1. Marrelli, Tina M. MSN, MA, RN, FAAN

Article Content

This March issue has the theme of palliative care and hospice care at home. As the trend seems to continue to incorporate words such as palliative care and care and caring and replace the word (in some instances) hospice-we hope that these changes do not change the important work of hospice. In her thoughtful Commentary, "Don't Say the Word [horizontal ellipsis]," Cindy Heffron, a hospice nurse case manager, skillfully addresses those times when families want the care-but do not want the word "hospice" to be used. In a time when the demographics show that we need such open and loving conversations (and skillful care) more than ever! Sadly, effective February 1, 2013, the Medicaid Hospice Benefit in Louisiana was eliminated (Louisiana-Mississippi Hospice and Palliative Care Organization, 2012). Unless I am mistaken, Louisiana will be the only state to cancel their Medicaid Hospice Benefit. (Oklahoma is the only other state not to have one, but they never implemented the benefit.) What a heartbreak for those patients and families. I would think that those costs might come in other (more expensive?) care settings, such as a hospital. This is truly sad and a testament to what we do, and do not, value. The VNAA column entitled "Home Healthcare and Hospice: A Time of Change" is also directed to home care and hospice and addresses new ways hospice and home care can adapt and provide the best care in changing environments.

Figure. No caption a... - Click to enlarge in new windowFigure. No caption available.

There are three information-packed continuing education (CE) articles in this issue. The first is authored by Lynn Lednick and colleagues from the Cincinnati Children's Hospital and is entitled "Is Self-Administration of Subcutaneous Immunoglobulin Therapy Safe in a Home Care Setting?" This article follows this question through the steps of conducting an evidence-based practice project and change. The next CE article, "Hoarding in the Home: A Toolkit for the Home Healthcare Provider," by Catherine Chater and colleagues defines this complex experience and reviews specific strategies to intervene through a skill development and harm reduction process. All of us who have walked into a home where we could hardly fit through the pathway to get to the patient (because of towering stacks of newspapers or other things lining the single route still walkable/accessible) will welcome this article with its in-depth coverage of the topic and the toolkit of resources. The third CE article is Judith Young's article, "Online Resources for Culturally and Linguistically Appropriate Services in Home Healthcare and Hospice, Part 4: Resources for European Patients", the fourth in a series of resources and provides helpful and easily accessible tools to help you as you care for patients from across the globe. The next, and final, part of the series will discuss African languages in a future issue. Here are the previous parts in the series:


* Online Resources for Culturally and Linguistically Appropriate Services in Home Healthcare and Hospice: Resources for Spanish-Speaking Patients. January 2012, 30(1), pp. E1-E7.


* Online Resources for Culturally and Linguistically Appropriate Services in Home Healthcare and Hospice, Part 2: Resources for Asian Patients. April 2012, 30(4), pp. 225-232.


* Resources for Middle Eastern Patients: Online Resources for Culturally and Linguistically Appropriate Services in Home Healthcare and Hospice, Part 3. January 2013, 31(1), pp. 18-26.



The "bad" in the title refers to Department of Health and Human Service's Office of the Inspector General's December 2012 report entitled "Inappropriate and Questionable Billing by Medicare Home Health Agencies." To access the full report, visit This 29-page report is very informative and should be read by all clinicians and managers. It includes very interesting and up-to-date data-for example, "in 2010, Medicare paid $19.5 billion to 11,203 home health agencies (HHA) for home health services provided to 3.4 million beneficiaries" (Office of the Inspector General, 2012). HHAs are considered to be particularly vulnerable to fraud, waste, and abuse. The Centers for Medicare & Medicaid Services designated newly enrolling HHAs as high-risk providers in March 2011, citing their record of fraud, waste, and abuse (Office of the Inspector General, 2012). This report also defines many components of the oversight including Medicare administrative contractors and others, and others. However, those of us working with home healthcare organizations that are doing the "right" things and know and adhere to the regulations and respect and understand homebound, understand the plan of care, and make visits and provide care in accordance with the highest of nursing and other standards should be outraged that some HHAs can hurt the rest of us by sheer association. This is why, I believe, it is more important than ever that visiting clinicians and managers know and understand the rules and that the patient documentation clearly supports covered and appropriate care.


The good is saved for last. As healthcare reform continues to be rolled out, the National Governors Association (NGA) released an article titled "The Role of Nurse Practitioners in Meeting Increasing Demand for Primary Care," which is a 14-page report essentially summarizing and making the case for the use of nurse practitioners (NPs) in the roles for which they have been educated to practice. The report states that "Research suggests that NPs can perform many primary care services as well as physicians do and achieve equal or higher patient satisfaction rates among their patients" (NGA, 2012, Abstract, para. 3). The article goes on to comment about the wide variation in state laws and regulations governing NPs. There are "sixteen states and the District of Columbia [that] allow NPs to practice completely independently of a physician and to the full extent of their training (i.e. diagnosing, treating, and referring patients as wellas prescribing medications for patients); the remaining 34 states require NPs to have some level of involvement with a physician, but the degree and type of involvement varies considerably by state" (NGA, 2012, Abstract, para. 3). To this end, please refer to the the full report on their Web site for definitions listed by state:


The changing healthcare landscape may provide you and your organization with innovation and change too. Please keep Home Healthcare Nurse in mind should you or a colleague wish to develop an article and submit it to HHN. We welcome both first-time authors and experienced researchers; together we make up the special world that cares for people where they love-their home!


I always welcome comments and queries from prospective authors and subscribers. I can be reached at




Louisiana-Mississippi Hospice and Palliative Care Organization. (2012) Regarding Governor Jindal's elimination of the Medicaid Hospice Benefit. Retrieved from[Context Link]


National Governors Association. (2012). The role of nurse practitioners in meeting increasing demand for primary care. Retrieved from[Context Link]


Office of the Inspector General. (2012). Inappropriate and questionable billing by Medicare home health agencies. Retrieved from[Context Link]