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SUB-PROBLEMS INCLUDING LEADING TO IMPAIRMENT AND BEST PRACTICES FOR HOME HEALTHCARE

Home health care is the fastest growing area in the healthcare industry. A recent sample study has identified risk factors in the health and safety of people receiving healthcare in the home. (See endnote 48.) Individuals in the homes were exposed to roaches, cigarette smoke, other insects and rodents, irritating chemicals, peeling paint, temperature extremes, unsanitary living conditions in the home and neighborhood, violence, and crime. Poor indoor air quality and lead paint are also concerns because many of the elderly live in older properties that are not well maintained.

The potential for the spread of healthcare-associated infections is considerable because of the surroundings which may include highly unsanitary conditions especially in the bathroom and kitchen, as well as the treatment being given to the individual and the lack of continuous professional nursing care throughout the day and night. There is a serious concern about the mishandling of biomedical waste, especially sharps and bandages. Indwelling catheters are the source of numerous infections in both use and potentially disposal. Home hygiene including disinfection procedures and effective hand washing may be a serious problem. The accumulation of the problems noted can lead to a situation where individuals acquiring infections in the hospitals, return to the communities and spread them to others in the family and community, and then return to the hospital where they become the source of new infections. (See Chapter 3, “Built Environment—Healthy Homes and Healthy Communities,” Sub-Problems Including Leading to Impairment for Housing.)

The healthcare providers may be highly experienced, such as visiting nurses, or have limited training or expertise and work under little or no direct supervision. Financial constraints on agencies providing home health care continue to increase with the result of poor pay for many health aides, constant turnover of people, and inadequate training or supervision of these individuals.

The safety of the patient is always a concern because of the many accidents that occur within the home setting. The safety of the healthcare worker revolves around many issues but especially lifting and exposure to contaminated bodily fluids. (See Chapter 6, “Environmental and Occupational Injury Control.”)

Best Practices for Home Health Care (This discussion will not include appropriate nursing

techniques for patient care which may be found in endnote 59)

  • • When nurses make visits to patients within the home and they observe numerous problems of housing and other environmental issues, they should contact the local health department and request that an environmental health technician come out to the site and conduct a housing evaluation in order to determine the types of problems which may lead to disease or injury. Part of the care plan for the individual and family should include the necessary correction of these deficiencies in order to provide quality care.
  • • The care plan established for the patient should help prevent infections, other health problems, and injuries by preventing and where necessary mitigating practices and situations which will avoid medical errors, medication errors, injuries due to accidents, especially falls, and infections.
  • • The individual and family should be taught how to properly care for the patient concerning the use of: sterile barriers and sterile equipment; appropriate bedding and moving of the patient frequently to prevent pressure ulcers; patient self-management for anticoagulants and other drugs; appropriate knowledge and use of information concerning adequate nutrition; and the types of situations in which the patient may experience falls or other debilitating situations because of safety hazards.
  • • The patient and family should be taught when to seek immediate health assistance in the event of an emergency, and especially when to contact 911 for emergency medical services.
 
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