RSPT 1241 Unit 3Home care

lecture notes by Elizabeth Kelley Buzbee

Unit 3: Home care objectives

  1. Discuss the role played by the in house RCP in the home care area. What is the job description of the discharge planner?
  2. What are the problems inherent in the last minute ordering of home care RC modalities?
  3. What is the advantage of using the hospital’s discharge planner?
  4. List the disciplines that make up the discharge planning team.
  5. Discuss the steps taken to include a patient in homecare.
  6. Discuss the role played by diagnostic tools & documentation of need in the ability of the homecare facility to get reimbursement
  7. Discuss the role played by the RCP and RN in the education of the patient & the patient’s family.
  8. Discuss the importance of the initial home visit. What does the RCP assess in the following?
  1. Psychosocial
  2. environment
  3. Physical assessment
  1. Differentiate between the plan of service and the respiratory car plan
  2. Discuss follow up plans and follow up telephone calls.

Lecture

  1. Discuss the role played by the RCP in the home care area.
  2. The RCP doesn’t just deliver the equipment to the home
  3. He selects and trains the patient
  4. He assesses the home setting as well as the patient’s physical status
  5. He assess the patient’s support structure

What is the job description of the discharge planner?

  1. Identifies the patient’s needs
  2. Degree of care needed
  3. Types of equipment need
  4. Identifies the patient’s resources
  5. Insurance coverage
  6. Caregivers and their abilities
  1. What are the problems inherent in the last minute ordering of home care RC modalities?
  2. Things get missed. Patient on ventilator will also need airway care products
  3. Discharge is delayed
  4. Financing is inadequate for the patient’s needs & there is no time to seek alternatives
  5. Care takers don’t get the training they need
  1. What is the advantage of using the hospital’s discharge planner?
  2. Gets discharge planning started in an timely manner [while the patient is in the acute care setting]
  3. Co-ordination with a single person [RN, Social worker RT] avoids duplication or omissions
  4. There is accountability in having a single coordinator
  1. List the disciplines that make up the discharge planning team.
  2. Patient
  3. Patient advocate [family or guardian]
  4. Doctor
  5. Discharge coordinator
  6. Hospital nurse
  7. Hospital RCP
  8. HME RCP
  9. Medical social worker
  10. Insurance company case manager
  11. Care givers [paid or unpaid]
  1. Discuss the steps taken to include a patient in homecare.
  2. Perform all required diagnostic tests to document need for homecare and assess the exact level of handicap
  3. Assess the patient’s limitations to self-care that may or may not have to do with his chronic illness. [Near-sighted can’t read flowmeter? Arthritis cannot change tank?]
  1. Discuss the role played by diagnostic tools & documentation of need in the ability of the homecare facility to get reimbursement
  2. Both the federal government and private insurance companies have strict guidelines on what they will pay for. The assessments must fulfill their criteria:
  3. i.e. Medicare will not send someone home on 02 whose Pa02 is more than 55-60 torr on Room Air or whose Sp02 is more than 88% on room air
  4. One cannot assume that the insurance will pay or that the patient will not refuse something he cannot afford
  1. Discuss the role played by the RCP and RN in the education of the patient & the patient’s family.
  2. It does the patient no good to go home on an apnea monitor if the family doesn’t learn how to respond to apnea appropriately
  3. Going home on a volume ventilator involves the caregiver not only a basic introduction to ventilators but to airway protection and suctioning and basic life support.
  4. This education involves an honest assessment of the caregiver’s real abilities. Family members may say, “Yes, I will care for him.” But not show up for training sessions or display inappropriate behaviors during training
  5. Caregivers may not understand the time commitments involved in caring for this patient in his home.
  6. Discuss the importance of the initial home visit.The RCP will evaluate the physical environment where this care will be done.
  7. The HME RCP will make first contact with patient by telephone after the doctor has written an order for the equipment and there is a referral to the HME company
  8. If the HME Company sends a sales rep the RCP needs to show up in the first 24 –48 hours to assess the setup and answer questions. In some states the RCP will be the only one to set up some of this equipment
  9. Refer to page 23 Table 2-4 for the kind of questions to ask the patient or the caretakers
  10. Suppose your tracked patient on Fi02 35% has only space heaters in his home. Which does he choose? 02 or heat?
  11. Suppose the patient’s wife is too elderly to do CPT on her husband
  12. Suppose the caretaker is illiterate?

What does the RCP assess in the following?

  1. Psychosocial: depression is an issue the HME must face & the RPC must always report suicidal remarks to the doctor
  2. Cultural problems can affect patient care in the home
  1. Environment: the RCP must assess the home for safety issues, fire prevention and other problems
  2. Electrical plugs are important
  3. Can the house support the TV and the 02 concentrator
  4. Does the house have air-conditioning? Smoke detectors? Fire extinguishers?
  5. The RCP must assess the fuse boxes & check for grounded plugs
  6. Where will the equipment be cleaned and stored?
  7. Map out an emergency exist
  8. Be reasonable. Not everyone keeps house as well as you do
  9. Refer to page 26 Table 2-6 for elements of home assessment
  10. Physical assessment: see page 29 table 2-7 for parameters needed to be assess during the visit.
  1. Differentiate between the plan of service and the respiratory car plan
  2. plan of service is the plan for the patient with simple needs; one who can take care of himself easily. The plan of service will state “we will deliver 2 tanks twice a month ect.
  3. respiratory care plan: more detailed plan because the patient’s needs are more extensive.It needs a signature from the doctor
  4. More fragile patient
  5. Less stable environment
  6. The focus of the care plan is to bring the patient into a higher level of self-sufficiency and to forestall relapses as well as promote clinical stability.
  1. Discuss follow up plans and follow up telephone calls.
  2. Follow up is needed because a patient who starts off on respiratory care plans with more intensive care may progress to needing only a plan of service
  3. For persons who refuse home visits a telephone follow up is a reasonable alternative.

Rehab and home care 11/6/18 4:26 PM 1