Home health nursing is a niche for nurses who have experience and enjoy being on the move and working independent from the hospital. Visiting nurses, now termed home health nurses, date back to the 1800’s. Lillian Wald founded the Visiting Nurse Service of New York in the late 1800’s and the current structure of home health care is based off that model.
Home health nursing consists of providing nursing care in an individual’s home. The nurse must possess ingenuity as the conveniences and equipment found in the hospital are generally not available. Nurses carry their own supplies and regularly utilize the nursing process and honed assessment skills.
There are many varied clinical responsibilities the home care nurse has. Some of these are reconciling medications, managing foley catheters, providing drain care, and teaching the patient. Serving as a case manager is another responsibility. This means caring for the patient from beginning of service to discharge back into the community or prior baseline. This includes coordinating with doctors, family members, and other members of the health care team. Building rapport and familiarity with a patient is more important than ever with the current COVID-19 epidemic.
The COVID-19 epidemic poses one of the biggest challenges across the entire health care arena including home care. Due to this epidemic, changes have been made to the delivery of home health care. These include utilization of telehealth, increased incidence of homebound patients, changes to PPE usage, and temporary waivers and allowances of Medicare requirements. Changes are evolving frequently and this information is current at the time of this post.
Due to COVID-19, nurses may provide telephone or telehealth assessments in addition to in-home visits if the patient’s condition is stable. These “visits” are allowed if the patient’s doctor permits. A combination of telephone/telehealth and in-person visits lessens the number of exposures the nurse has with the patient. A phone call or telehealth assessment involves asking questions in order to determine the patient’s status and identify any new or worsening health issues. If the patient has current technology telehealth video visits can be conducted that allow for the nurse to see the patient on the computer screen.
In order to qualify for home care a patient must be deemed homebound. This may be determined from a doctor’s order or due to the patient’s health condition. A patient can be admitted into home health if he or she is homebound. Due to recent temporary Medicare changes if a patient is suspected COVID positive or confirmed COVID positive, he or she can be considered homebound. These measures reinforce the stay at home theme to help in lessening COVID spread.
Changes to PPE usage are the same as the requirements in the hospital. If a patient is COVID positive, Airborne and Contact Precautions are taken. This means the home health nurse would wear a N95 mask, face shield, goggles, gloves, gown, and perform proper donning. Upon exiting the patient’s home, the nurse would doff and leave the used PPE outside the home according to his or her agency policies.
Current guidelines from the CDC and NAHC (National Association for Home Care and Hospice) require all home care staff to wear masks when in contact with any patient. If the patient is COVID positive, then a N95 mask must be worn. Patients who are COVID positive must stay separated from others in the home preferably in a room with a closing door to assist in quarantining. It is also recommended that all patients — regardless of COVID status — wear a cloth mask during each visit.
Home health nurses are providing increased education to patients and their families focusing on infection prevention in the home. Handouts from reliable sources such as the CDC are being provided to family members. Nurses are also providing education on proper hand washing technique and disinfection guidelines for laundry, surfaces and other areas of the home.
As noted earlier, COVID-19 has impacted all areas of health care and home health is no exception. By providing increased education to staff, patients, and families; the goal is to decrease the intensity and mortality rate of this pandemic. Nurses are on the front lines and need to stay abreast of frequent changes to Medicare rules. It’s also necessary to take current measures to protect themselves and their patients during this challenging time in history.
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