By Debra Wood, RN, contributor
March 2, 2012 - A confluence of factors--payers pushing care to less expensive settings, an aging population, baby boomers? expectations for care--is driving health care from institutions to the community, creating opportunities for experienced nurses able to practice more autonomously.
?Many things they are doing in the hospital can be done at home, if you give them the resources,? said Christine Hooker, MSN, RN, clinical director of ambulatory care at SUNY Downstate Medical Center in Brooklyn, N.Y., who has found that managed-care policies have resulted in patients being discharged sooner.
Hospital nurse managers coordinate with the clinical coordinators in the clinics to arrange services needed to allow patients to convalesce at home.
?Patients are happier around their family in a comfortable environment,? Hooker added.
Marie Blessington, RN, director of clinical leadership development at Bayada Home Health Care of Moorestown, N.J., has noted an increase in patient acuity in patients coming out of the hospital.
?They have greater clinical needs, and require more rehabilitation and general teaching and education,? Blessington said. ?They don?t come out of the hospital ready to manage their illness independently.?
Caring for such patients requires highly skilled nurses who can work independently.
?Their clinical sensibility needs to be acute; they have to know their stuff,? Blessington said. However, she added, many nurses do not view home care as a career path, but more of a second job for extra money. She has been with Bayada for 20 years and moved up within the organization, which has offices in 24 states and India and provides skilled and supportive services.
?It is so gratifying to be able to keep people in their homes, to age in place and have a quality life despite catastrophic issues,? Blessington said. ?I hope nurses as they decide about their careers recognize home care has just as much challenge.?
Lora Mantelman, RN, president of Sienna Home Care in Northbrook, Ill., also reported an increase in patients? acuity with more complicated care needs.
?Home care is exploding, with the baby boomers coming along,? Mantelman said. ?It?s what the baby boomers are going to expect.?
Patients with long-term needs also are receiving more care at home. Mantelman has some patients who Sienna staff members have cared for for years, allowing them to stay home as long as they can.
The Program of All-inclusive Care for the Elderly (PACE) serves people age 55 and older who need nursing home-level care, but with supportive services, they are able to stay in their own homes. Medicaid and Medicare cover the cost of services, which includes adult day care, medical care, home care, prescription drugs and other care deemed appropriate by a multidisciplinary team.
?In a community-based environment, you do not have economies of scale [available in an institution], but what you have is an opportunity to honor individuals? ability to live in the community,? said Shawn Bloom, president and CEO of the National PACE Association. ?To do that, nurses become an integral part of the care delivery model.?
The number of PACE programs has more than doubled during the past five years, Bloom said, and he expects additional growth moving forward. In 2011, 82 PACE programs were operating in 29 states. Participants go to an adult day center, where professionals organize their care. But Bloom said much of the actual care takes place in the home.
?In models of care, like PACE, which emphasize the importance of primary care, nurses become paramount,? Bloom said.
Patients frequently say they want to die at home rather than in the hospital or nursing home but most do not. Hospice can increase the possibility of dying at home with the appropriate support.
?People want to be at home, be cared for and die at home,? said Judy Bartel, MSN, ACHPN, CHPCA, FPCN, chief clinical officer of Hospice of the Western Reserve in Cleveland, Ohio.
Bartel expects that in the next two years more people will die at home due to changes in reimbursement for readmissions. Hospices are growing in numbers. More nurses are working in the field and more will be needed in the future.
?The movement toward community-based care will be a celebration,? Bartel said. ?Nurses who come to us for employment, say this is what I?ve always wanted to do, what I learned in nursing school.?
?
Find Top Travel Nursing Positions
Now is a great time to be a travel nurse with more travel opportunities available at top facilities nationwide. NurseZone gives you access to the nation?s leading staffing agencies. Search thousands of jobs and find positions in the location and specialty of your choosing.?Get started?today!
?
? 2011. AMN Healthcare, Inc. All Rights Reserved.?
nightline brady quinn brady quinn bloom box fat tuesday girl scouts obama sweet home chicago
No comments:
Post a Comment
Note: Only a member of this blog may post a comment.