Often, the preparations before a treatment or procedure is just as important as the follow-up care. Learn how the professionals at these home health care services ensure that patients have a safe and effective recovery.
When someone develops a life-changing disease or is in need of surgery, it’s easy to focus on treatments and procedures. But laying the groundwork before treatment, and following up afterward, is also extremely important to successful disease management and recovery.
Home healthcare bridges these gaps. Highly specialized services, provided by knowledgeable medical professionals, equips patients with the care and education they need to optimize their outcomes. By making a home assessment, encouraging healthy lifestyle changes, managing medications, and providing education, skilled nurses and physical therapists can make an immense difference in the lives of patients and their families.
Sometimes patient home care actually begins in the hospital, with home care liaison professionals, says Elaine Thomas, director of home care for Sherman Home Care Partners, in Elgin.
“Sherman Hospital patients choose the home care services they prefer,” she says. “When they choose us, we start the transition while they’re in the hospital, and continue services until the patients are able to take care of themselves.”
The home care team crafts a custom plan and identifies an appropriate staffing arrangement for each patient.
“Our first assessment visit focuses on how knowledgeable a patient is about his or her disease or physical condition, what the specific needs will be, and what the current status is,” Thomas says. “We look at possible barriers to accessibility at home, make sure the patient has, or can easily acquire, medications, and see whether or not there’s a caregiver at home who is capable of assisting the patient.”
The home healthcare team carefully evaluates long-term needs of patients with chronic health conditions, such as heart disease, diabetes, cancer and ostomy.
“For patients with congestive heart disease, for example, we set up equipment that allows them to transmit blood pressure readings, oxygen levels in the blood, weight variations and other vital information to us, without them needing to come into the clinic,” Thomas explains. “This saves patients time and stress, while helping us to meet the goal of early intervention, in case something isn’t right. This also helps patients to avoid rehospitalization.”
Home healthcare specialists often catch problems quickly because of special protocols set up for patients with certain conditions, such as total joint replacement or post-surgery cardiac recovery.
The primary goal is to keep patients stabilized longer for better outcomes. “We teach self-care, along with how to recognize the signs and symptoms of emerging problems,” Thomas says. “They learn when to call for help, and what the appropriate responses should be for their specific health challenges.”
It takes experienced, highly trained therapists and nurses to work in the growing home healthcare field, because of the unique challenges it presents.
“We face an increasing amount of state and federal regulation in home care,” Thomas explains. “Our staff operates in uncontrolled environments – unlike in hospitals – where variables can make the job really tough. At home, patients face the influence of social and physical obstacles. It’s a whole different world at home, where medicine management and other aspects aren’t so closely monitored. We empower the patient to cope with these situations.”
The home care staff also provides an extra set of eyes and ears for doctors.
“We establish a connection with each patient, to develop trust and confidence,” Thomas says. “We help them to make all the right choices. Face it – change is hard for anyone, but when a patient comes home from the hospital in a totally different condition than when he or she went in, it’s so much harder. We engage them to the point where we can aid them in making necessary changes to their lifestyles. We help them to recognize barriers to their successful recovery and well-being, and to better understand their own cultural, social and philosophical needs. It takes a very special kind of connection to help them live at home safely and independently.”
Helping patients to reach that point isn’t always easy. While some recover as expected, others face certain barriers when it comes to wounds and healing.
This is especially true of diabetic patients. Judie Truelsen, director of Northwest Community Hospital Home Care, Arlington Heights, explains that many diabetic patients need skilled assessments of their home environments, as well as their medical conditions.
“We don’t often see patients who require amputations, but we do see severe wounds that may be slow to heal, because of the nature of the disease,” she says. “The patients may be admitted to home care for wound treatment, but they may also require guidance for their medications, integration of exercise into their daily regimens, instruction on good nutrition, and adjustments that make their home environments easier to navigate safely.”
As long as patients are considered homebound and require a skilled service, they may receive the benefits of Northwest Community’s highly trained team. In most cases, as long as conditions are properly met, Medicare and other insurance will cover the cost of home care services.
Ultimately, home healthcare is a bridge between the hospital and independent function, and is intensely instructional, Truelsen says.
“Our teams do their best to collaborate with the patients, and with each other, to assure good patient outcomes and to foster the patients’ independence,” Truelsen says. “We advise patients on how to care for themselves and how to develop the best methods to promote healing, so they can stabilize their medical conditions. This includes an assessment of the physical layout of their homes for such things as bathroom and stairway setups, accessibility, and lighting, with an emphasis on safety.”
Education is the primary focus for Candy Sanders, a Certified Diabetes Educator (CDE) and certified wound care nurse, one of five nurses on Northwest Community Hospital Home Care’s multi-disciplinary diabetes team who specializes in wound care and cardiac conditions. The team also includes physical therapists, a medical social worker and a registered dietician.
“I call it the triangle of care,” Sanders says. “Its points are the hospital, the outpatient clinic and home healthcare. Among these points of care, we develop a communications network that supports each patient through the treatment and healing process. A person can be overwhelmed by their hospitalization experience. Sometimes, a patient will come in for heart surgery only to discover he or she also has undiagnosed diabetes.”
It’s easy to imagine the confusion and anxiety this kind of health challenge can create. Not only do patients face cardiac surgery and recovery, but they also must deal with a new condition and its accompanying medications, which need to be closely balanced and monitored. And some patients have other issues that complicate treatment and healing even further.
“As a CDE, my focus is to learn how much a patient already knows about diabetes and self-care,” Sanders says. “We check what they know against what they need to know, including how to plan a meal, monitor their blood glucose, give themselves injections, and take their medications as scheduled. And, we give instructions regarding such issues as ketoacidosis and the long-term complications of diabetes. They need to understand not only how to prevent complications, but also how to be alert to their onset. There are myriad assessments vital to each patient’s needs.”
Sanders is particularly passionate about diabetes education, because five of her eight siblings were diagnosed with Type 1 or Type 2 diabetes.
“As a child, that was scary,” she says. “Now I can help others. I feel fortunate that I can do this. I see it as a gift.”
Sometimes, Sanders accompanies other clinicians on consultative home visits, helping both patient and clinician to understand how diabetes affects many organ systems. This dual focus helps to reinforce the benefits of home care, on several levels.
“Another aspect of home care is social interaction,” Sanders explains. “Coping with a chronic illness can be stressful on the relationships within families, as well as with friends and colleagues. Often, we see patients who are discouraged by the immense amount of self-care they need to assume. It’s time-consuming, plus patients don’t always take their medications or follow the doctor’s orders accurately. We encourage them to never give up.”
In general, the duration of home care lasts as long as patients require skilled services and are home-bound. While in home care, patients receive skilled guidance for diabetes management, including dietary education. Once patients are fully recovered, they receive more education and follow-up services at Northwest Community Hospital’s Diabetes Services department, located in the outpatient clinic.
“Some patients refuse to believe they have diabetes,” Sanders says. “They’ll say, ‘Oh, I’m on the edge of having it,’ or ‘I’m just a little diabetic.’ There’s no such thing. I’ll go into a home to find candy bars all over the place. Patients will actually tell me that the candy is for their grandchildren. Maybe. But patients really love me because I explain that they can eat candy. My mantra is, ‘There is no forbidden food.’ But it matters how much they eat and what they eat with it.” She explains that it’s not the sugar, but the amount of carbohydrates they consume, that matters.
Ultimately, weight control plays an essential role in managing diabetes, and many other medical conditions. Excessive weight directly impacts patient health, and may affect outcomes after many kinds of treatments and surgeries. For some patients, obesity is the reason surgery or medical treatment is sought. In such cases, many will require long-term home healthcare.
At the Bariatric Treatment Center at DuPage Hospital (CDH) in Winfield, eight doctors (four of them surgeons) are part of an assessment team that consults with patients on the best ways to address weight control challenges.
“CDH offers three different types of weight loss surgeries, plus two non-surgical plans,” says Julie Sanfilippo, a registered dietician at the bariatric center. “If a patient doesn’t want a surgical solution, we talk to them about our exercise programs that meet four nights a week, one-on-one consultations with a dietician, medicine-based weight loss regimens, and New Directions, a meal replacement program that includes supplemental shakes and bars.”
The key to success is for patients to adapt well to their new diets or surgical interventions at home, says Sanfilippo. Those who opt for the bariatric surgery are monitored for five years, to ensure they’re complying with the structured eating program.
“CDH offers gastric bypass surgery, in which surgeons cut part of the stomach to create a smaller stomach pouch and bypass part of the small intestine,” Sanfilippo says. “LAP-BAND surgery involves an adjustable band that limits the amount of food a patient can ingest at one time. Recently, we began offering the gastric sleeve surgery, which restricts the amount of food a patient can eat, by reducing the size of the stomach.”
For patients with diabetes, bariatric surgery marks a major change in how they must eat and take medication. It also means they’ll need the supervision of medical professionals.
“Many bariatric patients don’t even go home with their diabetes medication after surgery, or if they do, it’s significantly reduced,” Sanfilippo says. “The surgery causes hormonal changes, which may result in a patient who is no longer considered diabetic. Not everyone can put their diabetes into remission, but it can happen.”
Sometimes a patient facing a particular major surgery, such as total joint replacement, must lose weight before the procedure. Excessive body fat can lead to increased risk of infection and impedes proper recovery. Obesity can prevent patients from recovering properly. In such cases, taking the weight off and keeping it off are essential to a patient’s recovery and long-term quality of life.
“We encourage patients to get involved in our educational programs at CDH,” Sanfilippo says. “We offer resources, diet management on an outpatient basis, and long-term support. We don’t want patients to just go home to the old, familiar routine and environment, without being armed with the appropriate help and information necessary to succeed.”
Thanks to home healthcare services, patients are finding it easier to recover and transition into healthier lifestyles. And, fewer must return to the hospital or remain in supportive care. With focused, intensive education and customized care plans, home healthcare professionals help patients to do their homework and graduate into better lives.