Saturday, November 3, 2018

MANAGE NURSING CARE...Home from the Hospital


Why choose home care rather than care at a nursing facility?
Where in your home?
What will you need?
When will who have to do what?
Who will you hire?
How will you manage the care?


You will learn from our experience how to prepare for the homecoming of your patient and how to manage nursing care at home thereafter.


Providing skilled nursing care at home is both challenging and rewarding for the caregivers. Home care is a blessing for the patient. Having chosen to provide it, you deserve to congratulate yourself. To make this project more manageable, take advantage of the advice and the forms provided here. 


Someone you care deeply about is being released from the hospital, with the alternatives of home care, hospice care, or a nursing home. You have to decide, or help them decide, which alternative is best. If you decide on home care, you may need to manage it. This book will help you understand how to provide skilled nursing care at home and will aid in your decision-making.

As noted, the co-authors have been involved for over a decade in supplying and managing skilled nursing care at home for Tina Su Cooper (Cooper, 2011):
In June of 2004, when she came home from the Critical Care Unit after the 100 days that nearly killed her, Tina was on a ventilator, quadriplegic, fed through a gastric tube. Not only was she totally dependent on us for her care, the list of infections and problems that had developed while hospitalized was daunting. She had been “colonized” by two strains of hospital-acquired bacteria and given only months to live. She was safer at home or in a hospice than in the hospital, our doctors agreed.  Being given the choice of home or the hospice meant there was a good chance she had only months to live. She took it in stride.

Over a decade later, Tina’s health has remained strong, and even though the losses caused by multiple sclerosis have been severe, including quadriplegia, dependence on a ventilator and the need to be fed and medicated by a gastric tube, she has been able to live an added twelve years and generally enjoy her life at home.

We, the co-authors, have long thought it worthwhile to write a book about our experience, but only recently got down to doing it. Investigating what was available at mega-bookseller, we found only one relevant entry when we queried “manage nursing care at home.” That book, How to Manage Family Illness at Home, which we will describe next, was written by a British author, Gill Pharaoh, published in paperback in 2004, re-issued as a Kindle e-book in 2015.
The chapter list for Ms. Pharaoh’s book is as follows:
     Chapter 1: Receiving the Diagnosis
     Chapter 2: Whom to Tell?
     Chapter 3: The Services of the Hospice and Palliative Care Team
     Chapter 4: Making Decisions about Work
     Chapter 5: How Much to Tell the Children?
     Chapter 6: Caring for the Carer
     Chapter 7: Looking at Ways in Which Everyone Can Help
     Chapter 8: The Physical Needs of the Person Who is Ill*
     Chapter 9: The Use of Aids and Appliances*
     Chapter 10: Some Common Symptoms and the Use of Medication
     Chapter 11: Physical Comfort, Health, and Safety for Everyone Involved
     Chapter 12: Children: Managing Change and Planning for the Future
     Chapter 13: Long-term Care: Unhappy Families and Mental Health
     Chapter 14: Acknowledging Anger
     Chapter 15: Dealing with Depression
     Chapter 16: The Question of Euthanasia
     Chapter 17: Dying at Home
     Chapter 18: Dying in the Hospital
     Chapter 19: The Effects of Bereavement
     Chapter 20: Supporting a Friend
     Chapter 21: Starting a New Life Alone

Ms. Pharaoh’s valuable book emphasizes the many significant psycho-social aspects of home care, and hospice care at home, two areas we are not going to explore in depth. Her two chapters that we have marked with asterisks cover topics similar to what is covered here, where we go into the “nuts and bolts” of managing nursing care for someone at home.

    A less restrictive search, for ebooks covering “nursing care at home,” gave the following titles:
·       Long Term Care: Everything You Need to Know about Long Term Care Nursing and How to Plan and Pay for Long Term Care and Insurance [2014]
·       Nursing Wild Birds for Release at Home: Booklet [2014]
·       Now and at the Hour of Our Death [2015]
·       American Cancer Society Complete Guide to Family Caregiving: The Essential Guide to Cancer Caregiving at Home [2012]
·       Keeping Your Mind While They’re Losing Theirs: A Sometimes Poignant Look at Dealing with a Parent who Has Alzheimer’s or Dementia [2015]
·       Five Ways to Pay for Home Healthcare and Stay in Your Home [2012]
·       AIDS Care at Home: A Guide for Caregivers, Loved Ones, and People with a AIDS  [1994]
·       Elder Care Activities: 105 Great Activities You Can Do at Home, in Assisted Living, a Retirement Community, or in a Nursing Home [2013]
·       Perspectives on Care at Home for Older People [2013]
·       Conscious Acts of Grace --- Gifts of Love and Kindness at the End of Life [2010]
·       Knocking on Heaven’s Door: The Path to a Better Way of Death [2013]
·       The Preemie Parents’ Companion: The Essential Guide to Caring for Your Premature Baby in the Hospital, at Home, and Through the First Years [2000]
·       Spiritual Midwifery [2002]
·       Keeley Meditation: Free Your Mind [2012]
·       The Complete Guide to Medicaid Nursing Home Costs: How to Keep Your Family Assets Protected – up to date Medicaid… [2008]
·       Comrades in Health: US. Health Internationalists, Abroad and at Home [2013]
·       Caregiver Relief: A Stress Management Guide [2013]
·       Seniors at Large [2012]
·       Cancer Caregiving A-to-Z: An At-home Guide for Patients and Families [2008]
·       Conversations at the Nursing Home: A Mother, a Daughter, and Alzheimer’s [2013]
·       Massachusetts General Hospital Handbook of General Hospital Psychiatry [2010]
·       Angels at the Door [2014]
·       Caregiving Tips A-Z [2008]
·       Making Myself at Home in a Nursing Home [2012]
·       Supporting People with Dementia at Home: Challenges and Opportunities for the 21st Century [2012]
·       Jekel’s Epidemiology, Biostatistics and Preventive Medicine [2013]
·       A New Look at Community-Based Respite Programs: Utilization, Satisfaction, and Development [2014]
·       Waiting at the Gate: Creativity and Hope in the Nursing Home [2014]
·       How to Find Someone to Care for Your Aging Person at Home [2010]
·       Providing Good Care at Night for Older People: Practical Approaches for Use in Nursing and Care Homes [2011]

   Some of these books would be logical sources for more detailed information on topics that will be just touched on here. There were 40 results for the Amazon Kindle ebooks. Expanding the search to all books on with the same “nursing care at home” topic gave 291 items. You will not suffer from a shortage of reading matter, if you wish.

   From the 40 titles listed above, we can make some distinctions about what our book does and does not cover: we cover nursing care for the chronically ill at home, including the elderly, but
·       not premature babies,
·       not end-of-life, hospice care,
·       not respite care for caregivers, and…unsurprisingly…
·       not nursing wild birds. 
   Those who want to explore topics not covered here are directed to some of the titles listed above, or the titles that come from a search that includes both printed and ebooks.
Subsequently, we became aware of an exceptionally complete treatise on home care, Tena L. Scallan’s excellent The Ultimate Compassionate Guide to Caregiving: A Simple Blueprint for Dealing with Today’s Healthcare Crisis Combined with Years of Wisdom and Sound Advice, published in 2015 and available in paperback and ebook formats from Amazon, a book which gives finely detailed advice on the non-medical care of patients in the home, advice which we summarize in our appendix, “Custodial Care at Home,” a book we urge our readers to obtain to supplement our own, which has more of a medical management emphasis. Similarly, in 2015 was published The Successful Caregiver’s Guide, by Rick Lauber (2015), particularly valuable for those who must move their loved ones to a care facility.

    We have organized the first part of our book along the lines of the traditional questions a journalist would ask, though in a somewhat different order: Who? What? When? Where? Why? How?

    We will start with why.  As Stephen R. Covey advised in his The 7 Habits of Highly Effective People, one should “start with the end in mind.”

Contact information:
Diane R. Beggin, RN
40 Sycamore Drive
Montgomery, NY 12549


Available from Outskirts Press and from Amazon:

How to Manage Nursing Care at Home

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