How to Assess Home Health Care Needs

• Step 1

  Intermittent skilled home health care is provided by a team of professionals including registered nurses, therapists (physical, occupational and speech/language), social workers, and home health aides. It is ordered and overseen by a physician. Skilled care is reimbursable under Medicare, Medicaid and private insurance, as long as the patient meets the criteria set out by each. Private duty home health care is usually considered custodial and is therefore an out-of-pocket expense. A physician's order and oversight is not required.

• Step 2

  When the home health care agency receives a request for care, a registered nurse or physical therapist makes a visit to determine the needs and establish a plan of care. The nurse can also offer information about other options if the patient does not meet criteria for care. The assessment covers three basic areas of need: the physical or functional needs and safety issues, the skilled or clinical needs, and the social needs.

• Step 3

  The patient's health history is obtained and a head-to-toe physical assessment is performed to determine skilled needs. This includes taking vital signs and observing the patient performing such tasks as transferring and ambulation, buttoning a shirt, using a telephone, tying shoes, getting and drinking a glass of water, combing hair, getting into and out of the bathtub. A home safety evaluation looks for potential fall or injury situations such as throw rugs, clutter or sanitation issues, long expanses of oxygen tubing or other hazards, and the ability to easily access emergency services.

• Step 4

  Medications, special diet requirements and nutritional status are reviewed with the patient and any caregiver for understanding and compliance. The nurse or therapist discusses the patient's health history and status to determine knowledge base and deficits. Clinical or skilled needs include teaching about medications, diet and nutrition, and conditions or diseases. Specific tasks such as wound care, IV administration, post operative treatments or exercises, diabetic teaching, etc., are performed and the patient and caregiver assessed for the ability to learn. Is there need and potential for improvement from therapy? Is there a need for assistance with hygiene care?

• Step 5

  Finally, the social situation is assessed. If the patient lives alone, is she safe and able to care for herself or does she require a higher level of care? What financial, emotional and physical aspects of support does the patient have or need? Is there a plan for the short-term as well as the long-term care needs for this patient? Would the patient benefit from social work services for counseling, life planning or resource referrals? All of the above is incorporated into a plan of care which is presented to the physician for approval. If the care needed is not skilled, referral to custodial care services should be made.

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• USUnited States

References & Resources

• NAHC: What is Home Care?
• Senior Home Care Services
• Home Health Assessment Questionairre
• OASIS and Medicare