A Registered Professional Nurse does an initial clinical assessment of the patient and their living environment to capture issues and problems that need to be addressed before a patient is admitted to home care. This ensures patient safety as well as company staff caring for the patient
The RN consults and collaborates with the Primary Care Physician as well as with other health care professionals. The MD or PCP authorizes home care with a signed doctor’s order before starting home care services. The RN sets up an individualized patient plan of care, educates patients and their families on various health conditions, assess patient’s status, record observations, administers prescribed medications and treatment. The RN also teaches the patient and families how to cope and manage illnesses or injuries. An Aide’s Plan of Care is also developed by the RN to include what the client’s care by the aide (HHA or PCW) should include as well as provide a supervisory and instruction tool for the RN to use as appropriate for each home visit.
To assess, plan, organize and participate in rehabilitative programs that improve mobility, relieve pain, increase strength or prevent deformity of patients suffering from chronic conditions, illnesses, or injury. Develops an individualized plan of care (POC) outlining goals and expected outcomes of the plan. Uses exercises, stretching maneuvers, hands-on therapy to ease pain, mobility, prevent further pain or injury. The therapist evaluates patient’s progress, modifies POC as needed, educates patients and families how to cope with challenges throughout the process.
To assess, plan, participate in rehabilitative programs that help restore vocational, homemaking and daily living skills as well as general independence to disabled persons. Treats patients with injuries, illnesses, or disabilities through the therapeutic use of everyday activities. Helps the patient develop, recover, improve, and maintain skills needed for daily living and working.
To assess, diagnose, and treat patients with speech, language, voice, and fluency problems. To prevent communication and swallowing disorders in adults and children resulting from a variety of causes such as: a stroke, brain injury, hearing loss, developmental delay, Parkinson’s Disease, or autism. May select alternative communication systems and track their use and perform research related to speech and language problems.
The Medical-Social worker provides clients, families, or vulnerable populations with psychosocial support needed to cope with acute, chronic, or terminal illnesses. Services include advising patient and family caregivers, providing patient education and counselling. Makes needed referrals for other social services (such as long term planning, Power of Attorney, Last Will & Testament, burial planning, among others).
The nutritionist provides assessment and evaluation of the client’s nutritional status and any recommendations for alterations on dietary regimens based on the authorized practitioner’s prescribed diet. Provides direct nutritional counselling to clients with acute condition or changes in their health status that requires education in their dietary regimen to control or prevent complications related to their medical conditions. Counsels patients on behavioral modification and intervention plans on which foods to eat or avoid and by providing personalized information for individuals. Provides consultation and direction to the home care nurse and other staff involved in the clients’ care.