by Marty Barnes
What is Home Health? The short answer is that Home Health is ANY medical service provided in one’s home. Home Health can be all types of things. Therapy services, nursing services, aides and attendants, and hospice or palliative care are all common forms of home health.
Therapy services provided in the home are pretty common, especially with children under age three who are still in some sort of early intervention program. Home therapy services may include physical, occupational, speech, vision, developmental and even play therapy.
In-home nursing services are typically what people think of when they hear the term Home Health. Nursing services in the home vary from patient to patient.
There are several different types of nurses that may provide care. Certified Nursing Assistants (CNA) are the lowest level, and are typically only allowed to perform basic tasks, such as taking vital signs, changing diapers, and assisting with exercises.
Licensed Vocational Nurses (LVN) or Licensed Practical Nurses (LPN) are at the first level of actual nurses, with the least amount of training. An LVN/LPN can provide most at-home care. In most areas, LVN/LPNs are not able to start an IV and they are not licensed to write the Plan of Care.
The next level of nursing includes Registered Nurses (RN) or nurses with a Bachelor’s of Science in Nursing (BSN). An RN/BSN can perform all of the care an LVN/LPN can, with the addition of IVs and writing the Plan of Care.
The final level is Nurse Practitioner (NP) or Advanced Practice Nurse (APN). An NP/APN can do all that an RN can do, and an NP can also write orders and prescriptions and see patients with less oversight.
The most basic form of home nursing is home visits. A home visit occurs when a nurse comes to the patient’s home to check in or perform a specific procedure. They may take vitals, check that the patient has been getting medications, or visit with the family to see if there are any medical needs not being met, questions that need to be answered, or if there is anything that the family needs help doing. A home nurse may also come to perform a specific task, such as administer an IV treatment, draw blood, or change a dressing. Home visits may occur daily, weekly or even monthly. The schedule is determined based on the patient’s needs and doctor recommendations.
Another form of home nursing is Private Duty Nursing (PDN). Private Duty Nursing is a little more involved than home visits. Instead of the nurse checking in on the family, the nurse is scheduled for a shift at the patient’s home. Private duty nursing can be as few as 4 hours a week to 168 hours a week (24 hours a day, 7 days a week). The number of hours that are approved will depend on child’s medical needs, the doctors’ recommendations and the individual family’s ability to care for their child.
Respite is another use of home nursing. Respite can often be confused with private duty nursing, as often it is the same nurses filling the role. Respite is a little different, however. Private duty nursing can be used when the primary caregiver is working, at school, sleeping, or tending to daily activities. Respite is supposed to be used to provide the primary caregiver with a break. Respite in many states cannot be used if the primary caregiver is at work or school. Each respite provider and state has its own guidelines. The best way to think of respite care is to ask whether the primary caregiver will get some respite (a break) during this time. Some children may also receive respite from an unskilled provider, such as a care attendant.
Some nursing agencies offer all types of nursing, while others may only offer one. In addition, some agencies serve only infants and children (pediatrics), some only adults, and some cover the entire population. Each agency is different. It is recommended that before selecting an agency for your home health needs you research the areas they cover and determine who will best be suited to fit your needs.
Aides, Attendants, and Homemakers
On occasion a patient will need help, but may not medically qualify for nursing services. In this case, a family usually relies on aides and attendants. Unlike nursing that requires a license, aides and attendants do not require any type of certification. Aides are typically used to help with Activities of Daily Living (ADLs) and can assist with administering some medications. Some families may also receive homemaker services, when an individual helps with tasks around the home, including cooking, cleaning, or general maintenance.
Hospice and Palliative Care
Hospice and palliative care services can be provided by some nursing agencies or by separate agencies. Hospice and palliative care combine nursing with pain management, family counsel, and other unique home services, such as music therapy, art therapy, or massage. Hospice and palliative care used to only provide services to patients at the end of their lives. Now, however, it is not uncommon for any person with a life-limiting condition to receive palliative care services through a greater portion of his or her lifespan.