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Home Health Nursing: Putting The Care Plan Back In The Nurse’s Hands Right Where It Belongs!


In today’s world, home health nursing is more skilled and the medical home model is more and more a reality in the present and future of home care. In that mix, somewhere the power of the skilled clinicians in the home has lost some momentum. Why has the nursing care plan become so dependent on the physician over the course of the last several decades? Let’s take a look at the past, present, and hopefully a change for the future.

Looking Back Before The 485:

Public health nursing really began back in the late 1800’s with Lillian Wald as its early pioneer. It was a brilliant combination of looking at the patient’s health and socioeconomic status in a way that could promote safety and wellness for those in their homes. The nurses did what was needed to be done for the patients at that time. It led to the visiting nurses associations in the early 1900’s that were focused on public health, disease prevention,  and wellness for all ages. Nurses at this time, were not functioning in a way that was hindered by face to face documentation, 485s, MD orders, and other heavy government regulatory constraints. Nurses used their critical thinking to determine the care plans they managed in the home within the scope of practice.  Most of this was separate from a physician. Why have we gotten so far away from the nurse being in charge of his/her own plan?

Fast Forward to the Expansion Of Medicare Home Health:

We know as more federal dollars come into play, more regulation for those the dollars comes with it. We saw the 485 become the standard for the nursing plan in 1967.  It contained items that needed ordered by the doctor but also routine parts of nursing care. The question is why? A nurse going into the home and doing vitals every visit is part of a routine nursing assessment. The idea that this is added to a 485 and signed off by a physician isn’t necessary. Routine nursing interventions are within the nursing scope of practice and would not have to have a physician order it. The same would apply for other skilled and trained professional positions within home health. If the state nursing board requirements are met and agencies determine skill and competency requirements have been met, then why does the home health benefit require the doctor to sign off on what isn’t necessary?

Let’s Get Back To Basics:

We as an industry need to focus on home health reform that puts the power of the public health nurse back into the home. Especially during this time of a pandemic illness, we should understand the importance of the professionals in community-based services. So much of the skilled nurse’s time is spent on documentation and regulatory requirements that aren’t in direct care of the patient. This doesn’t make any sense and is frankly a reason many have left the industry altogether. The physicians don’t need or want additional papers to sign and don’t need to know every nursing intervention being considered. If there is something specific, then the doctor will make that known.

So, what does all this mean? It means that politically, we should be focused on health care reform that makes sense for this industry. Nurses and other skilled professionals in home health are programmed to do exactly what Lillian Wald planned hundreds of years ago. We need to get the power of patient care back in their hands. It is critical for the patient as well as the industry.

Kenyon Homecare Consulting Can Help With Change:

Whether you are looking to change your care planning process or improve operational function, Kenyon Homecare Consulting can help. With a full spectrum of homecare, home health, and hospice services, we can help in the start-up process all the way to those with long-standing agencies dealing with educational or operational needs. Call us at 206-721-5091 or contact us online for your free 30-minute consultation with a senior consultant to work through being the change you desire at your agency. Please join us for our free webinar on May 14th entitled Learning Organizations Produce Financial Success Through Positive Corporate Culture. We hope to see you there. 

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