Chapter 34: Home Health & Hospice Nursing

Home Health & Hospice Nursing traces the historical evolution of home care from Lillian Wald’s Henry Street Settlement to modern delivery systems, categorizing agencies into official, nonprofit, proprietary, and hospital-based structures based on their governance and tax status. A major focus is placed on the financial and regulatory landscape, explaining how the Balanced Budget Act established the Prospective Payment System (PPS) and the requirement for the Outcome and Assessment Information Set (OASIS) to measure clinical outcomes and determine Medicare reimbursement. The text details the specific eligibility criteria for Medicare-covered home health services, which demand that patients be homebound, under a physician’s care, and in need of intermittent skilled nursing or therapy. The chapter also outlines the Albrecht nursing model for home health care, which connects structural, process, and outcome elements to guide nursing practice, alongside the application of ANA standards and QSEN competencies. Practical guidelines for conducting home visits are provided, covering the entire sequence from referral receipt and preparation to environmental safety assessments, infection control, and the cultivation of nurse-client trust. Furthermore, the narrative explores the complexities of documentation, interdisciplinary collaboration, and the critical role of informal caregivers, emphasizing the need to mitigate caregiver burden. The final sections distinguish hospice and palliative care from curative treatments, focusing on symptom management, pain control, and psychosocial support for terminally ill patients with a life expectancy of six months or less. This includes a discussion on ethical and legal considerations such as advance directives, living wills, and durable power of attorney, as well as the importance of delivering culturally sensitive care during the dying process.