Introduction to the Home Health Agency Role - Essay Example

? Introduction to the Home Health Agency Role First M. al Affiliation Introduction to the Home Health Agency Role 0 and Federal Regulations and Requirements for HHA Certification According to Davila (n.d.), there is no standardized educational requirement to be a home health aide (HHA). It depends on which state the HHA is in, but in some states, they do not even need a high school diploma. Other states need them to take some preparation classes before given the jobs. These preparation classes are usually offered in the community colleges or vocational/technical schools. Most skills trainings for HHAs are taught by other healthcare professionals, and they usually learned on the job. Generally, their trainings are molded around the unique needs of the patient. Depending on the level of complication of the client’s illness, the HHAs trainings could be done in a few hours to a few days. For more complex cases, some employers provide training classes, which the aspiring HHA has to pass before they are given a job. There is no license for HHAs, but there are some employers who would rather hire certified HHAs. The certification process includes an examination and 75 hours of training and skills testing. Other requirements may include a background check of candidates, before enrolling them to a program, due to the high trust nature of the job. Sometimes, health screenings may be required to prevent patients from contracting diseases from their caregivers. 2.0 Purpose and Goals of Home Care Home care involves a wide scope of care for a wide variety of patients outside the hospital setting. The services that home health care companies provide can range from nursing care, physical therapy, and even occupation therapy from qualified medical professionals to smaller services from home health aides. The care provided could be as simple as assistance in everyday activities, such as bathing and eating, to more complex services requiring more specialized professionals. Essentially, the purpose and goal of home care is to provide an adequate level of care usually achievable at the hospital, and bring it to the patient’s home. 3.0 Members of the Home Health Care Team (With Functions and Interaction) Physician. Physicians perform home visits to the patient at regular intervals wherein they assess the patient in an environment that he or she is more comfortable. They assess how the patient handles his or her illness at home. They also regularly check and make adjustments and interventions when necessary. There are two ways in which physicians can function in the home health care setting. First, they rely on the home health care nurse, as the leader, mediator, and coordinator of the group, leaving them to be the evaluator of the patient’s health, which is to be coordinated with the rest of the team by the nurse. Second, they are the one who will lead the team by taking a more active role in patient care. The mnemonic INHOMESSS enumerates the roles of the physician including immobility, nutrition, home environment, other home health care members, medications examination, safety, spiritual health, and services by home health agencies. Furthermore, at the patient’s home, physicians will be able to get a more in-depth assessment of aspects of the patient’s life that is not normally accessible from the hospital setting. Moreover, they can look for environmental factors found in the home that can affect the patient’s illness; they can see how the patient acts in a more comfortable setting than in a hospital, and they can assess the patient’s compliance with the therapeutic regimen including diet, exercise, and medications. From these observations, they can identify faults in the patient’s activities and make interventions to change them for the patient’s health. They can also assess the tasks of the health care team and change them to suit better with the therapeutic regimen, especially if they are the one functioning as a team leader and a coordinator. Nurse. Most of the care in home health care setting is rendered by nurses. They collaborate with the physician to give the patient the proper care that he or she needs. They also work with the rest of the personnel in the home health care team to coordinate the services being provided; this is to make sure the patient gets an optimal service from each of them and improves his or her quality of life at home. They perform different nursing interventions adjusted in frequency to suit the patient’s needs. During the initial assessment, they also decide which of the other ancillary services are needed by the patient, and this is relayed to the physician who makes the final decision. The nurse’s recommendations influence the interventions ordered by the physician. The treatment plans vary based on the changes noted by nurses since they spend the most time with the patient. In this regard, they are the ones in the position to make the comprehensive problems lists and the assessment of care and goal plans. When there are multiple therapies to be done by different members of the home health care team, the nurse schedules the interventions in a way that they do not overlap so as not to cause inconvenience to the team or stress the patient. Perhaps the most important responsibility of nurses is the documentation. They compile all the data about the patient including the treatment plans, prescriptions, and assessments. These documents serve as a valuable resource to be used by the whole health care team and a proof that the team is doing their job. Nurses are also the ones who stay in contact with the whole team and other community services that could be tapped to help the patient. The nurse updates the rest of the team and allows the sharing of information through case conferences. Pharmacist. The role of the pharmacist in the home health care setting is to be responsible for the patient’s or caregiver’s willingness and ability to be trained and to properly administer medications including the appropriate indications, dose, route, method of administration, and appropriate laboratory tests; this is to monitor the patient’s response to the pharmacologic therapy. Pharmacists use their clinical judgment as to whether the first dose of any drug should be given at the home. It is their job to teach the caregiver about the medications, their effects and adverse effects, any drug interaction, storage and preparation, disposal, special precautions, and general management of drug effects, such as emergency procedures. They also make sure that the patient does not run out of medications by checking their stocks and by directing them to where they could get medical supplies. Moreover, pharmacists work together with other health care professionals, the patient, and the caregiver in the making of the appropriate pharmaceutical treatment plan for the patient. They must always be available in case there are any problems, questions, or concerns regarding the pharmacologic treatments. Physical therapist. The physical therapist is needed when the patient has trouble ambulating or has a disability that prevents him or her from performing everyday tasks. It is his or her job to assess the patient’s disability to determine if the latter needs assistive devices. Once a patient is eligible for an assistive device, the physical therapist is the one who will teach the patient in its proper usage. He also helps the patient in increasing his or her mobility and reducing risks of injuries from accidents. He creates a home exercise program to help the patient moves around comfortably. During every visit, he assesses the patient’s mobility and adjusts the exercises as appropriate to the patient’s range of motion, muscle strength, and endurance. Occupational therapist. The occupational therapists are concerned with how the patient’s disease or disability affects his or her ability to function normally. It is their job to help patients achieve a higher level of independence in everyday task, such as bathing, dressing, elimination, cooking, eating, and housework. They provide patients with information about various techniques, equipments, and aids that would allow them to function through their disability. They can help the patients make adjustments to their homes and belongings to improve the patient’s functionality; they can teach energy conservation techniques for patients who have low endurance; they are also the ones who teach patients in using specially designed devices to increase their autonomy and functionality. By allowing patients to do more by themselves, their self-esteem increases, and the need for constant supervision decreases. These therapists manipulate the environment of the patients to make it easier for them to function, such as widening doors for wheelchairs, grab rails, guide rails, placing objects and switches within arm’s reach of patients, adjusting furniture for easier travel around the house, etc. Speech therapist. The speech therapist helps patients recover and develop their communication skills, especially to those who have lost the ability to speak normally. Furthermore, speech therapists teach compensatory communication mechanisms that use visual cues and cognitive retraining. They use a wide range of communication aids and technology, such as hearing aids or an electrolarynx, and they also teach sign language and the use of communication boards. As technology for the speech impaired increases, some speech therapists can even teach patients in the usage of transcription technology, which transcribes spoken words onto a computer screen. Social worker. The social worker provides emotional and psychological support to the home care team. In addition, he or she is the one with access to community care services when there are conflicts with the treatment plant or if the patient refuses care. When more support is needed in the care of the patient, the social worker assesses the patient with regard to mobility and personal care ability including an assessment of finances if the patient can afford another professional on the team. Social workers also include the assessment of the rest of the home care team in the making of this decision. Moreover, they are the link to formal and informal sources of support whether they come from social groups, organizations, or help groups. They coordinate, teach, counsel, assess, and facilitate ethical decision making issues. They also maintain standards through regular visits and inspections. They are available through a 24 hour emergency call system for the elderly and disabled patients. Home health aide. The home health aide fulfills the personal care role for the patient. Furthermore, he or she does the minor tasks including bathing, clothing, positioning, and environmental care of the patient under the supervision of the home care nurse (Kurashi, 2006). 4.0 Roles and Responsibilities of the Certified Home Health Aide The certified home health aides carry out the personal care responsibility for the patient. These people perform under the guidance of the home care nurse and follow a written care plan outlining activities and tasks to be done for the patient. These include the basic tasks of bathing the patient, helping the patient to sit upright position off and on to bed, grooming, dental hygiene, basic exercises, and medication. Sometimes, these individuals may help in some household chores, such as changing bed linens and keeping the patient’s room clean as part of environmental care. Some of these jobs can be done by a trained, paid housekeeper. Family members are also candidates for the role of a home health aide (Kurashi, 2006). 5.0 Common Observations and Documentation to be completed by the HHA According to the Home Health Aide Training Manual by Green (1996), the frequent observations of the HHA include general observations, such as weight changes, changes in the ability to perform care, ingestion of alcohol or drugs, fevers, and/or episodes of weakness; skin observations, such as rashes, breaks or tears, changes in color, itching, and/or bruises; head observations, such as headaches, dizziness, fainting spells, and hallucinations; eye observations, such as failing eyesight, excessive watering of the eyes, and/or dryness of the eyes; ear observations including hearing ability, tinnitus, and/or discharge from the ears; nose and throat observations including congestion, voice changes, nosebleeds, toothaches, patient’s dental hygiene, bleeding gums, difficulty swallowing, and halitosis; breast observations, such as nipple discharges, lumps, and/or pains; respiratory system observations including shortness of breath, abnormal breath sounds, coughing, and/or fluid filled lungs; heart or vascular system observations involving the patient’s heart rate, the regularity of his heartbeat, and any chest pain; stomach and intestinal observations, such as the patient’s appetite, abdominal discomfort, diarrhea, constipation, vomiting, blood in the stools, and incontinence; urinary system observations, such as the patient’s frequency of urination, the color of the urine, incontinence, blood in the urine, the amount of urine, and any pain or difficulty in urination; observations of the patient’s genitals, such as any abnormal discharges, pain, lesions, and other abnormalities; observations of the patient’s musculature, such as muscle weakness, neck or back pain, joint pain, cramps, and limitations to movement; changes in mental/emotional state, such as crying, depression, nervousness, and restlessness; and finally, neurological system observations, such as seizures, numbness, tingling, paralysis, and/or loss of function. All these observations are to be documented along with the activities done by the HHA during his or her shift. Also, all of these are documented for the benefit of the patient, the home health care team, and the HHA himself or herself. By documenting these details, the patient’s condition can be tracked; the health care team can identify incremental changes in his or her condition and adjust the care plan accordingly while it also protects the HHA since the documentation is a reflection that the latter is doing his or her job correctly. 6.0 Key Steps in the Communication Process and Methods of Communication The key steps in the communication process are Creation, Transmission, Reception, Translation, and Response. Methods of communication, especially in the home health care setting consist of verbal and non-verbal modes of communication, such as written communication (Schreiner, n.d.) 7.0 Key Steps to Accommodate Communication with Clients who have Hearing or Speech Disorders It is prudent to keep in mind that this type of communication is difficult; hence, patience is needed. First, the nurse must speak in short, clear sentences. Second, he or she must not use a lot of jargon in communicating with clients. Third, he or she must use communication tools, such as pen and paper, pictures, or sign language if the patient has been taught. Lastly, if the patient cannot speak, then the nurse must ask yes or no questions instead, use communication aids, and/or consult a speech therapist (“Communicating with patients,” 2009) 8.0 Effective Techniques for Communication with Home Health Team Members One of the most effective and most important techniques for communication is the written form of communication of the documentation. This record of everything done by, to, and about the patient is meant to be a non-urgent form of communication between the health team members. They update it so that the other team members will get updates, and this is where interventions and orders are seen so that they may be guided accordingly in the care of the patient (Green, 1996). Another effective technique for communication with the health team is the case conference. This is a regular meeting between all the members of the team wherein they exchange information and plan for the care of the patient. The verbal and written exchanges of this conference result in a treatment plan that covers multiple aspects of the patient’s care, hence, making sure that the patient receives holistic care (Kurashi, 2006). 9.0 Ways to have Effective Communication in Learning about the Client Effective communication can go a long way to help in learning things about the client. It is important to form a good nurse-patient relationship with trust. To effectively communicate with the client and to gain his or her trust, as well as information about him or her, the nurse must be prepared with information for the client’s questions, maintain eye contact, observe body language, listen closely, pay attention to both verbal and non-verbal cues, avoid medical jargon (phrasing questions in ways the patient will understand), and most of all, be sensitive to the client and choose the right moment to ask questions (“Communication skills,” 2007). 10.0 Access to Community Agencies to Meet Client Needs As stated above, the home care nurse and the social worker both have access to other community agencies and resources. Through the National Association for Home Care and Hospice, some of the affiliates and community agencies that could cater to the needs of the client include Hospice Association of America, Private Duty Homecare Association of America, Center for Health Care Law, World Homecare and Hospice Organization, Pediatric Home Care Association of America, Hospital Home Care Association of America, Proprietary Home Care Association of America, Voluntary Home Care Association of America, Home Medical Equipment Association of America, Psychiatric care services, and many more (Kurashi, 2006; “NAHC affiliates,” n.d.) 11.0 Organizational and Time Management Techniques for a Daily Work Schedule According to Wittenberg (2012), there are many ways to save time for the home health care team: A. Use time management building blocks: 1. Identify your goals 2. Review your time utilization 3. Match time utilization patterns with your goals 4. Prioritize for a better time management 5. Eliminate time bandits (procrastination, perfectionism, etc.) B. Use computerized documentation C. Plan and Manage your schedule ahead of time including your own self-care time D. Do the whole job or one thing at a time. E. Stay focused F. Telephone management G. Stress Management References Communication skills (Essence of care benchmark). (2007). Retrieved from http://www.nursingtimes.net/nursing-practice/clinical zones/educators/ communication-skills-essence-of-care-benchmark/361127.article Communication with patients who have speech and language difficulties. (2009). Retrieved from http://www.patientprovidercommunication.org/article_2.htm Davila, L. (n.d.). How to become a Home Health Aide. Retrieved from http://www. innerbody.com/careers-in-health/how-to-become-a-home-health-aide.html Green, K. (1996). Home health aide training manual. Burlington, MA: Jones & Bartlett Learning. Kurashi, N. (2006). Home health care team members. Middle East Journal of Age and Ageing, 3(1). Retrieved from http://www.me-jaa.com/mejaa6/homehealth.htm NAHC affiliates. (n.d.). Retrieved from http://www.nahc.org/affiliates/home.html Schreiner, E. (n.d.). 5 steps to the communication process in the workplace. Retrieved from http://smallbusiness.chron.com/5-steps-communication-process-workplace-16735.html Wittenberg, S. (2012). Effective time management. Retrieved from http://nursing.advanceweb.com/Article/Effective-Time-Management-3.aspx Read More