Home Health Services

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Home health services

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 agencies such 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.

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 overwhelmed 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.

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

Dollinger, Malin, Ernest H. Rosenbaum, and Greg Cable. Everyone's Guide to Cancer Therapy, Revised Third Edition. Kansas City, MO: Somerville House Books Limited, 1997.

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.

ORGANIZATIONS

The American Cancer Society. 800-ACS-2345. <http://www.cancer.org>.

National Association for Home Care. 228 7th Street, S.E.Washington, D.C. 20003. 202-547-7424. <http://www.nahc.org>.

National Cancer Institute. Building 31, Room 10A31, 31 Center Drive, MSC 2580, Bethesda, MD 20892-2580. 301-435-3848. <http://www.nci.nih.gov>.

National Center for Complementary and Alternative Medicine. NCCAM Clearinghouse, P.O. Box 8218, Silver Spring, MD 20907-8218. 888-644-6226. <http://nccam.nih.gov>.

Visiting Nurse Association of America. 11 Beacon Street, Suite910; Boston, MA 02108. 617-523-4042. Fax: 617-227-4843. <http://www.vnaa.org>.

Esther Csapo Rastegari, R.N., B.S.N., Ed.M.

KEY TERMS

Home parenteral nutrition (HPN)

—HPN provides liquid nutrition via infusion for patients who are malnourished, or who have had surgery altering the usual process of chewing, swallowing, or digesting food.

Meditation

—Meditation is a technique in which the individual focuses on a word or phrase to the exclusion of other thoughts. It has been shown to lower blood pressure and reduce stress.