Frequently Asked Questions
Chapter 22: Home Care

What services are offered in home care?

Services provided in home health care include nursing care, physical therapy, speech therapy, occupational therapy, nutritional counseling, and medical social work.

What is the history of home care in the United States?

Home care began as a service to mothers and children in poor, urban areas, and then expanded into the rural areas where care was provided to clients of all ages. The Medicare Act of 1965 extended home health services to qualified elderly in their homes. The benefit was extended in 1973 to younger recipients with disabilities. With the institution of the prospective payment system (PPS) for Medicare clients in 1983, hospitals began discharging older people from the hospital as early as possible, causing an increased demand for home care. Requirements for Medicare reimbursement were restricted to restrain costs.

What is the OASIS data model?

The Outcome and Assessment Information Set (OASIS) is a data model used to collect information on Medicare home health beneficiaries for quality of care.

In what types of credentialing activities do home care agencies participate?

Home care agencies participate in (1) state licensure, which addresses minimal standards for staffing, policies, and procedures of the agency; (2) Medicare certification including surveys of the charts, policies, procedures, billing practices, qualification of care providers, and administrative structures of the agency; and (3) voluntary accreditation through the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) or the Community Health Accreditation Program (CHAP).

What is the difference between non-profit and proprietary home care agencies?

Non-profit agencies are tax-exempt voluntary agencies financed by concerned citizens. Any profits they make must be reinvested in the agency in some way. Proprietary agencies are not tax exempt and their profits may be used to reward investors. Hospitals also provide home care, whether non-profit or proprietary.

How are the “skilled” services provided by registered nurses (RNs) and licensed practical nurses (LPNs) similar, and how do they differ?

Both registered nurses (RNs) and licensed practical nurses (LPNs) provide skilled nursing, but only the RN can assess the client and write a plan of care.

What are the three levels of services provided by home health aides/home care aides (HHAs/HCAs)?

The three levels of services provided by HHAs/HCAs are (1) providing a safe home environment; (2) providing personal care; and (3) assisting clients with medications, dressings, and exercises.

What is the difference between hospice care and palliative care?

Hospices provide comfort and quality of life to clients with terminal illness and to their families. Palliative care focuses on relief of physical symptoms only.

How is “skilled care” defined according to Medicare guidelines?

According to Medicare guidelines

• Skilled care is reasonable and necessary, intermittent (not continuous) care provided to clients who are homebound.
• The client must be under a physician’s care and the physician must certify the need for home health care.
• Skilled care must be done by licensed caregivers (RN, LPN, PT, OT, and ST).
• Skilled care must include observation and assessment; teaching and learning; performance of skilled, direct hands-on care; and management and evaluation of a client care plan.

What is the difference between the SANE tool and the Katz Index of Independence in Activities of Daily Living?

The SANE tool assesses the senses, activity, neurological status, and emotional status of the client. The Katz Index of Independence in Activities of Daily Living assesses the ability of the client in bathing, dressing, toileting, transferring, continence, and feeding.

What are components that should be covered in an assessment of the caregiver?

Components that should be covered in a caregiver assessment are (1) their knowledge of technical skills, signs and symptoms, and how to advocate for the client; (2) their stress level; (3) family financial resources; (4) evidence of legal planning, such as living wills and durable powers of attorney; and (5) the family’s extent of social support and coping.

What are some aspects of the home safety assessment?

Aspects of home safety include such components as lighting, floor hazards, electrical hazards, warmth or cooling, fire safety, and availability of emergency numbers.

What are some nursing diagnoses common in home care?

Nursing diagnoses common in home care are caregiver role strain/risk for caregiver role strain, ineffective management of therapeutic regimen, noncompliance, impaired home maintenance management, and deficient knowledge.

What should the nurse consider when developing a teaching plan in home care?

When developing a teaching plan in home care, the nurse should consider (1) the knowledge and skills the client begins with, (2) the client’s capacity to learn, (3) the health needs of the client, and (4) the tasks that will be taught. Additionally, the teaching plan should include new information and reinforcement of previously learned information. Documentation should include the need for learning, the receptiveness for the client and family, and progress made toward goals.

What qualifications are needed for home care nursing?

The requirements for home care may include a baccalaureate of Science in Nursing (BSN), due to its emphasis on community health nursing; experience with complicated medical equipment; skill in physical assessment; and knowledge about Medicare/Medicaid guidelines and case management.

How does the home health care nurse maintain the confidentiality of client information?

Home health care nurses maintain the confidentiality of client information by making sure the phone lines they use are confidential, by securing any client records, by checking phone numbers for accuracy when using fax numbers, and by only disclosing information to families or insurance companies under defined written policies.