1. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins
Chapter 11: Care Management,
Case Management,
and Home Healthcare

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Chapter Highlights
• Defining care management and case management
• Situating case management as a key component to home
visiting
• Historical overview and definition of home care practice
• Description of the home care provision of services
• Examining types of home care agencies and services and
reimbursement
• Exploring role and scope of home care nursing practice during
a home visit
• Identifying interdisciplinary roles and use of telehealth
• Describing types of chronic care conditions in home care

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Question
Is the following statement True or False?
Case management is the development and coordination
of care for a selected client and family.

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Answer
True
Rationale: Case management—development and
coordination of care for a selected client and family
Care management—coordination of a plan or process to
bring health services together as a common whole in a
cost effective way

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Care Management
• Defines the evaluation of health care interventions,
including need and appropriateness of care, and the
actions taken to attain effective and efficient outcomes
• Case management

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Home Health Care
• Quality health care in places and spaces where people
live most of their lives
• Continued development of ways to inform health care
providers what realities affect health promotion and
prevention in diverse complex lives of people and families
• Cost containment in the health care industry

7. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins
Question
Is the following statement True or False?
Home care is part of a continuum of care where clients
have the opportunity to live through the experiences of
subacute, chronic, and end-of-life care.

8. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins
Answer
True
Rationale: Home care is part of a continuum of care
where clients have the opportunity to live through the
experiences of subacute, chronic, and end-of-life care.

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Types of Agencies
• Private/voluntary (not-for-profit)
• Hospital-based
• Proprietary (for-profit)
• Public

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Financing and Regulation of Home Care
• Home health care services are reimbursed by local, state,
and federal funds; private insurance; and private
individuals.
• Medicare has the following criteria for eligibility
– Home bound
– Plan of care
– Skilled needs
– Intermittent care needs
– Necessity

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Role and Scope of Home Health Practice
• Assessment by collecting data about home care clients
• Diagnosis through the analysis of these data
• Outcome identification that helps home care nurses
identify nurse-sensitive measures
• Planning in the form of nurse-sensitive interventions
directed to the identified outcomes
• Implementation-identified nurse-centered actions in
collaboration with clients and families
• Evaluation outcome accomplishment through nurse-
sensitive interventions

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Question
Is the following statement True or False?
Telehealth is a form of electronic communication to
deliver chronic care, and specialty consultations.

13. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins
Answer
False
Rationale: Telehealth is a form of electronic
communication to deliver acute care, not chronic care,
and specialty consultations.

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Interdisciplinary Care
• Various members of the health care team, not just
nurses, contribute their expertise to client management
in the home.
• Generally, the following groups receive care from home
health agencies
– Adults with acute or chronic illnesses
– Older adults
– Mothers and newborns
– Children and their parents

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Telehealth
• Telehealth is a form of electronic communication used to
deliver
– acute care and specialty consultations
– home telenursing
– electronic referrals to specialists in expert health
facilities

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Home Care Models
• Assisted living
• Home visits to the homeless
• Parish/Faith community nursing

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Home Visit
• Initiating the visit
• Preparation
– Equipment
– Directions
– Personal safety

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Home Visit (cont.)
• The actual visit
– Assessing for risk of medication errors
– Assessing for risk of falls
– Assessing for risk of abuse and neglect
• Termination of the visit
• Post-visit planning

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Nurse–Family Interactions in Home Care
• Culture
• Contracts
• Confidentiality