Partners in
Education
Home Health and Community Nursing
Objectives
|
|
|
Discuss the Partners in Education
Program |
|
Describe the history of home care |
|
Identify the different types of home
care providers |
|
Explain the current state of home care |
|
Identify home health employees |
|
Describe homecare practicum experience |
|
|
|
|
|
|
Partners in Education
Program
|
|
|
What is the Partners in Education
Program |
|
What are the benefits of the program |
|
Who is eligible to participate |
What is the Partners in
Education Program ?
|
|
|
Program that joins business and
academia |
|
Expands the educational curriculum |
|
Broadens learning opportunities |
|
Integrates home healthcare education
and practical experience into the community health curriculum |
|
|
What are the Benefits of
the Program?
Student Benefits
|
|
|
Greater body of knowledge to include
home health |
|
Acquire clinical skills and knowledge
through observation and performance of patient care in the homecare
environment |
|
Witness the many benefits of homecare
and expand career opportunities by considering homecare as a career |
School Benefits
|
|
|
Program incorporates homecare education
and practical clinical experience into community health curriculum, providing
a more comprehensive experience |
|
Expands business and community
relationships and services |
|
Advances local community and economic
development through additional career opportunities for nursing graduates |
School Benefits
|
|
|
|
Aligns the school with the nation’s
leading homecare company |
|
Clinical experts from Gentiva are able
to serve as guests speakers in topics such as: |
|
Homecare technology |
|
Healthcare compliance |
|
Utilization management |
|
Joint Commission on Accreditation |
|
Health Insurance Portability and
Accountability Act |
Gentiva Benefits
|
|
|
Develops a stronger corporate
citizenship through community involvement and economic development |
|
Nurses will experience the benefits of
being a home health nurse |
Who is Eligible to
Participate?
|
|
|
Students currently enrolled in an
accredited course of study in nursing or related health topics |
|
Eligible students who meet state,
school and Gentiva requirements to participate as student observers and
providers of care under direct supervision of a nurse preceptor |
Student Responsibilities
|
|
|
|
Assume responsibility for learning
experience |
|
Follow all company policies and
procedures |
|
Provide agency with required health
clearance documentation |
|
Physical exam |
|
TB clearance |
|
Immunization against communicable
diseases |
|
Provide agency with proof of OSHA
training |
|
|
|
|
Student Responsibilities
|
|
|
Conduct behavior in a professional and
ethical manner |
|
Respect the confidentiality of patient
health information |
|
Provide the agency with student
learning activities plan |
|
Complete evaluation of student
experience |
History of Home Health Care
History of Home Health Care
|
|
|
Not new and innovative concept |
|
For centuries, families cared for sick
and disabled loved ones at home |
Organized Home Care
1885-1910
|
|
|
|
Most seriously ill individuals were
treated at home |
|
Nurses chose to work in the home rather
than in a hospital |
|
Most nurses remained with the patient
24 hours/day |
|
Around 1910 shift from private duty
nursing to home care visits with focus on: |
|
Direct patient care |
|
Teaching family members to care for
sick relatives |
Organized Home Care
1885-1910
|
|
|
Infectious diseases prevalent resulting
in high death rate so nurses focused on providing lessons on physical and
moral hygiene |
|
Trained nurses taught skills for
healthy living and personal responsibility for health |
Expansion of Visiting
Nurses 1911-1929
|
|
|
|
American Red Cross |
|
Established rural visiting nurse
service |
|
Helped local chapters establish
community visiting nurses services |
|
Opened an average of 68 visiting nurses
programs monthly |
|
Metropolitan Life |
|
First insurance company to offer
visiting nursing benefits to policyholders across the country |
|
Nurses worked for either public or
voluntary agencies |
Centralization of Hospitals
1930-1954
|
|
|
Fewer patients were sick at home |
|
Hospitals were preferred for medical,
surgical and obstetrical patients |
|
Private duty nursing was now provided
in hospitals |
|
Reduction in need for training home
care nurses |
|
Metropolitan life terminated its
visiting nurses benefits |
|
Red Cross’s national nursing service
was closed |
Rebirth of Home Care
1955-1964
|
|
|
|
The rebirth of home care is attributed
to: |
|
The rising cost of hospital care |
|
Increase in chronic illness |
|
Rapidly aging population |
|
Three types of formalized home care
providers |
|
Hospital based home care |
|
Community based home health service |
|
Home maker services |
Rebirth of Home Care
1955-1964
|
|
|
|
Funding for these home care providers
was limited to: |
|
Private contributions |
|
United Way |
|
Local health and welfare departments |
|
Fees charged to patients. |
Acceleration of Home Care –
1965 to Current Day
|
|
|
Increase of chronically ill and
disabled patients put financial strain on agencies for funding |
|
Medicare legislation provided home care
services to the elderly |
|
Medicaid legislation provided home care
services to the poor |
|
Older American Act provided home and
community support to older Americans as an alternative to
institutionalization |
Acceleration of Home Care –
1965 to Current Day
|
|
|
|
Home care recognized as: |
|
Cost containment measure |
|
Alternative to hospitalization |
|
Alternative to nursing home placement |
|
Medicare Diagnostic Resource Groups or
DRGs |
|
Hospital paid fee based on patient
diagnosis |
|
Sooner patient discharged, greater
chance hospital would benefit |
Home Care Providers
Home Health Agencies (HHAs)
|
|
|
20,000 HHAs in America |
|
Wide range of service |
|
Care team that provide and coordinate
patient care |
|
Available 24 hour a day 7 days a week |
Types of Home Care
Providers
|
|
|
Home health agencies |
|
Hospices |
|
Infusion therapy companies |
|
Respiratory therapy companies |
|
Durable medical equipment and supply
dealers |
|
|
Types of Home Health
Agencies
|
|
|
Traditional – visit or combination of
visit and shift |
|
Staffing |
|
Homemaker and personal care |
|
|
Home Health Agencies: Traditional
|
|
|
Nursing |
|
Physical, speech and occupational
therapy |
|
Medical Social Services |
|
Personal care |
|
|
Home Health Agencies: Staffing
|
|
|
Long term staffing in the home |
|
Institutional staffing - Company may
also provide temporary employees to institutions to fill open positions or to
supplement staffing during peak shifts |
|
Finder fee is charged or the company
may bill by the hour |
Home Health Agencies: Homemaker and Personal Care
|
|
|
|
Assistance with daily living activities |
|
Bathing |
|
Dressing |
|
Meal preparation |
|
House cleaning |
|
Companionship |
Hospices
|
|
|
|
Service for the terminally ill |
|
Interdisciplinary Team |
|
Skilled professional |
|
Volunteers |
|
Care provision |
|
Physical |
|
Spiritual |
|
Emotional |
|
Financial |
Infusion Therapy Companies
|
|
|
Medication |
|
Equipment |
|
Training |
Respiratory Therapy
Companies
|
|
|
Provide respiratory equipment, such as
C-pap machines and oxygen concentrators |
|
Rapidly growing segment of the industry |
Durable Medical Equipment
and Supply Dealers
|
|
|
|
Deliver, install and train the patient
to use equipment at home |
|
Respirators |
|
Wheelchairs |
|
Walkers |
|
Catheters |
Hiring a Caregiver Directly
|
|
|
|
Caregiver is hired outside of an agency |
|
Patient or family is responsible for |
|
Hiring |
|
Supervising |
|
Paying |
|
Decreased cost - increased risk |
|
|
Summary
|
|
|
20,000 HHAs in America |
|
Wide range of service |
|
Several different types of home care
providers |
Home Health Care Employees
Introduction
|
|
|
Health Services is one of the largest
industries in the country, with more than 11 million jobs, of which 6.3% are
in home health care. |
Working Conditions
|
|
|
Daily routine may vary |
|
Surroundings differ from case to case |
|
Clients may have a combination of
services requiring different levels of skills |
Home Health Care Employee
Base
|
|
|
|
Field Professional caregivers |
|
Field Paraprofessional caregivers |
|
Office support |
|
Administrative |
|
Clinical |
Field Professional
Caregivers
|
|
|
|
Registered Nurses |
|
Licensed Practical/Licensed Vocational
Nurses |
|
Therapists |
|
Physical |
|
Occupational |
|
Respiratory |
|
Language and Speech Pathologist |
|
Social Workers |
Field Paraprofessional
Caregivers
|
|
|
Home Health Aides |
|
Personal Caregivers |
|
Homemakers |
|
Chore Workers |
|
Companions |
Registered Nurses
|
|
|
|
Nurses |
|
Promote health |
|
Prevent disease |
|
Help patients cope with illness |
|
Assess patients’ conditions and home
environment |
|
Provide patient care and instructions |
|
Record symptoms, reactions and progress |
|
Supervise Home Health Aids |
Licensed Practical Nurses
(LPN) and Licenses Vocational Nurses (LVN)
|
|
|
|
Follows the direction of Registered
Nurses |
|
Provide basic care |
|
Observes patients and reports adverse
reactions |
|
In some states can administer
medication and IV fluids |
|
|
|
|
|
|
Physical Therapist
|
|
|
Provides care to patients with acute
orthopedic, nerve and/or muscle disorder |
|
Assesses current level of functionality
and creates individualized care plan |
|
Performs therapeutic treatment and
establishes a home program for patient/family to follow |
Occupational Therapy
|
|
|
|
Works on fine motor skills needed to
perform activities of daily living |
|
Dressing |
|
Eating |
|
Grooming |
Respiratory Therapy
|
|
|
Tests lung capacity and analyzes oxygen
and carbon dioxide concentration |
|
Measures patient’s potential of
hydrogen (PH) |
|
Provides temporary relief to patients
with chronic asthma or emphysema |
Speech and Language
Pathologist
|
|
|
|
Performs patient evaluations |
|
Provides services to patients that have
disorders with |
|
Communication |
|
Swallowing |
|
|
Social Worker
|
|
|
|
Helps people function in their
environment |
|
Provide Counseling to help the client |
|
Identify concerns |
|
Consider effective solutions |
|
Finds reliable resources |
|
|
Home Health Aide
|
|
|
|
Provide non-skilled care |
|
Personal care |
|
House keeping |
|
Meal preparation |
|
Dressing |
|
Companionship |
|
Supervised by RN or PT |
|
Report changes in patient’s condition
to supervisor or case manager |
|
|
Office Support
|
|
|
|
Administrative support staff |
|
Scheduling |
|
Payroll/Billing |
|
Record maintenance |
|
Clinical managers |
|
Overall responsibility for patient
management |
|
Supervision and management of field professional and paraprofessional
staff |
Caregiver Related
Challenges
|
|
|
Stranger in the house |
|
The patient resists care from the
caregiver |
|
Professional boundaries break down
between the caregiver and the family |
|
The caregiver and family push
boundaries of allowable care |
|
The family desires to fire the agency
and retain the caregiver |
Current State of Home Care
The Market Opportunity
|
|
|
|
2004 Home Care Spending - $62.5
billion* |
|
Home care industry growth drivers |
|
Aging population |
|
Medical/technological advances |
|
Patient preference for home care |
|
Changing family structure |
|
Cost advantages |
|
|
|
|
|
*Source: Centers for Medicare & Medicaid
Services Projection |
The Cost Advantage
Aging Population = Higher
Spending
Home Care Statistics
|
|
|
|
8 million Americans receive home health
care |
|
20,000 organizations provide home
health care |
|
7,000 Medicare certified |
|
13,000 Not Medicare certified |
|
|
The Home Care Market
Home Care Goals
|
|
|
Reduce hospitalization and nursing home
days |
|
Reduce emergency room visits |
|
Allow terminal patients to die at home |
|
Provide support for patient’s caregiver |
|
Enhance optimal growth and development |
|
Enhance functional potential |
Most Likely Users of Home
Care
|
|
|
|
Women are more likely then men to use
home care |
|
Those most likely to have a home care
visit |
|
Aged 85 and older |
|
Widows |
|
Living alone |
|
Having difficulties with basic daily
activities |
|
|
Top Home Health Diagnoses
Top 5 Diagnoses: GHS
Home Care: Significant Role
Home Care Practicum
Homecare Practicum
Experience
|
|
|
Assignment of student to agency |
|
Notification by preceptor to student |
|
Make arrangements to meet preceptor at
agency for first day |
|
Schedule dates with preceptor for
future practicum days |
Homecare Practicum
Experience
|
|
|
Follow Learning Activities Plan |
|
Regularly review student experience
with preceptor |
|
Document on appropriate forms if
performing a skill |
|
|
The Home Care Admission
|
|
|
Receiving a referral |
|
The initial patient assessment |
|
Establishing the Plan of Treatment |
Referral
|
|
|
|
Received from: |
|
Facility |
|
Physician office |
|
Insurance verified |
|
Initial orders are received for care |
|
Assessing professional scheduled to
perform initial patient assessment |
Initial Assessment
|
|
|
|
Skilled need |
|
Appropriate for homecare |
|
Safe environment |
|
Appropriate/adequate resources |
|
Ability to learn |
|
Report findings to clinical manager |
|
Plan of treatment is established |
|
|
Plan of Treatment
|
|
|
|
Assessment |
|
Problem identification |
|
Goal are determined |
|
Care delivery |
|
Patient Teaching |
|
Coordination of care |
|
|
Resources
|
|
|
Micromedex/CareNotes Patient Education
Material |
|
Gentiva University |