Nursing: Challenges of Nursing Patients at Home

The practicality, feasibility and possibility of nursing patients at home

Can a patient be nursed effectively, at home? Yes, that is possible, but it may present serious challenges for those who are involved in the patient's nursing care, as each patient is unique. The care that is required may be different.

Prior to any patient being sent home from the hospital, the home situation must be properly assessed by a qualified professional. Community nursing case managers can spend time with family members, prospective nurses or potential caregivers, with respect to prospective nursing care in the patient's home. In conjunction with the patient's physician, the hospital and the family, a case manager will assess the practicality, feasibility and possibility of the patient being nursed at home.

While still in hospital, the patient will be assessed on many different levels, prior to discharge. The required level of care must be determined, in each situation. The patient may need full time, professional nursing care. If not, there are other levels of nursing care available. Community nursing services, agencies or other organizations have many kinds of caregivers with varying skill sets.

Here is an example: An elderly patient recovering from a hip fracture may do well at home, with a weekly visit from a registered nurse and the full time assistance of a personal support worker, a housekeeper or a companion.

When a family is transferring a family member to his or her own home from the hospital, there are important factors that must be taken into consideration.

Some of the challenges of nursing patients at home, may include the following:

The acceptance of nursing care at home by the patient, his or her family and the designated nursing care provider: Most patients want to be discharged from hospital. Patients choose nursing care at home, rather than further hospitalization although, some are fearful of nursing care at home, after prolonged hospitalization. Many family may welcome the opportunity to give nursing care to another family member. Others may be reluctant to accept this responsibility. Family members assigned the responsibility, may be willing to participate in the nursing care or be apprehensive for different reasons. Attempting to get everyone to agree about nursing care for a patient presents a challenge for a case manager attempting to organize nursing care. He or she will work closely with the family to resolve these concerns prior to or after the patient's discharge.

The cost of nursing care:

The cost of nursing care in the hospital must be weighed against the cost of nursing care in a patient's home. Is there adequate insurance coverage for long term nursing care? Does insurance cover nursing a patient at home or is it limited to hospital care? Is there full time nursing care coverage or just partial coverage? Does the patient have to pay up front first and submit a claim to the insurance company or is the claim submitted directly to the insurance company? The insurance issues are important because the cost of nursing care can be high for a patient.

The availability of medication, equipment and medical supplies:

In a hospital setting, medication, equipment and medical supplies are accessible, but may not be when a patient goes home. The location of the patient's home will determine to some extent, whether there will be a problem. If a patient lives in a town or city, many things are easily attainable. For a country setting or a more remote area, this might not be feasible. It is important to find out if the medications, equipment and medical supplies are covered by the patient's insurance or if the patient is expected to provide an upfront payment.

Here is an example: A young woman recently had surgery on her back. She needs to have a hospital bed, a walker and a wheelchair, as well as pain medication and dressings. She may rent the hospital bed, walker and a wheelchair or purchase them. Pain medication and dressings are attainable at a local drugstore. The cost of some or all of these might be covered by the patient's insurance company.

Twenty four hour nursing care demands:

In a hospital setting, twenty four hour nursing care is not a problem, but when a patient goes home, provisions must be made for continuous nursing care. These need to be answered. How many nurses or other caregivers will be required on a weekly basis? Will the patient be alone with a nurse or a potential caregiver? This can be a problem if the patient has to be lifted. Are there other people living in the patient's home? Is there someone available to assist the nurse or other caregiver twenty four hours a day? If not, is there someone else who can be there at various times to assist?

Transportation for physiotherapy, medical treatments, procedures or doctor's appointments: A patient receiving nursing care at home, may need regular transportation for doctor's appointments, physiotherapy, medical treatments or various procedures. The cost of transportation may depend upon the mileage involved, particularly when an ambulance is required. This may be covered in full or in part, by the patient's insurance. There may be family members who can provide transportation, but this might create a financial burden for them. A case manager may be able to assist the family or patient, to making suitable arrangements with various organizations for transportation.

Patient safety issues:

Patient safety is a primary concern, when considering nursing a patient at home. Safety issues need to be addressed before a patient is released from the hospital. Can the patient be alone during the day or at night? Is he or she properly oriented to the home environment? Are there hazards in the home that present problems? Will equipment be required to prevent the patient from injuring himself or herself? These issues may involve temporary and permanent changes, in the home or be effectively resolved, by involving additional caregivers.

Essential nursing care and basic patient needs:

Nursing care with respect to medications, dressings, treatments or required procedures must be considered. One nurse will be assigned to organize this aspect of the nursing care. Many different skill sets can be learned by other caregivers, while the patient is hospitalized. Once he or she goes home, a registered nurse may be able to supervise a potential caregiver, who is able to master different skills or procedures. Basic patient needs are an ongoing concern in nursing a patient at home. A regular patient assessment will determine when he or she can meet his or her own needs. 

Consider the following questions. Can a patient access and use the bathroom facilities, without assistance? Is he or she able to provide his or her meals? Who will attend to the patient's laundry? Is there someone willing to make certain that all of the basic needs of the patient are met, at all times?

Provision of respite care:

Respite care is important for nurses and other caregivers when a patient requires ongoing nursing care. Is there someone who can relieve the nurse or care giver, on a regular basis? Other family members can provide valuable assistance, when the patient is being nursed at home.

Establishing routines and schedules:

When in the hospital, a patient is on a regular nursing care routine. At home, establishing the same routine may not be possible, depending upon the circumstances. It may take time to establish an appropriate routine. Co-operation by other family members is important. Setting up a schedule for family visits can be helpful. Assigning or designating certain tasks is also important. One family member should not have to bear all of the responsibility for a patient's care.

Protecting the dignity of a patient with respect and love:

Protecting the dignity of a patient, must be foremost in terms of nursing care. In terms of healing, health and wholeness, it is vital that a patient knows that he or she is respected and loved. Physical, mental, emotional and spiritual needs must be considered. Many patients are concerned about being or becoming burdens to other family members, when they need nursing care. At times, it is easier for family members to care for a family member, at home. Tensions can be eased and stress reduced. Many patients are more comfortable at home than in a hospital setting. While these are only a few of the challenges of nursing a patient at home, there are numerous others that might be encountered, depending upon the unique circumstances regarding a particular patient. Each situation is different and should be regarded as such.

Nursing care in a patient's home is always a possibility, but it is not a matter that should be taken lightly. It is always worth considering when a patient a patient requires nursing care.