Understanding Private Home Care

The following information is provided to help families/patients and care providers establish a professional working relationship within a home environment. The general guidelines are designed to help patients and families prepare for the experience of home care and provide a means of avoiding common sources of conflict and stress. It is important for patients/families to go over the issues identified and make the necessary decisions regarding each content area. The patients/families and the case manager should then meet with the nursing personnel who will be in the home to define roles and responsibilities. When a nursing agency is involved, the agency supervisor needs to be involved in the discussions to assure the decisions made are not in conflict with agency policies and procedures.

The primary focus of the in-home nurse should be the care of the medically compromised or fragile patient. Although home-care personnel are employed to care for one patient, the fact that he/she will also be interacting with other members of the family requires clearly defined relationships be established with other family members as well as other health care professionals. The initial months of home care can be difficult as everyone adjusts to their new roles and responsibilities with multiple providers of care.

There are tensions that may occur between family members and nurses when caring for a medically compromised person at home. One of the major sources of tension seems to be the conflict that may occur due to a lack of clear role definition. Family members may feel they are not being listened to or that they are viewed as being petty for being irritated by "minor inconveniences." Nurses may feel family members are interfering with the care they are supposed to provide. This experience over the course of many weeks can be very frustrating for everyone. Again, clearly defining roles can effectively minimize conflict and tension that may occur. The agency case manager can be helpful in working with families to resolve these issues.

The role of NEN is to provide private duty nursing, skilled nursing, therapeutic rehabilitation, aide staff, homemakers and companions to care for clients at home. The following are the duties and responsibilities of NEN with respect to the care that is rendered:

• Attempts to provide uninterrupted care for the patient based on physician orders.
• Provide training and education to appropriate family members for personal care services in the event that care cannot be provided for a specified period of time.
• NEN attempts to identify and make available one trained back-up caregiver for care to be provided. It is preferable to have two, and sometimes it may be necessary.
• Develops and follows a plan of treatment/plan of care which is signed by the physician which describes all medical care & services to be provided.
• Verifies all physician orders not directly received by a nurse licensed to receive orders.
• Provides only those services that are authorized by the payer.
• Notifies the client/caregiver if there are changes in the schedule.
• Notifies the physician if there are scheduling problems. Assists the patient in preparing for emergencies and disasters.
• Reports to protective agencies and/or law enforcement agencies, incidents or suspected abuse of elderly persons, dependent adults and children, as mandated by law and regulation.
• Adheres to all Federal, State and local laws and regulations.
• Adheres to state nurse practice acts in reporting nurses for violations in practice.
• Maintains the confidentiality and integrity of all information related to the care of the patient.

The following are the duties and responsibilities of the Client/Family with respect to the care that is rendered:

• Provides an environment that is conducive to the care being provided. (ie., room for medical equipment and supplies, clean safe room for patient/service providers/water and power in the home, working telephone that is available at all times)
• Provides a safe environment for the staff and Client.
• Informs and updates "List of Contacts". These are individuals that have been previously trained to act as back-up caregivers in the event that staffing is not accomplished. There must be a minimum of one trained individual (family member/friend) available at all times as back-up.
• Maintains appropriate eligibility for the identified payer source(s).
• Informs NEN of changes in name, address, insurance/payer, employment, and eligibility for payer of record, etc.
• Informs NEN of any changes in medical condition, medications, or conditions that affect the in-home nursing care plan.
• Provide care for any individuals in the home other than the Client.
• Maintains all authorized medical equipment as ordered by the physician.
• Participates in preparing back-up emergency plans and maintains a sense of readiness in the event of activation.
• Arranges for and provides all transportation that is needed relating to the care of the Client (i.e. physician visits, school, etc.)
• Work with NEN to resolve problems.