Academic journal article Care Management Journals

Understanding Home Care as a Treatment Option

Academic journal article Care Management Journals

Understanding Home Care as a Treatment Option

Article excerpt

Every day, thousands of older persons are discharged from hospitals and many of them receive some form of home health care. Whether that need for care is generated by ill health or an accident, owes to a chronic condition, or is just brought on by the natural aging process, home health care is often the treatment of choice, primarily because most people would prefer to remain at home over being placed in a nursing home. And there are significant reasons for this preference.

In addition to being in the familiar surroundings of home and community, at home there is less chance that individuals will face exposure to pathogens, including multi-drug-resistant bacteria. Additionally, when care is provided in the home, the patient receives the attention of a caregiver who is focused solely on that person's health needs. Finally, being home generally comforts patients and provides an increased incentive to improve.


Home care is care provided to patients in their homes to restore their functional capacity, to allow them to manage their care independently, and to enable them to remain safely in the community. Unfortunately, long-established images of home care consist of visiting nurses simply performing vital sign measurements and changing dressings while home companions do household chores. This, however, is an especially narrow view. Today home care can include skilled nursing, physical therapy, occupational therapy, speech language therapy, respiratory and infusion therapy, home health aides, social workers, and nutritionists. Patients are provided with needed durable medical equipment, diagnostic testing and laboratory services. Sometimes, when required, clinical nurse specialists are called upon to provide supervision or direct treatment for specific conditions; for example, wound care, congestive heart failure, diabetes or asthma.

Additionally, the availability of technology-based solutions that can now be provided in the home makes it feasible for patients who at one time had no choice but to enter a hospital to be adequately cared for in the community. "[T]he high-tech home care industry has rapidly and relentlessly erased, for increasing numbers of families, the boundaries between hospital and home, between intensive care units and the living room" ( Arras, 1994, p. S1).


From the hospitals' perspective, discharging patients to home care can provide the following benefits:

* Assist in reducing length of stay

* Provide continuity of care, ensuring that patients can remain safely in their homes

* Improve outcomes and increase patient and caregiver satisfaction

* Reduce patient exposure to hospital-acquired infections

* Help prevent avoidable rehospitalizations and ER visits

Following hospital discharge, many patients continue to have issues that require ongoing care. For example, patients who are hospitalized because of the onset of a new medical condition or the exacerbation of a chronic one, have wounds that may require complex treatment, or are deconditioned or at risk of falling, are all good candidates for home care. An effective way to determine whether home care is appropriate for any particular patient is to consider what interventions are going to be required in the next phase of recovery. Then consider the most appropriate setting for this patient's needs. If these interventions can safely be provided in the home, this is likely where patients would prefer to be and the venue where they will best progress.


The general indication for a referral to home care is the existence of "skilled needs." The professionals in home care can provide for the patient's skilled needs, that is, those that fall under the general categories of management, evaluation, or instruction of the condition. See Table 1.

In addition, home care staff can discuss diagnoses, explain disease processes and expected outcomes, identify the correct health care provider to contact under which circumstances, make referrals to other needed health care providers, and generally support the patient's ability to master those skills that will maintain selfsuffi ciency at home. …

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