This has been an exciting time for HHN and for me-I contacted and spoke with past editors-including the first one-Sandra Siddall! After months of calling (too?) many people and Googling and Binging for hours-I actually got to Sandra through the network of colleagues and friendships forged in the early 1990s when I worked at the central office of (what was then) the Health Care Financing Administration (HCFA), now the Centers for Medicare and Medicaid Services (CMS). Some of those nurses are still working in government or as government contractors and we stayed in touch after 20 years! Another "home healthcare is a small world" success story!
This January 2012 issue of Home Healthcare Nurse addresses two important themes. The first is "Acknowledging Our Past While Looking to Our Future," which features thoughts from past editors of Home Healthcare Nurse who submitted pictures and/or some thoughts looking back over and across the years. The second is the theme of "Celebrating Diversity," which January's Guest Editor, Judith S. Young, a medical librarian who serves on the Home Healthcare Nurse Editorial Board, addresses in a separate editorial. You may notice that three things have been changed and added to the cover of Home Healthcare Nurse! These are, first, a 30th-year seal; second, the word "interdisciplinary" has been added to the subtitle so it now reads "the interdisciplinary journal for the home care and hospice professional" to better reflect the scope and content of the journal; and third, a banner that states "the leading voice of home care clinicians since 1983." We hope you enjoy these new changes that reflect the continuing changes in healthcare provided at home.
While looking to the past and living in the present, we cannot help but consider the future of home healthcare and other healthcare provided in the home. Medicare home health agencies (HHAs) continue to undergo change. The federal healthcare reform changes are steps toward integrating care across care settings with an emphasis on prevention, primary care, and the transition points of care. Both individual care and population care is emphasized. Transition points can be defined as the areas of gaps that patients experience when moving or migrating to the next or another care setting. These include hospital to home, home to and from the hospital, and the like. Specialized nurses in home healthcare can assist patients to make effective care transitions-both with safety and quality factors addressed. Areas that are problematic and costly in transitions include medications, follow-up care, and continuity of the care plan from site to site. Home healthcare nurses (HHNs) have an important role to play in transitions and keeping their patients safe while navigating the complex healthcare system.
I hope that 2012 becomes the year when the term "hand-off" becomes obsolete. The patient and plan of care should not be passed "off" but skillfully transitioned "over" to/for care with the level of staff or services needed for that component of care-while still being cared for and with the plan of care still being "managed" by the entity that best knows the patient-perhaps from a long-term perspective. One analogy could be the hospice model of care: the patient may need and move through/to another level of care, but the hospice is still managing that unique and individualized patient plan of care for that patient and family. To me, these are the good parts of the future-they may be called accountable care organizations (ACOs), "medical homes," case or care management models, transitional care models, and/or more and better ideas yet to come and be created. This is the time for home healthcare clinicians, managers, and thought leaders to prove and provide the evidence that drives the plan and attains outcomes that can be attributable to skillful assessments and interventions. If you and your system have an innovation or care model that works, or have been collecting data and have outcome data, Home Healthcare Nurse is interested in reviewing your model and manuscript. Original research is needed in home care, and not only for clinicians and managers-policymakers and elected officials also need to hear the good news of care models that work and are cost-efficient and effective-and that use the unique body of knowledge in home healthcare. You can make that difference!
Sincerely,
Tina M. Marrelli, MSN, MS, RN, FAAN, Editor
[email protected]
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