![]() Therefore, compared to the hospitalized patient, the home health care patient often has a greater role in determining how and even if certain interventions will be implemented. In home health care, clinicians recognize that the care setting-the home-is the inviolable domain of the patient. Nonetheless, many decisions are made by clinicians on behalf of hospitalized patients. Respect for patient autonomy is valued in hospital-based care. #Pure hearts personal care home professional8, 9 Certain distinctive characteristics of the home health care environment influence patient safety and quality of outcomes: the high degree of patient autonomy in the home setting, limited oversight of informal caregivers by professional clinicians, and situational variables unique to each home. Home health care nurses spend more time on paperwork than hospital nurses and more time dealing with reimbursement issues. The nurse-physician work relationship involves less direct physician contact, and the physician relies to a greater degree on the nurse to make assessments and communicate findings. For example, home health care nurses work alone in the field with support resources available from a central office. The home health care environment differs from hospitals and other institutional environments where nurses work. 6 Common diagnoses among home health care patients include circulatory disease (31 percent of patients), heart disease (16 percent), injury and poisoning (15.9 percent), musculoskeletal and connective tissue disease (14.1 percent), and respiratory disease (11.6 percent). 5 Medicare beneficiaries who are in poor health, have low incomes, and are 85 years of age or older have relatively high rates of home health care use. In addition, the care must be provided on an intermittent and noncontinuous basis. ![]() 5 To be eligible for Medicare reimbursement, home health care services must be deemed medically necessary by a physician and provided to a home-bound patient. The Centers for Medicare and Medicaid Services (CMS) estimates that 8,090 home health care agencies in the United States provide care for more than 2.4 million elderly and disabled people annually. 2–4 Physicians may refer patients for home health care services, or the services may be requested by family members or patients. 1 The goals of home health care services are to help individuals to improve function and live with greater independence to promote the client’s optimal level of well-being and to assist the patient to remain at home, avoiding hospitalization or admission to long-term care institutions. Home health care services include nursing care physical, occupational, and speech-language therapy and medical social services. Home health care is a system of care provided by skilled practitioners to patients in their homes under the direction of a physician. ![]()
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