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Home Health Nursing Care Plan Standards and Regulations

Excerpts from OASIS-C Guidance Manual, September 2009 for 2010 Implementation, Appendix A, Centers for Medicare & Medicaid Services:

The comprehensive assessment must

(1) identify the patient’s continuing need for home care;

(2) meet the patient’s medical, nursing, rehabilitative, social, and discharge planning needs; and

(3) for Medicare patients, identify eligibility for the home health benefit, including the patient’s homebound status.

It should be noted that the data items in OASIS-C are not, in and of themselves, a complete or comprehensive assessment. Home health agencies will need to supplement the OASIS-C data items with others necessary for a full assessment.

For example, the OASIS-C items do not include vital signs, assessment of breath sounds, or collection of data on fluid intake, which are part of a more complete assessment. Each agency will be expected to incorporate the OASIS-C items into its own comprehensive assessment documentation and related policies and procedures.

The Home Health Nursing care plan is the blueprint for the patient’s entire care needs, and directs the actions of all health care team members. A new caregiver should be able to know everything essential about the patient by reading the Home Health Nursing care plan.

The Home Health Nursing care plan is a measure of quality of care. It gives a comprehensive picture of where the patient is at present and what is hoped to be achieved in the future, and is a guide for daily charting and care.

The Home Health Nursing care plan:

Increases consistency of care

Focuses all interdisciplinary team members on the same problems

Describes the patient’s functional abilities and needs

Sets goals to maintain the patient’s highest level of functioning

Addresses the patient’s physical, mental, emotional, and social needs

Provides a reference to measure progress or decline in the patient’s condition

Home Health Care Articles

Home Health Care Transitions Problem

Home Health Aide Pay Rates Increasing

Over 25 Percent of Home Health Episodes End in Rehospitalization

More Reasons to Care for the Caregiver

Long Term Care and Home Health Nurses Favored in Loan Repayment Program

New Home Health Regulations on Face-to-Face Encounters and Reimbursement

Home Based Primary Care Encouraged by CMS

Increased Wages and Overtime Protection on the Way for Home Care Workers

Home Health Nursing Care Plans

Home Health Care Plans

2012 OASIS-C Edition

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The ninety-five Home Health nursing care plans and plan of care forms in this book cover every nursing diagnosis and care plan problem that may be generated from the OASIS-C form for the nursing plan of care. Terminology is based on OASIS-C language and nursing diagnosis definitions and classifications as outlined by the North American Nursing Diagnosis Association (NANDA).

The home health nursing care plan format follows the care plan standards from the American Nurses Association.

95 Home Health Nursing Care Plans in the book and on the CD for the Nursing Plan of Care

Abusive

Activity Intolerance

Airway Clearance, Ineffective

Allergies

Allergies, Food

Ambulation

Amputation / Prosthesis

Anemia

Anger

Angina

Anticoagulant Therapy

Anxiety

Bathing

Bed Mobility

Blepharitis

Blood Glucose Monitoring

Blood Sugars, Unstable

Breathing Patterns, Ineffective

Chewing Problem

Cognitive Deficit

Colostomy / Ileostomy

Conflict with Caregivers

Conflict with Family

Constipation

Cooking

Dental Care

Depression

Diarrhea

Dressing Care Plan

Dressing Lower Body Care Plan

Dressing Upper Body Care Plan

Eating

Fall Risk

Family Coping

Fluid Volume Deficit

Fluid Volume Excess

Foot Ulcer, Diabetic

Gastrointestinal Discomfort

Grooming Care Plan

Hearing Aid Use

Hearing Impaired

Heart Failure

Housekeeping

Hypertension

Hypotension

Hypothyroidism

Incontinence, Bowels

Incontinence, Functional

Incontinence, Stress

Incontinence, Urge

Intravenous Therapy

Laundry

Manipulative Behaviors

Medication, Inhaler

Medication, Insulin Injections

Medication Issue

Medication, Nasal Spray

Medication, Pain

Medication, Psychotropic

Medication Self-administration Care Plan

Obesity

Pacemaker

Pain

Pain, Cognitively Impaired

Paranoia

Parkinson’s Disease

Peripheral Artery Disease

Peripheral Vascular Disease

Range of Motion

Refuses to Eat / Drink

Resists Care

Restraint

Rheumatoid Arthritis

Seizures

Shopping

Skin Breakdown

Skin, Fragile

Sleep Pattern Disturbance

Smoking

Social Isolation

Socially Inappropriate Behavior

Speech Impaired

Strengths

Swallowing Problem

Telephone

Terminal Prognosis

Toileting

Tracheostomy

Transfers

Transportation

Tube Feeding

Urinary Retention / Catheter

Urinary Tract Infection

Visual Impairment

Wandering

Weight Loss

The first section of the book covers regulations and standards for nursing care plans, Home Health Nursing care plan components, and Quality Measures and Outcome Measures.

Because the terminology of the home health nursing care plan is based on OASIS-C language, it is very easy to see which care plans and plan of care forms are triggered by the OASIS-C entries.

The home health nursing care plans can be used to supplement the nursing plan of care, and are also extremely useful for teaching patients and caregivers.

All of the home health nursing care plans and nursing plan of care forms in the book are also on the CD. When the CD is placed in a computer, the care plans can be opened in a word processor. Entries can be added or deleted to individualize the home health nursing care plans.

View and Print Home Health Nursing Care Plans and Forms

Heart Failure Care Plan Dressing Care Plan

Pain Care Manual

Home Health Nursing Care Plan Standards and Regulations

The Home Health Nursing care plan:

Home Health Care Articles

Home Health Nursing Care Plans

95 Home Health Nursing Care Plans in the book and on the CD for the Nursing Plan of Care

Heart Failure Care Plan
Dressing Care Plan