Home health care is experiencing dramatic growth, which presents its managers with challenges of a magnitude unseen in the past. As their organizations become more complex and their staffs become larger and more diversified, these managers must demonstrate skill in directing and guiding their organizations. They face the same administrative situations as other health care managers, but have some additional handicaps to overcome. Specifically they have to be unusually innovative and creative. The components of management that differentiate effective managers from ineffective are discussed in terms of their application to home health care.
UR ISSUE EDITOR, Pat Green, has been on the editorial board of Home Health Care Management & Practice since 1994. She has personally contributed several articles to the journal in her area of expertise, pediatrics. Pat is a graduate of the University of Pittsburgh, where she received a bachelor’s of science degree in nursing and a master’s degree in nursing education. Pat is certified in staff development and continuing education and has a wealth of pediatric and maternal child experience, which she willingly shares with others. She has twice served in the capacity of item writer for the NCLEX examination in the area of
A transition from utilization review to utilization management and quality improvement (UM/QI) is occurring in home health care today. Prior authorization of payment by managed care companies for services delivered by providers is an area of concern. Questions arise regarding service delivery, payment, and patient need. Health care reform calls for agencies to take a closer look at their utilization patterns regardless of the payment source. Services delivered must match patient need for care if the outcomes are to be of high quality and the care cost effective. The UM/QI specialist must be aware of the expectations and requirements of managed care companies, federal and state regulatory agencies, accrediting bodies, and, ultimately, the patients whom they serve. This article discusses the potential conflicts faced by providers and the role of the UM/QI specialist in home health care today.
As the use of clinical pathways spreads from the hospital setting to home care, it is tempting for home care agencies to aggressively implement their own clinical pathway programs. However, clinical pathway implementation without careful consideration of process issues and staff educational needs can be highly problematic. Pro-Health Home Nursing Services of Cincinnati, Ohio, presents the process support and educational program behind its total knee replacement clinical pathway. They conclude with their list of development and process guidelines for the implementation of clinical pathways in home care.
Medical nutrition therapy is a vital component of nutritional management of diabetes in home health care. Many studies document the cost-saving and therapeutic benefit of nutrition intervention in diabetes care. Home health care agencies need to have dietitians on staff for nutrition assessment, counseling, and development of individual patient care plans. Dietitians can help to train nurses and home health care aides in interdisciplinary patient care that incorporates the 1994 nutrition recommendations and principles for people with diabetes mellitus. There are benefits and barriers to home health care nutrition visits, and providing medical nutrition therapy to home health care patients with diabetes can bring about lasting, permanent change.
The home health care practitioner who works with elderly clients is oftentimes confronted with the competing interests of the patient, family members, medical community, and community at large. A correct understanding of legal and ethical issues relating to the right to die will help home health care agencies adopt appropriate clinical policies to guide practitioners.
As we approach the turn of the century, the field of medicine also approaches a turning point. Health care expense has soared, and often patients are not feeling better. It is time to reevaluate the therapies and their use. Massage is over 2000 years old, yet some are just discovering it as a healthful therapy. Many have not considered the numerous ways massage and similar adjunct therapies can benefit those who receive home health care.
Tuberculosis (TB) is on the rise. An estimated 10 to 15 million people in the United States are infected. This resurgence poses a challenge to all health care providers, including home health care professionals, where many patients fall into the "high risk" category. Therefore it is urgent that home health care agencies look at their prevention and control measures and ensure that guidelines are current for preventing the transmission of TB. Most importantly, there should be comprehensive TB education for all staff. With this knowledge, home health staff can assist in the early identification and treatment of patients with this debilitating disease.
Between the 1940s and 1950s, over 250,000 persons survived the polio epidemic with a variety of disabilities. As varied as the "victims" involved in this epidemic, so were the resulting disabilities, ranging from total dependence on a ventilator to localized muscle weakness. Most polio "survivors" have led productive lives; however, in the past decade many survivors have reported a resurgence in muscle weakness, fatigue, difficulty in swallowing, insomnia, respiratory difficulties, and pain: postpolio syndrome. Darlene contracted polio at the age of 3 in 1955. Since this was at the "end" of the epidemic, she was a younger victim. This article is an overview of one woman's challenges and successes: the ability to live a full life with a disability.
The restructuring of the health care system will result in expansion of health promotion and disease prevention services in the community. Nurses in education and home health care can work together to develop practice models of the future by using the resources of both institutions to improve the community's health. The Neighborhood Wellness Center, a nurse managed center, is described and the benefits to home care, nursing education, and the community are discussed.
The human immunodeficiency virus (HIV) continuum of care within the Inova Health System (IHS) has three levels of management: individual case management, linkage management, and disease-state management. Individual case management takes place at each operating unit— physician's office, hospital, home health care setting, or hospice—and has a multidisciplinary team that addresses treatment, education, therapy, and counseling. Inova Home Health and Hospice of Northern Virginia developed a staging tool to objectively determine the appropriate level of care and to provide a seamless transition between home health care and hospice. Inova's HIV Services provides the disease management component, incorporating proactive and cost-effective management of patients through the disease life cycle and across all settings.
A retrospective chart audit of home health care clients with the primary diagnosis of insulin-dependent diabetes mellitus (IDDM) revealed that the average number of visits for care exceeded the average number of visits for teaching. Using Orem's Self-Care Deficit Theory of Nursing, a critical pathway was designed to extend the number of visits incorporating teaching and to sequence teaching so that the client/caregiver would not be overwhelmed with instruction at the beginning of care. Physiologic needs and safety are addressed first on the pathway, followed by health promotion and disease prevention. A flexible method for documentation minimizes variance.
