Desiree Stevens

HOME HEALTH
5/20/14

Desiree Stevens

Home health care is a service that is provided out of an individuals own home for an
illness or injury that they are not yet recovered from. Care provided may include; nursing care,
specialized therapy, specific medical equipment, pharmacy and intravenous products, and
personal care (Leah William, Jetta Lee. Fuzy, and Julie Grafe). Home care is known to be less
costly and just as efficient if not better than hospital care or long term facility care. The ultimate
goal is to treat an illness or injury and to regain the clients independence as much as possible.
The care provided to patients in hospitals and long term care facilities require more
supervision than those that are provided home health care. If one is released from the hospital
and still need care provided; it may be continued in a long-term facility, rehabilitation hospital,
or a home health agency. Long-term care is for patients that need care or assistance for a long
period of time after being released from the hospital. Home health care is typical for short term
assistance.
If patients need further assistance after being released from a hospital or care facility,
they are typically referred to a home health agency by their doctor. They may also be referred by
a hospital discharge planner, a social services agency, the state or local department of public
health, the welfare office, a local agency on aging, or a clients senior center (Fuzy, Jetta Lee.,
and William Leahy). Clients and/or their loved ones can make the choice to commit to home
health care as well. When a specific agency has been selected, a staff member does and
assessment on the patient. The clients home will also be assessed to assure safety of client and
worker. Services performed to the clients vary on the size of the agency. Small agencies may
provide basic nursing care, personal care, and housekeeping services. Larger agencies may
provide speech, physical, and occupational therapies and medical social work. All home health

agencies have professional staff that make decisions about what care and services are needed
(Fuzy, Jetta Lee., and William Leahy).
When caring for someone as a home health aide, you do not address them as a patient.
You may address them as Mr., Mrs., Ms., or Miss. You may also refer to them be their
last name or the name they ask you to call them. Every individual is different and has different
views and aspects of things. Therefore, something that you call one individual on a normal basis
may totally offend someone else. You must ALWAYS respect your client and obtain their
confidentiality.
Due to trying to achieve cost cuts, hospital stays have been cut short. Unfortunately, some
patients may be released before they are fully ready to be released. Therefore, home health
agencies are what some individuals choose to fall back on for further assistance upon arriving
back at home. Some are referred to them by physicians, family, care facilities/departments, and
they may suggest it themselves. Home health care can be short-term or long-term; it just depends
on the individuals needs.
Payments for home health care are typically provided by the following pay sources:
insurance companies, health maintenance organizations (HMO), preferred provider
organizations (PPO), Medicare, Medicaid, and individual clients or family members (Fuzy, Jetta
Lee, and William Leahy). Medicare provides payments on a 60-day period determined off the
clients condition. If the payment provided is exceeded the agency is a loss of money, however; if
it does not exceed, the agency makes money. Due to this factor, cost must be monitored closely.
Medicare is what most agencies base their qualifications off of because they are one of
the most specific of all coverages. In order for an individual to have home health care covered
by Medicare, the patient: requires medically reasonable and necessary intermittent skilled

services, is homebound, is under the care of a doctor who determines the need for home health
care and provides a care plan, and must be seen by a doctor or other approved provider within 90
days before the start of homecare services or 30 days after the start of services (Home Health
Service Eligibility). Also, the agency the client is using must be approved by Medicare in order
to receive coverage. If the things listed above are met, Medicare will cover intermittent skilled
nursing, physical therapy, or continued occupational therapy, home health aide, medical social
services, and medical supplies. Services that are not covered are 24 hour/day care at home, meal
deliveries, and homemaker services (Home Health Service Eligibility).
As said above, Medicare has a 60 day payment period set and if the cost of care exceeds
the amount the agency loses money; if it doesnt exceed, the agency makes money. The clients
themselves dont have to pay any for home health care if they meet all of the necessary criteria
and follow the guidelines of the payment structure. However, one must pay 20% of the
Medicare approved amount for durable medical equipment (Home Health Services.). Before
beginning home health care ones coverage provider should tell how much they will pay. They
should also inform one of any services not covered and how much the payment requirement is
for the specific care or equipment. There should always be a home health advance beneficiary
notice before providing services and supplies that are not covered (Home Health Services.).
A home health aide is responsible for taking care of people who have disabilities,
chronic illnesses, cognitive impairments, or an age-related health problem (McKay, Dawn R.).
The care that they provide include; administering medications, changing bandages, and
checking vital signs (McKay, Dawn R.). They may also be responsible for helping with
domestic duties, transporting patients, child care, massage, record keeping, grooming and
hygiene, and helping with movement (Home Health Aide Job Description and Salary).

Although they are independent workers, they are still monitored by a medical professional, such
as a registered nurse (RN).
Often, the title of a certified nurses aide (CNA) and a home health aide (HHA) are
mistaken to be the same job title. Both of these jobs have something to do with caring for a
patient directly while being supervised by a nurse or physician, and that is why they are often
confused. Although there are a few differences between the two; bother of them are considered
as stepping stones in ones career path, others consider these positions as lifetime careers. Both
fields require some training and are very similar in methods of training, but HHAs go more in
depth on administering prescribed medication. One main difference between the two is that
CNAs can work with multiple patients in a day when HHAs may just work with 1 to 2 patients
every single day. As far as their responsibilities in patient care; they are very similar, but HHAs
can administer medication while CNAs cannot.
The first step an individual needs to take to become a HHA is having a high school
diploma. It is required that home health aides receive training from an RN, LPN, or an
experienced HHA. Some facilities require training from vocational schools, community
colleges, or home health care agencies (McKay Dawn R.). If one works for an agency that
receives U.S. Medicare or Medicaid reimbursement must complete a state approved training
program and competency evaluation (McKay Dawn R.). Every state is different with specific
requirements for this specific subject. In Oklahoma specifically, the agency in which the HHA is
working at must complete performance reviews and provide at least 12 hours of training each
calendar year and have in-service education supervised by a nurse that has 2 years of minimal of
nursing experience and one of those years must be under the home care provision. They also
have to make sure all certifications are current (HRDS_Chapter677.pdf).

In order to maintain an HHA certification in Oklahoma, and application must be filled out
when time acquires every two years. The training program that an individual chooses to take
must inform them that an HHA needs to complete a nurse aide training and a competency exam
if, upon applying for renewal of certification, has not provided at least 8 hours of nursing or
health related services for compensation with the previous 23 months (HRDS_Chapter677.pdf).
As an HHA, there are multiple responsibilities you are given. Alongside the basic
medical procedures that is you duty to perform. You may also have to assist with housekeeping,
family contact, the independence of patient, communication, transportation, and safety
awareness (Fuzy, Jetta Lee. and William Leahy). As a worker, you are required to accommodate
to environment and time changes because every individuals personal preferences and home will
be different. That is part of the job description and you have to learn to go about it with a positive
and flexible attitude.
Other than patient care, a home health aide may be responsible for some housekeeping
duties. These duties include; cooking, cleaning, laundry, and grocery shopping for some
patients (Fuzy, Jetta Lee and William Leahy). Although, it is vital that you plan and set client
priorities with the time limit assigned to them. You may also have to assist with family contact.
You may speak to the family more of than you would in any other work facility. Uplifting and
encouraging the family to involve them as much as they can with the client is important. You
must also communicate with your client as much as possible and find out if changes to the care
plan were made by the doctor. Or you may be communicating with your client to report physical
or emotional changes that may change the care plan.
As a home health aide there are a few things you cannot do; such as administer
medications, insert or remove tubes, go out of scope of practice, performing procedures that

require a sterile technique, diagnose or prescribe medications, or tell the family a diagnosis or
medical treatment plan (Home Health Aide Student Manual).
After being referred to a home health agency, the nurse will perform an assessment on the
possible future client and their home to assure their individual needs will be affectively met and
if the environment is safe for both you and the client. After these steps are performed, they gain
you as their client.
While at the residents home, the home health aide will perform many different tasks for
and with the resident. Although you work independently, you must record and/or report pretty
much your whole day at a clients home. Otherwise, your supervisor has no idea if youre doing
your job efficiently and correctly. After doing the job(s) assigned, one needs to document all
skills, tasks, and changes performed and observed. Some agencies may require you to clock
in/out from the clients home and you may also contact your supervisor for help or questions.
Going into a clients home, there are many different things you are required to report and
record. One may want to make a checklist going into a clients home so you can remember whet
to report and record. If there are any changes with your client, it needs to be reported and
recorded. If it is life-threatening or dangerous to the client; report it immediately. One needs to
include subjective and objective information when required. If a patient is exhibiting combative
behavior, report it to your supervisor and try to figure out what the patients is having a conflict
about. It is important to remember that there is always a reason behind every behavior, no matter
how absurd it may seem. While recording, it is important to write neatly, use a black ink pen, and
if a mistake is made; draw a line through it and intial it with the date, your name, and title.
Reporting and recording is a very vital part of an HHAs job.

As a home health aide, a typical day at work would go something very similar if not
exactly like this:
1.Keep records of a clients condition or progress
2. Discuss a client with a case manager
3. Administer medications
4. Help patients get in and out of bed
5. Bathe, dress, and groom clients
6. Change and launder clients linens
7. Engage clients in conversation or otherwise entertain them
8. Serve meals (Home Health Aide-Career Information).
The duties of housekeeping typically have a fairly wide range. It involves simple cleaning
and taking care of normal household functions, including: dusting, straightening, vacuuming,
sweeping, washing dishes, cleaning the bathroom and kitchen, and doing laundry (Home
Health Aide Student Manual). Certain tasks may be performed on certain days of the week, just
depending on the clients personal preferences. Tasks that are not required of the HHA to
perform include moving heavy furniture, washing windows, taking down drapes, cleaning the
attic and basement, or mowing the lawn (Home Health Aide Student Manual).
Although every client will be different on what they what done on a regular basis, there
are general guidelines to housekeeping for almost every area in a typical home. With the kitchen
you must clean after every use, wash dishes, wipe surfaces, take out garbage, and store leftover
food daily. Weekly, one should clean the refrigerator and was the floor. When washing dishes,
use hot soapy water; rinse in hot water; wash glasses and cups first, then silverware, plates and

bowls, and lastly, pots and pans; then let dishes dry on rack (Home Health Aide Student
Manual).
In the living room; clear clutter and put objects in correct places, empty wastebaskets,
and make beds daily. Keep frequently used items within easy reach, dust and vacuum at least
weekly (Home Health Aide Student Manual).
Clients bathrooms may be used by them or multiple people, but one should clean toilet
and raised toilet seat attachment daily, change launder bath linens as necessary, and replace toilet
tissue, soap, and facial tissue as needed. Empty wastebasket daily as needed as well. (Home
Health Aide Student Manual).
In a clients bedroom it is typical to empty and clean bedside commode, make bed and
change launder linens as necessary. Care for clients personal laundry; hand wash in sink or
machine wash in clients home, in laundry room, or Laundromat. Then dry laundry and return to
proper place (Home Health Aide Student Manual).
If a client is not able to do their own laundry independently, this may be a task one will
be required to perform. The general guidelines of doing laundry are: sort items to be washed in
categories, select correct detergent, select correct detergent, select correct water temperature,
load the machine, dry items, remove items, fold, and store (Home Health Aide Student
Manual).
For clients meals; planning, meal preparation, storage, and food safety are very
important. More importantly, it is your responsibility if the client is not able to do it themselves.
One should plan for meals for a week, or at least several days before shopping. One needs to
pay close attention to certain restriction, the number of people present, food preference, and
budget. Along with meals, snacks and leftovers need to be planned for when you are not present.

After planning, make a list and go shopping (Home Health Aide Student Manual). When
preparing for a meal you need to wash hands frequently, keep everything clean, avoid re-using a
knife or cutting board after using them on meat, defrost frozen food in fridge, wash fruits and
vegetables, cook food thoroughly, never leave food out for more than two hours, and keep cold
food cold and hot food hot (Home Health Aide Student Manual). For storage of food you
have prepared or bought, maintain the fridge temperature between 36 and 40 degrees, maintain
freezer temperature at 0 degrees, dont re-freeze thawed items, keep containers sealed good to
keep things out of food and keep it fresh, and when in doubt throw it out (Home Health Aide
Student Manual). Food safety is a very important aspect to consider everywhere. Uncooked
meat and poultry must be handles properly and cautiously. There are four simple steps to achieve
this;
1. Store properly
2. Avoid cross contamination
3. Cook thoroughly
4. Keep hot foods hot and cold foods cold
Always wash hands thoroughly before and after preparing all food, not just meat. If you do any
other activities during, before, or after you prepare food; wash hands once again (Home Health
Aide Student Manual).
In Oklahoma, a certified home health aide makes a minimum of $17,451 yearly
($8.39/hr.) and a maximum of $25,750 ($12.38/hr.). CNAs in a hospital or long term care facility
on the other hand, make a minimum of $17,597 yearly ($8.46/hr.) and a maximum of $26,291
($12.64/hr.). As one can see, these pay rates are fairly close in numbers.

Alongside getting paid hourly, home health agencies also offer mileage reimbursement.
As of 2014; the going rate for business miles driven is 56 cents. It is your own responsibility to
efficiently and honestly record your mileage. It usually starts when you leave the first house you
go to and end at the last. You use YOUR vehicle to get from place to place, so that is a personal
choice one is required to make when choosing this as your career or job.
There are many different aspects of a home health agency and a home health aide as an
individual. There are so many different things that come into play with this profession; such as
the roles, responsibilities, and salary of a home health aide and the environment and supervising
of the agency. Without home health care, patients would have to either go into a long-term care
facility or stay with a family member either forever or until the individual regains independence;
which may never happen without the proper care. I think that home health care is a very good
thing to fall back on when you or a loved one has become ill or injured and doesnt have full
independence after being released from the hospital. It gives individuals a chance to live
independently for as long as possible, which in my perspective gives the person confidence and
motivation to get better. Home health care is a helpful establishment and a great career choice for
some individuals.

Works Cited
1. Home Health Care: What It Is and What To Expect. Whats Home Health Care? The
Official U.S. Government Site For Medicare, n.d. Web. 28 Apr. 2014
2. Leahy, William, Jetta Lee Fuzy, and Julie Grafe. Providing Home Care: A Textbook for
Home Health Aides. Third ed. Albuquerque, NM: Hartman Pub., 2009. Print.
3. Fuzy, Jetta Lee, and William Leahy. The Home Health Aide Handbook. Third ed.
Albuquerque, NM: Hartman Pub., 2011. Print.
4. Home Health Service Eligibility. Home Health Services Eligibility. Health Partners,
2013. Web. 07 May 2014.
5. McKay, Dawn R. Home Health Aide-Career Information. About.com Career Planning.
N.P., n.d. Web. 07 May 2014.
6. Savoy, Carley. Differences Between HHA and a CAN. FindHHAtraining.com. N.p.,
n.d. Web. 07 May 2014.
7. http://www.ok.gov/health2/documents/HRDS_Chapter677.pdf
8. Home Health Aide Student Manual. Meridian Technology Center. 07 May 2014.
9. Home Health Aide- Career Planning Information. About.com Career Planning. N.p.,
n.d. Web. 12 May 2014.
10. Home: Occupational Outlook Handbook: U.S. Bureau of Labor Statistics. U.S. Bureau
of Labor Statistics, n.d. Web. 12 May 2014.
11. 2014 IRS Mileage Rate. Company Mileage. N.p., 2014. Web 13 May 2014.