Home health care has become a standard service through most hospitals. Home health care agencies deliver comprehensive and supportive care to the patient right in the home, either by a skilled professional who provides medical care or by caregivers or aids who are trained to help the patient with daily activities.

“We serve all ages and our services are available 24 hours a day, seven days a week,” said Nora Stangel, RN, director of Home Health at Wallowa Memorial Hospital. “Our services are delivered at home to recovering, disabled, chronically or terminally ill persons who are in need of medical, nursing or therapeutic treatment and/or assistance with the essential activities of daily living.”

Patient care and post-surgical rehabilitation at home has gained popularity because it allows a patient to avoid unnecessary hospitalization, and the home is a familiar, relaxed environment conducive to healing.

“Patients are in their own environment,” said Stangel, “and no nurses are coming in and interrupting the patient or waking him. Home is often a quiet environment. Family members can be in the home too. On the other hand, some people do better in the hospital because they like the security or because they don’t have family members to help them at home.”

Home health care professionals are equipped to provide help and education to those newly diagnosed with diabetes, those who are undergoing chemotherapy or who need pain management. Caregivers can receive training about home safety issuesand patient fall prevention.

Registered nurses provide skilled services such as surgical wound care and dressing, injections and intravenous therapy, ostomy training and education on disease prevention and treatment. They are trained to make patient assessments and can provide case management services.

Nutritional information and education are provided by home health care professionals for patients on chemotherapy and those with conditions like diabetes, nausea, celiac disease, irritable bowel syndrome, hypertension, colostomy and ileostomy.

“We work closely with your physician to coordinate all aspects of your care, focusing on helping you recover and regain your independence,” said Stangel.

In addition to rehabilitation services, home health care agencies also render end-of-life care. Never is their work more compassionate than at this time in a patient’s life.

“The majority of our end-life cases involve cancer or end-stage lung, heart, renal or diseases of any of the body systems,” said Stangel.

Above all else, pain management is crucial for terminally ill patients, and home health care professionals work closely with the patient’s physician to keep ahead of the pain with appropriate medications and dosage instructions.

“It entails the referral from the physicians,” said Stangel, “and if the patient starts on oral pain medications, we make sure that dose is able to keep the pain down. We want the level of pain between 2 to 4 on a scale of 1 to 10. But if we see the patient is needing to take a lot of break-through medication or needing to take medication every four hours, then we’ll go into a long-acting medication.”

The home health care nurses act as liaisons between the patient’s family and the ordering physician.

“Instead of having the family call the physician,” said Stangel, “the doctor give us parameters, and we know what we’re able to do. We’ll get specific orders from the physicians. Then we let the family know if we can go up to a certain dose.”

Once a patient’s pain gets to a level where they are no longer able to take oral medication or it’s not holding, skilled nurses will consult the physician for a pain control pump which delivers medication into a PICC line or subcutaneously.

Home health care nurses will educate the family and caregivers about the dying process by means of written articles and by talking to them. When the nurses make their visits to the home, they observe the patient’s condition and look for the progression of signs that precede death. The family is advised in whatever they need, Stangel said.

Signs that precede death in most people as their body systems slow down include: difficulty breathing, anxiety and fear, declining level of consciousness, depression, pain, circulation, nausea, dry mouth, loss of appetite, difficulty eliminating and sleep disturbances.

Skilled home health care professionals help the family as the patient is dying. After the patient dies, they also help guide the family to other people who can help with grief counseling or pastoral services.

“We sometimes suggest that people talk to the mortician to get some of those arrangements started in advance,” said Stangel.

Each state has its own requirements for reporting a notice of death.

“If it’s a patient that a home health care agency is involved with or it’s an anticipated death, then the process goes a little easier,” said Stangel. “You don’t have to call in the sheriff and then the coroner or medical examiner. If it happens suddenly, those cases must be investigated.”

Patients who need home health care services should review their Medicare coverage and make sure they meet the qualifications listed on the following website: http://www.medicare.gov/coverage/home-health-services.html. To receive coverage, the home health care agency assisting the patient must be Medicare-certified.

The staff at Home Health in Wallowa County includes Stangel with more than 26 years with Wallowa Memorial Hospital; Margaret Rystrom, RN, MS, CNL, a clinical nurse leader, and Jeff Greene, BS, ADN.

For more information, contact Stangel at 541-426-5427.