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How to Make an Effective Home Visit

presented by Kim Corral and Tina Marrelli

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Disclosure Statement:

Financial: Tina Marrelli is an employee and share holder of Marrelli and Assoc. Inc, with book sales. Tina Marrelli is  a share holder with book sales of Innovative Caregiving Solutions LLC. Tina Marrelli is an author who receives book royalties from Sigma Theta Tau International Publishing. Tina Marrelli receives compensation from MedBridge for this course. Kim Corral is an employee and share holder of Chelta, Inc  Kim Corral receives compensation from MedBridge for this course. For both instructors there are no financial interests beyond the production of this course.
Non-Financial: Tina Marrelli and Kim Corral have no competing non-financial interests or relationships with regard to the content presented in this course.

Satisfactory completion requirements: All disciplines must complete learning assessments to be awarded credit, no minimum score required unless otherwise specified within the course.

MedBridge is committed to accessibility for all of our subscribers. If you are in need of a disability-related accommodation, please contact support@medbridgeed.com. We will process requests for reasonable accommodation and will provide reasonable accommodations where appropriate, in a prompt and efficient manner.

Accreditation Check:
This foundational course addresses the three parts of the patient home visit and information and processes that surround and support effective and holistic home visits. This includes a practical and holistic definition of a home visit, the use of the care planning process through the visit, the patient-related and other activities that occur during a skilled visit, and strategies to document care that was provided during the visit. This course will also explain why having exemplary organizational, clinical, and interpersonal skills is key to making value-based home visits. This is because numerous and complex facets of care, including the patient's goals, the plan of care, physician orders, care team members, the patient's environment, care coordination, and communication, all come together in this structured, person-centered encounter.

Meet Your Instructors

Kim Corral, RN, BSN, MA Ed, COS-C

Kim is a registered nurse with a master's degree in education and more than 30 years of home health experience. She is an experienced leader in home health care, having held both clinical and operational positions at regional and national levels for large corporate home health organizations. She brings a passion for providing the clinical…

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Tina Marrelli, MSN, MA, RN, FAAN

Tina Marrelli is the president of Marrelli and Associates, Inc., a publishing and consulting firm working in home care for more than 30 years. Tina is the author of 13 books, including the Handbook of Home Health Standards: Quality, Documentation, and Reimbursement (6th edition, 2018). Other books include A Guide for Caregiving: What’s Next? Planning…

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Chapters & Learning Objectives

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1. The Home Visit: The Foundational Unit of Care

This chapter sets the stage for the most common care delivery mechanism in home care: the home visit. A holistic definition of an effective home visit will be offered as well as practical application, where the patients are "out there" and the environment of care may be as varied as the patients served and homes visited.

2. Pre-Visit Activities: Setting the Stage for Success

In this chapter, pre-visit activities will be featured. With this topic come the detailed organizational and other activities that must be addressed to have a successful planned patient home visit. This information applies to many kinds of home visits, including skilled Medicare visits, well-baby visits, infusion care, hospice home visits, and other kinds of home visitation programs and models. Pre-visit activities will include obtaining physician orders and other demographic and referral information, identifying needed paperwork, completing any pre-admission work on your tablet or device, and more. A patient example begins here and follows through the home visit and post-visit activities. It is important to note that physician orders and coordination and communication activities are a key part of all of the visit's components.

3. A Knowledge of Your Community Served: The Environment of Care

Home care and home care visiting occurs in the context of local communities. Familiarity with your community and its strengths, areas for improvement, and resources can help make home visits more successful and safe. A brief desciption of a "windshield assessment" will be given as well as a brief overview of safety when out in the community and in homes. There are safety implications for both the patient and the home care team in the home and community. Some of these risks and factors will be addressed.

4. The Patient's Unique Environment of Care: The Home

This chapter addresses the home visit and activities that occur once the team member arrives at the patient's home. Of course, there must be physician orders to see/assess/evaluate this patient. The initial visit may be the most important visit for a number of reasons. The visiting team member, such as a nurse or a therapist, has "new eyes" and can use this objective presence (only once!) to observe and use all senses to value incoming input and data. This is also the first time we meet our patient and is the initial assessment visit from which we start to create the actionable plan of care. During this visit, we clarify expectations and schedules and explain home care and home care services. We also begin the interactions that form the basis for the patient experience. This chapter addresses the processes to create a workable plan of care. This includes reviewing all the noted data from all sources, such as interviewing, observing, and the use of all of our senses for more data collection. We obtain/explain/complete the initial paperwork, including consent, and the mutually agreed-upon goals are developed with the patient and family/caregivers.

5. Post-Visit Activities: Pulling It All Together

This chapter addressed the activities that take place after the visit has concluded. Sometimes we contact other team members, such as the physician (to collaborate/confirm the plan of care or to clarify any orders) or an aide supervisor or therapist, all to coordinate care and communicate information while at the patient's home. At this stage, it is important to clearly identify the patient's skilled care needs and validate that this patient and their care needs meet your organization's admission criteria.

6. Visit Evaluation: Reviewing Care and Documentation

This chapter provides a review of some of the most important parts of home care documentation after a patient visit: the comprehensive assessment, the plan of care, and the documentation of the care and services provided at this visit.

More Courses in this Series

Welcome to Home Care: An Overview

Presented by Kim Corral, RN, BSN, MA Ed, COS-C and Tina Marrelli, MSN, MA, RN, FAAN

Welcome to Home Care: An Overview

Subscribe now, and access clinical education and patient education—anytime, anywhere—with video instruction from recognized industry experts.
This foundational course offering provides a big picture overview of home care. Home care comprises many models of care delivery systems and types of home care. A brief history of home care, a snapshot of where we are now by the numbers, and the differences between home care and any other health care practice setting are addressed. A holistic and practical definition of home care is also presented. Additionally, this course will also explain why having exemplary clinical, self-motivational, organizational, and people skills is key to success in home care practice and management.

View full course details

Orientation: An Overview of Documentation Requirements in Home Care

Presented by Kim Corral, RN, BSN, MA Ed, COS-C and Tina Marrelli, MSN, MA, RN, FAAN

Orientation: An Overview of Documentation Requirements in Home Care

Subscribe now, and access clinical education and patient education—anytime, anywhere—with video instruction from recognized industry experts.
Today's home care clinicians must have an understanding of the trends, regulations, and other external factors that impact care provided and the documentation surrounding care. Home care is a global term, and home care services can range from solely personal care services (non-medical) to very skilled levels of care with licensed nurses providing care to medically fragile adults and children. Because of this, there are many models and methods of delivering home care. For purposes of this course, we will be focusing primarily on the provision of “visits” as the primary model of home care vs. hourly care. Medicare is the largest payer of home health services, and visits are the usual unit of care delivery. Medicare sets the standards for home care, regardless of the payer. It is for this reason that an overview of documentation requirements is the first course. The differences in documentation requirements for home care versus other settings (e.g., OASIS) will de discussed, and the purposes of documentation, supporting medical necessity, and coverage criteria will also be addressed. This course is designed to provide tangible tools for both clinicians and leadership/management to apply as they improve their processes and practices related to effective documentation in home care.

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Orientation: Care Planning

Presented by Kim Corral, RN, BSN, MA Ed, COS-C and Tina Marrelli, MSN, MA, RN, FAAN

Orientation: Care Planning

Subscribe now, and access clinical education and patient education—anytime, anywhere—with video instruction from recognized industry experts.
The ability to perform an accurate comprehensive assessment and develop an individualized plan of care for home care patients is the foundation for care delivery in home care. This course will review the steps of the care planning process, a type of problem solving method. A discussion will be provided regarding the application of this process and the value it brings to patient care.

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Orientation Program: Team Member Safety in the Community

Presented by Kim Corral, RN, BSN, MA Ed, COS-C and Tina Marrelli, MSN, MA, RN, FAAN

Orientation Program: Team Member Safety in the Community

Subscribe now, and access clinical education and patient education—anytime, anywhere—with video instruction from recognized industry experts.
This course addresses the common safety-related factors in the community and home environments. Home care team members can be exposed to a number of potentially serious hazards which range from dangerous pets (eg. biting) to firearms (ie. guns) in homes. Environmental hazards include smoke, needlesticks, unhygienic homes, germs and pathogens, structural house problems, hoarding and many others. This course seeks to identify some of these safety hazards and dangers so that clinicians and managers/leaders can better understand and apply their risk management and safety policies related to such situations and protect their team members.

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Medicare Coverage and Documentation Requirements: The Fundamentals

Presented by Kim Corral, RN, BSN, MA Ed, COS-C and Tina Marrelli, MSN, MA, RN, FAAN

Medicare Coverage and Documentation Requirements: The Fundamentals

Subscribe now, and access clinical education and patient education—anytime, anywhere—with video instruction from recognized industry experts.
The value of the clinical documentation that supports the tenets of coverage and quality cannot be overstated. Clinicians and managers/leaders need to proactively describe care and services in the terms detailed in the Medicare Benefit Policy Manual, Chapter 7. This, then, is the guidebook when seeking answers, examples, and clarity. This overview describes the fundamentals of Medicare coverage and the associated required documentation to support medical necessity, the individual patient's need for the skilled care and service, and the tenets of the home care program.

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What is Case Management in Home Care?

Presented by Kim Corral, RN, BSN, MA Ed, COS-C and Tina Marrelli, MSN, MA, RN, FAAN

What is Case Management in Home Care?

Subscribe now, and access clinical education and patient education—anytime, anywhere—with video instruction from recognized industry experts.
The home health industry demands that patient care be provided in an efficient and effective manner. Case management is a strategy which supports this demand. This course defines the concept of case management and discusses the skills and core knowledge concepts required to manage not only individual patient episodes but entire caseloads of patients. Strategies for applying this process to individual patients and caseloads will be discussed with practical examples that can be applied in the care practice setting.

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