New York Home Health Care

A new study released today by the National Association for Home Care & Hospice’s (NAHC) Foundation for Hospice and Homecare has documented that nurses, therapists and home care aides who serve chronically ill elderly and disabled patients drive nearly 5 billion miles each year.

“The sheer volume of miles driven by the employees of the nation’s home care and hospice agencies to reach shut-ins with complex medical problems is astonishing,” said Val J. Halamandaris, President of NAHC. “Our data shows they traveled 4.8 billion miles in 2006 to provide medical and nursing care to 12 million people who are so disabled that they cannot leave home without assistance.”

Halamandaris added that the “angels of home care cross all types of terrain, from crowded metropolitan streets to the dirt roads of frontier America, in all types of weather to provide care for the patients who depend on them — many of whom suffer from congestive heart failure, stroke, chronic obstructive pulmonary disease, diabetes, cancer, Alzheimer’s disease and other life threatening conditions.” The nation’s home care organizations provided more than 428 million medical and nursing million visits in 2006.

According to the study, which is based on Medicare cost reports required to be filed with the Federal government augmented by responses to a nationwide industry survey, the 4.8 billion miles driven in 2006 is the equivalent of:

• 1,386,458 trips across the U.S. at its widest point
• 192,920 times around the earth
• 10,017 roundtrips to the moon
• 52 trips to the sun
• More than double the 2 billion miles driven globally by UPS, the international delivery service

According to the National Association for Home Care:

• Approximately 7.2 million people in the US require some form of home health care.

• More than 20,000 home health care providers exist today.

• Almost two-thirds of home health care recipients are women.

• Almost two-thirds of home health care recipients are over age 65.

• Conditions requiring home health care most frequently include heart disease, cancer, diabetes, and hypertension.

• Approximately 36 billion dollars was spent on home health care in 1999.

• Medicare is the largest single payer of home care services. In 1997, Medicare spending was approximately 40 percent of the total home health care expenditure.

May 13, 2008 - A low-vision rehabilitation program that includes a home visit, counseling, assistive devices such as magnifiers and assignments to practice using them appears to significantly improve vision in elderly veterans with diseases of the macula (the area of the retina with the sharpest vision), according to a report in the May issue of Archives of Ophthalmology, one of the JAMA/Archives journals.

“Low vision, chronic visual impairment that limits everyday function, is one of the 10 most prevalent causes of disability in America,” the authors write as background information in the article. In addition to affecting daily function, low vision increases the risk of depression, injury and an overall decline in health.

Most diseases that cause low vision are not curable.

“In most cases, impaired vision cannot be corrected and rehabilitation is the only option for regaining lost function for the patient with low vision. Low-vision rehabilitation aims to restore functional ability, the ability to perform tasks modulated by visual impairment.”

Joan A. Stelmack, O.D., M.P.H., of the Edward E. Hines Jr. VA Hospital, Hines, Ill., and the University of Illinois at Chicago College of Medicine, and colleagues studied 126 patients (average age 78.9, 98 percent male) with low vision and diseases affecting the macula who were eligible for Veterans Affairs (VA) services.

Between November 2004 and November 2006, participants were randomly assigned to one of two groups. In one, patients received a low-vision rehabilitation program incorporating a low-vision examination, counseling, assistive devices such as magnifiers and five weekly sessions provided by a low-vision therapist to teach use of the assistive devices and other adaptive strategies.

They were also assigned homework to ensure they used the devices outside of rehabilitation. The other group was placed on a wait list for the rehabilitation program and received no treatment for four months, an amount of time veterans might normally wait to receive such services.

After four months, the 64 patients in the treatment group received an average of 10.46 hours of face-to-face low-vision rehabilitation and experienced a significant improvement in all aspects of visual function, including reading ability. Among the 62 patients in the group that did not receive rehabilitation, vision and functional ability declined over the four-month follow-up.

“Significant improvements in functional ability for mobility, visual information processing, visual motor skills and overall ability also were seen in the treatment group; small losses in these functions were observed in the control group,” the authors write.

“At least 10 hours of low-vision therapy, including a home visit and assigned homework to encourage practice, is justified for patients with moderate and severe vision loss from macular diseases,” they conclude.

“Because the waiting-list control patients demonstrated a decline in functional ability, low-vision services should be offered as early as possible.”

Editor’s Note: Funding for this research was provided by a Department of Veterans Affairs Rehabilitation Research and Development grant. Funding for the low-vision devices prescribed and dispensed to veteran participants was provided by the Department of Veterans Affairs Prosthetics Service.

In a study involving 214 patients, researchers found that the patient-physician relationship is strengthened when patients see themselves as similar to their physicians in personal beliefs, values and communication style. Further analysis revealed that patients’ perception of similarity to their physician is a multidimensional construct that includes both personal and ethnic components, some of which are more strongly related to outcomes than others. Researchers found that of the two dimensions, personal similarity appears more strongly related to patient trust, satisfaction and intent to follow the doctor’s recommendations. Regardless of issues of race and gender, a doctor who is skilled in providing information, showing respect, and supporting patient involvement can establish a connection with the patient that contributes to greater patient satisfaction, trust, and commitment to treatment. The authors assert that these findings support the need for communication skills training as a foundational part of medical education at all levels.

Understanding Concordance in Patient-Physician Relationships : Personal and Ethnic Dimensions of Shared Identity By Richard L. Street, Jr., Ph.D., et al

Old age can keep us from doing things we once thought were easy. As we grow older, living on our own can become something of a struggle. However, home care and home health care services can provide the elderly or sick with the aid and activity they need on a daily basis, allowing them to continue living an independent life.

With over one million people making use of home health care, it has proven to be a successful alternative to long-term nursing facilities. A normal home care service consists of a nurse or aid visiting the patient’s home every day to help assist with whatever needs assisting. This can vary from simply cooking meals and housecleaning to providing the patient with physical therapy and medicine. No aspect of what a patient needs is overlooked, and every patient is treated differently according to his or her needs. While one patient might need help keeping maintenance of his or her home and minor physical therapy, another may require help in being bathed and fed. Nurses are trained to be attentive to any potential needs their patient may have.

The need for home health care isn’t always clearly determined. It is a good idea to consult with a doctor before deciding whether you or someone you know should seek the aid of home health care services.  Consulting with a doctor may also help you financially. If your doctor confirms the need for home services and orders it, financial burden can be lifted off your shoulders through Medicare. Research the agency you use to make sure they can do whatever needs to be done to aid you or a loved one. Check if the nurses are licensed and trained. This research can help prevent any problems along the way.

One important thing to remember is that home care services and home health care services are different. While home care may provide the elderly with daily check-ups and domestic services, home health care includes helping a patient recover from an ailment, such as a heart attack or stroke. Depending on what is required, you might want to make sure that those you’d be hiring are licensed therapists or nurses.

Home health care is a great way to provide yourself or a loved one with the aid and medical treatment that’s needed on a daily basis. It allows patients to live healthy lives without encroaching on their independence. If you or someone you know is not ready to go to a long-term nursing facility, home health care is a viable alternative that might just be worth looking into.