July 16, 2015

What is home health nursing and what should you expect from in home care?

A-Nurse-in-the-Room-home-health-nursingNursing care is no “stranger” to a client’s home. Dating as far back as 1813 in Charleston, S.C., efforts to bring nursing care to the community has been an organized process.

At the time, the advent of major hospitals was still years away and most care (even from physicians) was centered where the client lived. Formal organizations began to spring up to address the public health needs of big cities (mostly in the northeast) and by 1909, nearly 600 organizations across the country were sponsoring the work of visiting nurses.[1] Home health insurance was even available then. Due to the concentration of population and industrialization, home health nursing (“HHN”) focused on cleanliness, hygiene, nutrition, and addressed many disease conditions it encountered.

Over the years, HHN went through many evolutions and almost became non-existent as hospital-focused care and reimbursement altered the healthcare approach. In the 1950’s and later, there was a re-discovery of HHN, especially with the start of Medicare. Now, HHN is a firmly established mode of care, recognized for its immense utility to keep patients out of costly hospitals, and of course, to provide treatment in a comfortable home setting.

The reason for noting the history of HHN is to remind us that process of providing care in the home is not new, and Epic Health Services is proud to continue the tradition started over 200 years ago. Despite that history, the nurse in your room is new to you and your house! In reality, they are, if you have never met them, a “stranger” in your home. It is a bit disorienting if you are not accustomed to having frequent nurses – and at all possible hours of the day.

Should you have expectations of them during their time with your loved one? Absolutely! Epic certainly does. Below is a brief list of expectations and guidelines for professional, cooperative nursing behavior.

  • Nurses are expected to be respectful and friendly at all times. They are literally a guest and should act like one. No assumptions should be made by them of where to sit, eat, use the bathroom or stow their gear. That is up to you. This is your home and your loved-one – whatever rules you have (unless they interfere with care) are honored.
  • Sometimes you “orient” the nurses because you have specific care routines and requests. If it is a new nurse in your house, they want to do the best job they can and that is best served by giving them the layout of supplies, where things are located, and any expectations you have.
  • Their time is to be devoted to the patient. Being on time is of paramount importance. Only the assigned hours should be worked and verified by you. Exceptions to this must be coordinated through your Epic office.
  • The nurse is expected to be neat and orderly. No odors (perfume, smoke, etc.) should be detectable. Cleaning up after themselves or with patient care is required.
  • Cell phone use should be at a minimum.
  • If there are down times during the shift, nurses are encouraged to ask your permission to read a book or mobile device. This is a concern, too, for night shift nurses, though monitoring of your loved-one occurs whether your loved one is awake or asleep. Documentation of the care delivered should be completed before the nurse leaves, except in emergencies. If by chance you discover your nurse nodding off, please notify the office. Please assist them by allowing sufficient lighting in the room to chart.
  • The physician provides specific clinical orders and care protocols, and we are to follow those orders. If the nurse is asked to go beyond what is noted in the plan of care, the physician will be followed up with to verify the additional orders.
  • You are to be given a “report” by the departing nurse if there is no shift to follow.
  • Medication administration is a big responsibility for the nurses. If you are out of a certain medication, please alert the nurse.
  • Due to unforeseeable circumstances, the nurse should know the address of your house and what exits are available. The office will call you about inclement weather to help prepare you for what to do in case of a power outage or other situation. This is true for clients with ventilators or dealing with other complex care needs.
  • What happens in your home is your business. Nurses are only concerned if it affects client care or themselves.
  • Mail from the office addressed to the nurse should be given to them promptly. Thank you for assisting in this communication route.
  • Use of “nanny-cams” or other recording devices is your choice. Informing the nurse of this fact is up to you!

Care for your loved-one is why we are there. If you have any questions or concerns, we welcome them and want to help with or resolve any issues as soon as possible. It is our distinct pleasure to provide care in your home, and to carry on a long tradition of home health nursing.

To learn more about home health care and home health nursing for your loved one, please request care here at the location nearest you.

[1] Home Healthcare Nurse: September 2012 – Volume 30 – Issue 8 – p 446–452

By Mark R. Ayers, RN BSN MHA

Regional Nursing Director, Houston