Critical thinking question for all you experts

jenfnp · Mar 11, 2004

A client has a postive medical history for morbid obesity, incontinence, pulmonay emboli, sleep apnea, and chronic back pain. The client has a Foley catheter and a PICC line that is flushed with heparin, and is on coumadin. Does this client, living at home, need a home health nurse, and why?

Is the client able to provide his/her own care? If the person is able to ambulate, drive, cook, bathe, etc. on their own, then, no they don't need a home health nurse. They should be able to go to an outpatient facility (including the home health agency office) for any dressing changes or lab tests. It is also possible in some cases to teach the client to perform their own dressing changes and flushes. How long is the PICC going to be needed? Does the patient need a port-a-cath? If the client is capable of the care, medicare or other insurance provider may not cover home health care. It is important to preserve the client's self-care abilities, and dignity in addition to conserving our health care resources to ensure the ability to provide care when it is really needed.

have a great day.

jenfnp:)

RubyRN,CHPN · Mar 11, 2004

Is the client able to provide his/her own care? If the person is able to ambulate, drive, cook, bathe, etc. on their own, then, no they don't need a home health nurse. They should be able to go to an outpatient facility (including the home health agency office) for any dressing changes or lab tests. It is also possible in some cases to teach the client to perform their own dressing changes and flushes. How long is the PICC going to be needed? Does the patient need a port-a-cath? If the client is capable of the care, medicare or other insurance provider may not cover home health care. It is important to preserve the client's self-care abilities, and dignity in addition to conserving our health care resources to ensure the ability to provide care when it is really needed.
have a great day.
jenfnp:)

Hi Jen, thanks for your reply. A person's ability to ambulate, cook and bathe for themselves does not disqualify them from receiving home health services from a visiting nurse. If you are speaking of custodial care or a home health aid, that's a different story. I've worked as a RN Case Manager for 7 years in home health and don't know of any home health agencies who provide in facility wound care, picc line maint, foley cath changes, etc. This service is provided in the pt's home with a Dr's order to a pt who is homebound and wants it. If the pt is not homebound the individual by all means should go to outpt. clinic to receive care. Preservation of self care would not disqualify an individual from the services of home health nurse. Medicare has provisions for individuals who are homebound to receive long term skilled care in the home for management of foley cath, picc lines, port a caths, etc. Home health services are important to individuals to keep them independent as possible while in the home.