Home care nurses occupy a unique position in caring for the elderly and disabled. Their direct contact with the patient means they are often the first to recognize when patients are ready to transition to the more intensive care afforded by a nursing home. The personal contact established with patients and family members help them be aware of family dynamics, which allows them to be a valuable resource to families making the decision during the transition.

While family physicians are ultimately responsible for all medical decisions, their time demands preclude them from providing intensive transition assistance family members and patients may need. The nurse can perform this role acting as a counselor and referral resource. The experiences the family has with the nurse develop into a relationship where the clinician is seen as a trusted advisor and team member. Instead of bringing in yet another "outside" expert to deal with these issues, the nurse can and should provide assistance and support to ease everyone's transition process. This role can be the most rewarding aspect of the nurse's experience.

Home care nurses can provide transition assistance to the patient and family that include:

Recognition and acceptance of the patients needs:

* Outlining to family members and patients their observations of the patient's condition, what needs exist, and how those needs are best met in a nursing home.

* Explaining to the family the realities of what to expect in an assisted living or nursing home environment.

Assistance with emotions:

* Offering insights to family members who may be feeling guilty about the transition about how best to prepare themselves and the family member.

* Advising family members on what to expect from the patient relative to acceptance or opposition to the move, and providing counseling on how best to prepare the patient.

* Communicating with the patient to help assuage fears of the change, as change is difficult for everyone.

Selection of the nursing home:

* Advising family members and patients on how to evaluate a nursing home based on patient care needs, the patient's temperament, and the nursing home's atmosphere.

* Encouraging family members to visit two or three facilities in the area to experience the facilities and determine the best choice.

Referrals:

* Providing referrals to specific nursing homes, nursing home placement services, or hospital professionals who advise the family on placement.

* Referring to attorneys or financial service providers who can inform the family that there are options on structuring and protecting assets.

* Providing a list of counselors and support groups that help families deal with these difficult transitions.

Assistance with the move:

* Advising the family and patient how to personalize the patient's room or area to make the transition smoother, and how to select the mementos to bring along.

Many home care nurses may perceive their role as limited to providing intermittent skilled nursing care. However, wise home care nurses and their organizations understand patient and family needs extend beyond administering medications or other nursing responsibilities. By entering the home, the nurse has the opportunity to work with patients and families and remain an objective, extremely valuable resource.