Home health care is a patient practice frequently used at many facilities in the United States. It is important not to confuse home health care with home care because the former is performed by non-clinical caregivers who should be trained and informed about all nuances of care, and the latter is a part of clinical care usually provided by registered nurses or therapists. There are many reasons why home health practices can be prescribed to a patient, including recent hospitalization, surgery, medication changes, a decline in function, and the patient’s age.
Few people are aware of the specific characteristics of this type of care or can recognize the diseases and cases where it is appropriate. Patients with chronic obstructive pulmonary disease (COPD) may benefit from home health care as it is a progressive disease with specific exacerbations that cannot be predicted. COPD management among elderly patients at home is an urgent topic for discussion because this process depends on a variety of external and internal factors, and medical workers need to understand their roles in caregiving for elderly patients with COPD.
Problem Statement
The main topic of concern for this project is to identify COPD as a serious health issue among elderly patients and demonstrate the value of home health care. COPD, as one of the most frequent chronic lower respiratory diseases, is the third leading cause of death among Americans of different ages (Centers for Disease Control and Prevention, 2018). Approximately 15.5 million Americans, which is 6.5% of the total US population, are diagnosed with COPD, and more than half of adults remain unaware of their diagnosis (Centers for Disease Control and Prevention, 2018).
There is no specific medication for COPD, and therapists rely on non-pharmacological treatment and the participation of informal caregivers in adherence with treatment recommendations and optimization of patients’ outcomes (Bryant et al., 2016). However, the problem is that non-clinical caregivers may misunderstand some important signs of COPD and fail to prevent the development of exacerbations at early stages. Therefore, home health care provided by professional nurses or therapists should be promoted among the US elderly population so that these medical professionals can examine patients, offer accurate and timely care, communicate with families, and participate in occupational therapy and physical routines.
Literature Review
COPD Diagnosis
Home health care may be offered to people of different ages, but the elderly are in need of special attention because of the need to control the development and progression of symptoms. COPD is a chronic non-communicable age-related disease primarily related to smoking (Incalzi, 2016). Some patients deny a history of smoking, showing the impact of external factors on COPD. The disease is characterized by progressive airflow limitation due to a response to an inflammatory process in the airways and the presence of noxious particles and gases (Cortopassi, Gurung, & Pinto-Plata, 2017).
In addition to the common symptoms of the disease, its overall severity in patients is determined by the presence of exacerbations and comorbidities. Signs of COPD are a frequent cough, shortness of breath, mucus production, and complicated, deep breathing (Centers for Disease Control and Prevention, 2018). According to Anzueto, Sethi, and Martinez (as cited in López-Campos, Tan, & Soriano, 2015), in the United States, hospitalization because of poorly defined exacerbations costs about $18 billion and has a 5-year mortality of 55%. In home care settings, control of COPD symptoms in the elderly is required.
The treatment and management of COPD are based on the results of appropriate diagnostic tools. Spirometric assessment aims to define the severity and progress of COPD (Stockley & Stockley, 2016). The two important characteristics of this process are the “maximal expiratory effort (a nebulous and individual concept)” and “the presence of airway disease and/or parenchymal destruction, which can result in early closure of the smaller airways and incomplete emptying” (Stockley & Stockley, 2016, p.118).
With the help of this test, the progression of COPD can be properly assessed. Informal caregivers can use spirometry at home, but there is a risk of reaching an incomplete and biased evaluation of the condition and thus failing to obtain the description of all changes in pulmonary function. Therefore, the progression of COPD in home health care needs to be identified by a professional medical worker with the thorough cooperation of the patient.
COPD Progression
There are many ways COPD can progress in patients. This disease depends on the personal characteristics of patients, their age, habits, and health conditions, and each patient is unique, which entails a new path of disease progression. From a general point of view, COPD results from oxidative stress, an imbalance between proteases and antiproteases, and a poor response to inflammation when inhaled toxins promote tissue destruction (Pandey, De, & Mishra, 2017).
The development of inflammatory cells leads to an increased number of neutrophils and other dangerous cells and obstruction in the lungs. Protease and antiprotease imbalance can be classified as serine (when neutrophils elastase destroys alveolar tissue), metallo (when metalloproteinase increases COPD severity), and cysteine (when caspases are not able to control apoptosis) (Pandey et al., 2017). Finally, oxidative stress is promoted by cigarette smoke when nitrogen and oxygen species lead to an imbalance of functional cells in the lungs.
All these pathological mechanisms result in mucus hypersecretion, airflow obstruction, pulmonary hypertension, and various gas exchange abnormalities. It is hard for an ordinary person to observe these anatomical changes, and people may continue thinking that they have bronchitis or similar respiratory diseases instead of starting treatment for COPD (Incalzi, 2016). However, the nature of COPD and its progression means that “control is forever in flux” and “an acute exacerbation could temporarily shift the person from having ‘self-efficacy’ to ‘dependence on care’” (Fotokian, Mohammadi Shahboulaghi, Fallahi-Khoshknab, & Pourhabib, 2017).
In elderly patients, the situation gets even worse because of the loss of treatment opportunities, the presence of new comorbidities, and the inability to complete all treatment and surgical options (Qin, Li, & Zhou, 2016). Many elderly patients want to stay at home and continue treatment under the most favorable conditions without realizing how the location of a person defines the quality of health and wellbeing (Boland et al., 2017). COPD in the elderly remains a serious problem with unpredictable progression.
COPD Complications and Process Improvement
In addition to a number of unpredictable exacerbations associated with COPD, elderly patients should also be aware of possible complications and consider the necessity of improving the disease process. According to the Centers for Disease Control and Prevention (2018), adults with COPD may also suffer from an inability to work and complete certain physical activities, have walking limitations, and report memory loss or the development of other chronic diseases like arthritis and diabetes.
Treatment for COPD aims to improve a patient’s health through quitting smoking, avoidance of air pollutants, taking medications, and following oxygen therapies. The characteristics of treatment at home include the necessity of following the rules and taking all prescriptions into consideration. Some caregivers may neglect the factor of air pollutants in the room, and evaluation by a nurse or another medical worker is strongly recommended.
COPD Management in Home Health Practice
After COPD is diagnosed in a patient, a care plan is usually developed within a hospital. In a certain period of time, discharge occurs, and patients are free to go home and continue COPD treatment there. According to Simmering, Polgreen, Comellas, Cavanaugh, and Polgreen (2016), COPD patients who are assigned home health care or leave hospitals without adequate medical advice are at risk of readmission within the next 30 days, and discharged patients with home (skilled) health care can avoid the development of complications and control the COPD process.
At home, elderly patients are observed by professional nurses and focus on the promotion of lifestyle changes, healthy eating, smoking avoidance, and pharmacological treatment. In addition, controlled breathing techniques and stress management can be offered by formal caregivers as a part of home health (Bryant et al., 2016). Elderly patients have better opportunities to receive effective treatment at home by cooperating with professional caregivers, and they reduce their chances of being readmitted or experiencing exacerbations that influence the progression of COPD.
Case Description
In this case, a 65-year-old male patient approaches a local therapist about chest pain, frequent shortness of breath, and a dry cough that is hard to control. He admits that he has a long history of smoking, with 2 packs per 5-7 days. In addition, he suffers from hypertension and mild obesity. The doctor uses a lung function test (spirometry) to measure the amount of air in the lungs, and the results are that the forced vital capacity (FVC) is 65%, and the forced expiratory volume-one second (FEV1) is 50%.
These numbers indicate that the patient has problems with his lung function because the spirometric findings are lower than normal (Cortopassi et al., 2017). Additionally, the arterial blood gas test is taken to verify the presence of COPD in the patient. However, even after being diagnosed with this disease, the patient refuses to stay in a hospital and insists on home health care with his wife as the main caregiver. The family is experiencing financial difficulties with paying for their health services and wants to try home-based care to minimize their expenses.
The doctor denies the possibility of leaving home at this stage of COPD because there is a threat of it becoming a severe case. Therefore, another option should be offered to the patient. Home health care with an informal caregiver without appropriate advice may result in early readmission in case of exacerbations. Home health care with a professional nurse is recommended. The nurse is responsible for observing the patient’s health and the development of any new symptoms, and reports on each incident of smoking (which is forbidden).
In addition, the nurse checks all medications to be taken, oxygen therapy (breathing activities) to be followed, and homemaking care to be offered. It is important for the patient to avoid any pollutants or irritants and maintain a healthy lifestyle. Therefore, short but frequent walks in the fresh air are recommended while a nurse aide dusts and changes linens. This is also an opportunity for the family to spend more time together. In case the wife refuses to accept this kind of help or wants to do this work on her own, a nurse should check the condition of the house during each visit.
Literature Findings on the Case
Taking into consideration the situation described and the personal attitudes of the patient towards the hospital and home health practices, an expected step entails consulting several scholarly sources and gathering material to build a common solution. In their systematic review, Boland et al. (2017) state that the location of care plays an important role in geriatric health care, and home interventions with the promotion of independence can be effective in assisting patients at home. Home health care is gaining recognition in the United States, as it provides a chance to develop personalized services and offer the required therapies while avoiding hospitalization (Landers et al., 2016).
The recommendations of Simmering et al. (2016) to rely on professional medical (nurse) help cannot be ignored, as it is a way to reduce readmission rates over the next 30 days. COPD may go unnoticed in a community, as well as the development of its exacerbations (Pandey et al., 2017). Complications or additional signs are poorly recognized by informal caregivers. Patient-nurse cooperation cannot be ignored in this case, as well as smoking avoidance.
Home health care is based on a number of therapies and practices a registered nurse needs to promote. For example, there is a need for special breathing activities and physical exercises under the control of a specially prepared nurse (Bryant et al., 2016). Education for the patient and his family is also an obligatory part of home health practice that aims at empowering the process from social and cultural perspectives (Fotokian et al., 2017).
Finally, spirometry tests need to be administered regularly to check if there are improvements in the patient’s condition. The tests can be administered at home and determine the severity of the disease progression at different periods of time (Stockley & Stockley, 2016). Finally, nutritional interventions and psychosocial support are important for patients with COPD (Cortopassi et al., 2017). Even if patients refuse professional help and believe that smoking avoidance is enough to treat COPD, they should be reminded that COPD can develop unnoticed, and only a medical expert can diagnose it after thorough observation and assessment.
Case Summary
In general, this case represents a male patient with an evident unwillingness to be hospitalized and a preference to rely on home health practices to treat COPD. He is a smoker with a long history, but he promises to quit this habit and focus on a healthy lifestyle. During the communication with him, no attention is paid to medications as a part of the chosen course of treatment. An expected step is to find out more information about medications for this patient and their potential effects with respect to his age and history of hypertension. Medications have to be provided along with training and education in order for patients not to make mistakes and follow the prescriptions exactly (Fotokian et al., 2017).
The age of the patient and another member of his family indicates the necessity of hiring a nurse who can take care of him and control his COPD signs and exacerbations. Sometimes, it is possible to confuse a new symptom with comorbidities. The home health caregiver is responsible for assistance with medications and symptom management (Bryant et al., 2016). Therefore, regular contact with a professional nurse is a good opportunity to avoid complications and receive the necessary help in time.
Solutions
Home health care plays an important role in the reduction of hospital readmissions among COPD patients. The results of researching literature on the disease suggest there are three main solutions in this case. First, a formal caregiver has to be hired to take care of the elderly COPD patient, organize scheduled visits, and define therapies. Second, education and recommendations must be provided during the course of treatment, and the patient has to learn about the threat of smoking in his condition and the importance of a healthy lifestyle. Finally, medication control is required to avoid harm to patients and promote cooperation with family members.
The conclusions about the value of home health care made by Simmering et al. (2016) are based on the analysis of several databases with patients from 480 hospitals. Although hospitalization is usually preferable among older patients, home-based care is also characterized by certain benefits, transformations, and improvements (Landers et al., 2016). Recognition of the financial aspects of home-based care by Medicare and Medicaid indicates the reliability of the research and the effectiveness of new solutions.
An expected step is to hire a formal caregiver and educate the patient about the necessary therapies and techniques. Home oxygen therapy is one of the most frequent options for COPD patients. The literature review by Bryant et al. (2016) includes a substantial discharge package with bronchodilators, steroids, and antibiotics for COPD patients who decide to continue their treatment at home. As a rule, a nurse plans to visit a patient three times per week and check the condition of the patient, the air quality in the house (an aide is hired to dust and do laundry), and how well the family follows prescriptions. A list of home care criteria needs to be created, and a nurse’s responsibility is to check if the patients are meeting all of them.
Education cannot be ignored in home health care because it provides a good opportunity to support patients and explain the importance of their decisions for the prevention of exacerbations. Exploratory qualitative research by Fotokian et al. (2017) shows that many patients may not follow the recommended lifestyle due to various reasons, including personal unwillingness, an inability to quit bad habits, or psychological dependence.
The task of a nurse in this case is to continue communicating, giving clear examples, and emphasize the alternative of hospitalization. The analysis of peer-reviewed articles by Cortopassi et al. (2017) is valid and reliable because of the use of recently published sources and discoveries, and it contains information about smoking cessation as an essential intervention for COPD patients. Quitting smoking determines the natural history and progression of the disease, as well as improves survival. Healthy eating and regular physical exercise should be adopted under the supervision of a medical worker.
The last solution in the case of the 65-year-old patient is the use of prescribed medications. During nurse visits, the number (and volume) of drugs needs to be checked. The portability and simplicity of spirometry tests make it possible to check the condition of the patient at home and observe the effectiveness of treatment. The review by López-Campos et al. (2015) is a credible source of information for nurses to identify the clinical perspectives of spirometry for patients under home health care. The combination of bronchodilators and inhaled steroids is important as it helps reduce airway inflammation, relax muscles, and relieve symptoms.
Conclusion
In general, despite the fact that home health care is a developing concept, many patients of different ages are eager to try it because of psychological, financial, and personal factors. In this case, a 65-year-old male patient refuses to consider hospitalization after being diagnosed with COPD and chooses home-based care with his wife as the main caregiver. To avoid unpredictable complications and prevent COPD exacerbations, the decision is made to hire a registered nurse to provide education about, control, and promote the necessary therapies and changes.
Using a number of recent credible studies and current research, the recommendations for patients are easy to follow. COPD management and prevention should be the responsibility of a nurse or the medical staff only. Patient and family involvement and prudence play an integral role in predicting morbidity outcomes, hospitalization, and readmissions.
References
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