This section is excerpted from chapter ten of Health Care Job Explosion and features home health care job opportunities.
An interview with a registered home care nurse and an overview of home health
care is excerpted along with a sampling of resources from the all new 4th
Health Care Job Explosion!. The remaining occupations are featured in the
same format as presented for licensed practical nurses in the text version of
Health Care Job Explosion! Occupational groups are divided into primary and
related occupations so that individuals can investigate other fields for
additional job opportunities.
Health Care Job Explosion features over 1,400 career
exploration and job vacancy resources. Resources are grouped with each
occupation and a sample of related resources are included with the first
Interview With A Registered Home Health Care Nurse
Lily Chan, a registered nurse with Children’s Home Care in Los Angeles, was born
in Hong Kong May 23, 1953. She completed a three year nursing program and worked
four years as a staff nurse there prior to moving to England. She took
additional courses in pediatric and cardiothoracic nursing before coming to the
When asked why she chose nursing, Lily said "I felt the need to take care of
someone as a basic personality trait." In addition, she enjoyed studying biology
and anatomy, and felt nursing could provide her with a good income. She also
thought that "the education and experience in nursing would help me take care of
my own health." Lily feels that the most satisfying aspect of a nursing career
is "providing a quality environment for the patient. Even the more menial tasks
become satisfying if you look at it that way."
A recruiting agency arranged for Lily to come to the United States in 1983 and
take the NCLEX licensing exam for RNs. They also found employment for her at
Methodist Hospital in Lubbock, Texas, as an interim permittee while waiting for
her RN license. In April of 1984, she began working at Childrens Hospital Los
Angeles. In 1995, Children’s Home Care was formed as an affiliate of CHLA.
Lily pointed out the advantages to working in home health care. "In home health,
you have time to deal with just one patient and family at a time. In the
hospital you can get pulled in five directions at once when it gets busy." You
also have a more flexible time schedule.
Lily was asked why she specifically likes pediatric home health care. "With
pediatrics, you are interacting with the whole family." Once she was taking care
of a child and complimented the mother on how good the chicken she was cooking
smelled. When she finished with the patient, the table was set with dinner for
Lily advised that anyone considering home health as a career must evaluate
their capabilities. "For home care you have to have a very broad knowledge base
and be creative and flexible. You have to improvise a lot." She also warned,
"the fear of many who transfer to home health care is that in a hospital, if
there is any problem, you can just yell and get assistance, while with home care
that security is lost. On the other hand, home care patients may not be as ill
as those in the hospital and there is emergency help available, such as calling
When asked for advice in finding employment, Lily responded, "It is hard for
a new graduate to get into, as they need a few years in acute care in a hospital
to develop the assessment skills." NurseWeek and the local newspaper are
good sources for job ads. Check with hospitals, too. Some have their own home
health care department.
I asked how to evaluate a home health care agency as a potential employer.
"Look for leadership quality. The whole mission and philosophy of the agency has
to support staff providing quality care. This affects how good you feel about
yourself. The agency has to balance the quality with cost."
If you really enjoy working with people and have confidence in your skills,
you will probably derive great satisfaction from caring for your patients in
Four occupations in home health care are presented in Chapter Ten:
Also presented are resources for the many professionals involved in caring
for patients in the home. These include, but are not limited to:
- Physical Therapists
- Social Workers
- Occupational Therapists
- Speech-language Pathologists
The development of in-home medical technologies, substantial cost savings,
and patients’ preference for care in the home have helped make home health into
one of the fastest growing segments of the health care industry. The National
Center for Health Statistics reported 1,355,290 home health care patients in the
United States in the year 2000.
Expected to increase at a 5.4-percent
annual rate to 1.3 million jobs by 2014, this industry’s growth reflects an
aging population, many of whom will have functional disabilities and will desire
to maintain an independent, home-based life style. One limit on home care growth is that Medicaid prefers to
pay for nursing home care, which is often more expensive. Vermont is the first
state to experiment with home care for Medicaid patients.
A rapidly evolving facet of modern health care is telemedicine, the use of
high-tech video equipment to facilitate communication among physicians,
patients, families, nurses and other allied-health professionals. In home
health, terms used are remote care technology, telehealth, and telehomecare.
Having telemedicine equipment in the patient’s home, or in a van that can be
driven to the home, means that fewer health care professionals are needed to
monitor patients. Remote care is a supplement to home visits, not a substitute.
Home health care workers can check in with patients as often as needed, even
viewing the progress in wound healing by video camera.
Personal and home care aides, and home health aides,
will be in great demand.
Not all patients needing home care are elderly. Disabled people of any age
may need some degree of home care. Patients recuperating from acute illness or
injury may need temporary home care. Children and adults with chronic illnesses
may need medical treatment that can be provided at home by a home health
professional, or may need training in specific medical therapies.
Home health care means providing health services and equipment to patients in
their home. Depending upon the needs of the individual patient, services may be
delivered 24 hours per day. Sometimes the purpose of home care is restoration of
health and/or function, while other times it is to maintain comfort, as in
hospice care. Home health care may provide for both the medical and the personal
needs of patients and their family members. Professionals involved include
physicians, nurses, physical therapists, occupational therapists, dieticians,
pharmacists, social workers, speech-language pathologists, homemakers and home
Many, but not all, patients are referred to home health care agencies after a
period of hospitalization. Patients should have a thorough evaluation, including
not just medical needs, but also assessment of the mental state of the patient.
In addition to evaluating the patient’s ability to comply with treatment such as
dietary recommendations and/or drug schedules, the family and social environment
needs to be considered. Various health care professionals may be involved in
this evaluation process.
Numerous factors may influence the decision to provide care for the patient
in the home rather than in a hospital, nursing home or other facility. Among
these are studies that have shown patients tend to recuperate sooner from an
accident or illness in familiar surroundings with caring family members. Another
consideration is the availability of competent assistance from family or
friends. The physical layout of the home must also be evaluated for adaptability
to the patient's needs. For example, a patient in a wheelchair will need
appropriate access to shower and toilet facilities.
Once the decision has been made that home health care is appropriate for a
patient, service is usually provided by a home health agency, hospice or
homemaker/home care aide agency. Staffing and private-duty agencies can provide
nurses, homemakers, home health aides or companions, but are not always required
to be licensed. Pharmaceutical and infusion therapy companies employ pharmacists
and nurses to assist patients requiring intravenous infusions. Medical equipment
suppliers and manufacturers may provide installation of medical equipment and
instruct patients on use. Some provide respiratory therapy services. Registries
connect home health nurses and aides with individual patients, who employ them
directly. Many home health care professionals are independent of agencies and
are employed directly by the patient or self-employed, often having several
clients at once.
The National Council on the Aging defines a home health agency as "a company
that provides many professional health care services, in the home, under the
direction of a physician. These comprehensive services include skilled nursing,
personal care assistance, physical, occupational and speech therapy, and medical
social work. Medical equipment, supplies and infusion therapies may also be
available. Home care agencies have an administrator or a director who is
responsible for the business and managerial operations. This person is often a
doctor, nurse, or social worker who has education or experience in
Certified agencies must meet licensing requirements. In addition, some are
accredited by the Joint Commission on Accreditation of Health-care
Organizations, (http://www.jcaho.org) or
Accreditation Commission for Health Care, Inc. (http://www.achc.org),
Community Health Accreditation Program (http://www.chapinc.org),
and the National Committee for Quality Assurance (http://www.ncqa.org).
Those participating in Medicare must also meet federal requirements.
A recent article by Lazelle Benefield, PhD, RN, in the American Journal of
Nursing explored the personal qualifications required for nurses to be happy in
their choice of home health nursing. The considerations cited apply to many
other professions. One advantage to home care nursing is the ability to follow
your patient’s progress consistently.
One issue in caring for patients in their home is the freedom of making
independent decisions versus the responsibility of making clinical decisions on
one’s own. Some people relish the independence, while others may feel
comfortable with more structure and more interaction with peers and supervisors.
Dr. Benefield emphasizes being proactive. Ask for advice from others in the
field, subscribe to home health journals and focus your continuing education
units on home health. If you are nervous about making independent decisions (you
will of course be consulting daily with professionals in other disciplines),
seek out the counsel of other nurses.
Another problem in home health is sorting out the variety of restrictions placed
on patient services by all the different HMOs, PPOs and insurance companies. The
home health nurse is responsible for documenting patient progress and justifying
continuing care based on patient capabilities or safety. If confidence is a
problem, obtaining extra training with experienced home care providers may help.
In an accompanying article, Janet Dyer is very specific about the personality
traits needed for success in the home health care field.6 She writes, "Nurses
who flourish in home health tend to be self-starters, independent and creative
thinkers...they also need to be well-versed in the latest technology...home
health tends to reward flexibility and well-rounded skills..."
- Online healthcare degree & certificate programs
Over 125 total resources are presented in the paperback version of
Health Care Job Explosion! 4th edition by Dennis V. Damp for this
occupational group. Resources include Job Ads, Job Hotlines, Job Fairs,
Placement services, Associations, Books, Directories and Internet (Web) Sites.
Your local library may have this book in their reference section or you can
purchase a copy for $19.95 plus shipping with all major credit cards from our
toll free service at 1-800-782-7424 (Orders Only).
American Association for HomeCare - 625 Slaters Ave., Suite 200, Alexandria,
Virginia 22314; 703/836-6263. (http://aahomecare.org/,
email@example.com) This is a national
trade association that represents all the elements of the home care industry.
The web site has directories of home health care providers, consultants and
state associations in the US and Canada.
http://www.caregiversguide.com Search by state for long term care
facilities, home care agencies, adult day care and alternative facilities.
Google.com (www.google.com) has directories
of hospices, extended care facilities and home health agencies. Click on the
word "more" then on "Directory" and then on "Health" to access resources. Over
360 home health and hospice providers are listed.
National Association for Home Care and Hospice (NAHC) - 228 Seventh Street SE,
Washington, DC 20003, 202/547-7424. (http://www.nahc.org/)
Members are agencies providing home care and hospice services. The Community
area of the web site provides an Agency Locator with information on more than
22,000 providers and a Job Exchange searchable by region. Contact information is
available for home care and hospice state associations.
Nursing Home INFO (http://www.nursinghomeinfo.com/)
Use the Facility Search feature to find nursing homes by facility name, state,
city, county or type of service.
State departments of health or insurance may be helpful in obtaining a Medicare
Survey Report to locate home health care providers in your area. Use any search
engine with the keywords "health department" and the name of your state or use
the state government listings in your telephone book to contact them.
The following occupations are featured in the all new 4th edition of
Health Care Job Explosion!. Each of the following occupations are featured
exactly like the Home Care Occupations
occupational description and includes resources for each listing. Your local
library may have this book in their reference section or you can purchase a copy
for $19.95 plus $5.75 shipping with all major credit cards from our toll free
service at 1-800-782-7424 (Orders Only). Also available at bookstores