Advantages and Disadvantages of Home Health Care

A warm and loving home environment where the patient can be among family keeps the patient in a good mood, which may have subtle health benefits.
• Family can take part in selecting caregivers, and fewer caregivers (as opposed to an entire nursing home staff) means closer and more personal relationships between caregivers and the patient.
• No hassles and costs associated with traveling long distances to visit relatives in elderly care facilities.
• No guilt for the family.and for the patient, no feelings of abandonment.
• If the patient is being cared for in his or her own home, this comes with a feeling of security, comfort, and privacy.
• Being present in the final stages of an elderly relative’s life helps family to patch up any old tensions and, eventually, to achieve closure.
• Young children can develop strong, valuable relationships with their elderly relatives and benefit from their wisdom, which is often difficult in care facilities.
• Home care is often cheaper.
• Family can personally monitor the patient’s health, elevate care if needed, and respond to any emergencies.

Disadvantages of home health care:
• Family members may not be prepared to take on this huge responsibility, which is often a highly demanding long-term commitment.
• Some patients require more advanced or intensive medical attention than home care can provide.
• Private homes are not equipped with the emergency response systems usually in place at elderly care facilities.
• Hired caregivers, depending on circumstances, may be absent during large portions of the day, leaving it up to the family to handle all care and any incidents that may arise.
• The patient may lack valuable friendships with others in his or her age group. Particularly when the patient is being cared for in his or her own home, loneliness may become a factor.
• The patient may not get enough privacy and alone time.
• Family may not have time to meet all of the elderly patient’s needs.
• There are no staff redundancies to make up for any skills or competence lacking in hired caregivers.
• Emotional complications within the family can negatively affect the level of care.

 

 

Advantages and Disadvantages of Nursing Home Care

A patient will be transferred from a Hospital to a Nursing Home when they are cleared of all infections and of all artificial supporting devices. The patient needs to be cleared of all artificial support devices (like a respirator) in order to be admitted into a regular nursing home (the patient can be on a respirator if they are being sent to a Skilled nursing home facility) and it is OK for the patient to have a feeding tube. In addition, the hospital staff must feel that they have done all that they can for the patient such that rehabilitation is the next step or the hospital staff may feel that they have done all that they can and nothing else can be done to better the patient's condition (the patient's condition is irreversible and the patient cannot be made any better). The latter case was the case with my mother and the doctors wanted to send her to a skilled nursing facility so that she could receive comfort care and hospice care (or end of life care). She was sent to a nursing home since there was nothing more that could be done for her medically. There are several types of nursing homes, but the two that I am the most familiar with are regular nursing homes and skilled nursing home facilities. In regular nursing homes, patients do not have any severe health problems and rehabilitation in the main objective. Usually, successful recovery is possible for most patients. In a skilled nursing home facility, patients are usually on respirators for breathing assistance, have feeding tubes and have a wide range of other problems that need to be treated medically. I like to think of a skilled nursing home facility as being the next step down from a hospital since patients in such facilities are not in such a dire condition that they need constant emergency care such as is given in a hospital. The nurses in skilled facilities are, however, trained to dealing with problems relating low oxygen saturation, can conduct CPR if necessasry and can address any severe problems that threatens the patient's life. All nursing homes offer 24 hour care to patients and, in general, skilled nursing home facilities are smaller than regular nursing homes. There are advantages and disadvantages to residing in a regular/skilled nursing home and the disadvantages especially need to be accounted for.

Advantages:

1. The Nursing Home facility is much smaller than a regular hospital and therefore, it will be easier for you to get into contact with relevant individuals such as physical therapists, physicians, admissions staff, and nurses. If there is an aspect of the patient's care that you are not satisfied with, it is easy to get such issues resolved in a nursing home. You can do so by bringing the issue to the attention of the facility's social workers who will work with you to figure out what the problem is and how it can be resolved. Social workers are also there to help you find information about other services (such as hospice care), to help you make changes in any preferences regarding the patient's care (like whether to revive the patient if the heart should fail) and to gather any necessary documentation regarding the patient's stay that you might need in handling the patient's affairs outside of the nursing home (health insurance, bank issues, etc...). Based on my personal experiences, I have found that it is just easier in a nursing home to find the people that you are looking for and to continually touch base with them since a hospital is so much larger and workers serve a greater number of patients.

2. Nursing homes are more focused on rehabilitation and so there will always be physical therapists, occupational therapists and speech therapists on hand if you have any questions. Also, there is a focus on engaging the patients socially in activities with other residents.

3. Nursing homes have a care team that consists of most of the individuals that will provide direct care to the patients. The team consists of Occupational Therapists, Physical Therapists, Speech Therapists, Physicians, care team coordinators, Social Workers, Respiratory Therapists (in skilled nursing home facilities) and Dietitians. Meetings are arranged between the caregivers and the care team bimonthly. The meetings serve as a great opportunity to get all your questions regarding various aspects of the patient's care answered at the same time and to get an idea of how different services are interacting with each other for the benefit of the patient.

Disadvantages:

1. Especially when a patient is being transferred from the Intensive/Critical Care Unit (I/CCU) of a hospital to a nursing home, the difference will be especially pronounced since in a nursing home, one nurse takes care of several patients and thus, patients do not get anywhere close to the individualized attention that they got at the hospital. Thus, it is very important to be with your loved ones as much as possible since the supervision of patients by the nursing home staff is not strict and thus, the nurses can miss important things. This is especially the case when the patient is immobilized or cannot express their needs to the nursing staff. When my mother was in her first nursing home, she could move her lips to talk, but no sound would come out and she was very much bedridden since she was in the nursing home in the first place so that her limbs could become functional again after not being used very much in the hospital. Thus, she couldn't really tell the nurses what she wanted or alert them to what she needed if they were far away. Since my mother had a feeding tube, very often she would move in a way that would cause the feeding tube to become disconnected which resulted in the feeding tube's contents spilling all over her bed and wetting her nightgown. The nurses that took care of her almost never picked up on this. The problem was addressed only because me and family would notice the problem when we came to visit her. The lack of cautious nursing home care became very pronounced to us when my mother had a cardiac arrest and the nurses got to her too late since there were no heart monitors to alert them and the nurses station was so far away from her room. Although the nurses were able to revive her heart, her cortical brain activity suffered greatly due to the moments of oxygen deprivation. Consequently, she went into a persistent vegetative state that she never recovered from.

2. There is only a few (2-3) doctors in nursing homes. Thus, one doctor is responsible for MANY patients. It is hard to catch the doctors if you have questions and their decisions may not always be the best since there are no specialists in the Nursing Home. If a specialist is needed (like a Cardiologist or a Psychiatrist), usually the patient has to locate a specialist outside the nursing home and has to arrange outpatient transportation in order to see that specialist.

3. Perhaps the biggest drawback is the fact that there are no machines available that monitor the patient's vital signs and which alert the staff when there is a problem with the vital signs. This is the case since when the patient is admitted into a nursing home, the patient is thought to be in a condition where it is not necessary to monitor their vital signs. In other words, patients in a nursing home are usually in a stable condition since otherwise they would not have been released from the hospital. Nurses do check the patient's heart rate, oxygen saturation and temperature every couple of hours, but they are not able to pick up any changes in the time in between. Thus, it is crucial for caregivers to obtain their own personal Pulse Oximeter so that they themselves can monitor the patient's oxygen saturation and heart rate when the nurses are busy. A pulse oximeter should only be purchased and used when the patient's problems involve their breathing rate and heart rate. In skilled nursing home facilities, if the patient is on a respirator, they will usually be closer to the nursing station than those patients that do not have a respirator and the respiratory machine makes noises when it detects that something is wrong with the patient's breathing or when it detects that the machine has been disconnected somehow. The feeding tube machines makes noises as well.

4. The Nursing staff in general is not as good as what you will find in a hospital. Nursing homes mostly employ LVNs (Licensed Vocational Nurses) instead of RNs (Registered Nurse). RNs are very common in hospitals since hospital work requires a greater amount of knowledge and training in the field of nursing that an RN can provide. LVNs usually handle the changing of a patient in hospitals (when the patient is in a regular room, not the ICU) and CNAs (Certified Nursing Assistants) usually handle changing the patient in nursing homes and they are also the ones that check the patient's vital signs every few hours. The plus side to having CNAs in nursing homes is that if there is a problem with the patient and the main nurse (usually LVN or RN) is busy, then you can always report the problem to the CNA who can help alleviate the problem.

Despite such disadvantages, some patients have no choice and must go to a nursing home in order to receive rehabilitation services since they cannot stay in the hospital since they do not need anymore medical care, but they also cannot go home since they cannot do everyday things without severely hurting themselves. As a caregiver, it is essential that you be with your loved ones as much as possible when they are in a nursing home so that you can tell the nurses what needs to be done and so that you can pick up on serious things that the nurses might overlook. Your role must be active in taking care of your loved one in a nursing home since the staff are not as diligent when it comes to making sure that the patients are as comfortable as possible.