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

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I just read another report that Americans are living longer. And, as the Centers for Disease Control and Prevention (CDC) headline states, "a child born in 2009 is expected to reach 78.5 years, but one expert says longer may not mean a better life" (, 2014). Life expectancy also rose by race it was reported (CDC, 2014). As home care nurses and professionals, we see first-hand that living longer may also bring a compliment of chronic diseases such as diabetes, hypertension, chronic obstructive pulmonary disease, and others. Similarly, in a thought-provoking op-ed piece published in the Sunday New York Times on December 1, 2012, entitled "On Dying After Your Time," Daniel Callahan, Cofounder and President Emeritus of the Hastings Center, skillfully crafted a rebuttal to the race to extend life though medical technology and modern medicine. Interestingly, the last sentence states that "we are not however obliged to help the old become indefinitely older. Indeed, our duty may be just the reverse: to let death have its day." I think of what home care and hospice nurses do every day working with patients toward the end of life and honoring their wishes about their life-and death. You can view the article at

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In this month's Home Healthcare Nurse for instance, Della Roberts and colleagues seek to help nurses in their decision-making process of planning visits to patients during their last months of life in "Applying Research Into Practice: A Guide to Determine the Next Palliative Home Care Nurse Visit." This topic and the operational implications of meeting patient and family needs and goals is an important one in our industry. A patient case study and a decision guide help provide evidence and a practical framework around this important topic.


Transitions are another area where home care and hospice must coordinate care and employ effective communications with other organizations, such as hospitals and with clients, patients, and their loved ones. The VNAA's column "Establishing a Value-Based Community Partnership: A Best Practice Approach" skillfully outlines one organizations quest for a framework of a transitions intervention model for effectively working with hospitals and other partners. Carl Meadows and colleagues addressed their journey in "A Systemwide Innovation in Transition Services: Transforming the Home Care Liaison Role." This article will make one think "out of the box" in a revised system where "anyone" can make a referral to home care. This is how we must think: no barriers, more outreach, and earlier, more organized processes across healthcare "gaps." As mentioned about the compilation of complexities brought on by (usually) more than one chronic disease will only increase as the population lives longer. Mary Ann Rosa and colleagues present "The Interdisciplinary Approach to the Implementation of a Diabetes Home Care Disease Management Program." This article supports evidence-based care and uses the American Association of Diabetes Educators framework. One of my favorite parts of this article is Table 2, entitled "How to Empower Patients and Caregivers." The article reviews the process of implementing this program, which took more than 2 years.


An evidence-based intervention article by Audrey Beauvais and John E. Beauvais, "Reducing the Fear of Falling Through A Community Evidence-Based Intervention," explores the use of a specific falls prevention program about the fear of falling and health-related quality of life in a group of community-dwelling older adults. Recommendations and lessons learned will help us all as we care for older adults in our care as patients, parents, neighbors and others.


Many home care patients have wounds and Bonnie Westra and colleagues present their study and findings entitled "Effectiveness of Wound, Ostomy, and Continence Nurses on Agency-Level Wound and Incontinence Outcomes in Home Care." Not surprisingly, the incidence of wounds, incontinence, and urinary tract infections was higher for agencies with no WOC nurse and those with WOC nurses had significantly better improvement outcomes in a variety of areas (e.g., pressure ulcers, lower extremity ulcers). This is an important study as it is the first to document the prevalence, incidence, and effect of wound, ostomy, and continence nurses on clinical outcomes for home healthcare agencies in a large national study. This is a must-read, as it speaks to the role of this specialty and its impact on care and organizations.


This month's Commentary, authored by Mary Narayan, is a heartfelt story that we can all understand if not always identify with. "Alzheimer's Be Not Proud" is a loving tribute to a sister from a sister. As more and more of us are touched by Alzheimer's or other dementias this is the kind of personalized care we seek provide.


As always, the range of topics in this month's February issue reflects practice-all kinds of different patients and families and with different cultures, conditions, and complexities. These articles and the information, tools, and practical lessons learned can be applied to your practice today-I encourage you to use them!


I hope you have a good Valentine's Day month! (I can hardly believe it is 2014!)

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Second IHCNO Conference


September 23-26, 2014




Save the dates!


Visit http://www.IHCNO to be placed on e-mail list!




Centers for Disease Control and Prevention. (2014). Life expectancy. Retrieved from


Callahan D.(2013, November 30). On dying after your time. New York Times. Retrieved from (2014). Americans living longer than ever: CDC. Retrieved from[Context Link]