acute illness, long-term health conditions, permanent disability, or terminal illness

Over 70% of home visits are for

clients older than 65

Clients that use home health usuallyhave a good support system and someone living with them as a care giver.

Treu or False

False

One third of those receiving home visits live alone

Medicare/Medicaid finance > 75% of home health services

Cost containment pressures

Aging population with increasing dependency needs

Advanced technology allows for sophisticated care in home

Integrates medical/surgical, community health, family health, gerontological and psychiatric mental health nursing in home health care practice

A Purposes of home health is to have what type of nursing given to clients in their place of residence?

Comprehensive nursing care and skilled nursing services are given to clients in their place of residence

Focuses on environmental, psychosocial, economic, cultural, personal lifestyles and limitations that affect health status

(holistic health care)

One purpose of home health care is to decrease nosocomial infections.

True or False?

Though Home Health care is beneficial to the individual pt it does not decrease costs of health care for unnecessary hospitalization.

True or False?

The Home setting needs to be safe

Service must be provided effectively in home environment

For a pt to be eligable for home health a time line of care must be in place.

True or False?

True

Services provided are reasonable and necessary, intermittent and time limited.

Documentation is required for Medicare reimbursement – including diagnosis, prognosis, functional limitations, medications and types of services needed

observation and assessment, teaching, procedures requiring nursing judgment

Set up primary contact with physician

Ability to identify and access community resources

Interdisciplinary collaboration and coordination skills

What is the Home Health Nurses’ Role?

Health Monitoring

Medication instruction including safety

Teaching about disease processes

Assessing and teaching home safety

Teaching about treatment processes to the client and/or family including managing complex technology

Infection control in the home and community

Documentation is accurate and thorough for payment

Coordination of para-professionals involved in the patient’s care

Advocacy, especially in negotiating the complex medical care reimbursement system

Patients who require intravenous and intramuscular injections

Patients needing Foley catheter insertions

A patient who requires teaching related to illness or injury until they can demonstrate independence in their care.

 Patients in need of medication management which also requires a nursing assessment (such as blood pressures, pulses, respiratory assessment, blood sugars, oxygen saturations), monitoring of medication changes or physician consults.

Management and evaluation of plan of care

Wound and decubitis care

Tube feedings, TPN and enterostomal care

Ventilator dependency and care of tracheostomy tubes

Diabetes care and insulin injection and glucose monitoring, IV treatments including chemotherapy and antibiotics

Wear a name tag and a uniform or other apparel that identifies you as a nurse

Do not carry a purse or wear expensive jewelry

Carry a cellular phone

Agency knows itinerary

Do not enter home without an invitation

Who is Hospice Care for?

Hospice care is for a terminally ill person who's expected to have six months or less to live, but hospice care can be provided so long as the person's doctor and hospice care team certify that the condition remains life-limiting.

·        Has less than 6 months to live

·        Treatment is palliative, not curative

·        Family members assume much of the care

Patients and family govern care

Help make patients remaining life comfortable, peaceful and meaningful

Psychological and spiritual support of dying patient as well as physical

Relief of pain and other symptoms of palliative care

Helping patients die with dignity

Assisting families with the grieving process during and after death of the loved one (bereavement support groups)

freestanding (dedicated hospice facilities)

Large volunteer staff

No high tech equipment, only for comfort

Respite care for family

Decision by client/families

Assists with comfort measures, terminal care giving needs, immediate bereavement care to family

If your loved one is in a long term care facility they do not qualify for hospice care.

True or False

False

Hospice care is also available at hospitals and nursing homes 

A hospice care team typically includes: 

A primary care doctor, Nurses, Home health aides, Spiritual counselors, Social workers, Trained hospice volunteers, and Trained bereavement counselors

What is the roll of the primary care doctor

 in hospice 

expertise in symptom management and end-of-life care 

What is the roll of the nurse

in hospice 

Nurses address symptom management, especially pain control, and other concerns about end-of-life, as well as provide support for loved ones.

What is the roll of the home health aid

in hospice 

Spiritual counselors such as chaplains, priests or lay ministers provide spiritual care and guidance for the entire family.

What is the roll of the social worker

in hospice 

Social workers provide counseling and support. They also address insurance and financial concerns.

Trained hospice volunteers offer a variety of services depending on needs, from providing respite for caregivers to helping with transportation or other practical needs such as grocery shopping and cleaning

What is the roll of the Trained bereavement counselor

 in hospice 

drug seeking is for the psychological euphoric effects and not for what the drug was intended to do such as pain control.

The changes in the brain chemistry causes intense craving and cannot be treated with just “will power” alone.

people take drugs for the purpose they were intended such as opioids for acute, chronic and intractable pain (Hospice Patients).  However, the longer the person is on the drug there is a progressive decreased responsiveness and larger doses are needed to achieve pain suppression.  The person’s primary motive is not to take the drug for the psychological positive effects, but rather for the physical effects that bring relief.

drug seeking behavior due to poor pain management and, once treatment is adequate, drug seeking behaviors stop.  Health Care Providers need to carefully assess the cause for drug seeking behaviors and strongly advocate for adequate pain control in their patients.

What Teaching can be done for family members about the signs and symptoms of approaching death:

·        Decrease in appetite and thirst

·        Losing control of bowel and bladder

·        Changes in the patterns of breathing and congested breathing

·        Withdrawal from daily life issues

·        Increased somnolence

·        Speaking to persons not physically present

·        Mottling in periphery of body

·        Expressing less pain

·        Restlessness or anxiety

·        Pain or discomfort

·        Spiritual support needs

·        Cultural traditions important to the family

What Support measures should you teach the family?

·        Allow them to sleep as desired

·        Support the patient’s decision not to eat or drink

·        Continue to touch the loved one and use comforting words

·        Re-position them if needed

·        Moisten their mouth with a moist washcloth

·        Keep a soft light in the room

·        Keep things calm around them and play their favorite soft music

·        Have visitors identify themselves and talk directly to the person

The best thing you can say to the bereaved is that you understand what they are going though and know how they feel.

True or False?

False

Don't say “I know just how you feel.”  “I understand.” 

Even if you think you do, you don’t

It is ok to say to the bereaved that you are not sure what to say at this time.

True or False?

True

 “I just don’t know what to say.”  is ok to say to the bereaved.

It is OK to recognize the difficulty of the bereaved situation. 

True or False

True

“I can’t imagine how difficult this must be for you.”  This tells the bereaved that you don’t really understand what they are experiencing, but opens the door to further communication if they so choose.

Which of these statements would comfort the bereaved most?

“It was God’s will.” “He/she is in a better place.”  

“It’s okay.” 

“He/she would want you to get on with your life.”

None of these!!!!!!!

“It was God’s will.” “He/she is in a better place.”  You may believe these statements, but they are not helpful to the bereaved that wants their loved one to be here!

 “It’s okay.” No, it’s not okay; they are hurting

“He/she would want you to get on with your life.”  Grieving people are doing the best that they can.  They need time and support to adjust to all the changes the death has created in their lives.