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purpose of this paper is to describe the community health nursing role of home
health nursing in the community setting of your choice. Health
promotion nursing interventions and a professional nursing organization related
to this role will also be examined. Directions This
APA paper is expected to be no more than four pages in length (not including
the title page and reference list). Below are the requirements for successful
completion of this paper. Please use the recommended APA Template linked below,
which incorporates the following categories as the first level headings on your
paper. APA formatting helps you to organize your paper in a professional manner
and provides consistent methods for citing your sources and completing your
reference page. See the documents in the APA category in Course Resources for
assistance with APA formatting. The Student Success Strategies resource has
great sections on writing scholarly papers and APA formatting.1.The role for this
paper must be on Home Health Nursing (not including
hospice). ❗ 2. Complete your paper on the provided template. The
template is formatted with the appropriate running head, title page, page
numbers, paragraph formatting, and most of the headings. Please edit the
headers and title page with your specific information. You are also encouraged
to view the Week 4 assignment tutorial found at the end of the Academic
Integrity Reminder.3.Locate and read at
least one scholarly peer-reviewed journal article (of your choice) that is related to a nurse’s role in health promotion in this setting. Search peer reviewed
journals to find a scholarly article on this topic. The article must be less
than 10 years old (less than 5 years is best).4.Thoroughly address the
following categories using the APA Template that is provided.❎ Introduction
(one paragraph):-The introduction should be interesting and
capture the reader’s attention.-Introduce the assigned community health
nurse role and a community setting where this nurse may work.-Introduce your community and where/how this
CHN role is utilized in your community-Identify population(s) served by this role in
your community-Include a purpose statement·❎ Community
Setting (two to three paragraphs)-Describe a practice setting for the assigned
CHN role.-Describe the population(s) served in this
setting.-Discuss three health services provided by the assigned
CHN role in this setting.-You may use your textbook or an outside
scholarly source to address these sub-points.·❎ Health
Promotion Nursing Intervention (two to three paragraphs) -Describe in detail health promotion
intervention(s) of the assigned CHN role specific to the community setting
identified.-Identify people/organizations/community
members this CHN role may collaborate with in health promotion
interventions.-Include one peer-reviewed journal article
discussed that clearly relates to nursing health promotion intervention.·❎ Professional
Nursing Organization (two paragraphs)-Provide a detailed description of a
professional nursing organization that supports nurses in this role in your own
words. Search the text, your article, or the Internet for one professional
organization that supports nurses in this role. If you can’t find an
organization specific to this group, search the American Nurses Association
(ANA) website for information on this role. Cite the organization in the body
of the text with (organization name, year), and include a complete reference on
the reference page.-Discuss one professional issue that this
organization is addressing related to this CHN role.·❎ Summary
(one paragraph)The
summary reiterates key points about:-The CHN role and community setting-Health promotion intervention-Professional organization-Includes a concluding statement.❎ Reference
Page: The reference page
should start on a new page (insert a page break). All references should be
cited within the body of the paper as (author or organization, year), and the
full reference should be included in APA format on the reference page. A URL
link alone is not an adequate reference. See the Chamberlain Guidelines for
Professional Writing in the APA Folder in Course Resources for examples of
properly formatted references.GuidelinesThe
setting for this paper must be on Home Health Nursing (Not
including hospice).·Length: This paper is
expected to be no more than 4 pages in length (not including the title page and
reference list).·Quotations should be
minimal—please paraphrase your sources. A maximum of one quotation
should be used for this paper. The
following are best practices in preparing this project.·Follow the guidelines
above carefully.·Use only the assigned
CHN role·Complete you own work.·Use the provided APA
assignment specific template.


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Type Your Title
Your Name
Chamberlain University College of Nursing
NR443 Community Health Nursing
March 2019
Type Your Title Here
Type your one-paragraph introduction here, and remove all yellow highlighted
instructions. The introduction should be interesting and capture the reader’s attention. Introduce
the assigned community health nurse role and a community setting where this nurse may work.
Introduce your community and where/how this CHN role is utilized in your community. Identify
population(s) served by this role in your community. Include a purpose statement.
See the APA file in Course Resources for additional writing resources such as the APA
Annotated Paper and the Chamberlain Guidelines for Writing Professional Papers.
Community Setting
Describe the community setting in two to three paragraph. Include a description of a
practice setting for the assigned CHN role and description of the population(s) served in this
setting. Discuss three health services provided by the assigned CHN role in this setting. Support
with textbook or scholarly source. Cite your source and include a complete reference on the
reference page.
Health Promotion Nursing Intervention
Discuss the role of the assigned community health nurse role in health promotion (two to
three paragraphs). Identify and describe one nursing intervention focused on health promotion
that the CHN could implement in the community setting identified. Support this health
promotion intervention with at least one peer-reviewed journal article and cite your source
(Author[s], year) in the body of your paper. Include the full APA reference for the article(s) in
the reference page. Describe in detail whom (i.e. people, organizations, community members)
the nurse could collaborate with in order to implement this intervention.
Professional Nursing Organization
Describe a professional organization for this CHN role (two paragraphs). Search the text,
your article, or the Internet for one professional organization that supports nurses in this CHN
role. Provide a detailed description of this organization in your own words. If you can’t find an
organization specific to this group, search the American Nurses Association website for
information on this setting. Cite the organization in the body of the text with (Organization
Name, year), and include a complete reference on the reference page. Describe one professional
issue that this organization is addressing related to this role.
End with a summary and conclusion (one paragraph). In one well-developed paragraph,
summarize important points from the body of your paper including the CHN role and setting you
identified, the nurses’ roles in that setting, the professional organization, and the health
promotion intervention you discussed. End with a concluding statement.
No matter how much space remains on the page, the references always start on a separate
page (insert a page break after the conclusion so that the references will start on a new page).
Type your references in alphabetical order here using the hanging indents set up here. Include all
references cited in your paper. This must include one scholarly peer-reviewed journal
article that was discussed above. Also reference the professional organization you
discussed (a URL link is not sufficient) and the text if you discussed it above. See your
APA Manual and the resources in your APA folder in Course Resources for reference
Nies, M. A., & McEwen, M. (2019). Community/Public health nursing: Promoting the health of
populations (7th ed.). St. Louis, MO: Saunders/Elsevier.
Nies, M. A., & McEwen, M. (2019). Community/Public health nursing: Promoting the health of
populations (7th ed.). St. Louis, MO: Saunders/Elsevier.
Home Health and Hospice
Home visits have been an integral part of nursing for more than a century, originating with
Florence Nightingale’s “health nurses” in England. Following Nightingale’s vision, Lillian Wald
founded the Henry Street Settlement in 1893. In addition, Wald, the “mother of public health
nursing,” launched the Visiting Nurse Service of New York, which has become the nation’s
largest nonprofit home- and community-based health care organization (Ruel, 2014).
Home health care includes a wide range of health care services provided to people in their homes
to help them through an illness or injury (, 2016a). Home health care is typically
more affordable than and just as effective as care that people receive in a hospital or skilled
nursing facility. In addition, home health care is more convenient for people and their families,
as the care they need is brought to them. Examples of home health care services include wound
care, education, IV therapy, nutrition therapy, follow-up with a patient after discharge from the
hospital, and monitoring of an unstable or chronic illness. The goal of home health care is to help
people get better in their own homes to regain as much independence as possible (,
Hospice care focuses on caring for people facing a terminal illness when the goal is no longer
curing the disease (National Hospice and Palliative Care Organization [NHPCO], 2016). Most
hospice care occurs in the home with support given to clients and their families. The goal of
hospice care is that each person will die pain free and with dignity. Ongoing support is provided
to the family after the patient dies (NHPCO, 2016)
Purpose of Home Health Services
The primary purpose of home health services is to provide nursing care to individuals and their
families in their homes. The specific objectives and services nurses offer vary according to the
type of agency providing services and the population served. Nurses who work for public health
departments, visiting nurse associations, home health agencies, hospice agencies, or school
districts usually provide home visits. Nurses who make home visits receive referrals from a
variety of sources, including the patient’s physician, nurse practitioner or nurse midwife, hospital
discharge planner or case manager, schoolteacher, and clinic health care provider. The patient or
the patient’s family can also originate requests for nursing visits to assess and assist in the
client’s health care.
Nurses from clinics or health departments often conduct home visits as part of patient follow-up.
These public health nurses make visits to follow patients with communicable diseases and to
provide health education and community referrals to patients with identified health problems.
Home health nurses who work for home health agencies that are affiliated with hospitals or
nursing registries often make home visits to assist patients in their transition from the hospital to
home. In addition, health care providers in private practice may order these visits when patients
experience exacerbation of chronic conditions.
The focus of all home visits is on the individual for whom the referral is received. In addition,
the nurse assesses the individual–family interaction and provides education and interventions for
the family and the client. The nurse evaluates how the individual and family interact as part of an
aggregate group in the community. The nurse identifies the need for referrals to community
services and performs the referrals as necessary.
Healthy People 2020
2020 Objectives for Home Health and Hospice Care

MICH HP2020-14: Increase the proportion of children with special health care needs
who receive their care in family-centered, comprehensive, coordinated systems.
MICH HP2020-24: Increase the percentage of women giving birth who attend a
postpartum care visit with a health worker.
OA-HP2020-2: Reduce the proportion of unpaid caregivers of older adults who report an
unmet need for caregiver support services.
OA-HP2020-4: Reduce the proportion of noninstitutionalized older adults with
disabilities who have an unmet need for long-term services and supports.
From Healthy People 2020: topics & objectives, 2013. 2017.
Home health care has changed dramatically in the last 20 years in relation to changes in
Medicare home health reimbursement. “The Balanced Budget Act of 1997 (BBA) (Public Law
105–33), which was enacted on August 5, 1997, significantly changed the way Medicare pays
for home health services” (Department of Health and Human Services [DHHS], 2017, p. 3).
Prior to the BBA, home health care agencies (HHAs) were reimbursed using a retrospective
payment system for services rendered. HHAs are now reimbursed using the home health
prospective payment system (PPS). Under the PPS, HHAs receive a fixed amount of money
based on reasonable cost given the client’s diagnosis and plan of care. Since the PPS was
implemented in 2000, the Centers for Medicare & Medicaid Services (CMS) made revisions in
2008 and 2012. The changes included providing coverage for more diagnosis groups and certain
secondary diagnoses, different resource costs depending on the timing of the home health
episodes as well as certain wound and skin conditions, and changes to the therapy schedule from
a single 10-visit threshold to multiple thresholds to allow for more visits if needed (DHHS,
Home health care services have changed to address the needs of the population. Home health
nurses visit clients of all ages and races. They visit clients who are acutely, chronically, or
terminally ill; were recently discharged from the hospital or a rehabilitation facility; need wound
care or intravenous therapy; have a feeding tube or tracheostomy; or high-risk pregnant women.
Home health care continues to focus on the care of sick patients and is expanding to include
health promotion and disease prevention interventions, including client and family education.
Currently, most reimbursement for nursing services is based on the patient’s need for skilled
nursing. On each patient visit, the nurse must document that the care provided is of a skilled
nature that requires the knowledge and assessment skills of a nurse and must verify that the
patient or a family member could not provide the same level of care.
Services coordinated in the home include not only skilled nursing care provided by registered
nurses (RNs), but also the services of physical, occupational, and speech therapists; social
workers; and home health aides. The broader home care industry definition of home health care
includes supportive social services, respite care, community nursing centers, group boarding
homes, homeless shelters, adult day care, intermediate-skilled extended care facilities, and
assisted living facilities (American Nurses Association [ANA], 2008).
In addition, telephone support services are becoming an increasingly important aspect of home
health care (Kelly and Godin, 2014). In telephone support programs, nurses contact clients
through regularly scheduled telephone calls to assess how the client is doing, how well they are
following the plan of care, and if they need additional support services or a home visit.
Telephone support programs are beneficial in improving client outcomes and decreasing
hospitalizations (Kelly and Godin, 2014).
Types of Home Health Agencies
Home health agencies differ in financial structure, organizational structure, governing board, and
population served. The most common types of home health agencies are official (i.e., public),
nonprofit, proprietary, chains, and hospital-based agencies. The number of freestanding
proprietary agencies has grown faster than that of any other type of Medicare-certified home
health agency. Freestanding proprietary agencies now account for 62% of all home health
agencies, and hospital-based agencies for 12% of all certified home health agencies (National
Association for Home Care and Hospice [NAHC], 2010).
There continues to be an increase in the number of managed care agencies, which may have any
type of financial structure. Managed care agencies contract with payers, such as insurance
companies, to provide specified services to the enrolled clients at predetermined prices. Managed
care agencies receive payment before offering services and are responsible for taking the
financial risk of providing care to patients within the budgeted allotment. This arrangement
works well with large numbers of enrolled clients, because the financial risk is spread across a
larger number of people, many of whom are healthy and will not require skilled services.
Official Agencies
Local or state governments organize, operate, and fund official (i.e., public) home health
agencies. These agencies may be part of a county public health nursing service or a home health
agency that operates separately from the public health nursing service but is located within the
county public health system. Taxpayers fund official home health agencies, but the agencies also
receive reimbursement from third-party payers such as Medicare, Medicaid, and private
insurance companies.
Nonprofit Agencies
Nonprofit home health agencies include all home health agencies that are not required to pay
federal taxes because of their exempt tax status. Nonprofit groups reinvest any profits into the
agencies. Nonprofit home health agencies include independent home health agencies and
hospital-based home health agencies. Not all hospital-based home health agencies are nonprofit,
even if the hospital is nonprofit. The home health agency can be established as a profit-
generating service and serve as a source of revenue for the hospital or medical center. In this
situation, the home health agency is categorized organizationally as for-profit and it pays federal
taxes on the profits.
Proprietary Agencies
Proprietary home health agencies are classified as for-profit and pay federal taxes on the profits
generated. Proprietary agencies can be individually owned agencies, profit partnerships, or profit
corporations. Provided that the agencies make profits, investors in corporate proprietary
partnerships receive financial returns on their investments in the agencies. A percentage of the
profits generated are also reinvested into the agencies. Agencies within chains have a financial
advantage over single agencies. The chains have lower administrative costs, because a larger
single corporate structure provides many services. For example, a multiagency corporation has
greater purchasing power for supplies and equipment because it purchases a larger volume. A
single corporate office can provide administrative services such as payroll and employee benefits
for all chain employees, thereby avoiding duplication of these services at each location. Criticism
of proprietary and chain agencies includes concerns over the quality of services provided by
agencies that are profit driven.
Hospital-Based Agencies
Since the implementation of the home health PPS, the number of hospital-based home health
agencies has significantly increased (NAHC, 2010). This trend is not surprising in light of the
fixed reimbursement under PPS and the hospitals’ incentive to decrease patients’ length of stay.
By establishing home health agencies, hospitals are able to discharge patients who have skilled
health care needs, provide the necessary services to the patients, and receive reimbursement
through third-party payers such as Medicare, Medicaid, and private insurance companies. The
rising number of home health agencies affiliated with hospitals indicates that these agencies are
profitable endeavors that provide hospitals with an additional revenue source.
Certified and Noncertified Agencies
Certified home health agencies meet federal standards; therefore they are able to receive
Medicare payments for services provided to eligible individuals. Not all home health agencies
are certified. The noncertified home care agencies, home care aide organizations, and hospices
remain outside the Medicare system. Some operate outside the system because they provide non–
Medicare-covered services. For example, they do not provide skilled nursing care and are not
eligible to receive Medicare reimbursement.
Active Learning
Contact a local home health agency and interview the agency director. Ask what type of agency
it is, the profit status, and whether it is Medicare certified. Report findings to classmates.
Special Home Health Programs
Many home health agencies offer special, high-technology home care services. Offering hightech services at home is both beneficial to the patient’s health and financially advantageous.
Through the implementation of these special programs, patients who require continuous skilled
care in an acute or skilled nursing institution are able to return to receive care in their homes.
From the financial perspective, skilled services provided at home are less costly than
Examples of special services are home intravenous therapy programs for patients who require
daily infusions of total parenteral nutrition or antibiotic therapy, pediatric services for children
with chronic health problems, follow-up for premature infants who are at risk for complications,
ventilator therapy, and home dialysis programs. The key to the success of all these programs is
the patient’s, family’s, or caregiver’s ability to learn the care necessary for a successful home
program and the motivation of these individuals to provide the care. If family or caregiver
support is not available in the home, the patient cannot be a candidate for any of these programs,
and other arrangements for care must be found.
Home dialysis programs are a growing trend. Through such programs, patients learn how to do
dialysis at home with a helper who is often a family member or friend. Patients and their helpers
receive 3 to 8 weeks of training from the dialysis clinic to learn how to use the equipment,
monitor their vital signs, and keep good records of their treatment. The clinic provides the
machine and all of the supplies and furnishes 24-hour telephone support. The patient follows up
at the clinic monthly to ensure that treatments are working and to discuss any issues or concerns
(National Kidney and Urologic Diseases Information Clearinghouse [NKUDIC], 2016).
Reimbursement for Home Care
Any individual older than 65 years who is homebound, under the care of a physician, and
requires medically necessary skilled nursing care or therapy services may be eligible for home
care through a Medicare-certified home health agency. These services must be intermittent or
part-time and require physician authorization and periodic review of the plan of care. The only
exception is hospice care. Any individual older than 65 years who is certified by a physician or a
nurse practitioner (NP) to be terminally ill with a life expectancy of 6 months or less is eligible to
receive the Medicare Hospice Benefit (DHHS, 2016). There is no requirement for the individual
to be homebound or in need of skilled care or for the services to be intermittent or part-time. The
hospice physician or hospice NP must recertify the patient after the first 90 days and then every
60 days to determine whether he or she is still eligible for hospice care (DHHS, 2016).
The rapid growth of the home health market is reflective of the following:
• Increasing proportion of people aged 65 years and older
• Lower average cost of home health care compared with institutional costs
• Active insurer support for home care
• Medicare promotion of home health care as an alternative to institutionalization
Patient or family payments comprise 46% of the private financing (12% of total spending) for
home health services. Private health insurance and nonpatient revenue pay the remaining pri …
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