geriatrics
Home Health Care
Introduction
Usually, home health care is indicated when patients need monitoring, adjustment of drugs, dressing changes, and limited physical therapy. Home health care is commonly used After hospital discharge (postacute care), although hospitalization is not a prerequisite, particularly for older patients Home health care can also be used for Patients with conditions that require many days of hospitalization each year (medically complex care) Medically stable patients with severe functional impairment (long-term care) Sometimes patients with acute or chronic problems Sometimes patients who are dying (end-of-life care) Home health care is being increasingly used to meet the demand for long-term care. Home health care, which can reduce nursing home placement by 23%, is less expensive than institutional care when home health aide and skilled care visits are scheduled appropriately. Home health care is provided by agencies, which vary in ownership, size, location, and services. Some are certified. To be certified, an agency must meet state licensing requirements and federal conditions for participation in Medicare. Such agencies provide skilled nursing care under the direction of referring physicians. Nurses provide services under the supervision of a physician, who consults with them as changes in care are needed. Caring for patients at home requires communication among health care practitioners to ensure that patients are maintaining function and are progressing as expected. The patients or caregivers need to promptly report changes in the patient’s condition to nurses or physicians to ensure that patients are monitored appropriately. Home health care may provide medical and nonmedical services (see table Services That May Be Provided in Home Health Care ). (See also Overview of Geriatric Care .) 