Most sophisticated equipment placed in home setting?

[RKMARK]

As a Hospice/Home Health RN for many years, I have witnessed the trend to send a patient home who requires increasingly technologically advanced equipment. For example, a vent-dependent patient was rare ten years ago in my area (south). Now complete TPN and PICC lines (etc.) are the norm, along with patients who require more skilled care than many caregivers are prepared to provide. However, it appears to me that the Home Health industry is guilty of simply "dropping" our patients off in the home setting with little regard to proper.....even basic.....instruction for the caregiver. In almost every instance I inquire about, the caregiver states that they felt overwhelmed and unprepared for the task they now faced. Even the most basic safety rules we all learned our first week in nursing school (i.e. proper lifting and transfer techniques/turning q 2 hr/skin and bed care) are never demonstrated. Think of how lost in K-Mart these caregivers feel when faced with complex machinery and the inevitable functional problems that will occur. I know it is, as always, a matter of reimbursement and lack of funds. Yet I can't help but feel that we, as professional nurses, should spend at least one full day in the home of a new client to assess the environment, available resources, and the capacity of the caregivers. How many backs would be spared and unnecessary visits saved if we could simply spend more time in the initial orientation period rather than leave our clients to their own devices? I sincerely feel this is a point that must be addressed, esp. given the tremendous growth in the elder population depending on their children as caregivers. Any opinions or input would be greatly appreciated. Thanks to all of my hard-working, hard-driving coworkers.

[caliotter3]

I've been on lots of cases with vents. Usually the family members know what is going on and can teach the incoming home health care provider. But in other instances, the family has very little idea of what is going on about anything, and there is often a language barrier as well. One lady told me that they would not allow her child to go home until the family members had been fully trained and passed competency tests at the facility releasing her child. I thoroughly agree with this practice.

[anticoagulationurse]

I have a patient on home hemodialysis 5 days/week managed by his wife and caregivers who received 5 weeks of training and know way more than I do about the machine!