As an 83-year-old male referred to home health services, Mr. B has ended up in the hospital several times. With a traditional payment source, Mr. B is unable to afford private pay in-home supportive care. While an option exists for Mr. B to live with his daughter, the patient displayed a refusal to live with her and instead prefers to live alone. The client is also not open to engaging in a discussion about moving to an assisted living environment. Hence, his physician has directed his admission into a home health agency with orders that include the provision of skilled nursing for his cardiac condition assessment. There also orders for physical therapy to provide for the establishment of a home exercise program. Home health aide also visits Mr. B three times a week to cater to his personal care needs.
Concerns
The main concern is that despite the significant assistance that he receives, Mr. B still does not have the care that he needs. While the RN case manager has attempted to assist him with an understanding of the care for his cardiac condition, Mr. B has not made any progress with the identified goals. This is due to his confusion and forgetfulness. Mr. B has also been unable to take part in the home exercise program due to his lack of motivation to complete exercise between therapy visits. Hence, it appears that Mr. B may not be an appropriate candidate for home health care.
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RN Case Manager
In this context, an RN case manager practices autonomously hold the responsibility for achieving the identified outcomes of care (Case Management, 2016). The RN Case Manager has carefully conducted several of her ethical responsibilities. Her main objective in Mr. B’s case was to provide skilled nursing for the assessment of his cardiac condition while also teaching him about his care and medication regime.
One of her ethical responsibilities was to validate the assessment and diagnosis of Mr. B. the RN Case Manager did this through her assessment of how appropriate home health care was for Mr. B. while she was aware that Mr. B had already rejected the idea of living with his daughter, she stated that based on her evaluation, the client's daughter should insist on living with him. The RN Case Manager also got involved in a mutual goal setting. While she had already established goals and objectives for the visit, these goals were revisited at the time of implementation. The case manager shared with the client the goals that had been structured for addressing his health needs, along with any additional problems identified (Clark, 2015). This was particularly significant as Mr. B would have the responsibility of implementing the interventions structured for the achievement of those goals. The Nurse stated that she had tried severally to teach Mr. B, and regardless of the aids that had been used, Mr. B continued with incorrectly taking his medication. While she was sure that he needed services, she was not sure that he was in the appropriate environment. In this way, the RN Case Manager had identified the appropriate nursing interventions and obtained the necessary materials needed to teach Mr. B. In this way, she catered to her different ethical responsibilities.
Plan of Action
To identify the best plan of action, several determinants have to be assessed (Clark, 2015). One of these determinants is Mr. B's economic status. Due to his existing financial resources, Mr. B is unable to afford private-pay in-home supportive care. Hence, he cannot be provided with private home care as he uses Medicaid as a traditional payment method. Another consideration is his occupational status as Mr. B does not work, which means that he stays at home. Client-family interactions are also a critical determinant that affects the health of the client (Clark, 2015). A nurse has to be alert to information concerning the family caretaker's responsibilities and how the plan will impact the caretaker and the client. In this case, Mr. B's caretaker appears to be his daughter. While the relationship between Mr. B and his daughter appears to be friendly, he has showcased a refusal to move into her home so that she can care for him. His refusal to move into his daughter's home and her willingness to take care of him is a major consideration.
Based on these considerations, the best action plan for Mr. B is to receive care at his daughter’s home. Due to his intermittent forgetfulness and confusion, Mr. B is unable to administer his medication correctly. This means that when left alone, Mr. B does not take his medication according to the orders provided by his physician. This creates a need for someone who can constantly track the administration of his medication. Moreover, Mr. B has showcased a lack of motivation to follow the exercise regimen that has been structured for him. This creates a need for someone that will support his desire to exercise in-between visits.
Realistic Outcomes and Goals
One of the realistic goals for Mr. B is that he will have the knowledge and instructions that he needs to properly administer his own medication. Due to his cardiac condition, Mr. B's medication is highly significant for his health status. Therefore, his ability to cater to his medication is essential to ensuring that he remains in good health. While Mr. B will have assistance, the possession of this knowledge will minimize the need for this assistance.
The second goal for Mr. B's treatment is that he will constantly follow his exercise regime. While the physical therapist has designed a home exercise program that caters to Mr. B's exercise needs, the client does not complete exercises in between therapy visits. Hence, it is essential that Mr. B is motivated to complete the exercises that have been designed within his home exercise program.
Provision of Ongoing Care Needs
The ongoing care needs required by the client include the administration of medication, an improvement of his hygiene, and the support of his home exercise program. For this needs, the most appropriate individual to cater to Mr. B. is because she appears to be his only caretaker and has the ability to follow up with these needs. When his daughters cater to these needs, Mr. B will have someone that constantly checks up on the administration of his medication. He will also be able to engage in the exercises that have been stipulated in his home exercise program. Hence, as according to his action plan, Mr. B's daughter acts as the best individual to cater to his ongoing care needs. This acts as the most appropriate direction for Mr. B's home care.
Conclusion
Home healthcare can be described as a variety of services provided for individuals of different ages within the home and community settings. These services include the promotion and teaching of health activities, curative interventions, and rehabilitation. Based on an assessment of Mr. B’s case, the best action plan is that he should live with his daughter. In this way, Mr. B will have an individual who will support the administration of medication and his exercise regimen. This will also remove the need for private in-home care.
References
Case Management. (2016). Case Management Society of America’s Standards of Practice for Case Management
Clark, M. J. (2015). Population and community health nursing. Pearson.
