Home Care Nurses Wear Many Hats

By Dana Pavelock
Director of Home Care Operations


It seems like every week our agency receives calls and letter praising the care provided by our nursing staff. Our Medicare Certified Home Health Agency (CHHA) maintains an active census of approximately 350 patients. Over the years, meeting their needs has become more complex as new technology and medical equipment make it possible for people to remain at home rather than in skilled nursing facilities. Let’s face it – very few people actually plan for accessing home care services but when suddenly faced with a significant medical issue that justifies these services nearly 100 percent of all patients served in home care are most satisfied with the services they received.
Granted, accessing that service when it is paid for through Medicare, Medicaid or commercial insurance makes the service that much more value added, but the real reason the experience is so positive is largely due to the nurses that deliver the care. In fact, many patients and family members clearly recognize the value of this service and often choose to continue to pay for private home care services long after Medicare or insurance is no longer willing to pay.
Nurses who work for a CHHA certainly wear many, many hats. They may be handling intake calls and initial home care assessments in addition to visiting their scheduled patients. Their skilled nursing includes cardiac and general systems assessment, wound care, medication management and significant patient and family teaching on how to manage new diagnoses. Supervision of the aides is part of their day as well, with other free time spent driving, working behind the scenes providing case management services, coordinating patient care and preparation for discharge. Last, but not least – there continues to be a lot of paperwork required by our regulatory bodies such as the state Department of Health. Obviously, individuals enter the field of nursing due to their desire to be nurturing skilled caregivers and to improve quality of life to whomever they serve. Fortunately for those that currently need home care services, these nurses have an untiring commitment to providing exceptional skilled care, great customer service and are able to provide care to throughout all areas of Dutchess County.
CHHA nursing services vary from agency to agency, each usually offering certain areas of specialized skilled nursing care and programs. For example, our agency is well known for the specialists we employ that provide ostomy, wound, cancer and psychiatric home care. Additionally, our nurses with specialized cardiac care training manage patient’s health daily via a combination of routine home care visits and through use of computerized Tele-Health Monitoring.
The starting point in accessing services from a CHHA is generally with obtaining an order from your treating physician or contacting the home care agency directly and presenting your circumstances to an intake worker who will help you navigate through the system. Most agencies will consult with the physician and obtain a script for an assessment to be completed. One of the primary criteria to receive in-home skilled nursing care the patient must be considered “homebound,” requiring assistance to be able to get in or out of the house due to a medical condition (decreased balance, endurance and difficulty walking do to some musculoskeletal or neurological deficits etc.)
The patient assessment is very comprehensive and a home safety evaluation will review various safety hazards to insure that the care needs can be delivered. Once an assessment is completed a nurse will create a plan of care in collaboration with your treating physician and other caregivers with the end goal helping bring you back to your prior level of functioning before your illness. Generally Medicare and some long term or private insurance will also authorize a Home Health Aide as an extension of the skilled services being provided. Aides are oriented and supervised by the nurse, to assist the patient with their personal care needs and/or exercise programs.