Ten Roller Coaster Years in Home Care: 1995 to 2005


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To celebrate HHN's silver anniversary, Tina Marrelli asked me to reflect on my 10 years as editor from 1995 to 2005. It's been fun looking back over the journals and considering the whirlwind of change and the increasing responsibilities home health nurses have assumed during that time.

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I took the helm of Home Healthcare Nurse as editor in the fall of 1995. Originally published bimonthly from its inception in 1992, thanks to Lippincott's support of the home health industry and home health clinicians and managers, my first issue in January, 1996, launched the journal as a monthly publication. During the decade I was editor, the home health industry rode a roller coaster ride of regulatory, reimbursement, technology, and clinical changes that may be the most tumultuous we've ever seen.


The whirlwind of change from 1996 to 2006 continues today. For those who experienced these times-celebrate, we made it through!! For those who weren't there but have heard the stories, please go down memory lane with me. As you read through the topics and the dates they were published, think of how what we think of today as "new" may not really be so, after all.


Outcomes and Reducing Hospitalization

From my June, 1996 editorial, "Outcomes & Incomes":


It is important that home care nurses begin NOW to look at the "way we've always done it" and make changes that support efficiencies even though it may affect our income. (Then, agencies were paid retrospectively based on what it cost to deliver care, there was emphasis on visiting as much as necessary, and nurses, paid per visit, often did 6-10 visits a day.)


From February 1997: "The Relationship Between Home Care Services & Hospital Readmission of Patients with Congestive Heart Failure"


From June 2000: "Home Care Nursing for Persons with CHF: Description and Relationship to Hospital Readmission"


From March 2003: "Medicare Survey Shifts Focus to Outcomes"



HHN is a peer-reviewed professional journal publishing original research, stressing implications for practice. This means you can rely on the accuracy of the material as a basis for clinical practice, policies, and procedures. This also means HHN is significantly different from other home care magazines and newsletters. During my tenure as editor, evidence- and research-based practice grew in importance and remains an essential component of home care nursing practice.


Publishing research on the professional life, work environment, and practice of home care nurses is also important. One of my favorite research studies is "Agency Characteristics Most Valued by Home Care Nurses: Findings of a Nationwide Study" (December 2003) and the follow-up study, "Home Care Nurses' Perceptions of Agency and Supervisory Characteristics: Working in the Rain" (August 2004). These articles provide essential information for agency recruitment and retention efforts.


The Evolution of OASIS

It quickly became evident that OASIS was going to be a BIG thing for home care and that was before certain OASIS items were linked to reimbursement. The first OASIS article in HHN was "Outcome-Based Quality Improvement & the OASIS Data Set," published in March of 1997. For the next 2 years, an OASIS article was in each issue until 1999; after that it was almost every issue!! My April 2000 editorial was "OASIS Is Here," and content on OASIS and OBQI continued as a focus with M0's of the Month and others articles on this major subject.


Of Special Interest

Educational supplements are published separately from the journal, focus on a specific subject, and mailed with an issue. Special topic issues are also published to present depth on subjects that are of great importance to home care nurses and patients. From 1996 to 2006, these supplements and special issue topics were published:




* Treating Deep Venous Thrombosis at Home with Low Molecular Weight Heparin, January 2000


* OASIS Skins & Wound Assessment, August 2003


Special Issues


* Point-of-Care Technology, December 2001


* OASIS, April 2000


* OBQI, so much we needed 2 issues!! August and September 2002


* Technology & Telehealth, October 2003


* Dementia, January 2003


* Cardiac, February 2004


* Diabetes, July 2004


Some of My Favorite Titles

The following topics/titles are a small indication of the thousands of pages of tips, techniques, disease management approaches, and stories of success from clinicians and agencies published in HHN over 10 years. Below are some of my favorite titles:


* 10 Things to Do when the Surveyor Picks You!!


* Have You Mastered PPS?


* Do You Have Narcophobia?


* What if Income Was Based on Outcomes?


* Disease Management-Carpe Diem Home Care


* Hanging Wet-to-Dry Out to Dry


* 10 Ways to Lose Your Medicare Certification


* Why I Would Rather Do OBQI Than Lie on a Beach!!


* Are You an Innovator, a Laggard, or Something in Between?



What I Remember Most [horizontal ellipsis]

As a telecommuter working out of my home office, I was isolated. For a home care nurse who loves people, that was difficult to get used to. However, I soon realized how important an editorial board and networking over the phone and at conventions were. The most surprising and valuable experience of my editorship was talking with wonderful home care nurses throughout the country via their phone calls, e-mails, and snail mail.


The joy of publishing articles on a variety of topics meant I've had the honor of getting to know the best practitioners, who are incredible people. I talked with hundreds who really cared about home care nursing and wanted to contribute, no matter what. Like [horizontal ellipsis]


* The 84-year-old lady who had been receiving home care, liked her nurses, but wanted to share with all home care nurses what it was like to be a patient.


* The former Assistant Dean of a nursing school who was committed to teaching nurses, even in the last stages of her ALS disease. Paralyzed and unable to talk, she wrote an entire article on what it's like to be a totally dependent patient, using two computers. She typed each letter of the manuscript by looking at the desired key on a keyboard. That computer would then send a signal to another computer to type the manuscript. What a teacher and an outstanding nurse!!


* The first-time author who learned, while the manuscript was in peer review, that she had pancreatic cancer. Thanks to the help of a board member who worked with her on revisions, and to the HHN publisher and production crew in Philadelphia, we rescheduled another article to make room for hers, which was picked as the cover article for the month. She saw her article in print before she passed away.


* The nurse author who, in a national writing contest, won a Gold Medal for her HHN article-the first she'd ever written!!


* The nurse authors who finished an article no matter what. One with a broken shoulder, one while recovering from the birth of twins, and yet another, an article for nurses about her husband's own experience, written while he was in hospice.



What I continue to be proud of is HHN's emphasis on one main goal: publishing a variety of clinical, regulatory, and work environment subjects so clinicians can provide the best and most cost-effective care for patients based on research, evidence, and sharing with their peers. HHN is a venue for home care nurses to WRITE-about new methods and approaches to patient care, their experiences, favorite patients, tips, regulations, and how their successes or failures can help others.


It was an honor and a privilege to be a part of HHN's legacy, and I hope that those who practice in home care continue to contribute to and value HHN for at least 25 more years!!