Home Health ?!

Forest2 · Dec 22, 2017

Home care is unique and not like any other nursing I know of. The nurse guides the care of the patient, including who does what, when, how and who is going to pay for it. The nurse monitors the coverage of the payer, insurance, Medicare or Medicaid, etc. and constantly evaluates to see if the patient meets each entity's criteria for payment, they must notify the patient of costs and who pays for what and how much the patient is responsible for.

The nurse accesses resources for supplies, medications, food, IV's, etc and works with other providers to make sure they have the information for delivery, schedules deliveries and teaches patients and their families how to give IV's, medications and everything to care for the patient. The nurse monitors and draws the labs and takes it to the hospital for testing. In addition, calls the physician for orders for things they have omitted or the patient needs. We are the eyes and ears in the home and life of the patient. The goals are always to get the patient independent so discharge can be made, It is true discharging planning. The nurse teaches the patient all about their diagnosis and self-management of such. It is a huge responsibility. You develop an intimate relationship with the family and the patient. They may become very dependent on the nurse so it is important to give them the necessary support to be independent.

The nurse functions more autonomously than a hospital nurse, this is why the nurses that are hired usually are required to be experienced. The nurse makes a lot of independent decisions and provides hands on care in the home alone. So you better know how to assess, give care and teach patients.

It takes quite awhile to be a good HHC nurse because there is so much to learn about insurance and advanced beneficiary notices, as well as how to handle yourself. Critical thinking is vital. If you are not a confident nurse you will not be able to do this job.

The working environment may not be clean, it may be infested with all sorts of things, feces, animals, etc. The safety of the patient may be in jeopardy due to family dysfunction. You serve as a advocate for the patient. No one knows the patient and their circumstance like the HHC nurse does. The role that is played is absolutely vital to the patients success in the home. You have to drive distances and have a dependable vehicle. You take call and work holidays and weekends. Decide if you are able to triage a patient over the phone or not because this is part of the job.

The nurse monitors the therapists so they meet their goals and do what they are supposed to do, the nurse also supervises the aide and writes all the care plans for each patient.

If the HHC has EMR, you may never need to go to the office but be able to work remotely, charting on a laptop and using one of the agency's cell phones to call doctors, make appt.s and arrange transportation, or call APS.

Remember all of this is on top of performing nursing care, such as wounds, iv therapy, assessment, etc. Documentation of a visit can be a bit hairy as it is all so regulated as well. Having a good HHC computer program helps.

Case conferences take place so you can meet with others to discuss the case and get advice when you get stuck. You can also call your manager to get help making decisions.

This job can be very rewarding, there are hugs and tears, families and patients are usually very appreciative and demonstrate that to you. You may end up eating meals with them or loving on their pets. You also have to have serious discussions when things are not going well, such as when hospice is more appropriate or when the family is not pulling their weight. Being able to do social work is very important. You have to be a strong leader.

I know this sounds very overwhelming and it is at first. It is not for everyone, you have to be flexible and are not on a certain schedule through the day like a hospital nurse. The nurse usually schedules the patients, that is when they are to be seen and how often and what for.

The agency may pay by the hour, by the visit or by salary. They generally pay for mileage.

Unfortunately, you do what a hospital nurse does and much more, so it is more challenging. This is not recognized by hospitals, so they do not give credit to HHC nurses like they deserve.

I know this is long but it is difficult to answer your question as to whether it is manageable or not. That depends on your level of comfort and ability, not so much on how long you have worked in a hospital.

I do hope this is helpful.

allnurses Guide · Dec 24, 2017

Forest2 put it all very eloquently, and I could not have said it better.

I will put it in a less eloquent manner:

Home health is stressful. You have way more responsibility

than a bedside/hospital nurse. Your life feels like it is no longer

your own. You may work very long hours. When you aren't

driving or seeing patients, you may be charting. When you

aren't charting, but instead trying to sleep, eat dinner with your

family, or watch a movie... one of your clients may call you...

....... and that's IF you use your personal cell phone, which I

always had to.

You have the option of not giving your clients, your personal

number, but instead having them call the agency with any

needs. However, you never know when one of the Physical

Therapists decides to give that ESPECIALLY needy client,

your phone number. :) That happened to me, yes.

Home health is not an easy option for someone who is

tired of bedside nursing. Many go into home health I

believe, thinking that it will be fun. No more bedside

nursing, no more being stuck in a facility.. flexible

schedule... autonomy.

Then those same nurses realize.... it's HARD.

I managed to do it for about 2.5 years. How I lasted

that long, I don't even know. :)

caliotter3 · Dec 24, 2017

There is an entire hh section on the site where you can find thread after thread, and post after post, all describing the home health environment, as well as a section on extended care home health. Most repeat the same experiences and observations. These experiences have not changed over the years. As long as you go into the specialty with eyes open, you can not expect to find much that is new from what has already been posted.

Libby1987 · Dec 24, 2017

Forest2 put it all very eloquently, and I could not have said it better.
I will put it in a less eloquent manner:
Home health is stressful. You have way more responsibility
than a bedside/hospital nurse. Your life feels like it is no longer
your own. You may work very long hours. When you aren't
driving or seeing patients, you may be charting. When you
aren't charting, but instead trying to sleep, eat dinner with your
family, or watch a movie... one of your clients may call you...
....... and that's IF you use your personal cell phone, which I
always had to.
You have the option of not giving your clients, your personal
number, but instead having them call the agency with any
needs. However, you never know when one of the Physical
Therapists decides to give that ESPECIALLY needy client,
your phone number. :) That happened to me, yes.
Home health is not an easy option for someone who is
tired of bedside nursing. Many go into home health I
believe, thinking that it will be fun. No more bedside
nursing, no more being stuck in a facility.. flexible
schedule... autonomy.
Then those same nurses realize.... it's HARD.
I managed to do it for about 2.5 years. How I lasted
that long, I don't even know. :)

The part about going into home health to find something easier is so true.

Do people go into the ED to escape stress? No, but many are drawn to home health trying to do just that.

The reason for going into home health should be a strong desire to practice this particular type of nursing, despite the incredibly steep learning curve of non intuitive material and presence or lack thereof of some inherent skills that allow you to develop efficiencies making the job doable. If you don't possess that highly organized detail oriented flexible/tolerant wiring, then it can help reduce the resentment that is sure to follow if you can accept that you're not naturally suited but choose to do it anyway.