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Making the Most of Your Home Visits

Advocate For Your Patients and Yourself

 

The Clinician’s Role

Home health patients are often referred from a facility. Therefore, transitioning from a well-equipped, well-staffed environment to receiving care at home can be a daunting task for the patient and his or her care givers. Home Health clinicians play a huge role in making this transition go smoother. It is imperative that clinicians are strong in their communication, education, assessment, and leadership skills.

With experience, clinicians will develop a skillset that assists in completing a visit systematically. With ever increasing regulatory demands and a growing senior population, it’s easy, especially for less experienced clinicians, to become overwhelmed during the flurry of activity that can happen during a home visit. From time to time even veteran clinicians should reevaluate their routines to make sure they are delivering excellent care while being efficient and methodical. This article has some tips to help clinicians evaluate and improve their routines.

Accurate Documentation

Visits need to be completed in a timely manner and in accordance with CMS regulations. Be sure to follow MD specific orders for admissions and/or discharges. OASIS item M0102 and M0104 (MD ordered SOC & Date of Referral) are process measure items and impacts star ratings, therefore accuracy is very important. Make sure your great care is well represented with great documentation. Be organized and have structure for the patient’s assessment and care. Set an appointment with the patient for visits. Consider the patient’s preference regarding the visit time. Their input may assist in a more productive experience. Once an appointment is set, plan accordingly. Map out the driving route to the home and consider any potential weather impact or road construction to prevent unnecessary delays. Prepare for the visit by reviewing all paperwork, including the referral and physician documentation. Knowing about the patient’s recent procedures, medical and social history, and current living arrangement will be beneficial. These topics are often discussed in the physician’s History & Physical documentation. Keep supplies organized, readily available for care during the visit to prevent wasted time.

Once in the patient’s home, stay on task and have a plan. Remember why you are there and execute the job at hand, while also making the patient feel important and involved. Focus on the patient and their needs. Do not allow the visit focus to turn to anyone else. Build trust and a good rapport with the patient as the opportunities present themselves. Assist the patient in understanding what to expect. Be attentive to their concerns, but do not allow the visit to be consumed by Q & A. Remove distractions as needed. Personal distractions should be avoided, such as cell phones or a preoccupied mindset. Distractions within the home may also need to be addressed (for example: pets, a loud TV or music, too many people around). Go into every visit with end goals in place and conduct the course of the visit in a way to get closer to meeting those goals. If the visit begins to veer of off the course you have planned, politely redirect its path.

Accurate Documentation Is Good For Patients and Clinicians 

Paint a true picture of your patient and their living conditions. This can often lead to an MSW or therapy referral to meet types of needs that may never be identified in a facility setting. Remember, if it isn’t documented, it didn’t happen. Therefore always be thorough in this part of your care. Make eye contact as much as possible, but attempt to jot down important information that you are gathering as you go. Start observing as soon as you pull into the driveway. Look at the yard, front porch and the condition of overall surroundings for safety hazards and concerns. Note who answers the door. If it is the patient, assess their speech, gait, demeanor, etc. from the very beginning to assist you in your overall assessment. Observe the cleanliness of the home and how it may impact the patient and their care. Be aware of the other people in the home. Keep the patient’s safety and your own safety as top priorities.

Make sure you speak clearly and in a manner that the patient can understand. Use common terms and explain procedures, plans, and paperwork. Exhibit warmth and empathy through your communication. Overcome barriers – speech, hearing, and vision then note whether specific therapy referrals are appropriate. Listen to the patient and address their needs, requests, and concerns. Their involvement in the visit, development of Plan of Care, and overall outcome will be determined by the visits. Communication extends to within the home health agency as well. Always provide a report time to other clinicians that will follow you into a home. It is also a good practice to attempt to inform the patient of who will be included in the care. The new Conditions of Participation place a strong emphasis on care coordination.

Watch For Signs

Patient safety is an essential factor that the visiting clinician must assess. Monitor family members to gauge any suspicious behavior that is indicative of abuse or neglect. Be aware of what the signs are of elder abuse. Be mindful of animals, especially dogs. Anticipate problems and position yourself close to the door with ease of exit at any point during the visit. Maintain your car and gas. Be available to leave on a second’s notice. Keep your cell phone charged and always have a plan. If a situation arises, stay calm. Do not be manipulated by anger, fear, or sadness.

Plan the visit in a way that eases the patient into the uncomfortable subjects at the right times. Be empathetic by stating the obvious, that things are personal and somewhat uncomfortable to talk about. Make sure to document any behavior that is aggressive. Report concerning behavior to the Clinical Manager and physician, as these situations need to be addressed quickly to prevent escalation. Patients of advancing age fear the loss of independence. Assure your patient that they are still involved in their care and remind them of their rights. Being a provider can take a toll on someone physically, emotionally, and mentally. Take time off when needed and minimize the time you take work home. Don’t be afraid to ask for help or for a break. Advocate for your patients and yourself.

References:
http://Cdss.ca.gov
http://allnurses.com/home-health-nursing/10-tips-for-292108.html
http://elderabuse.stanford.edu/screening/signs.html
https://www.brightfocus.org/alzheimers/article/warning-signs-elder-abuse-and-tips-caregiver
http://www.preventelderabuse.org/elderabuse/communities/advocacy.html

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Select Data is committed to a strong compliance program that includes educating all personnel on mitigating HIPAA breaches. For more information about Select Data and their commitment to quality in Home Health and Hospice, call 1.800. 332.0555.

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