their
capacity for self-care and coping. In this case, the
family/spouse is the client.
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Question
A 20-year-old woman is caring for her 5-month-old baby,
who has frequent episodes of apnea. Immediate action
was frequently needed and, on one occasion, CPR was
needed to revive the baby. What public health nursing
interventions could you use to address the needs of the
client and her baby in this situation?
A. Health teaching and counseling
B. Screening
C. Collaboration
D. Consultation and collaboration
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Answer
A. Health teaching and counseling
Counseling establishes interpersonal relationships with
families or individuals to increase or enhance their
capacity for self-care and coping. In this case, the
family/parent is the client.
Health teaching communicates facts, ideas, and skills that
change knowledge, attitudes, values, beliefs, behaviors,
and practices of individuals and families.
Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins
Question
A 70-year-old woman is caring for her husband, who has
terminal lung cancer. What public health nursing
interventions could you use to address the needs of the
client and her husband in this situation?
A.
Case management; referral and follow-up;
counseling
B.
Health education; screening
C.
Outreach
D.
Health education; screening; referral and follow-up
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Answer
A. Case management; referral and follow-up; counseling
Referral and follow-up assist individuals and families to
identify and access necessary resources to resolve
concerns. Hospice would be a priority referral.
Case management optimizes self-abilities of individuals and
families to coordinate and provide services. Even at the
end of life, case management is important.
Counseling establishes interpersonal relationships with
families or individuals to increase or enhance their
capacity for self-care and coping. This would be for both
the client and the spouse.
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