General Info


Diagnosis


Intervention


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Home Health Services

Article written by Sherry Brient, PT


General information

Home health care is skilled medical service that is provided in the home and may include nursing, physical therapy, occupational therapy, speech therapy, social service, dietary counseling, and home health aides. Many older people who are electing noninstitutional living are receiving home health care as their physical capabilities diminish. Younger adults and children with disabilities or those who are recuperating from acute illness, injury, or surgery, such as total hip replacement, also may be recipients of home health care. As well, people who are experiencing terminal, end of life diseases may receive home health services. It is anticipated that,as the length of hospital stays decrease, an increasing number of people will require rehabilitation services such as physical therapy when they return home.

Home health care services may be paid for directly by patients and/or their family members or through a variety of public and private sources. Public third-party payers include Medicare, Medicaid, the Older Americans Act, the V.A., and Social Services block grant programs. Some community organizastions, such as local chapters of the American Cancer Society or National Easter Seal Society, may provide funding for home care services. Private third-party payers include comercial health insurance companies, managed care organizations, CHAMPUS, and Worker's Compensation.

Home health services can be delivered by various types of home health providers, including home health agencies and independent providers. The term home health agency usually indicates that the home care provider is Medicare certified and has met federal and state requirements for patient care and management and thus can provide Medicare and Medicaid home health services. Different agencies will provide a variety of home health services and professionals.

Changes in health care reimbursement have challenged providers of home health services to make more efficient and effective use of resources. The reimbursement structure under which services are provided becomes increasingly complex with frequent changes in the regulations that govern the reimbursement of home health services. According to HCFA, home health services are a mandatory benefit for individuals who are entitled to nursing facility services under state Medicaid plans. Services must be provided at a recipient’s place of residence.

Home bound status is a primary requirement for an individual to receive home health services. The criteria for homebound include:

1. Patient cannot leave home without considerable and taxing effort.
2. Patient absences are infrequent, or are for short duration.
3. Patient absences from home are primarily attributable to the need to receive medical treatment.
4. Non-medical absences from the home, such as walks around the block, or trips to the barber, are infrequent or of relatively short duration.
5. Patient's non-medical absences do not demonstrate an ability to obtain health care outside rather than in the home.

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Diagnosis

Patients with many kinds of injuries or illnesses resulting in functional impairment may benefit from home health services. More specifically individual diagnostic-related groups most likely to need home health rehabilitative services are:

  • stroke

  • chronic obstructive pulmonary disease
  • heart failure
  • major joint procedures
  • hip/femur procedures

 
Other common diagnoses or problems indicating home rehabilitative services may include but are not limited to:

  • falls and balance problems

  • multiple sclerosis
  • cancer
  • spinal cord injuries
  • weakness and debility
  • osteoporosis
  • osteoarthritis
  • spinal compression fractures
  • rheumatoid arthritis
  • various long bone or joint fractures
  • amputations and prosthetic training
  • decreased function following surgery or acute
  • pain management
  • hospitalization
  • cardiac conditions
  • difficulty for caregiver to provide safe confident care
  • parkinsonism
  • paraplegia or quadraplegia

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Intervention

A typical initial physical therapy visit.

A referral for home health services is generated through the patient's physician. If necessitated by the patient's medical condition a nurse will be the admitting professional and will be the case manager, who coordinates all services provided. If nursing is not indicated, the physical therapist wiill admit the patient to home health and coordinate all services provided. Both will communicate closely with the referring physician regarding plan of treatment and progress.

The initial physical therapy visit may include:

  • providing information for communication and emergency procedures

  • signing of consent to treat forms
  • assessing home safety and making recomendations
  • evaluating patient function and dysfunction to determine baseline abilities by utilizing various tests and assessment tools
  • identifying problem areas
  • setting individualized goals and planning treatment between the patient, P.T., and caregiver (taking into consideration the patien's prior level of function)
  • establishing treatment frequency and duration in order to achieve goals
  • treating the identified problems to initiate progress toward goals
  • instructing/supervising the patient and/or caregiver with a home exercise program

 
Subsequent physical therapy visits will focus on teaching and providing treatment techniques to help the patient and/or caregiver achieve the established functional goals and to reach a higher level of independence or self sufficiency.

Some of the treatment techniques utilized may include:

  • walking/balance training and testing to improve gait pattern and safety

  • therapeutic exercise and strengthening such as: PNF (Proprioceptive Neuromuscular Reeducation),
  • NDT(NeuroDevelopmental Treatment), Feldenkrais, and other manual techniques
  • pain management such as: TENS (Transcutaneous Electrical Nerve Stimulation) , MFR(Myofascial Release)
  • exercise/stretching, joint and soft tissue mobilization, modalities (heat, cold, ultrasound)
  • posture training
  • teaching integration of body mechanics/leverage into home activities of daily living for patient and caregiver, upgrading of home exercise program.
  • ordering of equipment and progressing with appropriate assistive devices
  • teaching wellness,prevention and safety

 
REFERRAL

You may consult with your physician for a home health referral if you feel that you or someone you know meet the criteria for home care. You may also call any home health agency in your area and they will assist you with how to access home health services.

 
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Topic of the Month

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