Working as a nurse in home healthcare for 27 years, I have experienced firsthand the changing landscape, including a complex aging population, nursing shortages, a highly regulated industry, and now a pandemic. Through all the ebbs and flows, one thing has remained constant—the positive influence a nurse has on a patient’s outcomes and quality of life.
Home healthcare nurses work with a wide variety of patients, including those undergoing acute illness or injury, navigating chronic conditions like congestive heart failure or experiencing progressive diseases like dementia. To ensure that nurses are fully equipped to meet the needs of such a diverse population, nurses make lifelong learning a requisite.
Home healthcare nurses have the unique opportunity to work autonomously in the patient’s home environment, which presents both rewards and challenges. The home environment requires a nurse to adapt to patients’ various values and lifestyles while establishing trust and delivering complex individualized care. Making on-the-spot decisions about the patient’s health status is crucial; therefore, nurses who show critical thinking are especially important in the home setting.
Misconceptions about home health
There are some misconceptions about home-based care, such as the idea that it is lower quality compared to the care provided in hospitals, facilities and other settings. That is simply not true; the care nurses provide in the home is just as effective as care received in a hospital or skilled nursing facility, along with the added benefit of care delivery in the comfort of home. Keeping patients safe at home, avoiding hospitalizations, and helping them return to an optimal level of functioning are at the heart of home healthcare nursing.
The greatest impact a nurse can have in this line of work is being a patient advocate. To achieve this, nurses become skillful at detecting early signs and symptoms of declining health, and they use their knowledge and expertise to take action. Advocating for the patient means communicating with the interprofessional team for a medication change, physician appointment or additional skilled needs such as therapy services. Being a good listener and effective teacher are also important while having the benefit of treating patients one-on-one in their home.
While having acute nursing skills learned in hospital settings is a benefit, home healthcare nurses must also have additional skill sets that involve addressing social determinants of health and collaborating with community resources to help the patient safely remain in the home.
Why home care over other settings?
When asked why I chose skilled in-home care over other health care settings, my answer remains consistent—there is no other setting where I feel I can use my experience and expertise to walk alongside a patient throughout their entire care journey. I can contribute to a positive experience and deliver the best gift—quality of life—in the comfort of their home. Therapeutic relationships with patients are at the core of nursing.
I want to share a story about Juanita’s journey. Juanita was in her 70s, with two adult children and five grandchildren. Juanita was a retired schoolteacher who later became an elementary school counselor in her mid-50s. Once Juanita retired, she volunteered at church and dedicated much of her time to organizing philanthropic work with the local women’s club in a small town where she was born and raised. Juanita and her late husband married in their 20s and lived out their lives united as a couple.
Shortly after the death of Juanita’s husband, the family recognized her health was declining. Juanita experienced several falls that led to multiple hospitalizations, surgical repair of a fractured hip and extensive rehabilitation; eventually she was cleared to go home again. It was then that her family observed changes in her mental status. Juanita exhibited signs of confusion and complained of a severe headache throughout the trip, which was unusual for this upbeat matriarch.
Upon her return, her family scheduled another physician appointment. This time, a home healthcare referral ensued, with a focus on physical therapy for strengthening and speech therapy for cognition. Therapy suggested nursing to assist with medication management and wound care after she experienced another fall. It was at that point that the nurse focused on Juanita’s medical history and engaged in interprofessional collaboration with Juanita’s physicians, pharmacists, therapists and family that she knew something more serious could be affecting Juanita’s health.
The nurse called Juanita’s primary care physician to express concerns about her multiple falls within the past six months that included head impact, and she shared her belief that the patient would benefit from a CT scan. Juanita was later diagnosed with a chronic subdural hematoma that required surgery to remove the pressure from her brain. Her recovery continued with the help of her home health nurse, who was advocating for her every step of the way throughout her care journey.
Success stories like Juanita’s often remind me how important it is to focus on person-centered care across the healthcare continuum. Encompass Health’s home health nurses make a positive impact on every patient and loved one they encounter in the patient’s most comfortable environment, their home. We learn about their story, their hobbies and their passion in life. This is my passion. This is the core of nursing.