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Healthcare reform has passed; we are all awaiting what "it means." We do know that changes will eventually restructure the face of our healthcare system. Healthcare policy advisors are discussing bundling payments for services that will cross silos of care. This means that a provider (perhaps a health system) will be reimbursed one payment for providing healthcare for one individual over a period of time-perhaps 1 year. The system would then have to develop a comprehensive plan to provide cost-effective, quality services.


Home health professionals can play a key role in a health system that focuses on keeping patients out of expensive care environments. We often deal with the challenges of caring for patients with chronic conditions by managing symptoms as a team and working with caregivers. The authors of articles in this issue provide us with evidence-based interventions for two costly chronic conditions, multiple sclerosis and diabetes. For patients with advanced multiple sclerosis, Reitman presents a comprehensive approach with a nurse-led team managing the patient's symptoms as well as addressing caregiver needs. She also includes a list of helpful resources for professionals, patients, and caregivers. Sanchez introduces us to a new technology for managing diabetes mellitus, continuous glucose monitoring system. In reviewing the literature on family caregiving, Sferrazza and Garcia-Willix focuses on four specific areas: caring for patients with dementia, differences in stress levels of caregivers, evidence-based interventions to alleviate caregiver stress, and a nursing theory to guide research and practice guidelines. In summary, the information in these articles can be incorporated into current practice and also considered when planning for the future. Home health organizations and professionals might take a proactive approach and develop a comprehensive plan for caring for populations with chronic diseases using a team approach. They can carve out their contribution and market their services as part of a provider team.


We also need political expertise as we sit at the "policy table," whether the table is in a board room or in a public official's office. Delaware State Senator Bethany Hall-Long provides a compelling argument for our increased involvement in politics and suggests strategies we might implement. Taking a legislator on a home health visit can be an effective strategy in communicating the value of home health. Sprinkel and Browning's article can serve as a useful guide for developing a legislator home visitation program.


Gaining political expertise will improve our effectiveness in addressing critical issues, such as workplace violence. McPhaul and colleagues developed an instrument to assess risk of violence toward staff during home visits. If home health administrators plan on recruiting professionals from a shrinking pool, we must address workplace violence. Complete the Political Self-Assessment Tool and develop your political skills. To become active participants in policy changes, we must be prepared with a plan and use effective political strategies to secure support for the plan. We cannot rely on others to do this for us. We must all be involved.