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Respect of Patient Autonomy and Features of Home Health Care

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Patient autonomy, safety and quality in home health care are the three primary aspects that most people are worried about. Typically, home health care system involves care provided at homes of the patients by qualified practitioners. They usually work under the direction of a skilled physician, which is why the quality aspect is always covered and kept detailed with the provided care notes.

There are different types of services provided under home health care such as :

  • Nursing care
  • Medical social services
  • Occupational and speech therapy.

The primary objectives of home health care services are varied and extensive and include:

  • Helping the patient or elderly to improve their physical function and activity
  • Helping them to live with more independence
  • Promoting the optimal level of wellbeing of the patient and elderlies
  • Assisting the patient to recover by staying at home instead of getting admitted to a hospital or any other care institutions for a long term.

You as a patient or as a family member of the patient can request for a home care service or the physician may even refer for home health care service for a specific patient and to keep an accurate and acute schedule.

No matter what type of homecare is being undertaken – whether it’s physical or mental – compiling detailed notes is an essential way to gather insight into more than just their physical needs, as patients may have other issues or preferred courses of treatment. This is why utilising detailed soap notes physical therapy that can be shared across several networks and platforms is essential for homecare, as it will allow different specialists to provide their input, identify problems and formulate the best course of treatment moving forward.

Few facts to know

According to the Centers for Medicare and Medicaid Services, CMS it is estimated that, there are about 8,090 home health care agencies such as myallamericancare and others operating currently in the United States. All these agencies taken together provide such useful services to more than 2.4 million US elderlies and disabled people annually.

If you are worried about the cost factor then be informed that you are eligible for a Medicare reimbursement only when the following conditions are fulfilled:

  • The home health care service requirement must be considered to be medically necessary for the patient by a qualified physician
  • Such services must be essentially provided to the home-bound patient only and
  • The home health care must be provided on a non-continuous and intermittent basis.

The most common medical conditions that may need home health care include:

  • Circulatory disease, found to be in 31% of patients
  • Heart disease, found in 16% patients
  • Injury and poisoning, comprising about 15.9% people
  • Connective tissue and musculoskeletal disease among 14.1% patient and
  • Respiratory disease found in about 11.6% patients.

Typically, the Medicare beneficiaries of home health care includes people who are 85 years old or more, or have very low income and are in poor health.

About the environment

Delivering home health care differs from that received in clinics, hospitals and other institutional setting in the care environment where typically the nurses work. For example:

  • The nurses working for home health care usually work alone in this setting though support resources are provided to them from the central office
  • The work relationship between the nurse and physician usually involve less direct contact
  • The physician too typically relies on the nurse to a greater degree to communicate findings and asses them
  • There is a lot of paperwork involved in home health care and east up most of the time of the nurses as compared to the hospital nurses and
  • They also have to think and work more towards the reimbursement issues.

The specific and distinctive characteristics of the home health care setting influences several aspects of the patient including safety, quality of service, the outcomes and the degree of patient autonomy.

In addition to that in the home care setting there is a chance of limited oversight of the casual caregivers by specialized clinicians. This is primarily due to the situational variables that are unique to each type of home.

About patient autonomy

It is said that when it comes to the respect for patient autonomy, it is valued more in a hospital based care. However, there are several decisions that are typically made in this setting by the clinicians on behalf of the hospitalized patients. On the contrary, in a home health care setting, the clinicians usually recognize the home of the patient as the inviolable domain.

That means, when compared to that of a hospitalized patient the home health care patient usually has more value and a greater role to play when it comes to determining how definite interventions may be implemented, and even they are to be implemented at all. For example:

  • In case of a hospitalized patient, the nurses and physicians or even the pharmacists will play a significant role together or individually in ensuring that proper antibiotics are given to the patient as per the need and according to the therapeutically appropriate intervals.
  • On the other hand in a home care setting however, the patient has the liberty to choose whether or not to take the medication as suggested at regular or irregular times in spite of the fact that the importance of a regular and on time medication schedule is explained.

Therefore, interventions to uphold patient safety and quality of home care will largely depend on the fact that the patient may at times choose not to act in consistent or desired ways with the pertinent evidence. In such a situation, even the best efforts of the clinician and the nurse may not provide the best and desired outcomes.

The unique setting factor

Apart from the deliberate negligence or variance in choices made by the patients who are capable and informed about the home care, it is also the variables of the individual patients that may influence the final outcome of such home-based treatments as compared to those provided to the patients who are hospitalized.

According to a research of Ellenbecker it is found that there are several other factors that may affect the final outcome of home health care as well as the ability of the patients to manage their medication schedules safely. These include:

  • Reading skill
  • Financial resources and
  • Cognitive ability.

On the other hand, none of the above variables will affect in whatsoever way the outcome of treatments and care provided to a hospitalized patient who is under safe administration of their medication routine.

Therefore, too much respect for patient’s autonomy can be detrimental for the recovery and overall wellbeing of the patient.

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