Home Health Nursing
With the push to reduce health care expenditures which include decreasing hospitalization rates and admissions to long term care, home health has been one area of nursing that has grown rapidly. The need for experienced home health nurses is high in most areas of the country.
Home health is an area of nursing that is primarily focused on caring for patients in their home. Nurses in this area make intermittent visits to the patient's home and sometimes in assisted living facilities seeing individuals there. The focus is to keep the patient in their home safely for as long as possible. Most visits are short term only and others are long term. Nurses may encounter patients from all across the lifespan and for all different kinds of health conditions.
Both LPNs and RNs can work in home health. Some employers may require RNs to have a BSN but this can vary widely.
Home health is expected to rise in the number of job opportunities. Organizations that hire home health nurses can be affiliated with hospitals and private non-profit or for profit companies. Some individuals are able to work as an independent provider and receive reimbursement directly for their services.
Nurses work exclusively in the patients' homes, with occasional visits a home office. These home visits usually take anywhere from 30-45 minutes to a few hours if a nurse is opening a new case. Nurses may face unsanitary conditions in home: exposure to cigarette smoke or parasites such as lice, scabies and bed bugs. Pets can be present as well. Driving is an integral part of this field and the nurse must be comfortable traveling.
Many home health agencies prefer or even require experience in home health nursing due to the meticulous documentation that is required for Medicaid and Medicare reimbursement. This documentation can be challenging to learn. Some may even be responsible for knowing how to properly utilize ICD-9 coding. Another reason for requiring experience is that the home health nurse has minimal supervision out in the field and decisions must be made independently. However some organizations are willing to train nurses new to the field.
Good communication and organization skills are imperative. Nurses organize their day by the number of visits he or she needs to make plus making time for the extensive charting required and drive time between different homes. They are also expected to communicate not only with patients and families but with physicians and other health care professionals. This may include social services organizations, insurance companies, respiratory and other medical equipment companies.
Visits comprise of assessments and evaluation of physical and mental conditions, assessment of safety in their home, and perform treatments or lab draws. Many of these visits may be patients who were recently discharged from the hospital or long term care facilities. Visits can also be done for medication administration and supervision of home health assistants who provide personal care. Teaching is an integral part in these visits.
Nurses are responsible for educating not only the patient but their caregivers as well. Home health nurses are usually more cognizant of reimbursement issues. Medicare visits are in general more particular in their requirements for reimbursement and patients are admitted short term for the most part. Forms such as the 485 are the "plan of care" that contain basic patient information along with medications and physician orders. This form is also important for reimbursement. Nurses must understand reimbursement for visits in order to properly plan their care before the patient must be discharged. Close communication and collaboration with other care managers from government and private insurance companies is important. Many times these care managers can approve more visits if the patient needs further care. Some Medicaid visits are much more long term but still requires knowledge of requirements for the patient to remain in the program.
Nurses may also visit patients for vital sign monitoring, wound care, monitoring drains, and intravenous therapy to name a few. Telehealth is another aspect of home health that involves remote biometric monitoring but not all organizations utilize this technology. This is a device that plugs into a phone line or data can be transmitted wirelessly. This is then sent to a database in the home office for nurses can evaluate. Blood pressure, pulse oximetry, pulse and weights are the most common factors.
Salaries can be paid per visit, per hour or even salaried. The amount of salaries vary widely. Some areas may pay nurses more than working in an acute care environment while others may pay considerably less. Mileage is paid but some agencies may not offer this option.
Home Healthcare Nurses Association
The American Association for Homecare
The National Association for Homecare and HospiceLast edit by DidiRN on Dec 2, '13
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