Ethical Aspects of Pediatric Home Care

PEDIATRICS ◽  
1992 ◽  
Vol 89 (5) ◽  
pp. 920-924
Author(s):  
John D. Lantos ◽  
Arthur F. Kohrman
Keyword(s):  
Health Care ◽  
Home Care ◽  
Home Health Care ◽  
Ethical Issues ◽  
Home Health ◽  
Critically Ill Children ◽  
Traditional Health ◽  
Advanced Medical Technology ◽  
Economic Forces ◽  
Traditional Health Care

This essay is a discussion of ethical issues that arise in the provision of home health care to technology-dependent children. Different ethical norms, especially with regard to the degree of professional responsibility for outcomes, traditionally have applied to home care and hospital care. In particular, parents generally are expected to do their best, but are not expected to have the same specialized knowledge of risks and benefits with regard to particular interventions as health professionals. When home health care involves the use of advanced medical technology, it strains traditional conceptions of parental responsibilities to care for the health of their children at home. It can also strain traditional concepts of professional responsibilities to care for critically ill children in hospitals. We discuss some of the tensions that arise as medical, psychological, and economic forces lead to the increasing use of high technology in the care of children outside of traditional health care institutions.

scholarly journals Practices used by a home care team: implications for caregivers

2021 ◽  
Vol 74 (2) ◽  
Author(s):  
Yara Cardoso Silva ◽  
Kênia Lara Silva ◽  
Isabela Silva Câncio Velloso
Keyword(s):  
Health Care ◽  
Discourse Analysis ◽  
Qualitative Study ◽  
Home Care ◽  
Home Health Care ◽  
Care Service ◽  
Health Care Service ◽  
Home Health ◽  
Care Team ◽  
Power Relationship

ABSTRACT Objectives: to analyze the practices of a home care team and their implications for caregivers’ performance. Methods: qualitative study with data obtained from observation of 21 users, 30 caregivers and 6 professionals from the home health care service in a municipality in Minas Gerais, from February to June 2018. The material was analyzed from the perspective of discourse analysis according to Michel Foucault. Results: team interference upon caregivers is exercised by disciplinary practices and prescriptive, authoritative and surveilling behaviors. The team’s knowledge-power relationship determines caregivers’ acceptance through convincing or through difficulty of understanding assigned orientations. Educational practices would enable caregivers to be constituted as active, participative, empowered and reflective subjects. Final Considerations: team practices interfere with caregivers’ ways of acting and being and they have implications in objectification and subjectification processes.

Home care reimbursement for intravenous ganciclovir therapy

1996 ◽  
Vol 53 (2) ◽  
pp. 161-163 ◽  
Author(s):  
Essy Mozaffari ◽  
Sean D. Sullivan
Keyword(s):  
Health Care ◽  
Managed Care ◽  
Home Care ◽  
Home Health Care ◽  
Home Health ◽  
Fee For Service ◽  
Geographic Variations ◽  
Intravenous Ganciclovir ◽  
Ganciclovir Therapy ◽  
Nursing Services

Variability in reimbursement for home i.v. ganciclovir therapy among three types of payers was investigated. A survey was developed to estimate reimbursement for drug and medical supplies and nursing services associated with preparing i.v. ganciclovir and administering it to persons with cytomegalovirus (CMV)-associated retinitis in the home care setting. The questionnaire was mailed to 45 home health care agencies and 11 nursing agencies. Of the 56 surveys mailed, 26 (46%) were returned and considered usable. Of the 26 respondents, 22 were home health care companies, 4 were nursing ageiicies, 22 served patients covered by managed care or state assistance that reimbursed on a per diem trasis, and 9 did not provide care to fee-for-service patients. The mean total daily-reimbursement rate (for ganciclovir, supplies, and nursing services) from managed care per diem plans was $137.69 per patient, compared with $I29.18 from fee-for-service plans and $72.68 from state assistance per diem plans. The dissimilarity may have been due to geographic variations in reimbursement and different mechanisms of reimbursement. Providers of home i.v. ganciclovir therapy for persons with CMV retinitis received the highest tnean total daily reimbursement from managed care per diem plans, followed by fee-for-service plans and state assistance per diem plans.

Depression Screening and Interventions for Older Home Health Care Patients

2011 ◽  
Vol 23 (6) ◽  
pp. 435-445 ◽  
Author(s):  
Colleen Delaney ◽  
Richard Fortinsky ◽  
Lorraine Doonan ◽  
Rita L. W. Grimes ◽  
Pearson Terra-Lee ◽  
...  
Keyword(s):  
Older Adults ◽  
Health Care ◽  
Home Care ◽  
Home Health Care ◽  
Education Program ◽  
Self Efficacy ◽  
Home Health ◽  
Depression Screening ◽  
Program Outcomes ◽  
The Impact

The increasing prevalence of depression in elderly home health care patients led to a statewide initiative in Connecticut to enhance evidence-based depression treatment for older adults. A training curriculum on depression screening and interventions was developed and disseminated to 25 home care professionals representing 14 agencies in Connecticut using a train-the-trainer model. Home care trainers included nurses and social workers. This article describes Phase I curriculum design and initial evaluation of the impact of the training on the preparation of trainers to provide depression care education at their home care agencies. Several evaluation measures, including an appraisal of the self-reported attitudes and self-efficacy of home care professionals towards depressed older adults, a pre/post-test to assess the trainers’ knowledge, and willingness of trainers to implement the education program at their agencies were used to assess program outcomes. Participants’ self-efficacy levels in screening and caring for depressed older adults was significantly increased following the education program compared to immediately before the education program (t, (24) = -4.204; p < .001).

A Qualitative Study of Professional Issues in Home Health Therapy

2017 ◽  
Vol 30 (1) ◽  
pp. 9-15 ◽  
Author(s):  
Eric Shamus ◽  
Sarah Fabrizi ◽  
Jeffrey Hogan
Keyword(s):  
Health Care ◽  
Occupational Therapy ◽  
Home Care ◽  
Home Health Care ◽  
Physical Therapists ◽  
Real Life ◽  
Occupational Therapists ◽  
Home Health ◽  
Professional Issues ◽  
Snowball Sampling

Professional issues are experienced by physical and occupational therapists working in home health care. A grounded theory method was utilized with snowball sampling to interview 11 home health physical therapists and six occupational therapists working with a variety of populations in the home health setting. Major themes were identified separately for physical and occupational therapy using open, axial, and selective coding. The themes were then recoded for shared themes among the two professions. The major research questions included the following: What professional issues are encountered by therapists working in home health care? What type of benefits and barriers do therapists describe when providing home health services? Finally, how do professional issues compare between the different professions? The five major themes identified by physical therapists included work environment, work characteristics, communication, patient and family, and work-life balance. The themes identified by occupational therapists included the natural environment, the context of health care, client factors, and therapist factors. Common themes described by both physical and occupational therapy providers included the real-life environment of the home, the structure of home care, and autonomy of service provision. Results provide information about professional issues faced by therapists working in the home health care setting. There are a number of issues that are common to both professions, and others that appear to be discipline specific. These findings will guide professional efforts as the demands for professionals working in home care increase.

Early use of home health care on health care utilization for patients with advanced lung cancer.

2013 ◽  
Vol 31 (15_suppl) ◽  
pp. e19015-e19015
Author(s):  
Steven Rousey ◽  
Kiran Krishan Lassi ◽  
Jodi Wieczorek ◽  
James Essler ◽  
Marie Brown ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Health Care ◽  
Home Care ◽  
Emergency Room ◽  
Home Health Care ◽  
Home Health ◽  
Advanced Lung Cancer ◽  
Control Group ◽  
Emergency Room Visits ◽  
Early Use

e19015 Background: Patients with advanced lung cancer historically have required significant use of health care resources including hospitalizations, ICU admissions and emergency room visits which are often related to inadequately controlled symptoms. Most patients with advanced lung cancer prefer to remain in their own home as much as possible and are willing to work with home nursing resources, if available. The purpose of this pilot study was to determine the effect of early use of home health care on health care utilization for patients with advanced lung cancer. Methods: Betweem May 2011 and May 2012, 18 patients were enrolled in a pilot program to explore early use of home care for individuals with advanced lung cancer. Inclusion criteria consisted of a diagnosis of stage III/IV lung cancer (any histology) and home care eligibility using Medicare criteria. The endpoints were hospitalization rate, number of ICU admissions and emergency room visits. The results were compared to an historical control group (562 patients with advanced lung cancer diagnosed between 2006 and 2011). Binomial confidence interval (CI) was used to estimate the 95% CIs and Fisher's exact test was used to assess the p-values. Results: Results at one year showed the hospitalization rates for the pilot group and the control group were 44% (95% CI, 22-69) and 78% (95% CI, 74-81), respectively (p<0.01) and the ER visit rate was 17% (95% CI, 4-41) and 41% (95% CI, 37-45), respectively (p=0.049). The ICU admission rates were 0% and 11% in the two groups, respectively, and this difference was not statistically significant. Home care visits ranged from 1-77 with an average of 12 visits per patient. The estimated cost of the home care program for the duration of enrollment was $2,330 per patient. Conclusions: Early use of home health care for patients with advanced lung cancer appears to reduce the rates of hospitalization and emergency room visits when compared with historical controls, and though the results were not statistically significant, none of the 18 patients in the pilot group were admitted to the ICU. A larger multi-institutional study will examine the potential of this simple intervention for cost saving, enhanced care quality and improved patient satisfaction.

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