1. 1 Copyright © 2012 by Mosby, an imprint of Elsevier Inc. Copyright © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Chapter 41 The Nurse in Home Health and Hospice

2. 2 Copyright © 2012 by Mosby, an imprint of Elsevier Inc. Copyright © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Objectives 1. Compare different practice models for home- based services. 2. Summarize the basic roles and responsibilities of home health and hospice nurses. 3. Explain the professional standards and educational requirements for nurses in home health and hospice. 4. Describe the three components of the Omaha System.

3. 3 Copyright © 2012 by Mosby, an imprint of Elsevier Inc. Copyright © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Objectives, Cont’d 5. Analyze how nurses in home health and hospice use best practice, evidence-based practice, and quality improvement strategies to improve the care they provide. 6. Cite examples of trends and opportunities in home health and hospice involving technology, informatics, and telehealth.

4. 4 Copyright © 2012 by Mosby, an imprint of Elsevier Inc. Copyright © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Definitions  Interprofessional collaboration  Home health care  Home health nursing  Hospice  Palliative care  Family caregiving

5. 5 Copyright © 2012 by Mosby, an imprint of Elsevier Inc. Copyright © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Evolution of Home Health and Hospice  Originated in the nineteenth century  Initial programs evolved into visiting nurse associations  Henry Street Settlement House  Home health services included as a major benefit when Medicare legislation was passed in 1965  Hospice care introduced in 1970s by Florence Wald

6. 6 Copyright © 2012 by Mosby, an imprint of Elsevier Inc. Copyright © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Evolution of Home Health and Hospice, Cont’d  First comprehensive, integrated palliative care program established at the Cleveland Clinic in 1987  1999: Center to Advance Palliative Care (Robert Wood Johnson Foundation)  Medicaid reimbursement for hospice care began in 1980 and Medicare in 1983

7. 7 Copyright © 2012 by Mosby, an imprint of Elsevier Inc. Copyright © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Description of Practice Models Population-Focused Home Care Transitional Care Home-Based Primary Care Home Health Hospice

8. 8 Copyright © 2012 by Mosby, an imprint of Elsevier Inc. Copyright © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Population-Focused Home Care  Evidence-based and data-driven approach  Usually include structured approaches to regular visits with assessment protocols, focused health education, counseling, and health-related support and coaching  Examples  Patients with psychiatric illnesses  Pharmacist home visit to older adults with atrial fibrillation and heart failure  Elderly diabetic patients living alone  Nurse-family partnership  Program of All-Inclusive Care for the Elderly (PACE)

9. 9 Copyright © 2012 by Mosby, an imprint of Elsevier Inc. Copyright © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Transitional Care  Set of actions designed to ensure the coordination and continuity of health care as patients transfer between different locations and different levels of care in the same location  Low-intensity interventions  High-intensity interventions  Transitional care model

10. 10 Copyright © 2012 by Mosby, an imprint of Elsevier Inc. Copyright © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Home-Based Primary Care  Offers patients an alternative to receiving services in a primary care clinic, community center, or physician’s office  These patients have functional or other health problems that make the trip from their homes to other care sites very difficult.  Veterans Affairs Administration hospital- based home care program  Medical home

11. 11 Copyright © 2012 by Mosby, an imprint of Elsevier Inc. Copyright © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Home Health  Provide care at home, and help patients and their families achieve improved health and independence in a safe environment  Medicare-certified  Recipients have diverse needs  Most common diagnosis is cardiovascular disease, followed by neoplasms and endocrine diseases  Skilled nursing services

12. 12 Copyright © 2012 by Mosby, an imprint of Elsevier Inc. Copyright © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Types of Home Health Agencies

13. 13 Copyright © 2012 by Mosby, an imprint of Elsevier Inc. Copyright © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Hospice  Four types of care  Routine home care with intermittent visits  Continuous home care when condition is acute and death is near  General inpatient/hospital care for symptom relief  Respite care in nursing home of no more than 5 days at a time to relieve family members  Four general categories of hospice providers  Home health agencies  Hospital-based facilities  Skilled nursing facilities  Free standing facilities

14. 14 Copyright © 2012 by Mosby, an imprint of Elsevier Inc. Copyright © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Scope and Standards  Quad Council’s eight domains of practice  Nursing process

15. 15 Copyright © 2012 by Mosby, an imprint of Elsevier Inc. Copyright © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Omaha System  Initially developed to operationalize the nursing process and provide a practical, easily understood, computer-compatible guide for daily use in community settings  Electronic health records (EHRs)

16. 16 Copyright © 2012 by Mosby, an imprint of Elsevier Inc. Copyright © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Omaha System Conceptual Model

17. 17 Copyright © 2012 by Mosby, an imprint of Elsevier Inc. Copyright © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Omaha System, Cont’d  Omaha problem classification scheme  Four levels  Omaha intervention scheme  Four broad categories  Omaha system problem rating scale for outcomes  Five-point Likert-type scale for measuring the severity for the concepts of knowledge, behavior, and status

18. 18 Copyright © 2012 by Mosby, an imprint of Elsevier Inc. Copyright © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Practice Guidelines  Steps of a home visit  Clinical examples from practice  Martha P.  Mr. Jones  Arizona childcare health consultant program

19. 19 Copyright © 2012 by Mosby, an imprint of Elsevier Inc. Copyright © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Practice Linkages  Outcome and Assessment Information Set (OASIS)  Medication management  Infection prevention

20. 20 Copyright © 2012 by Mosby, an imprint of Elsevier Inc. Copyright © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Accountability and Quality Management  Evidence-based quality/performance improvement  Outcome-based quality improvement  Benchmarking  Accreditation

21. 21 Copyright © 2012 by Mosby, an imprint of Elsevier Inc. Copyright © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Professional Development and Collaboration  Education, Certification, and Roles  Master’s degree  Hospice and Palliative Nurses Association  Interprofessional Collaboration  Physical therapists  Occupational therapists  Social workers  Home health aids

22. 22 Copyright © 2012 by Mosby, an imprint of Elsevier Inc. Copyright © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Legal, Ethical, and Financial Issues  Medicare fraud and abuse  Living will  Power of attorney for health care  DNR documents  Local, state, and federal regulations  patient advocates  Malpractice

23. 23 Copyright © 2012 by Mosby, an imprint of Elsevier Inc. Copyright © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Trends and Opportunities  National health objectives  Healthy People 2020  Organizational and professional resources  Technology, informatics, and telehealth