House calls – Nurse providing care at home

by Bobby Anderson, Staff Writer

In more than four decades of nursing, Nancy Bell, R.N. admits she’s tried just about a little bit of everything.
But the one role she has now may be her favorite.
Bell found her current assignment a little more than a year ago. The home health company she was working for at the time went under and Bell found herself looking for the next chapter.
Khalid Bokhari, owner of ComForCare Home Care, was there to show her the way.
“He approached me to see if I would like to go work for his company,” she said. “Khalid seemed really like such a fine person I knew he was someone I wanted to be associated with on a professional level.”
In her role at ComForCare, Bell visits all of the new clients. Other times she’s in the home as a caregiver. When needed, she is also in the office taking the mountains of chart work that come with home care services.
“He keeps it very low key,” Bell said of her boss. “He doesn’t come across as an authoritarian boss. He comes across as a coworker and he always refers to us as a team. He uses that word a lot and it certainly boosts our morale. The office is a very pleasant environment, everybody seems to get along and there’s a lot of laughing that takes place.
DECADES OF EXPERIENCE
Bell started her nursing career in Chicago right out of college as a psychiatric nurse. A move to Oklahoma brought her into the cardiac transplant realm. She began working in home health. Along the way she worked in neonatal intensive care, hospice and in nursing homes in a management role.
“I’ve hit a lot of different areas,” Bell said.
Home health has been her true passion.
“I was working in home health on people who had just gotten home from surgery or who had a wound that needed care but not hospitalization,” Bell said. “The physicians appreciated us so much because we helped keep people out of the hospital.
“The doctors were always very appreciated, polite and friendly with the home health nurses and I really liked that.”
So if there are any nurses looking for a change she tells them there are other options.
Home health is a good one.
“I would tell them the most important thing if they’re going to do home health is that they have to be flexible. They have to be able to go at the drop of a hat,” she said. “It’s not like having a set schedule the way you do in a nursing home or hospital. In home health you have to be able to go when the person needs you.
“You have to be flexible in your time and you have to be willing to meet a variety of personalities during the day.”
HEALTH AT HOME
The impact home health nurses like Bell can have on quality outcomes is coming more into the forefront.
The United Hospital Fund (UHF) and the Alliance for Home Health Quality and Innovation (the Alliance) recently released a report titled, “I Can Take Care of Myself!” exploring patients’ refusals of Home Health Care Services, on the under-examined issue of patients who refuse home health care services when they are discharged from inpatient care.
Such refusals can lead to higher rates of readmission to the hospital and a lower quality of life.
Although information on this complex issue is limited, a study by Kathyrn Bowles, PhD, of the Visiting Nurse Service of New York and the University of Pennsylvania, found that 28 percent of 495 eligible patients refused home health care services.
Their reasons ranged from concerns about finances, to a fear of losing control and privacy, to the belief that family members could manage needed care on their own. Those who refused home health care were twice as likely as those who accepted to be readmitted to the hospital within 30 or 60 days.
“As medical care increasingly moves from hospitals into the community, which for most people means care at home, the importance of home health care services in discharge planning is growing in importance,” said Carol Levine, director of UHF’s Families and Health Care Project and co-author of the report. “But there is little guidance for hospital staff on what to do when eligible patients refuse home health care.”
Bell sees her role in health care continuing to grow.
“I see it as nurses becoming more partnered with physicians. The physicians don’t make house calls anymore but they have nurses who can do the house call aspect of nursing. So sort of we’re getting back to house call nursing with the nursing as the intermediary.”