GLORIA BUTLER BALDWIN

Home healthcare isn’t just one option out of many for a lot of people, it’s a necessary service. Even if patients or their families are reluctant to use home healthcare, insurance companies are increasing pressure for people to take care of their own medical needs at home. As baby boomers reach their senior years and hospitals become more crowded, the need for home healthcare will increase even more. Family members are being trained to do some of the tasks typically done in hospitals, sometimes with disastrous results.

According to the Mississippi State Department of Health’s Office of Health Facilities and Licensure, Mississippi has 62 licensed home health agencies, including two which are inactive, 10 affiliated with the Mississippi State Department of Health, three out-of-state agencies, and 47 private ones.

A moratorium on home health agencies has been in existence since the early 1980s. With that many home health agencies in place serving thousands of patients, there is concern about increased medical errors.

The question is raised: Who’s to blame for errors? The home healthcare nurse who is being forced to train families who are sometimes incapable of understanding? Families who are being forced to add more to their already very busy lives? Or the numerous caregivers who don’t communicate with each other?

A study by numerous departments at the Vanderbilt School of Medicine in Nashville of two of the largest urban home healthcare agencies in the United States — The Visiting Nurse Service of New York and The Visiting Nurse Association Foundation in Los Angeles — found medication errors in home healthcare patients, although the study did not look at who or what caused the errors.

According to the study, conducted between 1996 and 1998, using The Home Health Criteria and The Beers criteria, nearly one-third of the home healthcare patients surveyed had evidence of potential medication problems or were taking a drug considered inappropriate for older people. Although the study is 10 years old, problems still exist. The Journal of the American Geriatrics Society, June 2001, indicated that more effective methods are needed to improve medication use in this vulnerable population. Medicare is paying an enormous amount toward home healthcare each year and, although there are exceptions, most patients only see their home health nurse once or twice a week. Between nurse visits, families are trained to dispense medication, treat wounds and keep IV medication going. Lawsuits are filed frequently against home healthcare providers, although there’s often a blur between who’s really at fault: the doctor, the home health agency or the family.

Clare Absher, RN, BSN, of CarePathways.com, said more families are turning to the Internet to find information about long-term care, in particular home care. “It is our nurse’s primary focus to support a family’s decision and assist in making this living option possible. Our nurses help families better understand the types of home care available, the kinds of caregivers best suited to their needs, and how to pay for home healthcare,” Absher said. “As a former home health nurse for over 20 years, I understand families’ multiple challenges to care for loved ones at home. I am frequently amazed by what families can handle when faced with truly difficult care situations with the strong support of capable and dedicated caregivers. Home health nurses that take the time upfront and go slow seem to have the most success with teaching families and encouraging independence. I have seen families overwhelmed countless times when a loved one is discharged from a hospital with little or no planning and preparation. This is when a competent home care agency or passionate caregiver can step in to take on some of the burden and ease this transition. In addition to possible lack of knowledge, misunderstanding expectations and inadequate preparation, sometimes it’s just that today’s families are incredibly busy. Participating in their children’s activities, juggling demanding careers, coupled with caring for an aging parent, is a tremendous challenge.”

Melanie Bowman, RN, MSN, director of the bureau of home health for Metro Home Health Agency, said it goes back to educational level.

“The majority are not non-compliant purposefully, it’s because of their educational level,” Bowman said. “The potential is definitely there for errors. In some situations, you have different family members caring in different shifts. If there is a change in the prescription and the family member fails to report it to the next family member, it can result in a problem. The goal of education of those family members is insuring their communication with each other, along with the nursing staff. It cannot be on the part of the home health or nurse to take that full responsibility.”


November 2007