Home health care involves medical care that patients receive at their homes. Home health care covers a variety of health care services that you can receive at your home for an illness or injury. ABC

The main goal of home health care is to help you with an illness or injury.

Nevertheless, home health care also aims to help the elderly live independently as long as possible. Below are some of the services our nurses can help with.

1. Chronic Disease Management
2. Diabetic Management
3. Congestive Heart Failure Management
4. Infusion Services
5. Patient/Caregiver Teaching
6. Ostomy Teaching/Care
7. Wound Care
8. Medication Management

---

1. The Chronic Disease Management

Chronic diseases are diseases that have been present for six months or longer and slowly progress over time. The World Health Organization classifies chronic diseases into four major types:

1. Cardiovascular diseases (stroke, heart disease)
2. Chronic respiratory diseases (asthma and chronic obstructed pulmonary disease)
3. Diabetes
4. Cancer

Chronic diseases are responsible for more than 60 percent of all deaths in the world annually, which makes them by far the leading cause of death globally. More than half of Americans are currently living with at least one chronic condition. These diseases significantly decrease quality of life, causing disability and death, and as such are a weighty public health problem around the world.

According to the World Health Organization, the burden of chronic diseases on the global economy is significant, as chronic diseases cause great losses in national incomes.

What Does the Chronic Disease Management Involve?

The health systems around the world are challenged by an increased incidence of chronic disease. The Chronic Disease Management (formerly Enhanced Primary Care) requires that chronic patients take a more active role in their day-to-day decisions when it comes to the management of their illness in order to cut the increasing costs of chronic disease burden and reduce the effects of chronic diseases on the patient population.

Chronic Disease Management (DCM) is an integrated health care approach to managing chronic conditions which typically includes screening, check-ups, monitoring, and patient education. It proposes innovative strategies to reduce spending in health care at the same time improving the wellness of the patients.

Chronic Disease Management involves interventions aimed to prevent or manage chronic conditions using a systematic, multidisciplinary approach. The main goal of disease management is to identify individuals at risk for one or more chronic diseases, to promote self-management, and to address the chronic condition with the best clinical outcome. 

The Chronic Disease Management requires a partnership between the patients and health professionals that empowers the patients to take a more active approach in managing their health. According to the Chronic Disease Management approach, patients who are more informed and involved tend to interact more effectively with their healthcare providers and are more motivated to take actions that will promote more positive outcomes.

The DCM approach allows health providers to plan and coordinate the health care of patients with chronic conditions, including those with illnesses that require multidisciplinary health care. Chronic Disease Management is designated to patients who require a structured approach and ongoing care.

In short, chronic disease management can improve your quality of life reducing your health care costs by preventing or minimizing the effects of your chronic condition.

---

2. Diabetic Management

Diabetes is a chronic disease that involves metabolic disorders which result in an abnormally high concentration of glucose (a type of blood sugar) in the blood if left untreated. Blood glucose is the main source of energy in your body and it comes from the food you eat. Insulin, a hormone produced by the pancreas, helps glucose from food turn into energy in your body.

Having Type 1 diabetes means that your body does not produce insulin. So, you need to take insulin every day to live. If you have Type 2 diabetes, your body does not make or use insulin well, so you may need to take insulin to control your diabetes.

Some women also develop Gestational diabetes when they are pregnant and that goes away when the baby is born (most of the time).

Having too much glucose in your blood can lead to different health problems such as kidney disease, heart disease, and stroke, diabetic neuropathy, eye disease, and other health issues.

While there is no cure for diabetes, you can take steps to manage diabetes and improve your health. Diabetes management involves your awareness of the factors that make your blood sugar level rise and fall and to know how to control these factors.

• Learn More about Diabetes

An important part of diabetes management is to learn more about living with this chronic disease. Talk to your health provider, take classes to learn more about diabetes, or search online. You can also join a support group to share experiences and get support in coping with diabetes.

• Manage Your Diet

A healthy diet is vital to healthy living in general. However, if you have diabetes, you need to know how certain types of food affect your blood sugar levels. Food diabetic management involves learning how to count carbohydrates in your food as carbohydrates have the biggest impact on blood sugar levels. Learn what portion size is appropriate for each type of food and measure your portions to ensure an accurate carbohydrate count. Also, make your meals well-balanced and pay attention to the types of carbohydrates you take. Coordinate the proportions of your food and diabetes medication to avoid hypoglycemia (dangerously low blood sugar).

• Exercise

Your diabetes management plan should include exercise because regular physical activity helps your muscles to use glucose for energy and your body to use insulin more efficiently. However, discuss an exercise plan with your GP and keep an exercise schedule. Make sure to stay hydrated during exercise as dehydration can affect your blood sugar levels.

• Manage Stress

Stress can increase your blood sugar levels, so learn how to manage tension. Strategies such as mindfulness meditation, deep breathing, working on your hobby, reading, gardening, and spending time in nature may be useful in strengthening healthy stress responses and managing anxiety.

---

3. Congestive Heart Failure Management

Congestive heart failure (CHF) is a chronic disease that causes a person’s heart muscles to pump inefficiently. The reason for this is fluid that builds up around the heart and affects the pumping power of the muscles. Congestive heart failure occurs when the ventricles of the heart (that normally pump blood to your body’s organs and tissues) cannot pump enough blood into your body.

The most common type of CHF is left-sided congestive heart failure which occurs when the left ventricle doesn’t properly pump blood in the body’s organs and tissues. As a result, blood and other body fluids accumulate in your lungs, liver, abdomen, and lower extremities.

As the disease progresses, built up fluids in your lungs make breathing hard and may even lead to death.

If you suffer from right-sided congestive heart failure, the right ventricle doesn’t properly pump blood into your body, which may lead to fluid retention in your abdomen and lower body. You may also have both-sided congestive heart failure.

Stages of Congestive Heart Failure

At the early stage of congestive heart failure, you may not experience any symptoms during regular physical activity and at rest. At this stage, you can manage your condition through monitoring, medications, and lifestyle changes.

As the disease progresses, you begin to experience shortness of breath and fatigue during physical activity. You should talk to your doctor if your condition limits normal physical activity.

Severe congestive heart failure usually means that you cannot perform any form of physical activity, with symptoms of CHF present even at rest. While there is no cure for congestive heart failure at this stage, you can still manage your disease to improve the quality of life.

Congestive Heart Failure Symptoms

Early signs of CHF usually involve fatigue, swelling in your feet, ankles, and legs, increased need to urinate, and weight gain. However, in the early stages of congestive heart failure, you probably won’t notice any changes in your health.

As your illness progresses, you may experience cough (that comes from congested lungs), irregular heartbeat, shortness of breath, and wheezing.

Symptoms that indicate severe HCF usually include rapid breathing, chest pain that spreads through the upper body, lack of oxygen in your lungs that causes your skin to turn blue, and fatigue.

Congestive Heart Failure Causes

CHF may occur as a consequence of other health conditions that affect the cardiovascular system, such as hypertension (high blood pressure), coronary artery disease, diabetes, or thyroid disease.

Congestive Heart Failure Treatment

CHF treatment depends on the stage and severity of your condition as well as on your overall health. It is normally treated with medications such as ACE inhibitors, Beta-blockers, antihypertensive medications, antiarrhythmic medications, antipsychotics, and diuretics.

However, if medications are not effective, more invasive treatments may be required. These normally involve angioplasty and surgery. 

---

4. Infusion Therapy

Infusion therapy is an alternative to oral treatment and it is intended for people who, due to their illness, cannot take medications orally. Also, some medications cannot be taken orally for different reasons (for example, the stomach acids would destroy them, and they would no longer be effective disease treatment).

Infusion therapy involves the intravenous or subcutaneous administration of drugs: medication is administered intravenously (IV) through the use of a sterile catheter or tubing that is inserted into a patient’s vein. However, this term also refers to the subcutaneous administration of drugs, where a drug is being administered under the patient’s skin.

In the past, infusion therapy was used only in hospitals. However, infusion therapy can now be safely administered in outpatient infusion centers and in the comfort of the patient’s home, allowing them more freedom to continue to live independently.

Who Can Administer Infusion Therapy?

Infusion therapy is normally administered by licensed and trained nurses. However, visiting nurses can educate and train the patient and caregivers on the safe administration of infusion therapy at home. They also visit the patient periodically to assess the infusion environment and provide the necessary care.

Home infusion therapy usually involves coordination among patients, caregivers, physicians, home infusion pharmacies, and, in some cases, home health agencies.

Once your physician prescribes home infusion therapy, the specially-trained infusion team will create an individualized care plan specific to your condition and health needs, provide training on how to administer the medication intravenously, determine the frequency of home visits from your infusion nurse, monitor your symptoms, and maintain regular communication with your health provider.

Who Needs Infusion Therapy?

Your physician will prescribe infusion therapy if your condition is so severe that it requires the medication to be administered directly into your bloodstream, if you are unable to swallow the drugs, or if your treatment involves a type of medication known as a biologic response modifier (specialty infusion therapy).

Infusion therapy is typically used to treat severe or chronic infections that don’t respond to oral medications (antibiotics).

Infusion therapy is often a therapy option for patients with infections that did not respond well to oral antibiotics, cancer patients and cancer-related pain, people with Chron’s disease, congestive heart failure, multiple sclerosis, some forms of immune deficiency disorders, patients with diseases of the gastrointestinal tract, some forms of arthritis, allergies, asthma, vomiting, diarrhea, and dehydration caused by nausea.

Is Home Infusion Therapy Covered by Insurance?

Most insurance plans cover home infusion services and medication. However, you may want to inquire with your insurance provider as there are broad differences in the coverage of each insurance provider.

---

5. Patient/Caregiver Teaching

If you have an acute or chronic disease, your health care provider may initiate patient and caregiver teaching process to help you and your caregiver (significant other or family member) understand your condition.

Patient/caregiver teaching is an interactive nursing intervention intended to help you gain skills and knowledge related to your disease, so you can manage it more successfully. This type of education also involves a change in your behavior and attitude to improve or maintain your health.

Patient and caregiver teaching provides you and your caregiver the means of participating in your health care management and helps make a difference in your life.

Sixty to seventy deaths in the United States annually occur due to chronic illnesses. Whether you will learn to adequately manage your health problems and maintain quality of life depends on what you learn about your illness and how motivated you are to follow-up with what you’ve learned.

Research shows that patients who are willing to learn and understand the importance of the teaching (including how to manage their medications and to follow-up with their health care providers) are 30 percent less likely to be admitted or readmitted to hospital than patients who did not have this training.

The Goal of Patient/Caregiver Education

The main goal of patient and caregiver teaching is health promotion and prevention of disease. Other aims of patient and caregiver teaching involve the management of disease and appropriate selection of treatment options.

If you have acute or chronic health problems, teaching can help you start a positive change in your behavior and improve understanding of your health care needs, therapy, and the importance of adherence to medical treatment. This should enable you to better manage your condition and more effectively cooperate with your caregiver and health care provider. In short, patient and caregiver teaching can prevent health complications and promote self-care, recovery, and help you stay independent.

Patient/caregiver teaching is intended for patients who would benefit from increased understanding and knowledge of their health condition and therapy. This type of education is also needed where the patient needs to improve skills necessary for safe and efficient health care and to foster a positive attitude and stronger motivation for disease management.

A Teaching Plan

Patient teaching is a process that uses a combination of methods such as counseling, instruction, and behavior modification. It can be planned or informal experience. If you have a specific learning need about health management or promotion of your condition, your health provider may need to develop a teaching plan.

This plan involves:

• Assessment of your needs as well as your ability and willingness to learn
• Identification of challenges that teaching can improve
• Teaching goals
• Teaching interventions
• Evaluation of the effectiveness of the teaching

However, every interaction with your health provider and a caregiver is a teaching opportunity. Patient and caregiver teaching can result in a permanent change in your motivation, attitude, and behavior, and lead to an improvement in your disease management and quality of life.

---

6. Ostomy Teaching/Care

Around 100,000 ostomy surgeries are performed annually in the United States. During ostomy surgery, a part of the bowel is brought through the abdominal wall and secured on the surface of the abdomen. A surgically created opening on the surface of the abdomen that allows urine or stool to leave the body is known as a stoma. There are two types of ostomy: a colostomy (ostomy of the colon) and an ileostomy (an ostomy of the small intestine)

The most common medical conditions that require ostomy include:

• Colon cancer
• Rectal cancer
• Bladder cancer
• Traumatic injury of the bowel or rectum
• Bowel perforation from a ruptured abscess or diverticulum

Many times, patients receiving an ostomy don’t receive much-needed pre-operative ostomy education and stoma fixing training. Whether there is no ostomy specialist available before your surgery or there has been no opportunity for pre-operative ostomy education or stoma sitting (for example, if your surgery was an emergency), you may find yourself discharged from the hospital with little to no ostomy management knowledge.

How to Teach the Ostomy Management to the Patient

Ostomy teaching is more than formal patient education. In real life, ostomy education happens on a more informal level, through every interaction with your ostomy nurse. If you have a caregiver (significant other or family member), training should include that person too.

In teaching, your nurse or ostomy specialist need to include basic information about ostomy. This information will help you adapt to living with an ostomy and understand that people with ostomies still can live full, productive lives.

The Basics of an Ostomy Management

Nowadays, most surgeries involve a short stay in the hospital. As an ostomy patient, you must be trained to empty your pouch before you are discharged from the hospital. There is no muscle around the stoma which means that you cannot control when body waste or gas leaves your body (the waste now goes directly from the stoma in a pouch around the stoma). The pouch blocks the odor of the waste and cannot be seen when you are wearing clothes.

You also need to have access to ongoing care and support. Follow-up care and learning to take care of your ostomy at home are essential to your treatment and safety.

Make sure to empty and replace your ostomy pouch as often as needed (follow your ostomy nurse’s recommendations). Inspect the skin under your pouch regularly. If the skin appears red, itchy, or irritated, gently remove the pouch, clean the skin with water and gently dry it. Sprinkle ostomy powder over the skin and replace the pouch. Talk to your ostomy nurse if you continue to have skin irritation.

Take your medications as prescribed and let your doctor know if you think you are having any problems with your medications.

Call your ostomy nurse or doctor immediately if you have belly pain, fever, you are vomiting, your stoma changes color or turns pale, swells or bleeds, or you cannot pass stools or gas. 

---

7. What’s Involved in Wound Care for the Elderly

Mobility issues and chronic medical conditions such as diabetes or peripheral vascular disease are common among the aging population. These conditions compromise skin and cause chronic ulcers (wounds) that require medical treatment and care.

What is a Chronic Wound?

A chronic wound is any wound that remains unhealed for longer than four weeks. The most common types of chronic ulcers involve pressure ulcers, ischemic ulcers, venous ulcers, and neuropathic ulcers. The basics of chronic wound care involve keeping the wound clean to prevent infection and promote healing.

A pressure ulcer, also known as bedsore is common among the bedridden elderly and it is caused by constant pressure, friction, and moisture. It typically affects bony areas of the body such as ankles, sacrum, etc. To prevent pressure ulcers, the patient should not be left in the same position for a prolonged time. Passive exercises are needed along with regular position change. It is also vital to promptly change the wet or dirty dressing, clothing, and bedding. Also, adequate nutrition is important to maintain healthy skin.

Treatment of these types of ulcers includes recognizing the four healing stages of chronic skin breakdown: coagulation, inflammation, proliferation, and maturation. The time taken for healing depends on bout internal and external factors.

• Internal factors involve aging, chronic diseases, long-term medicament therapy, and alcoholism (which weakens nutrient absorption).
• External factors include repeated injuries, improper wound care, and wound infection, and persistent pressure on the wound (which prevents blood circulation).
• Each of these factors may affect the immune system, making the wound more prone to infection which delays or prevents healing.
• While there is a unique therapeutic goal for each of these chronic wounds, nutrition and proper wound care are a foundation for the management of chronic ulcers. 
• Whereas in some patients the treatment goal is complete wound healing, achieving a manageable chronic wound is an acceptable outcome in other patients.

Nearly 70 percent of all pressure ulcers occur in the aging population.  As we age, our skin loses its water content, tensile strength, vascularity, subcutaneous tissue, and stability of small blood vessels. These factors compromise skin integrity and increase the risk of chronic ulcers.

How to Treat Wounds in the Elderly?

If chronic ulcers are not treated properly, wound infection may result. So, adequate knowledge and wound management are very important.

Any wound should be kept clean and monitored closely. However, chronic wounds require extra attention as these wounds take much longer to heal than would normally be expected (about 2-3 months).

Chronic wounds should be treated by a qualified health care professional. The most common treatments for chronic ulcers involve:

• Identifying and treating the underlying cause of the ulcer
• Regular cleaning of the wound
• Removing the dead tissue
• Use of antibiotics and anti-inflammatory medications
• Warming the area around the wound to increase blood flow
• Applying vacuum-assisted wound dressings (apply negative pressure to the wound to encourage healing)
• Pain management

Also, in some types of the wounds oxygen therapy has been found very helpful.

How to Recognize Wound Infection

Local signs of wound infection include:

• Swelling
• Pain
• Redness
• Warmth
• Secretion

Other, general signs of infection are:

• Fever
• Shudders
• Rapid breathing and pulse
• Nausea
• Headache
• Sickness

If you experience any of these signs, seek immediate medical attention.

---

8. Medication Management for Elderly and Disabled

Medications are widespread treatment for many conditions and diseases in elderly people and people with disabilities. However, the aging population often faces challenges in managing their medications. If you don’t use them appropriately and safely, taking multiple medications can have serious consequences. Therefore, having knowledge and understanding of indications for your medications and the importance of taking them every day is an essential part of medication management.

You may feel overwhelmed by managing your medications. If you are disabled and have no access to transportation or you lack social support (such as a family member or friend to pick up your medications), you may struggle with the ability to adhere to your medication regiments.

Medication management is not limited only to prescribed medication but also involves the over-the-counter medications and herbal remedies/alternative medicines you are taking. You should inform your health care provider about over-the-counter medications that are not on your medication list.

Collaboration between health care providers involved (including your caregiver) is essential to providing good medication management. Many experts outline that open communication between health care providers, pharmacists, patients, and their caregivers is important in addressing concerns and barriers, and other causes for medication nonadherence.

Polypharmacy

One of the most common problems linked to medication use among the elderly and disabled persons is the use of multiple medications simultaneously, which is known as polypharmacy. Studies show that the more medications you use, you are more likely to experience medication-related problems.

Prescription medication use among the elderly has more than doubled over the last two decades. One study found that elderly patients on average take two to four medications daily. But for many people with chronic conditions, such as Alzheimer’s, diabetes, or heart disease, multiple medication use is the norm.

The Role of a Caregiver

If you care for an aging or disabled person, there is a great chance that they suffer medication-related problems. However, many of these conditions are preventable. An important part of medication management is to recognize them and help the person use their medications correctly, effectively, and safely.

Caregivers to people with Alzheimer’s or other types of dementia commonly report problems with getting their family members to take their medications as directed, in the right amount, and on time.

Before a medical appointment, you should prepare a list of important questions related to medications for your loved one’s health care provider such as:

• Why is this medication prescribed?
• How long will my loved one have to take the medicine?
• Will they need a refill when they finish this prescription?
• Is there a typical time period after which the person’s symptoms should improve?
• Will this medicine interact with other medications the person is already taking?
• Should this medicine be taken with food? Are there any types of food the person should avoid while they are taking this medicine?
• What happens if the person misses a dose of the medicine or takes too much?
• What possible side effects might the person experience with the medicine?

Make sure to ask the elderly person’s pharmacist to provide special pillboxes, devices, or other aids that remind you and senior to take medications. For persons with vision impairments, ask the pharmacist for prescription labels in large print.

Also, if the senior experiences difficulties opening bottles or break tablets (this problem is common for people with arthritis), inquire about large, easy-open bottles or ask the pharmacist to split the tablets is a prescription dose is a one-half tablet.