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

Article Content

This January issue of Home Healthcare Nurse is an exemplar of how varied home care practice has become. Infection control, fall prevention, wound management, palliative care, and cultural competency are all a part of the milieu under/in which we practice and/or manage.

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In their article, "Validating a Multifactorial Falls Risk Assessment," Michele James and colleagues performed a retrospective chart review to look closely at falls and patients who sustained a fall as well as some clients in the same age range and time period who did not fall. Critical variables were identified as higher areas of risk. Such information assists clinicians as they assess and care for patients in their homes. Many aspects of patient safety and supporting patient safety are addressed in home care visits.


The infection control concerns related to nursing bags and "bag techniques" are important ones and have implications for operations and practice. Mary McGoldrick, in her article "Bag Technique: Preventing and Controlling Infections in Home Care and Hospice," addresses some of the fundamentals of nursing bags and the issues that make this CE information-packed and a must-read. My favorite sections-and maybe yours-are the sections about "Decontamination and Cleaning the Surfaces of the Nursing Bag," always a hot topic on listservs, and the table titled


"The Great Home Care Debate: Barrier vs. No Barrier"; the list of barriers is interesting too!


When we as home care or hospice clinicians think of home visits and infection control, wound care and wound dressings are a good example. Wound care is a natural part of any discussion related to infection control and prevention. This issue of HHN has two articles related to wound care assessment and management because of this and the sheer prevalence numbers of patients with wounds cared for at home. One is "Effectiveness of Wound, Ostomy and Continence-Certified Nurses [WOCNs] on Individual Patient Outcomes in Home Healthcare," which helps make the case for the unique skill-set of these clinicians and their impact on patients. The second wound-related article is authored by Barbara Dale and colleagues and is entitled "Practical Evidence-Based Palliative Wound Care: Principles of Care." This CE article addresses palliative care and then managing the patient with wounds and meeting their unique needs. Both of these would articles would be great articles to share with your administrator and others as you seek to have WOCNs on your organization's team to improve care and achieve desired outcomes. Those of you who have WOCNs on your team: feel free to write me and tell me your experiences, perhaps "before and after" there was a wound specialist or WOCN at your organization. I welcome this dialogue! And because competence is a key component of quality, the VNAA's column is "New Quality Movement in Hospice and Palliative Care: Where Is It Going?" This is an overview as hospice over the next months will begin to collect and submit data on seven new measures. Integrating these measures and other quality indicators into best practices will be the goal.


We have the vision of also providing culturally appropriate care. In the article "Enhancing Cultural Competency in Home Care Patients Caring for Latino/Hispanic Patients," Anne M. Grady describes a unique program of education and measuring change in cultural competence. This article can serve also as model for other agencies seeking to improve their competence with cultural groups in their patient demographics and geographic catchment areas.


Motivational interviewing (MI) is one strategy to promote behavioral change. In this issue's Research Briefs column, "Effectiveness of Motivational Interviewing to Improve Chronic Condition Self-Management: What Does the Research Show Us?," Noreen Coyne and Deborah Correnti of the Visiting Nurse Service of New York look at and analyze four very different articles from the literature that are all related to MI. According to Coyne and Correnti, motivational interviewing is a tool to promote behavior change that has been used in addiction and can be used to promote lifestyle changes like diet and exercise. They include initiatives related to cardiovascular health and those with diabetes mellitus in their brief. Coyne and Correnti provide practical or operational implications for home care about each of these articles and the techniques employed.


As we all work to continue the efforts of the triple aim: (a) decreasing costs and bending the curve, (b) improving health, and (c) improving healthcare, we have a new year in which to strive and set goals that work for us and our practices and organizations. Those of you who know I have worked in the government and with Medicare know how much I value policy and progressive policy to improve patient care. To that end, please know that the Commission on Long-Term Care's (2013) final report was released last September. The Commission on Long-Term Care Report to the Congress is a long document, 138-pages, but it is an interesting read. Appendix A lists a plethora of commissioner ideas. Perhaps one of the most interesting and innovative is designated as number 19 (p. 92):


19. Make the most of Medicare-the one national program we have now by removing current barriers to Medicare coverage for people with long-term and chronic conditions.


1. Redefine the homebound requirement for Medicare home health coverage so that people who cannot obtain the services they need outside the home can obtain them at home.


a. Currently the homebound definition restricts some people from getting care at home although they cannot consistently leave home to obtain the services they need.


b. Do not add a cap or co-insurance to the Medicare home health benefit.


i. Proposals are being considered to limit home care, which would further exacerbate the already limited ability of people to obtain home and community-based services.


ii. The savings estimate, at $730 million/10 years for the co-pay, does not warrant this further limitation on home care.


2. Remove the three-day hospital stay requirement for skilled nursing facility (SNF) coverage so people without the need for an acute inpatient hospital stay can at least get some Medicare nursing facility coverage.


i. Absent removing the three-day requirement, eliminate hospital "observation status," or count all days spent in the hospital as "inpatient" for purposes of qualifying for subsequent SNF stays.


3. Eliminate the 24-month Medicare eligibility waiting period for people who qualify for Social Security Disability Insurance (SSDI).


4. Ensure the Jimmo v. Sebelius settlement is effectively implemented to eliminate the "improvement standard" requirement for determining Medicare coverage and ensure coverage is also available for skilled services to maintain an individual's condition or slow deterioration.



Together we can improve care and policy for our patients and their caregivers.


The complete report can be accessed at


I wish you the best in 2014 and as always, I welcome your feedback!




Commission on Long-Term Care. (2013). Commission on Long-Term Care report to the Congress. Retrieved from