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Home care service and practice are directed toward home visits—the unit of value in home care. This includes intermittent visits, shifts and staffing hours, hospice home visits, “well-baby” visits, or other therapeutic models and time spent in the patient’s home. As explained in Chapter 2 (“What Is Home Healthcare and Home Care Comprised of Exactly?”), there are many kinds of visits and services provided in home care under the broad umbrella term of “home care.”

This chapter provides exemplar practices that incorporate processes and important details to better frame home visits so you can understand their importance. For organizational, operational, and practice reasons, types of visits will be discussed as well as tips for the three distinct parts of a visit:

  • The previsit activities

  • The home visit

  • The postvisit activities

It is important to note that a visit or a patient encounter comprises all three of these parts regardless of the type of discipline or service.

There are a few kinds of home visits in home care. These include the visits to perform the comprehensive assessment, a “revisit” for continuing care, supervisory visits of the aides (or other team members as promulgated by state or other regulation), on-call visits, and discharge visits. Of course, Medicare sets many of the standards, and as Medicaid and other insurers align more closely with Medicare, it is important to be aware of this trend and these standards as changes continue.

This chapter also addresses care and care planning and how the nursing or care-planning process becomes integrated into visits and across time. The case example presented in this chapter integrates some of the complex factors that illustrate home care and home care practice’s unique value.


The previsit activities include these steps: 1) obtaining physician orders, 2) obtaining permission(s), 3) eliciting patient information and status, 4) gathering supplies, and 5) knowing the community.

Planning is an important component seen in all kinds of visit activities. The previsit activities entail phone calls and other communications. Like all interactions, make these communications “set the stage” for success. These communications also begin the interface that becomes the basis of the “patient experience.” Of course there must be positive patient satisfaction, but as the healthcare world shifts toward the patient “experience,” all team members have a role in this holistic approach that generates patient and family perceptions of satisfaction.

It is also very important to “get off “on the “right foot.” This begins with the referral source, such as the hospital discharge planner and the physician who will be signing the initial orders and/or following the patient once that patient is back at home. The physician is also the professional with whom the home care nurse interacts to obtain orders and (perhaps) subsequent certifications and other patient-related communications. ...

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