For an increasing number of patients, there’s no place like home… for health care.
Not only is home where most patients want to be, it offers positive outcomes at a more affordable price than acute care settings, says a Joint Commission report entitled, “Home — The Best Place for Health Care.”
Amy Berman, senior program officer for the John A. Hartford Foundation, called home health care the linchpin of the U.S. Department of Heath and Human Services’ National Health Care Quality Strategy because it delivers quality care at a more affordable cost, the report said. Home health care helps to avoid hospital readmissions and secondary infections, to better manage complex chronic diseases and to reduce the costs associated with hospital and nursing home stays.
Home health care organizations serve more than 8.6 million patients a year in the United States and that number is growing.
“Since we see the patients in their environment, we can address the barriers that may be keeping them from managing their disease. They may be confused about the instructions or not be able to afford the medication,” said Brian Rogers, a branch manager with Visiting Nurse Health System. “Our job is to devise the strategies and give them the tools they need to manage their disease and feel better.”
Sophisticated technology, a highly trained staff and close cooperation with hospitals and insurers make it possible.
“Home is where the vast majority of our patients want to be; it’s where they feel happier and comfortable. That’s especially true during the holidays,” said Rogers, a former ICU nurse who supervises 41 nurses and clinicians. “Patients don’t get to take time off from being sick, so neither do our clinicians. We all work some holidays to make sure everyone’s needs are met .”
Because patients would rather be with family during the holidays, doctors are more likely to send them home if it is safe to do so.
“We also see a greater demand for postsurgical therapy, as patients schedule more joint replacements and other surgeries at the end of the year to take advantage of paid deductibles,” Rogers said.
November, December and January holidays coincide with the cold-and-flu season, making older and medically fragile patients more vulnerable. Sometimes, celebrations exacerbate chronic conditions.
“Someone with diabetes may be more tempted to eat sweets and before he knows it, his disease is out of control and we’re called in to help him manage his symptoms. This season is a busy, but rewarding time for home health workers,” Rogers said.
“Caring for a hospice patient is different medically, psychologically, socially and spiritually during the holidays,” said Lanise Shortell, hospice and palliative pediatric nurse at Visiting Nurse Health System.
At the back of everyone’s mind is the thought that this may be the last holiday season with their child.
“We will visit more often to make sure that our children are very controlled medically and that their symptoms are well-managed so that they can spend times with those special visitors who have come to see them,” said Shortell, RN, CHPPN.
Hospice nurses spend more one-on-one time counseling and educating out-of-town visitors, so that they feel more comfortable seeing a patient.
“People are often shocked at the level of care we can provide at home. We can set up IVs and pumps, like in the hospital, and eliminate the stress of going back and forth for treatment. That helps everyone,” Shortell said.
It takes a team of doctors, nurses, dieticians, chaplains and social workers to care for hospice patients and their families.
“If a patient’s condition worsens, we may recommend moving up a holiday or birthday so that it can be celebrated, and we get invited to a lot of those celebrations because we become like one of the family,” she said. “We get close to our children, their parents, grandparents, pets and friends. They are all our patients.”
Visiting Nurse Health System social workers often work overtime as travel agents to help their young charges travel with their families, Shortell said. By contracting with other agencies, they’ve sent children to Disney World, Hawaii and to see grandparents.
“People think hospice is a sad thing, but we are so pro-life. We helped a family take a first family vacation to Myrtle Beach last summer. The mom cried when they got back, but she was so glad that they had done it,” she said.
Hospice care, particulaly during the holidays, allows family and friends to shower a patient with love and to say those things they want to say so that there are no regrets after a patient passes away.
“When we can help them live in the moment and have good memories, it helps families get through the loss later,” Shortell said. “It won’t take away the pain, but it eases it.”
Shortell likes the challenge of applying her clinical skills and compassion to give children and their families special moments to cherish.
“This isn’t a job. We celebrate with them, we get postcards and pictures and we carry a piece of every child we care for with us always,” she said. “Our patients give us inspiration and strength. They teach us to value the moments we have, and that makes our own holidays more of a celebration.”
Private-duty nursing care
For families of medically fragile patients, a private-duty nurse can be a godsend. For Carolyn Kimbrough, a nurse with PSA Healthcare in Atlanta, it’s a labor of love.
“You develop a relationship with your patients. You get to know their moods and needs, and you know that you’re giving their parents a sense of relief so that they can work or do what they need to do without worrying about their child. You become a trusted part of the family,” said Kimbrough, LPN. “It’s a lot of responsibility and can sometimes be overwhelming, but at the end of the day when the patient has a smile on her face and gives you a hug, you know it’s worth it.”
Kimbrough has been the primary nurse for Jada McAdoo for three years. Diagnosed with a progressive neurological disease when she was in middle school, McAdoo, 18, has memories of a life that included school, cheerleading and dancing.
“She’s like my child and I’m like her second mother,” Kimbrough said.
McAdoo is tracheotomy- and ventilator-dependent and receives nourishment through a tube. Recently she regained the ability to speak with the assistance of a Passey-Muir Valve.
“When I heard about this device, I jumped on it. She hadn’t been able to speak for a year,” Kimbrough said. “She can express herself. It just takes longer. Her grandmother cried when she heard her speak.”
Kimbrough’s first duty is to make sure the equipment is running smoothly and that McAdoo is stable. If she suspects something is wrong, she assesses her patient from head to toe.
“I’m like a detective who has to figure out what is going on. She coded on me a year ago and I had to take her to the hospital. She stayed two months but she’s much happier at home, so that’s where we want to keep her,” Kimbrough said. “She has moods and that’s OK. My goal is to let her live life as a teenager.”
When McAdoo is doing well, the nurse and her patient watch movies and TV shows, listen to music and talk.
“She loves the holidays. She has a tree in her room, and we’ll decorate it and sing carols. She loves socks, so I bring her ones with different holiday designs,” she said.
Kimbrough is even more vigilant about maintaining a sterile, disinfected environment at this time of year. She’ll ask visitors to wash their hands and wear paper coverings over their shoes.
“Her airways are already compromised, so I have to keep everything as germ-free as possible. She can tire easily with extra visitors, but she enjoys the holidays, and afterward it will be just us hanging out like normal,” Kimbrough said.
The nurse, who has worked in home health care since 1995, relishes the relationships she develops with each patient.
“Each diagnosis is different and the equipment changes frequently, but my level of care is always the same,” she said. “It’s why I’m here. I thank God I can be a nurse.”