Key Terms: Home parenteral nutrition, Meditation, Respite care, T'ai chi.
Definition
Home health services refers to those health care services provided to the patient in his or her own home.
Description
Home health services can vary depending on the insurance coverage, but usually include nursing, physical therapy, occupational therapy, speech therapy, home health aides, social work, nutritional education, infusion therapy, blood drawing, and other laboratory services. Such services may also include bringing medical equipment into the home for patient use. Home health services do not provide around-the-clock care, but rely on the patient having other caregivers, such as family members, friends, or other community resources.
Home care services can be provided by many different organizations, such as the Visiting Nurses Association (VNA), home health agencies (which vary in the range of services provided), hospice organizations, providers of home medical equipment, and pharmacies with delivery services. Patients requiring a range of specialized services may find more continuity of care if one agency is able to provide all, or almost all, of the services they need. Hospice care is care provided to patients who are terminally ill. Most hospices care for their clients within the home. The goal of hospice is to help the client and their family deal with the physical, emotional, and spiritual issues associated with dying. Excellent pain management is a priority.
Nursing Care
Skilled nursing care provides the backbone for home care. Visits may include wound and ostomy care; infusion therapy such as home chemotherapy, antibiotics, or home parenteral nutrition (HPN); patient and caregiver teaching; ongoing assessment of the client's physical and emotional condition and progress; pain control; psychological support; and supervision of home health aides. The nurse may function as a case manager and coordinate the various other services the client is receiving. The nurse assesses the home environment for safety and for appropriateness of continued home care.
Physical Therapy
Physical therapists develop a plan for the client to restore (as much as possible) the physical condition lost following surgery or as a result of a decline due to the disease process. They also teach patients how to prevent further injury or deterioration and how to maintain gains made.
Occupational Therapy
Occupational therapists assist patients in restoring or enhancing their ability to perform their tasks of daily living. Patients may need to learn how to use adaptive equipment such as a prosthesis. The goal is to achieve the highest level of functioning possible.
Speech Therapy
Speech therapists work with clients who have difficulty swallowing or clearly communicating.
Home Health Aides
Home health aides function under the supervision of a registered nurse. They provide care with personal hygiene, such as bathing and dressing, feeding, and ambulating. They may assist a nurse in providing patient care. They may provide homemaking services and companionship, or those tasks may be covered by a homemaker or attendant.
Social Work
Social workers may assist clients in accessing the services that are available to them based on their insurance, and in learning what community resources exist. They may also facilitate the referral process, and provide counseling and patient advocacy.
Nutritional Education
Nutritionists and registered dieticians may educate clients on their nutritional needs, and on how to go about attaining them. They may also be involved if HPN is required.
Infusion Therapy
Some patients may receive their chemotherapy or antibiotics at home, or may require infusion of liquid nutrition (HPN). While these services may be provided by a nurse, a separate agency or company may provide the equipment and products.
Laboratory Work
Blood drawing and other laboratory services may be provided by a nurse, a phlebotomist, or a laboratory technician.
Home Medical Equipment
Following surgery or treatment in a hospital, patients may need the delivery and servicing of items such as special beds, wheelchairs, walkers, catheters, and wound care and ostomy supplies.
Volunteers
Volunteers may provide a range of assistance such as respite care for the primary caregiver(s), caring for the home, cooking, cleaning, emotional support, companionship, running errands, making telephone calls, child care, elder care, and providing transportation. They may come from the patient's circle of friends or religious organization, or from such agencies as Meals on Wheels.
Causes
Many individuals with conditions that do not necessitate care in a hospital setting often require short-term or long-term home care. They may need care to assist them in regaining their health similar to that prior to their illness, or may need ongoing care as their condition deteriorates due to metastatic disease. One trend that is gathering speed in the early 2000s is an increase in home health care services as opposed to nursing home care.
Special Concerns
Insurance coverage plays a major role in funding home health care. In organizing home care the patient must fully understand which services will be fully covered, covered but with a co-payment, or not covered at all. Insurance coverage may vary depending on whether the service provider is within a specified approved network. It must also be clear how often and for how long the services will be needed, and whether the insurance benefits cover the entire time period of anticipated care. The patient's safety must always remain a priority. The patient and the caregiver(s) may suffer from isolation and depression. Primary caregivers may become over-whelmed with caring for the patient, and there may come a point at which the level of care needed may no longer be able to be provided in the home setting. The health of the primary caregiver must periodically be assessed.
Treatments
Treatments provided in the home include wound and ostomy care, intravenous (IV) chemotherapy or antibiotics, HPN, and physical, occupational, and speech therapy.
Newer Trends and Future Concerns
One trend in home health care is greater use of the telephone and Internet for contact between home health care workers and medical professionals, and for information gathering. The U. S. Department of Health and Human Services has sponsored a new web site intended to help consumers as well as professionals make informed choices about home health care agencies. In addition, the growth of so-called telehealth systems has already had an impact on nursing education and practice in the home health care field. The field of telehealth is expected to expand dramatically in the early 2000s, as experts estimate that home health care is 10–15 years behind other fields in its use of computers.
Another trend is the growing emphasis on culturally sensitive home health care. In many cases, patients from minority ethnic groups and cultures are more comfortable being cared for in their homes by caregivers who share their background or have been trained to understand it than to be sent to large urban nursing homes where they are isolated from familiar customs and language. Studies of the feasibility of home health care for Native Americans in remote locations are presently being conducted in Canada.
One worrisome concern for the future is the increasing difficulty of recruiting and retaining high-quality home health care workers in the United States and Canada. The aging of the general North American population coupled with the high turnover in the field of home health care poses a serious problem for policy makers.
Questions to Ask the Doctor
- What kind of home care will I need?
- For how long will I need the different services?
- What happens if my condition worsens?
- Will my insurance cover the services you are prescribing?
- What kind of care is available to help my family care for me?
- Are there alternative therapies that would help my condition?
- Are any of these therapies covered by my insurance?
- Are there any side effects to these therapies?
- Who is in charge of making sure my pain is well controlled?
Alternative and Complementary Therapies
Clients may contract to have home acupuncture or massage therapy. On their own they may engage in yoga, t'ai chi, meditation, guided imagery, visualization, or other stress-reducing techniques that help them better cope with their situation. They may also choose to investigate herbal supplements and medications; all supplemental medications should be approved by a physician before use.
Resources
Books
Levin, Bernard. American Cancer Society: Colorectal Cancer. New York: Villard Books, 1999.
Runowicz, Carolyn D., Jeanne A. Petrek, and Ted S. Gansler. American Cancer Society: Women and Cancer. New York: Villard Books/Random House, 1999.
Teeley, Peter, and Philip Bashe. The Complete Cancer Survival Guide. New York: Doubleday, 2000.
Periodicals
Applebaum, R. A., S. A. Mehdizadeh, and J. K. Straker. "The Changing World of Long-Term Care: A State Perspective." Journal of Aging and Social Policy 16 (January 2004): 1–19.
Fermazin, M., M. O. Canady, P. R. Milmine, et al. "Home Health Compare: Web Site Offers Critical Information to Consumers, Professionals." Lippincott's Case Management 9 (March-April 2004): 89–95.
Hotson, K. E., S. M. Macdonald, and B. D. Martin. "Understanding Death and Dying in Select First Nations Communities in Northern Manitoba: Issues of Culture and Remote Service Delivery in Palliative Care." International Journal of Circumpolar Health 63 (March 2004): 25–38.
Lee, H., and M. Cameron. "Respite Care for People with Dementia and Their Carers." Cochrane Database Systems Review February 2004: CD004396.
Stone, R. I. "The Direct Care Worker: The Third Rail of Home Care Policy." Annual Review of Public Health 25 (2004): 521–537.
Williams, K. "Preparing Nurses for Telehealth: A Home Health Care Example." Medinfo 2004(CD): 1908.
Organizations
The American Cancer Society. 800–ACS–2345.
National Association for Home Care. 228 7th Street, S.E. Washington, D.C. 20003. 202–547–7424.
National Cancer Institute. Building 31, Room 10A31, 31 Center Drive, MSC 2580, Bethesda, MD 20892–2580. 301–435–3848.
National Center for Complementary and Alternative Medicine. NCCAM Clearinghouse, P.O. Box 8218, Silver Spring, MD 20907–8218. 888–644–6226.
Office for the Advancement of Telehealth. 5600 Fishers Lane, Room 7C-22, Rockville, MD 20857. (301) 443-0447. Fax: (301) 443-1330.
Visiting Nurse Association of America. 11 Beacon Street, Suite 910; Boston, MA 02108. 617–523–4042. Fax: 617–227–4843.
—Esther Csapo Rastegari, R.N., B.S.N., Ed.M.; Rebecca J. Frey, Ph.D.
