38 CHAPTER 8 / Home Care
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1
Define home health care.
Concepts for Lecture
1. Historically, home care consisted primarily of nurses providing
private–duty care in clients’ homes and care of the ill by their own
family members.
Home care today involves a wide range of health care profes-
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2
Compare the characteristics of home health nursing to those of institutional
nursing care.
Concepts for Lecture
1. Home health care nursing, or visiting nursing, includes the nursing
services and products provided to clients in their homes that are
needed to maintain, restore, or promote their physical, psychological,
and social well-being.
C
HAPTER
8
HOME CARE
S
UGGESTIONS FOR
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LASSROOM
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CTIVITIES
•
Give examples of situations in which home
care may be used as an alternative to hospital-
ization.
S
UGGESTIONS FOR
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LASSROOM
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CTIVITIES
• Invite a panel of home health care nurses and
nurses who work in institutions to compare the
characteristics of home health nursing with those
of institutional nursing.
•
Have students discuss the advantages and
disadvantages they perceive in caring for the
client and family in the home.
CHAPTER 8 / Home Care 39
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3
Describe the types of home health agencies, including referral and reim-
bursement sources.
Concepts for Lecture
1. There are several different types of home health agencies: official or
public, voluntary or private not–for–profit, private, proprietary,
institutional-based, and private–duty agencies. All must meet specific
standards for licensing, certification, and accreditation.
Private, proprietary agencies are for-profit organizations and are
governed by either individual owners or national corporations. Some
2. Home care agencies receive reimbursement for services from various
sources: Medicare, Medicaid, private insurance companies, and pri-
vate pay. Medicare and Medicaid programs provide reimbursement
for home health care services; however, these agencies have strict
3.
Clients may be referred to home health care providers by a physician,
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4
Describe the roles of the home health nurse.
Concepts for Lecture
1. Major roles of the home health nurse are those of advocate, caregiver
(provider of direct care), educator, and case manager or coordinator.
As an advocate, the nurse explores and supports the client’s
S
UGGESTIONS FOR
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LASSROOM
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CTIVITIES
•
Invite a panel of guest speakers to discuss
home health care delivery in your community.
Ask each to discuss the types of client services
and types of nursing care provided. Ask the
panel members to address the process of reim-
bursement.
nursing assessment information, plan of care,
client and nurse safety issues, infection control,
and caregiver support. Have each student share
S
UGGESTIONS FOR
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LINICAL
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CTIVITIES
• Arrange for a variety of home care clinical
experiences for students. Assign students to
keep a journal of their experiences in which
they document how the home health nurse en-
acted the roles of client advocate, caregiver,
educator, and case manager.
40 CHAPTER 8 / Home Care
The educator’s role of the home health nurse focuses on teach-
ing illness care, the prevention of problems, and the promotion of
wellness or well–being in the client, the family, and other related
persons. It may involve teaching others with whom the client inter-
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5
Identify the essential aspects of the home visit.
Concepts for Lecture
1. The goal of the initial home care visit is to obtain a comprehensive
clinical picture of the client’s needs and begins with the documents
2. Following this initial assessment, the nurse determines whether
3. The data required by Medicare for the nursing plan of care include:
all pertinent diagnoses; a notation of the client’s mental status; types
4. On subsequent home visits, the nurse observes the same parameters
5.
Documentation of care given and the client’s progress toward goal
S
UGGESTIONS FOR
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CTIVITIES
• Obtain copies of the forms several home health
care agencies use to “open a case.” Review these
with the students.
•
Review the Medicare requirements for the
nursing plan of care listed in Box 8–1.
process enacted during the visit and the type
CHAPTER 8 / Home Care 41
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6
Discuss the safety and infection control dimensions applicable to the home
care setting.
Concepts for Lecture
1. Hazards in the home are a major cause of falls, fire, poisoning, and
3. Other aspects of client safety relate to emergency situations.
Ways the home health care nurse can assist the client and caregivers
4. Some less-desirable living locations pose additional personal safety
concerns for the nurse. Many home health agencies may have
5. The goal of infection control in the home is to protect clients, care-
givers, and the general community from the transmission of disease.
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7
Identify ways the nurse can recognize and minimize caregiver role strain.
Concepts for Lecture
1. Signs of caregiver strain include difficulty performing routine tasks
2. The nurse needs to encourage caregivers to express their feelings and
also convey understanding about the difficulties associated with
S
UGGESTIONS FOR
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CTIVITIES
• Have the students explore their state health de-
partment website to determine the process to be
followed to enroll in a program to place all med-
ical information in a location for emergency per-
sonnel access.
S
UGGESTIONS FOR
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LINICAL
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CTIVITIES
•
Determine whether the institution offers a week-
end respite program, and ask a representative of
the institution to discuss this program.
sion increases caregiver confidence and increases the likelihood of
caregivers asking for assistance in other situations.
When activities for which assistance is required are identified,
the nurse and caregiver need to identify possible sources of help,
such as volunteer and agency sources.