No Place Like Home

October 01, 2012

After being hospitalized for weeks with a bout of cellulitis that resulted in a deep leg wound, 66-year-old Burbank resident Jean Ann Mattis learned she would finally get to go home.

The thought was alternately welcome and terrifying. How would she care for her wound? What if she couldn’t? What if it got worse at home?

Thanks to Providence Home Care, Jean Ann healed with the help of home health nurses who tended to her needs every step of the way. And similar stories unfold every day for patients recovering from heart attacks, strokes, cancer and other conditions—right in their own homes.

The First Step

In Jean Ann’s case, her wound extended from knee to thigh and required consistent monitoring and maintenance. The prospect of leaving the hospital and caring for herself was intimidating. “I was terrified of never healing,” she says.

Providence Home Care nurses came every other day to bandage the wound, using a new, absorbent dressing to speed healing. Her physical therapist helped her relearn how to walk without a limp. And after just two months of home care, Jean Ann is back on her feet, climbing stairs, bathing and even shopping on her own. “When the final bandage came off, it felt like a miracle,” she says.

A Meaningful Mission

Jean Ann’s story illustrates the main objective of Providence Southern California’s two home health agencies: to help patients return to life on their own.

“We want patients to become as independent as possible in their homes,” says Belinda Condit, MSN, RN, NE-BC, administrator for Providence Home Care, which serves the San Fernando and Santa Clarita Valleys. Little Company of Mary Home Health serves the South Bay.

The first step is a “start of care” visit, in which a nurse will go over medication instructions and perform a safety assessment of the home. “Medication mistakes and falls are the major causes of re-hospitalizations,” Condit says.

Available Services

Providence Home Care and Little Company of Mary Home Health offer a wide array of nursing services, including:

• IV therapy

• Wound care

• Catheter care

• Pain management

• Injections

Depending on a patient’s needs, physical therapists can work on mobility, and occupational therapists help patients re-assume daily activities, such as dressing and meal preparation.

Additional home care services include speech therapy, assistance with bathing and help finding community resources. Specialty services are also available, including a special cardiac team that works with heart failure, post-op heart surgery and heart attack patients.

In the Valleys, Providence Home Care offers pediatric care for children on tubes, vents or central lines for chemotherapy.

In the South Bay, Little Company of Mary Home Health also has a mental-health team. Manager Bo Erwin says some of his home health nurses have additional psychiatric training, equipping them to add an extra layer of expertise for patients who may have psychiatric needs in addition to other diagnoses, such as heart disease or diabetes.

Benefits of Home

At Providence, we understand that home is the place where patients are most at ease. That’s why we’re being proactive to help you stay there.

Providence Home Care is participating in a study with Health Services Advisory Group, a Medicare-contracted organization that focuses on healthcare quality. “It’s an enhanced home health program to try to keep patients where they are most comfortable—home,” Condit says. “We’ll be doing things as simple as providing more visits at the beginning of care, when patients are most vulnerable, and calling patients on Fridays to make sure they are OK heading into the weekend.”

Research supports these efforts: Condit cites a recent Johns Hopkins study that shows home healthcare decreases hospital readmissions by 25 percent.

Meeting Your Needs

Most patients, including Jean Ann, utilize home care for an average of 60 days. Others need only a few visits, while some require weekly or monthly care on a long-term basis.

Jean Ann can’t imagine having tended to her serious leg wound alone. “I couldn’t have put my mind in the right place without Providence Home Care’s help,” she says. “Not only did my nurses give me the courage to face my wound, but they were caring, compassionate caregivers while they helped me heal.”

SIX STEPS FOR A SUCCESSFUL TRANSITION

While physicians, families, friends and facilities (such as skilled nursing or rehabilitation facilities) can refer patients for home care, most patients transition from a hospital inpatient setting. Here’s how Providence helps smooth the transition from hospital to home:

1. We make sure you’re going home on schedule.

2. We call you before discharge.

3. We make sure before your first visit that you understand insurance coverage and copays. (With most Medicare Advantage plans, there is no copay.)

4. We ask you to have all your medications ready for the nurse to review.

5. We try to schedule your first home visit within 24–48 hours of discharge.

6. We develop a plan of care and maintain coordination of care by entering everything we do into your electronic medical record so it’s available to your physician.