Home Health & Hospice

Insider’s Scoop | Stay focused on the focus of care

Homecare Insider, February 29, 2016

Editor’s note: This week’s Insider’s scoop/Inside story is from Documenting Medical Necessity: A Practical Guide for Home Health, by Heather Calhoun, RN, BSN, HCS-D, COS-C. This practical resource provides down-to-earth, conversational documentation tips, and dozens of example scenarios to help nurses understand medical necessity and document in a manner that encourages proper, complete reimbursement. Click here for more information.

The focus of care is the main reason the patient was admitted to home health in the first place. A particular educational need of the patient and/or caregiver, a specific hands-on skill that is to be performed, or observation and assessment of the patient’s clinical condition can be the focus of care. The plan of care (POC) should spell out these needs and be supported by physician documentation of the diagnosis or illness being treated.

It is easy to lose the focus of care, because home health staff members are usually task-oriented people. They go into the home with a particular task to teach, perform, or assess, and that is what is done during the visit, instead of looking at the patient as a whole and understanding the original intent of home health services.
For example, the clinician’s POC says to teach the patient diabetic foot care, and the next two or three visits involve documenting education of diabetic foot care. However, the main reason the clinician was asked to admit and see the patient is to address the patient’s severe congestive heart failure (CHF) and prevent rehospitalization due to the CHF. The clinician is so focused on going down a prewritten list of things to teach that he or she waits until the third week of care to start addressing the CHF, after teaching about falls, pain management, and diabetic foot care.

Although managing the diabetic foot care is important, it’s also important to take some time during every visit to compare the patient’s condition and treatment against the reason for receiving home health and evaluate how the patient is fairing in regard to this reason.