Home health care

To understand health care delivery system .

1. HOME HEALTH CARE Presentor -: Ruma Sen MN(Previous) RAKCON

2. OBJECTIVES Define home health care. Purpose of home heath care . Nursing Process approach of home health care. Types of services available in home health care. Home health care- Indian Scenario .

3. Definition Home Health Care is the provision of medically related professional,para -professional services and equipments to individuals and their families in their place of residence for the purpose of promoting, maintaining, or restoring health or of minimizing the effects of illness and disability.

4. Four Different Perspectives Official Services are provided to individuals and their families in their place of residence for the purpose of promoting, maintaining, or restoring health or of minimizing the effects of illness and disability. Patient Skilled and compassionate care is provided on a one-to-one basis in the comforting and familiar surroundings of the home.

5. In the home, the nurse encourages the patient to use imagery to relax and relieve pain. (From Lewis, S.M., Heitkemper, M.M., Dirksen, S.R. [2004]. Medical-surgical nursing: assessment and management of clinical problems. [6 th ed.]. St. Louis: Mosby.)

6. Four Different Perspectives (continued) Family It is a means to keep the family together as a functioning, integrated unit. Provider All disciplines involved are challenged to provide excellent care in often less-than-excellent conditions and surroundings.

7. Historical perspective Home care was formerly defined as simply providing physical care to the sick in their homes, but the scope and complexity of the concept and practice have grown . •Roots of the concept can be traced to the New Testament of the Bible, which describes visiting the sick as a form of charity. • The first home health care program in the United States was organized in 1796 as the Boston Dispensary. • The first visiting nurse service in the United States was formed in Philadelphia in 1886.

8. HISTORICAL OVERVIEW When Medicare became effective in 1966, it revolutionized home care by –Changing it to a medical rather than nursing model of practice –Defining and limiting services for which it would reimburse –Changing the payment source and even changing the reason home care was provided . Diagnosis-Related Groups (DRGs) –Congress enacted this prospective payment system in 1983 as a part of the Tax Equity and Fiscal Responsibility Act for hospitals receiving Medicare reimbursement. –Based on major diagnostic categories, a set rate is paid for the hospitalized patient's care rather than the “cost” or charges traditionally billed by institutions.

9. Historical Overview Diagnosis-Related Groups (DRGs) (continued) –The net effect of the change was a major shift of patients out of the hospital into their homes, extended-care facilities, or skilled nursing facilities. –This created a challenge in terms of volumes of patients seen, necessity of more skilled nursing care over intensive times, and the evolution of highly technical procedures in the home.

10. CHARACTERSTICTS Skilled or compassionate care. Involves family in care. Co-ordination with all diciplines . Independent decision maker. Accountability

11. Role of Home Health Nurse Advocacy Coordinator Educator.

12. SERVICE COMPONENTS SKILLED NURSING CARE PHYSICAL THERAPY SPEECH LANGUAGE THERAPY OCCUPATIONAL THERAPY MEDICAL SOCIAL SERVICES HOME HEALTH AIDE

13. COMMUNITY ORIENTED HOME HEALTH CARE-: PRINCIPLES

14. Agencies may have to comply with federal, state, and local laws and regulations via the following: – Licensure by the state –Certification by the state certifying body designated by the federal government Accreditation by an outside agency that evaluates how well the agency meets certain standards set by the accrediting organization.

15. Requisites of Home care The nurse should be well versed with-: Strong knowledge base. Knowledge of family dynamics. Cultural practices. Spritual values. Communication principles.

16. CHANGES IN HOME HEALTH CARE JCAHO is looking for agencies to establish ethics committees to handle issues that arise in the home. Psychiatric nurse clinicians are being reimbursed by Medicare for home visits. Social workers are taking a more active role in home health care. More home health agencies are employing nurse pain specialists to assess and manage pain control in the home .

17. Research Input-: Saba, V. (August 30, 2002) "Nursing Classifications: Home Health Care Classification System (HHCC): An Overview" OJIN: Online Journal of Issues in Nursing . Vol. 7 No. 3. . Abstract-: This paper provides an overview of the Home Health Care Classification (HHCC) System focusing on its two interrelated taxonomies: HHCC of Nursing Diagnoses and HHCC of Nursing Interventions both of which are classified by 20 Care Components. It highlights the major events that influenced its development, current status, and future uses. The two HHCC taxonomies and their 20 Care Components are used as a standardized framework to code, index, and classify home health clinical nursing practice. Further, they are used to document, electronically track, evaluate outcomes and analyze home health care over time, across settings, population groups, and geographic locations

18. Result The two HHCC System taxonomies can be integrated into any home health system and linked electronically to any CPRS designed to collect the data required for federal home health care reporting and reimbursement. The system is being used to (a) improve the efficiency of assessing and documenting home health nursing care, (b) provide the strategy for evaluating quality and measuring outcomes of care, and (c) develop a costing method for reimbursement and payment. They are used to develop electronic clinical pathways, measure practice, and determine care costs. The two HHCC System taxonomies are available on the Internet, offering the world-wide nursing community the means to manage and monitor clinical nursing practice.

19. The Home Health Nursing Process-: Assessment_-: Admission –The initial evaluation and admission visits are made by an RN within 24 to 48 hours of the referral. The evaluation and admission process generally includes at least the following: •Complete patient evaluation •Environmental assessment

20. •Identification of primary functional impairments •Assessment of the family or significant other support system •Determination of knowledge and adherence to treatments and medication . •Determination of desire for care and services •Involvement of the patient and family in the development of the plan of care and goals . .•Notification to the patient of rights as a patient, along with costs, payment sources, and billing practices. •Explanation of the patient’s right to self-determination

21. Nursing Diagnosis-: Interrupted family process Impaired parenting Anxiety Caregiver role strain – Impaired physical mobility – Imbalanced nutrition Ineffective airway clearance Risk for impaired skin integrity Family coping, compromised Family coping, disabled Coping, ineffective –Ineffective management of therapeutic regimen Knowledge, deficient Risk for caregiver role strain Risk for injury

22. Implementation-: Care is provided by LPN usually but RN makes visits and educates the family The to enable them to participate in care .The nurse assists them in understanding medication administration ,range of motion exercises etc.They are provided with helpline numbers to consult when required or there is any change in clients condition.

23. PLANNING Careplan Visits Collaboration Clients needs Family needs Time frame Patient-centered goals and outcomes. With family for expected outcome.

24. DOCUMENTATION CLEAR ,CONCISE THE OMAHA SYSTEM THE NIGHTANGLE TRACKER SYSTEM

25. EVALUATION-: Evaluation is done periodically to check whether expected outcomes are met or not.If not then plan of care is revised.

26. HOME HEALTH CARE IN INDIA Home-based health care in India is gaining traction and is poised for transformation. Once an unorganized and fragmented sector, it is fast catching the attention of entrepreneurs and investors and becoming an organized, technology-led industry with standards and protocols. With life expectancy increasing significantly in India, home health care is becoming mandatory.

27. “The home health care market in India, currently estimated to be a $2 billion to $4 billion-a-year opportunity, is driven by an aging population, the increasing prevalence of chronic diseases and the need for better quality post-operative and primary care.”

28. India with a geriatric poulation of more than 100 million expected to rise 200 million by 2018. Home health services are at a very nascent stage and mostly provided by private companies in urban areas. Rural healthcare is still dependent on primary health care system where home health care is provided by primary health care centre. Rural health care sector is experiencing severe staff crunch thus unable to reach a large chunk of people still prefer to urban area.

29. Summary •Current trends support the growth of home care as an economical, humane, preferred health delivery system for many types of care. •Home care provides needed assessment and evaluation of chronic illnesses to prevent acute episodes. •Aides can provide necessary support in activities of daily living to enable the patient to remain in the home. •Skilled nursing and therapy offer rehabilitation and prevention of deterioration, as well as methods to cope with physical disabilities.  

30. Key points Home health care allows individuals to maintain personal control and to participate in the direction of their personal care. Families are an important part of the success of home care services as home care workers provide care, supervision, assistance, and support in attaining the care plan goals. Home health care is not a new concept; however, legislative, regulatory, and current health care trends have changed the way it is provided.

31. KEY POINTS Home health services are reimbursed by federal, state, local, group, and private sources. Although some aspects of nursing interventions in the home are the same as those practiced in other health care setting, home health care nurses pay particular attention to interaction and cooperation among family members, the patient, and other members of the health care team.

32. KEY POINTS The acuity levels of patients requiring care in their homes continues to rise, and the technological equipment, including use of mechanical equipment and invasive procedures such as intravenous therapies, are increasing in home care. These factors, when combined with shorter hospital stays, require extensive discharge planning to prepare patients and family for home health care.

33. “…home health care is a vital part of medical care, a link to the past, and a unique opportunity for service, commitment, and compassion.”

34. Bibliography-: Patricia.A.potter,Basic nursing practice,6 th edition,21-29 Taylor Carol,Fundamentals of nursing,5 th edition.Ch8-148-151 Susan.c.dewit,fundamentals of nursing skills,3 rd edition:56-69 Joyce . M.Black,Health care delivery system,8 th edition 71-118 www.nursing world.org/main menu/hhccoverview.html www.nursingcenter.comarticle_id_1287272

35. THANK YOU