An elderly man lives with his daughter and her family. Up until recently, he has been able to get out of his bed or a chair independently. Because of a chronic lung condition and worsening arthritis, he must now ask for assistance from his family to rise to his feet. Right now he is able walk with his walker, but his daughter is fearful that he will continue to deteriorate. Because he is reluctant to ask for help, he stays in his chair most of the day. She can see that he seems weaker and slower these days. He is also complaining of increased pain in his joints.

Since he can no longer rise without assistance, the family must ensure that someone is home with him at all times. The daughter and her husband both work, so managing this dynamic is proving to be problematic. She is able to obtain some assistance from extended family and her church members for now, but she is afraid those resources may soon disappear.

While the daughter wants her father to remain in her home, she is struggling to provide him with all the care he now requires.

Typical home health response:

Skilled nursing could be implemented. This would allow a nurse the opportunity to perform such interventions as:

• Identify any possible underlying causes for the increased weakness, such as a worsening of a previously stable lung condition, and report those findings to the physician.
• Assess the client’s pain management regimen, establish effectiveness and facilitate improved pain management
• Instruct family on risks associated with impaired mobility and methods to prevent complications

Physical Therapy/Occupational Therapy could be implemented to address the clients decreased mobility and functional status, with the goal of returning him to independence with bed/chair transfers and ability to safely walk with his walker throughout his daughter’s home.

Home Health Aide could be implemented, if indicated, to assist caregivers with personal care to ensure that client does not develop skin complications related to his immobility.

Result: With home health assistance, it is determined that the client’s deterioration is related to low blood oxygen levels and increased joint pain. A physician’s order is obtained for pain medication and home oxygen. With the help of therapy and nursing services, the client shows drastic improvement. His pain is controlled, his strength improves and he is once again able to rise to his feet independently and walk throughout the house. Because the client is now able to be left alone safely, the daughter is confident that she will be able to keep her dad with her in her home…where she feels he belongs.

A elderly woman is having frequent headaches and goes to see her physician. He tells her that her blood pressure is quite high and starts her on two new medications. A few days later, she begins to notice that she is lightheaded and weak in the mornings. She often feels the need to lay down for a nap before noon, which is unusual for her. This continues for another two weeks. The woman begins to attribute these changes to her new medications and decides to stop taking them. Although it is difficult for her to get to the doctor, she makes a followup appointment to see him in a week. At that appointment, the physician tells her that her blood pressure is still too high. The physician changes the woman’s medications yet again.

Typical home health response:

Skilled nursing could be implemented. This would give a nurse the opportunity to perform such interventions as:

• Assess the client’s blood pressure frequently and notify the physician of her response to the new medications.
• Assess underlying dietary considerations, such as a high sodium diet, that could be negatively impacting the client’s health status and instruct the client on healthy alternatives.

Result:With home health assistance, the client experiences fewer adverse effects from her medications and is able to take them as ordered. This compliance, along with the regular blood pressure reports he receives from home health staff, allows the physician to determine whether or not the medication prescribed is effective. The client’s blood pressure stablizes and she becomes more knowledgable about how her dietary choices can negatively impact her health status.

An elderly woman has congestive heart failure. Her condition has worsened over the past few years and she requires frequent trips to her physician to obtain lab work and manage her illness. She knows her son must miss work to take her to doctor appointments and she worries that she is becoming a burden to him. Because of these feelings of guilt, she ignores her symptoms and postpones seeking care.

Typical home health care response:

Skilled nursing could be implemented. This would allow the nurse an opportunity to perform such interventions as:

• Assess the client’s understanding of how to successfully manage her heart failure and instruct her on techniques to promote wellness.
• Assess the client’s physical status and report symptoms or complications to the physician before they become severe. Doing so can drastically decrease the need for nonroutine physician visits and reduce dependence on overburdened caregivers.
• Obtain any required labwork, such as monthly fingerstick PTcINR’s.

Result: With the assistance of home health, the client becomes more knowledgable about how to manage her heart failure. This results in an improvement in her condition and fewer unscheduled doctor visits. This, along with home health’s ability to obtain her monthly labs, decreases how often the client’s son must take off work to take her to the physician.

A normally active elderly gentleman notices he is becoming weaker and more unsteady on his feet. He used to be able to go to the Senior Center three times a week for lunch and to play cards with his friends. Now, he is beginning to stumble somewhat and is afraid he may fall. He is also so exhausted when he comes home from the Senior Center that he is reluctant to attempt the outing at all. The change in his life routine is leaving him feeling vulnerable, isolated and fearful that his deterioration is an inevitable part of aging. His wife notices that he is becoming withdrawn and less likely to participate in family events.

Typical home health care response:

Skilled Nursing could be implemented. This would allow a nurse the opportunity to perform such interventions as:

• Identify any possible underlying causes for the increased weakness, such as a worsening of a previously stable cardiac condition, and report those findings to the physician.
• Identify any symptoms of situational depression and facilitate treatment, if indicated.

Physical Therapy could be implemented to address the client’s decreased strength and balance issues, with the goal of returning the client to his prior activity level.

Result: With the assistance of home health, it is established that the gentleman’s heart is stable. His decline in strength and balance eventually led him to experience an overall deconditioned state. Because of his home health physical therapy program, he was able to regain his strength and return to his previous active lifestyle. In addition, he was taught a home exercise program that will help him maintain this lifestyle on a long term basis. He feels like himself again and resumes his outings to the Senior Center.

An elderly woman is becoming more and more forgetful. Her daughter, who works full time and cannot see her mother but once a week, fears that her mom is no longer taking her medications correctly. The daughter is also noticing that her mom is losing weight, she is sleeping more than usual and her personal hygiene is deteriorating.

Typical home health care response:

Skilled Nursing could be implemented. This would allow a nurse the opportunity to perform such interventions as:

• Identify possible underlying causes for the decrease in her mental status, such as infection, and notify the physician of findings.
• Assess the client’s ability to manage her medications effectively and implement strategies to promote as much independence as possible with the task.
• Assess nutritional status and implement strategies to increase client’s food/fluid intake.
• Establish the level of assistance required to keep the client safely in her home and coordinate care with the staff, family or alternate caregivers to ensure her needs are being met.

Physical/Occupational Therapy Evaluations could be implemented to identify and address any functional deficits, with the goal of increasing the client’s ability to remain safe and independent in the home setting.

Home Health Aide services could be initiated to assist patient with bathing, dressing and other personal care, until the client demonstrated an ability to safely perform the task independently.

Medical Social Work Evaluation could be ordered to establish which community resources, such as meals on wheels, are available to the client.

Result: With assistance from home health, the client’s medications are successfully managed, her mental and nutritional status improve and she begins to become more active and take better care of herself. Her daughter is taught to fill her mom’s med minder once a week and to identify signs and symptoms of complications that could indicate another deterioration in her status. The medical social worker established meals on wheels and identified a benefit available to the client through a long term care policy she purchased years ago. A referral was made to a private caregiver service and the client now receives 12 hours of sitter services a week. Because home health care was able to identify and coordinate care with all available resources, the client is able to remain safely in her home.