As I read the articles that appear in this issue of Home Healthcare Nurse, I was struck by the fact that the authors all focus on a topics that are at "the edges" of home healthcare. Overwhelmingly, home healthcare focuses on older adults who have Medicare as their primary health insurance. But home healthcare is broader than that patient population, and it is paid for not only by Medicare but also by Medicaid, the Veterans Administration, and private insurers.
In this issue readers are presented with many issues that occur around the edges of home care. For instance, the article by Jean Walker and colleagues titled "Self-Care Management Practices for the Home Health Nurse: Staying Hale and Hearty Through Enhanced Self-Care and Ergonomics-With a Case Study" focuses on the holistic well-being of nurses, but it has implications for every provider within the home health industry. Walker and colleagues weave the story of a home healthcare nurse named Daisy into the article and illustrates how Daisy's application of ergonomics, her recognition of her own unhealthy practices coupled with determination and a plan, dramatically moved her to a position of better health. Walker and colleagues include a self-care model of home health nursing ergonomics that is both comprehensive and easy to apply.
Traditionally, licensed practical nurses (LPNs) are also at the edges of home healthcare, which largely employs registered nurses (RNs). However, Carl Meadows and Joan Prociuk present a Canadian project that successfully integrated LPNs into the treatment team alongside of RNs in "Integrating Licensed Practical Nurses Into Home Care Nursing: One Health Authority's Journey." Constrained by limited budgetary means and a growing need for home-based nursing services, the authors undertook an initiative to increase the ratio of LPNs to RNs, while keeping costs neutral, expanding nursing resources, and maintaining the quality of nursing care within the home. The authors also provide important details regarding the challenges faced in this study-not the least of which was resistance from RNs-and how these challenges were addressed and resolved. This article presents valuable information for other home care providers who want to expand the role of the LPN.
Kimberly Newton and Kimberly Lamarche address the importance of providing support to parents of chronically ill children and their parents in their article "Take the Challenge: Strategies to Improve Support for Parents of Chronically Ill Children." Although the sick child is the primary focus of the clinician, ignoring or undermining the role of parents can lead to negative outcomes that impact everyone, including the child. The authors focus on strategies to partner with parents, to give voice to the struggles of dealing with a sick child on a day-to-day basis, and to recognize the burdens carried by many parents who are not only home-based caregivers to their sick child, but may also be the bread winner(s) for the family. Such situations represent an amazing challenge to parents to balance what are frequently conflicting demands and to do it well. Clinicians who are cognizant of these challenges not only support parents more effectively but help to create environments where ultimately children thrive.
"The Fundamentals of Hospice Compliance-What Is It and What Are the Implications for the Future? An Overview for Hospice Clinicians, Part 2: Hospice Risk Areas," by Susan Balfour, examines issues of hospice compliance that may be misunderstood by hospice clinicians resulting in Medicare reviews and other negative consequences. Clearly hospice, which provides care to those at the end of their lives, is on the edges of home healthcare. This article provides a clear discussion of the five main areas that Medicare targets in compliance reviews. These areas include (a) assessing performance, (b) general inpatient and continuous care claims, (c) improper revocations, (d) coverage requirements and care planning, and (e) hospice care in the nursing home. Ms. Balfour included three case examples to illustrate the approach of a hospice to these five areas.
The last article, coauthored by myself and Sandra Yambor, focuses on psychiatric home care, which consistently is at the edges of home healthcare services. Home healthcare literature is replete with articles about the incidence and the treatment of depression. However, there is a lack of published or peer-reviewed articles in the literature that address how bipolar disorder is managed in the home. The challenges of managing bipolar disorder in the home setting are addressed and this is illustrated through a case study where a therapeutic relationship allowed the patient and his wife to stay together and do well.
As these articles aptly illustrate, you have to look at the edges of home care to fully appreciate its breadth and depth!