To understand health care delivery system .

1. Presentor-: Ruma Sen
MN(Previous)
RAKCON

2. OBJECTIVES
Define home health care.
Purpose of home heath care .
Nursing Process approach of home health
care.
Types of services available in home health
care.
Home health care- Indian Scenario.

3. Definition
 Home Health Care is the provision of
medically related professional,para-
professional services and equipments to
individuals and their families in their
place of residence for the purpose of
promoting, maintaining, or restoring
health or of minimizing the effects of
illness and disability.

6. Four Different Perspectives
Official
Services are provided to individuals
and their families in their place of
residence for the purpose of promoting,
maintaining, or restoring health or of
minimizing the effects of illness and
disability.
Patient
Skilled and compassionate care is
provided on a one-to-one basis in the
comforting and familiar surroundings of
the home.

7. In the home, the nurse encourages the patient to use imagery to relax
and relieve pain.
(From Lewis, S.M., Heitkemper, M.M., Dirksen, S.R. [2004]. Medical-surgical nursing: assessment and
management of clinical problems. [6th ed.]. St. Louis: Mosby.)

8. Four Different Perspectives (continued)
Family
It is a means to keep the family
together as a functioning, integrated
unit.
Provider
All disciplines involved are
challenged to provide excellent care
in often less-than-excellent
conditions and surroundings.

9. Historical perspective Home care was formerly defined as simply
providing physical care to the sick in their
homes, but the scope and complexity of the
concept and practice have grown.
•Roots of the concept can be traced to the
New Testament of the Bible, which describes
visiting the sick as a form of charity.
•The first home health care program in the
United States was organized in 1796 as the
Boston Dispensary.
•The first visiting nurse service in the United
States was formed in Philadelphia in 1886.

10. HISTORICAL OVERVIEW
 When Medicare became effective in 1966, it
revolutionized home care by –Changing it to a
medical rather than nursing model of practice –
Defining and limiting services for which it would
reimburse –Changing the payment source and even
changing the reason home care was provided .
 Diagnosis-Related Groups (DRGs) –Congress
enacted this prospective payment system in 1983
as a part of the Tax Equity and Fiscal
Responsibility Act for hospitals receiving Medicare
reimbursement. –Based on major diagnostic
categories, a set rate is paid for the hospitalized
patient's care rather than the “cost” or charges
traditionally billed by institutions.

11. Historical Overview
 Diagnosis-Related Groups (DRGs) (continued)
 –The net effect of the change was a major
shift of patients out of the hospital into their
homes, extended-care facilities, or skilled
nursing facilities. –This created a challenge in
terms of volumes of patients seen, necessity of
more skilled nursing care over intensive times,
and the evolution of highly technical procedures
in the home.

12. CHARACTERSTICTS
Skilled or compassionate care.
Involves family in care.
Co-ordination with all diciplines.
Independent decision maker.
Accountability

13. Role of Home Health Nurse
Advocacy
Coordinator
Educator.

14. SERVICE
COMPONENTS
SKILLED NURSING
CARE
PHYSICAL THERAPY
SPEECH LANGUAGE
THERAPY
OCCUPATIONAL
THERAPY
MEDICAL SOCIAL
SERVICES
HOME HEALTH AIDE

15. COMMUNITY ORIENTED HOME HEALTH
CARE-: PRINCIPLES

19. Agencies may have to comply with federal,
state, and local laws and regulations via the
following: –
Licensure by the state –Certification by the
state certifying body designated by the federal
government
Accreditation by an outside agency that
evaluates how well the agency meets certain
standards set by the accrediting organization.

20. Requisites of Home care
The nurse should be well versed
with-:
Strong knowledge base.
Knowledge of family dynamics.
Cultural practices.
Spritual values.
Communication principles.

21. CHANGES IN HOME
HEALTH CARE
JCAHO is looking for agencies to establish
ethics committees to handle issues that arise in
the home.
Psychiatric nurse clinicians are being
reimbursed by Medicare for home visits.
Social workers are taking a more active role in
home health care.
More home health agencies are employing nurse
pain specialists to assess and manage pain
control in the home.

22. Research Input-:
Saba, V. (August 30, 2002) "Nursing Classifications: Home
Health Care Classification System (HHCC): An Overview"
OJIN: Online Journal of Issues in Nursing. Vol. 7 No. 3.
Abstract-:This paper provides an overview of the Home Health
Care Classification (HHCC) System focusing on its two
interrelated taxonomies: HHCC of Nursing Diagnoses and HHCC
of Nursing Interventions both of which are classified by 20 Care
Components. It highlights the major events that influenced its
development, current status, and future uses. The two HHCC
taxonomies and their 20 Care Components are used as a
standardized framework to code, index, and classify home health
clinical nursing practice. Further, they are used to document,
electronically track, evaluate outcomes and analyze home health
care over time, across settings, population groups, and
geographic locations

23. Result
The two HHCC System taxonomies can be integrated into
any home health system and linked electronically to any
CPRS designed to collect the data required for federal
home health care reporting and reimbursement. The
system is being used to (a) improve the efficiency of
assessing and documenting home health nursing care,
(b) provide the strategy for evaluating quality and
measuring outcomes of care, and (c) develop a costing
method for reimbursement and payment. They are used
to develop electronic clinical pathways, measure practice,
and determine care costs. The two HHCC System
taxonomies are available on the Internet, offering the
world-wide nursing community the means to manage and
monitor clinical nursing practice.

24. The Home Health Nursing Process-:
Assessment_-:
Admission –The initial evaluation and admission
visits are made by an RN within 24 to 48 hours
of the referral.

The evaluation and admission process generally
includes at least the following:
•Complete patient evaluation
•Environmental assessment

25. •Identification of primary functional impairments
•Assessment of the family or significant other
support system
•Determination of knowledge and adherence to
treatments and medication.
•Determination of desire for care and services
•Involvement of the patient and family in the
development of the plan of care and goals .
.•Notification to the patient of rights as a patient,
along with costs, payment sources, and billing
practices.
•Explanation of the patient’s right to self-
determination

26. Nursing Diagnosis-:
 Interrupted family process
 Impaired parenting
 Anxiety
 Caregiver role strain –
 Impaired physical mobility –
 Imbalanced nutrition
 Ineffective airway clearance
 Risk for impaired skin integrity
 Family coping, compromised
 Family coping, disabled
 Coping, ineffective –Ineffective management of therapeutic regimen
 Knowledge, deficient
 Risk for caregiver role strain
 Risk for injury

27. Implementation-:
 Care is provided by LPN usually but RN makes visits
and educates the family The to enable them to
participate in care .The nurse assists them in
understanding medication administration ,range of
motion exercises etc.They are provided with helpline
numbers to consult when required or there is any
change in clients condition.

28. PLANNING
Careplan
Visits
Collaboration
Clients needs
Family needs
Time frame
Patient-centered
goals and outcomes.
With family for
expected outcome.

29. DOCUMENTATION
CLEAR ,CONCISE
THE OMAHA SYSTEM
THE NIGHTANGLE TRACKER
SYSTEM

30.  EVALUATION-:
 Evaluation is done periodically to check whether
expected outcomes are met or not.If not then plan of
care is revised.

31. HOME HEALTH CARE IN
INDIA
Home-based health care in India is gaining
traction and is poised for transformation.
Once an unorganized and fragmented sector,
it is fast catching the attention of
entrepreneurs and investors and becoming an
organized, technology-led industry with
standards and protocols.
 With life expectancy increasing significantly
in India, home health care is becoming
mandatory.

32.  “The home health care market in India, currently
estimated to be a $2 billion to $4 billion-a-year
opportunity, is driven by an aging population,
the increasing prevalence of chronic diseases
and the need for better quality post-operative and
primary care.”

33.  India with a geriatric poulation of more than 100
million expected to rise 200 million by 2018.
 Home health services are at a very nascent stage
and mostly provided by private companies in urban
areas.
 Rural healthcare is still dependent on primary health
care system where home health care is provided by
primary health care centre.
 Rural health care sector is experiencing severe staff
crunch thus unable to reach a large chunk of people
still prefer to urban area.

34.  Summary
 •Current trends support the growth of home care as an
economical, humane, preferred health delivery system for
many types of care.
 •Home care provides needed assessment and evaluation
of chronic illnesses to prevent acute episodes.
 •Aides can provide necessary support in activities of
daily living to enable the patient to remain in the home.
 •Skilled nursing and therapy offer rehabilitation and
prevention of deterioration, as well as methods to cope
with physical disabilities.


35. Key points
 Home health care allows individuals to maintain
personal control and to participate in the
direction of their personal care.
 Families are an important part of the success of
home care services as home care workers provide
care, supervision, assistance, and support in
attaining the care plan goals.
 Home health care is not a new concept; however,
legislative, regulatory, and current health care
trends have changed the way it is provided.

36. KEY POINTS
 Home health services are reimbursed by federal,
state, local, group, and private sources.
 Although some aspects of nursing interventions in
the home are the same as those practiced in
other health care setting, home health care
nurses pay particular attention to interaction and
cooperation among family members, the patient,
and other members of the health care team.

37. KEY POINTS
 The acuity levels of patients requiring care in
their homes continues to rise, and the
technological equipment, including use of
mechanical equipment and invasive procedures
such as intravenous therapies, are increasing in
home care. These factors, when combined with
shorter hospital stays, require extensive
discharge planning to prepare patients and family
for home health care.

38. “…home health care is a vital part of medical care,
a link to the past, and a unique opportunity for
service, commitment, and compassion.”

39.  Bibliography-:
 Patricia.A.potter,Basic nursing practice,6th edition,21-29
 Taylor Carol,Fundamentals of nursing,5th edition.Ch8-
148-151
 Susan.c.dewit,fundamentals of nursing skills,3rd
edition:56-69
 Joyce .M.Black,Health care delivery system,8th edition
71-118
 www.nursing world.org/main menu/hhccoverview.html
 www.nursingcenter.comarticle_id_1287272