Home Health Care as a Quality Assurance Program

This report explores the concept of home health care as a quality assurance program, including its principles, stakeholders, and recommendations for improvement. It discusses the importance of home health care in providing support to patients who require special attention while at home. The report also highlights the principles that guide the implementation of the program, the stakeholders involved, and the challenges and successes of the program. Recommendations are provided to enhance the effectiveness of home health care as a quality assurance program.

Running head: NURSING ASSIGNMENT 1
Nursing Assignment
Student’s Name
Institutional Affiliation

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Nursing Assignment
Introduction
Quality assurance refers to the process of monitoring of the activities of client care to
determine the degree of excellence attained to the implementation of activities (Dye et al. 2014).
Assessing the quality of healthcare has been considered one of the main issues of global agenda
reforms in healthcare. For the quality to be ensured, a combination of planned and systematic
action is required. This is to ensure the services provided meet the requirements given for quality
services and achievement the patients’ needs. Quality assurance is based on good planning,
presentation and excellent training of nursing staff (Strickland et al. 2015). An organization may
have a variety of quality assurance programs. Therefore, this report explores “home healthcare”
as a quality assurance program, the principles which underline the implementation approach of
the program, the personnel involved in the program together with the effectiveness of their role,
and the recommendations that will enhance the success of the program.
Definition and Background Information
To begin with, Home health care refers to home-based healthcare services provided in
support of patients (Murdaugh, Parsons & Pender, 2018). Provision of these home health
services is of great importance to those patients who are out of the hospital but still require
special attention while at home. These patients can be adults or children. According to an article
by Home Care Ontario, Canadians who require home care have to register for healthcare services
which are fully funded by the government. The government cares for home-based health care
services for old people and persons with complex medical conditions who must be closely
monitored. The issue is that not everyone qualifies to receive the services. At times some people
may fail to get the free health services offered at the residential. These people can however

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appeal through the Ontario Health Services Appeal and Review Board. The community support
services are also available to offer aid to the people who require home care services. In Ontario,
for instance, Local Health Integration Network is assigned the responsibility of deciding who
receives care, the level of care and how long to provide healthcare. A specific procedure has to
be followed in order to arrange home care and community services. Some of the home health
services offered include short-term nursing, physiotherapy, speech-language therapy, social
work, occupational therapy and rehabilitation services. There are also home making services as
well as personal care. Home health care allows people to acquire treatment services while in their
homes rather than being under institutional-based care (Rijnaard et al. 2016). Healthcare services
can be professional or just home care. Some of the professional health services which can be
delivered in homes include care for wounds, education on diseases and their management,
therapeutic services, psychological and medical assessment.
On the other hand, home health care services include transportation, helping with house
chores such as laundry and meal preparation, companionship among others (Leff, Carson, Saliba
& Ritchie 2015). These services help in post-hospital recovery after hospital discharge. Usually,
it is one thing to provide patients with medication and treatment in the healthcare institution and
another thing to make a follow-up after the medication process. In most cases, patients die not
because of poor medication, but due to lack of a follow-up after being discharged from the
hospital. Therefore, home health care is a quality assurance program as it aims at promoting a
100% recovery of the patients.
Principles of the Program
However, home health care has some standards of conduct that guide the professional
health care service providers. The conduct forms the principles that underline the implementation

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approach of the program. According to Varkey, Reller & Resar (2007), continuous quality
improvement is essential as it goes in hand with the principle that every process has
opportunities for improvement. Most organizations use various QI methodologies, common ones
are plan-do-study-act, six sigma and lean strategies. The principles guiding this quality assurance
program include the following. Firstly, professional health care providers are required to provide
competent medical care with honor and respect for human rights and dignity. There must be a
rule that should guide the medical health provider to deliver services as per human rights and
dignity (Nelson et al. 2014). This principle guides the quality of the services by protecting the
patients through assurance of quality service delivery. Secondly, home care medical service
providers are expected to maintain high standards of professionalism by telling the truth to the
authorities. It is necessary to make a follow up in ensuring the delivery of services to the patient
is up to the standard. Thus, the health care providers are bound to report the truth to the
authorities who later make an assessment and take action on any false information. This principle
aims at not only promoting the quality provision of healthcare services to the clients but also
enhancing satisfaction among the patients. Thirdly, home care professionals are required to put
the interest of the patients as their professional priority (Lang et al. 2014). This means that the
decisions made by the home care service provider should not be influenced by personal goals.
Patient complaints should be fully addressed. Over the years, a lot of deaths have been reported
due to the negligence among the nursing staff. At times, the patient is assumed to be okay and
discharged from the hospital. In such a case, the home health care provider has to me keen
without making any assumptions toward the complaints presented by the patient. This is a
fundamental approach in ensuring that the patient recovers fully from the ill-health condition.
Fourthly, the professional home care service providers are to respect the law and recognize their

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responsibility seeking changes in the requirements which are contrary to the best interest of the
patient. This principle ensures that all the actions undertaken by the healthcare providers are not
only in line with the law but also patient-centered. Fifthly, home care service providers are
required to respect the rights of their clients, their colleagues and other healthcare practitioners
and shall protect patients’ satisfaction and privacy as enshrined within the law (Lewis, Lewis,
Leak, King & Lindomanne 2016). This principle ensures successful collaboration between the
nurses, patients and other health practitioners. Such cooperation has proven to significantly
promote the quality of services in enhancing the full recovery of the patients. Sixthly, home care
professionals shall continue excelling in their medical study and consultation. Lastly, the
professional home care service provider shall choose who to save, the environment to work in
and who to associate, except during emergencies (Stall, Nowaczynski & Sinha 2014). These
principles remind care providers what is expected of them and guide them in their duties.
Stakeholders of the Program
Consequently, home health care is provided by professionals who include nurses (both
registered and licensed practical), therapists (physical and occupational) and social workers
(Dumanovsky et al. 2016). These professionals can work independently, as part of an
organization or part of a franchise. There are also caregivers who offer non-medical care such as
assisting patients in bathing, dressing, getting the patients out of bed and also assist them when
they are in need to use the toilets (Shepperd, Gonvalves-Bradley, Straus & Wee, 2016). The
work of the home health care professionals and caregivers has been effective in reducing the
number of hospital readmission, promoting quality lifestyle among the patients, increasing the
independence of the patients. In Ontario, health care professionals in home based care are
expected to provide a range of services which include nursing care, physiotherapy, occupational

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therapy, social work, speech language therapy, healthy eating and home healthcare supplies
(Ontario.ca, 2018)
What is not Working
Considering that some of the services may work effectively, others may be missing
completely. New ideas are available, but the implementation of the ideas becomes the problem.
A challenge of how to establish a unique model for home-based health care in an organization
may arise. Satisfaction of patients' demand is another big challenge (Pang et al. 2015).
Similarly, information needs to be managed as the program grows and scale. In this case,
good data storage is required. Because the service is home-based, various equipment only found
in the hospital may be unavailable. In some cases, caregivers and professional home care persons
may not have a close relationship with the patients. Health promotion may also be missing
especially where there is no health education, sanitation, maternal and child health care and
immunization.
Similarly, clients' participation in decision making about their lives may also fail. In such
cases, identification of the health needs of the patients and the community as a whole becomes
difficult. Therefore, the expected respect for diversity is left out. Still, when health professionals
are not well distributed in rural areas to fulfill the needs of home-based patients, universal
accessibility is violated.
What is Working
Shojania & Grimshaw, 2005 discusses the role of science in health care improvement.
The approach is mainly based on evidence hence is termed as Evidence-Based Medicine (EBM).
It involves the use of evidence in making decisions about care for patients. With interventions
that use multiple strategies, a number of solutions to problems facing health care have been

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addressed. Some aspects of the approach are considered to be working by taking into account the
achievements and the fact that the approach has been successful in several cases. The approach
has been able to reduce the total patient care cost-effectively (Brann & Gustavson, 2013). It can
also be confirmed that the approach has resulted in competent medical care practices which have
not only respected the rights of the patients but also their dignity. The professional home health
care providers work to ensure their goals are driven mostly by the patient’s interest. The
approach has also encouraged the professionals to work in an environment of their choice with
the patient of their choice. This approach, therefore, has both the working aspects and some
aspects which do not work effectively as seen above.
My Role as an Operating Nurse in the Program
As a nurse, there are several roles placed on my shoulders to ensure that home-based
health care program is operational. During my internship program in one of the medical health
centers, we were grouped and given the task of providing health care services in homes.
According to an article by Glickman et al. 2007, community plays an important role in provision
of home-based health care. During this duration of internship, I became part of the home-based
health care providers where I learned various home health care services such as offering
counseling to the patients and residential hospices. I later on became a full time nurse. Currently,
my major role as a nurse is to improve patient-experience of quality care.
Also, my job as a nurse not only influences the whole process of implementing a
successful home health care program but also influence the work of colleagues both at my levels
and other levels. To improve and evaluate the quality of care, patients’ experience comes plays
an essential role (de Oliveira, do, Prado & Kempfer 2014). My organization assesses patients’
experiences and the results are used for internal quality improvement. Am also authorized to use

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the results published from the patient’s experience to determine the nursing ability of the nurses
who are assigned the caring duties. In so doing, I can identify incompetent colleagues, their
nursing skills and their ability to handle patients together with the nurse’s communication
abilities. This assessment operation makes me able to keep the nurses at bay with their work and
train them with a fundamental aim of enhancing their competence in the delivery of quality
patient-based healthcare services.
Recommendations
I would suggest some recommendations for the achievement of designed goals and
objective of home health care as a quality assurance initiative. Firstly, the U.S Food and Drug
Administration and the Office of the National Coordinator for Health Information Technology
should collaborate to establish regulations, certification and monitoring of health care
applications and systems that make up medical devices and health information technologies
(Davis & Kotowski, 2015). For the certification process to be justified, evidence showing that
manufacturers have followed the required guidelines is vital in this case. A similar strategy can
be adopted within my organization.
Still, the U.S Food and Drug Administration (FDA) should promote the development of
new standards focusing mainly on human factors research on labelling techniques and providing
materials for instructions used for medical devices designed for home use by lay users. The
approval process of such standards should be smoothened to facilitate and enhance
improvements of the materials by those responsible for manufacturing them. On the other hand,
the organization at hand should initiate a program that assesses and reports the effectiveness and
efficiency of the material in promoting quality home health care.

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Again, it is recommended that professional caregivers and groups responsible for
advocacy should undertake proper training and be certified and accredited. This strategic
approach shall ensure that the formal caregivers have good preparation to offer better care in the
homes, develop appropriate materials for training the informal caregivers which offer them
guidance and ensure effectiveness in their work. Therefore, proper training and accreditation
programs aids in promoting quality delivery of services to the patients.
Also, it is recommended that Federal agencies such as U.S Department of Health and
Human Services and the Centers for Medicare and Medicaid Services, together with the U.S
Department of Housing and Urban Development and U.S Department of energy, should unite to
enhance enough access to home modifications that are healthy and safe. This strategy shall aim
at ensuring that who reside in homes that may hinder them from receiving needed health services
obtain home assessment (Blais, 2015). Such homes may expose the residents to dangerous threat
or limit self-care management hence accessibility, and universal design of new housing becomes
necessary.
Additionally, it is recommended that Federal agencies should be at the forefront in
developing ways of making house visitation easier and accessible. With access to more houses,
health care services can be established (Abdallah, 2014). There should also be healthcare
teamwork and coordination to overcome barriers. Raghupathi (2014) recommends that medical
device database for physicians, pharmacists and nurses should be established so that they have an
easy time choosing the appropriate device to prescribe for patients who are receiving home-
based treatments.
Still, the agencies can survey to collect data on important information regarding home
health care. The information gathered should include health attributes of the patient, the nature of

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caregiving being applied to the patient and the home settings or environment in which the patient
resides (Daly, Speedy & Jackon 2017). Lastly, assessment tools should be developed in home
health care. The tool should analyze the tasks required in home-based health care and match the
tasks with the caregiver’s abilities to carry out the duties (Rubenstein et al. 2014). This helps in
identifying the most qualified home health care provider and having them do the task.
Conclusion
In conclusion, quality nursing care should be ensured within in any health care system.
Medical health practitioners must assume responsibilities for whatever actions and decisions they
make, and they always take the patients interest and consider it their priority. Home-based health
care services are the ultimate solution to the current health related problems in Ontario and other
parts of the globe.

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