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Home infusion, oxygen/respiratory and ventilation therapies require that medical equipment be brought into the home. Caregivers and patients must then learn new skills and make changes to the home to accommodate the equipment and procedures.
To help patients and caregivers better understand what is required of them, Apria Healthcare provides the following overview.
Medical Conditions Requiring Therapies at Home
Home infusion therapy, whereby drugs, pain medications or foods/liquids are administered directly into the body via various types of catheters, or tubing, is frequently used for patients with infections, nutritional disorders, cancer and, in children, hormonal growth problems. Many other conditions are also treated successfully with home infusion therapy.
Oxygen/respiratory therapy, in which oxygen is delivered to patients via nasal tubing or a mask, can include patients with congestive heart failure and chronic obstructive pulmonary disease (COPD), such as emphysema, asthma, and other respiratory problems.
Ventilation therapy, in which patients must be assisted in their breathing via a ventilator, usually is administered to those with neurological disorders affecting the brain and spinal cord; those with muscles weakened by diseases, such as amyotrophic lateral sclerosis (also known as Lou Gehrig's disease) or muscular dystrophy; and people with lung damage.
Blood glucose monitoring is critical in controlling the effects of diabetes. There are two types of diabetes that must be monitored according to your physician's direction.
Type I diabetes is usually diagnosed in children and young adults. You may have heard type I described as juvenile, juvenile onset diabetes or insulin-dependent diabetes. This type of diabetes occurs when the body doesn't produce insulin at all. Insulin injections are usually necessary to keep blood sugar in balance.
Type II, also called adult onset diabetes, occurs when the body still produces insulin, but doesn't produce enough, or the body is not able to utilize it. Type II is by far the most common form of the condition, affecting 90% of those with diabetes.
Ages of Patients Who May Benefit From Homecare
Patients on these different therapies vary dramatically in age. Patient ages range from infancy to old age. Typical patient ages include premature infants needing assistance with breathing; teenagers and young adults injured in accidents who need ventilators; middle-aged patients with HIV, patients of all ages with cancer and organ-transplant patients needing antibiotics to address infections caused by their compromised immune systems. Senior citizens controlling their blood glucose levels or seniors who might have emphysema or other chronic breathing problems requiring supplemental oxygen also benefit from homecare.
Treatment at Home Versus in the Hospital
In the 1980s, hospitals began allowing patients to be treated at home on infusion and ventilation therapies to reduce both hospital and patient costs. For patients, the benefits include not only reduced costs but also reduced risk of infection. Plus, patients usually respond better to therapy and are happier in their own homes with family and friends, and this has been proven to result in better healthcare outcomes.
For oxygen/respiratory therapy, typically less complex than the other two therapies, at-home treatment began as a trend a few years earlier and for the same reasons. Additionally, many oxygen/respiratory patients have more mobility at home and on trips outside the home than permitted in a hospital.
Most patients can do their own blood glucose monitoring at home. Daily monitoring is an important part of controlling the effects of diabetes. Self testing, along with regular consultation with the treating physician, can help reduce the complications associated with diabetes.
Daily and Long-Term Treatment
How many hours daily are spent on treatment and for what time span varies according to the patient's illness and the prescribed therapies.
The amount of time a patient is on infusion therapy can vary. For example, patients receiving total parenteral nutrition (TPN) may require therapy during sleep time only, for 12 to 16 hours, or some may require 24-hour therapy. Some antibiotic therapies may be required for 30 minutes to one hour two or three times daily for one to six weeks. Some conditions may require a four-hour infusion once a month. The length of therapy also varies by condition; some therapies may be for a week, and some medications may be required for a lifetime.
Similarly, prescribed oxygen/respiratory therapy may vary daily from sleep time only up to 24 hours. Children may be gradually weaned off the therapy if their condition improves, but for elderly people with chronic conditions, therapy often continues for the rest of their lives.
The most critical are ventilator patients, who typically are kept on ventilatory support 24 hours a day for the rest of their lives. However, some patients' conditions may require sleep ventilation only.
Many diabetic monitors on the market today require only 5 seconds to give an accurate blood glucose reading. They also require less blood and some offer the capability of testing on sites other than the finger. This helps to reduce the pain associated with the continuous use of the finger as the source of the blood sample.
Equipment
- Home infusion therapy: A variety of electric-powered, pole-mounted or battery-powered ambulatory pumps are used. Most pumps have a battery backup in case of power failure. The patient has limited mobility because of the tubing inserted in either a vein, in the fat layer in the chest or back, through an arm or sometimes through the spinal column. Apria Healthcare clinicians work with patients to provide as much independence and mobility as possible, and to provide the appropriate pump to meet each patient's therapy and lifestyle needs.
- Oxygen/respiratory therapy: Typically, three basic options exist. One of them, for patients needing more oxygen than room air allows, is a concentrator, an electric-powered machine about the size of a small piece of carry-on luggage. It concentrates oxygen drawn from the surrounding air and delivers it at a higher concentration to the patient via nasal tubing.
Another option, for those needing a higher flow of oxygen, is compressed oxygen from tanks, most commonly delivered via nasal cannula or tubing. These tanks vary in size from about 5 feet tall to smaller ones that can be loaded on a cart to allow travel outside the home. Because the oxygen is under pressure, tanks need only a regulator, a small mechanical device attached to the container, to allow for controlled release.
- Diabetes therapy: Star Medical Rx, a member of the Apria family of companies, offers a complete line of diabetic testing supplies for all the blood glucose monitoring systems it provides, and delivers them right to your door. Their friendly customer care representatives will contact the customer periodically for refills to ensure that the customer is never short on supplies. Its billing department will process all insurance and Medicare claims, take care of reorders and any necessary paperwork.
- Ventilation therapy: For those with the most severe breathing problems, electric-powered ventilators with internal back-up batteries are used. If a patient is to receive ventilation therapy for more than two weeks, he or she may have a tracheostomy, in which an opening is made in the throat below the vocal chords to allow easier connection to the ventilator.
Mobility can be extremely limited, not only because of the 5-foot hookup but also because of the patient's condition. However, technology has advanced so much in terms of size and weight of equipment that patients can be as mobile as they want to be.
Additional Equipment to Support Homecare Patients
Depending on their condition, patients on these various therapies may need additional medical equipment such as hospital beds, wheelchairs, commodes, suction machines for the ventilator, gauze, tape, additional tubing, blood glucose monitors, test strips, control solutions and other supplies. The attending physician assesses the need for additional equipment and supplies in cooperation with the hospital and Apria. This will also determine how much of the cost will be borne by the patient's medical insurance or government payor.
Patients' Responsibilities
For many patients, home infusion and oxygen/respiratory therapies offer more responsibility and control of their own healthcare. But such patients will need manual dexterity or a caregiver in the home to use some of the equipment and administer their therapy after being taught by a qualified Apria Healthcare employee. We have found that patients and caregivers who learn how to perform the procedures associated with their home healthcare products and services experience better health outcomes than those who do not learn.
Caregivers' Responsibilities
Caregivers who assist patients with these various therapies have different levels of responsibility, depending on patient condition. Typically, they need to learn how to connect the equipment to the patient and how to operate it. They may also need to monitor the patient while he or she is on the equipment.
With more critical patients, caregivers may also need to assist in other procedures associated with the patient's medical condition, such as changing dressings, emptying catheter bags and suctioning fluids out of patients' lungs. They may need to arrange for nursing care to handle some of these responsibilities.
Additionally, with home infusion therapy, knowledge of basic infection control is needed. With oxygen/respiratory therapy, knowledge about safety when handling oxygen is needed. Apria Healthcare instructs patients and caregivers in both these areas. Our local home infusion nurses, pharmacists, respiratory care practitioners and delivery professionals ensure that patients and caregivers are able to demonstrate all components of their care before they are permitted to operate equipment or care for themselves independently. This is to ensure the patient's safety in managing these new processes and procedures.
Arranging for Therapy
After the doctor, hospital or case manager, in coordination with the patient and caregiver, has prescribed therapy at home, an assessment is made of the suitability for such treatment. The patient's condition is evaluated, patient goals are set and the type of equipment to be used is determined.
At this time, Apria also verifies the patient's insurance, informs the patient and family of any co-payment that will be billed, arranges for the first home visit at which caregiver training is provided and evaluates the home environment for homecare.
Paying for Therapy
Typically, medical insurance covers all or a portion of the costs associated with the various therapies. Before the patient is sent home, approval must be received from the patient's insurance carrier. Depending on the patient's medical coverage, Medicare, managed care or insurance covers all or a portion of the costs associated with various homecare therapies. Before the patient is sent home, Apria checks with the patient's insurance carrier to ensure that the patient's benefit plan covers the therapy and obtains approval for the patient to go home.
If the patient lacks coverage, financial hardship statements are available to determine coverage by Medicaid or some other source. Payment plans are also available depending on the therapy and degree of financial hardship.
Caregiver Training
Before a patient is sent home, caregivers receive training in basic care related to the therapy, how to operate and troubleshoot the equipment, and what to do in emergencies.
For those on oxygen therapy, simple instruction and a patient education booklet are given when the equipment is delivered and the patient is sent home. If the patient is already at home when the therapy begins, this instruction is performed at home. This can take about 30 minutes. For more intensive ventilation therapy, as much as 10 to 15 hours of training at the hospital over two weeks may be needed before the patient and family are ready to begin home ventilation.
For more complex home infusion therapy, caregivers may receive several hours of instruction at the hospital or at home during two or three visits from a home infusion nurse. The amount of instruction time depends on the therapy, as well as the patient's and caregiver's abilities to learn, understand and comply with instructions.
Conditions in the Home
The home environment is critical to the success and safety of home infusion, oxygen/respiratory and ventilation therapies. An initial assessment may be made in a 10-to-15-minute phone call, followed by a longer, in-home visit to prepare the home for the patient and the equipment.
If conditions cannot be met and pose a threat to patient safety, therapy at home may not be allowed. In general, the following are evaluated:
- Running water: Needed to ensure a clean environment exists to lessen the risk of infection, especially in home infusion therapy. For all therapies, hands should be washed before patient connection to the equipment, and tubing must be flushed regularly using supplies provided by Apria. Specific instruction is supplied by the clinician or technician. If running water is unavailable, delivery of bottled water can be arranged.
- Telephone: Needed for emergencies and to communicate with doctors and Apria regarding therapy, equipment and medical supply inventories. In cases of financial hardship, some phone companies provide limited-access connection to 911 and/or Apria. Emergency numbers should be posted by the phone.
- Electricity: Essential to power home infusion therapy pumps, oxygen concentrators and ventilators, which require grounded, three-prong outlets. Electrical outlets may require rewiring and power surge protectors may be needed for ventilators. For patients using oxygen tanks, which require no electrical power, electricity is still a safety essential for light at night. Circuit breakers and fuses should also be marked. Patients who use support equipment that requires electricity should inform their electricity provider.
- Adequate heating, air conditioning and lighting: Needed to maintain a steady temperature for the patient and provide light at night to administer treatment and medical procedures.
- Refrigerator: Needed to store medications and/or nutritional liquids used in home infusion therapy. Refrigerators are checked for cleanliness and availability for storage and to ensure that the patient is receiving adequate nutrition.
- Bathroom: Should be located close to where the patient receives treatment.
- Smoke alarm: Needed as a safety precaution.
- Steps: Evaluated to ensure that tanks or other needed medical supplies can be delivered and the patient, if mobile, can enter and exit safely and easily.
- Storage space: Needed for oxygen bottles for those on oxygen/respiratory therapy and medical supplies, such as dressings, tubing and medication, for all therapies.
- Trash disposal: Regular trash pickups should exist so that discarded medical supplies and soiled dressings will be disposed of. (Needles and certain other items are to be placed in a provided "sharps" container for their disposal. An Apria nurse will explain to the patient what should be thrown in these containers and the procedure for mailing/pickup for incineration.)
- Home safety: Patients should not be at risk of falling, being injured or trapped in their homes in emergencies. Homes should be uncluttered and free of piles of papers, boxes and rubbish so that walking is easy. Doors should shut completely and flooring should be in good condition and with no loose throw rugs. Doors also should be wide enough to allow wheelchair passage, if needed.
- Fire safety: Typically, two exits should exist in the home. For those on oxygen/respiratory therapy, a well-ventilated storage space indoors, away from open flames such as fireplaces or gas stoves, is advised for oxygen tanks. Because a tiny amount of leakage normally occurs with tanks, storage next to clothes in a closet should be avoided to avert the risk of combustion from oxygen-saturated garments. Tanks also should be stored upright to avoid bumping them, which could cause them to "torpedo," or propel rapidly across the floor.
- Smoking: Family members, caregivers and patients on oxygen/respiratory therapy must agree not to smoke in the home to avoid igniting oxygen dispersed at the end of tubing. Signs are provided, reading "Oxygen in Use. No Smoking." They should be posted on the front door or on tanks to advise visitors of the no-smoking prohibition.
- Pets: Unrestrained pets or an excessive number of animals can pose a cleanliness problem.
- Others living at home: A method for the patient to summon others in emergencies should be created. The number of people at home should not be excessive to avoid hindering proper treatment.
Follow-Up
Once the patient is at home and on therapy, a follow-up call is made at 24 hours to ensure all needs are met and to set up additional home visits or appointments. Subsequent home visits or check-up telephone calls occur regularly, the frequency depending on the type of therapy and the patient condition.
For example, follow-ups for patients on ventilation therapy typically are made once or twice a week in the first month, then every 30 days for the first six months and finally, if no problems exist, every 60 to 90 days. During home visits the equipment is run through a battery of tests to ensure it operates correctly. The patient is also assessed to ensure that the goals of his or her therapy are being met.
Emergencies or Questions
Some Apria branches offer a toll-free telephone number to reach an Apria pharmacist if the patient is on home infusion therapy, a respiratory therapist if the patient is on oxygen/respiratory therapy or a nurse. In most cases, the patient will call his or her local Apria Healthcare branch. In a life-threatening emergency, however, the patient should call 911 immediately.
Skilled and knowledgeable staff members, familiar with the equipment and able to troubleshoot over the phone, are on call 24 hours daily, including holidays and weekends. They can answer questions regarding the patient's condition or how to operate the equipment. |
