Home-based treatments are a welcome option
When Michelle Johnson was diagnosed with cancer a second time, she decided to rely upon a resource that had helped her the first time around: the ability to receive inpatient-like hospital services in the comfort of her own home.
Johnson used University of Michigan Home Care services after her initial surgery for esophageal cancer. U-M nurses helped with her PICC line, changed her dressings, provided nutritional supplements and educated her about her home-based chemotherapy -- all in the comfort of her own home.
"From day one, I felt completely comfortable and well taken care of," Johnson says.
When the 32-year-old graphic designer had a recurrence eight months later, she decided to use the home-care route again. Johnson goes to the Cancer Center every other week for her infusion. She stays for about two hours to get one chemotherapy infusion, then goes home with a fanny pack containing a second infusion. She hooks it to her port and wears it continuously for 46 hours before disconnecting it at home. A Home Care nurse helps her several times a week with the fanny pack infusion.
"I feel like a regular person," Johnson says. "If I had to sit for two or three days in the hospital's infusion center every week, it would take an emotional toll on me. This way, it doesn't slow me down. With my home chemo, it enables me to do things I want to do. I go out to dinner with friends, I go to fundraisers, I can even do some freelance work now and then."
As more cancer treatments can be done in an outpatient clinic, rather than requiring overnight hospital stays, the next step in care is to bring more services right to patients' homes. Often, patients or their families are asked to handle connecting or disconnecting catheters or pumps, changing dressings and administering injections themselves.
"One of the reasons home care runs so smoothly is that so many procedures have been standardized and coordinated between HomeMed and the U-M Cancer Center," says Debra Kovacevich, M.P.H., B.S.N., R.N., nurse manager at HomeMed. "With such high standards of hospital care, it is easy to transfer standard processes to home care. We also have many patient education materials tailored to our patients."
The Comprehensive Cancer Center's Skills Lab teaches some of these home care skills so that patients can participate in their own treatment and recovery. The focus is on reducing the uneasiness of performing these tasks at home.
With the initial diagnosis and the recurrence of her cancer, Johnson has now used in-home medical care services during post-surgery recovery, radiation and chemotherapy.
"It has been great to be able to see the same nurse every time," Johnson says. "It helps with the continuity. And we talk about things other than cancer."
HomeMed Nurse Theresa Sirrine, R.N., has even trained Johnson's mother, who has a health care background, to disconnect the infusion pump so that Johnson doesn't have to wait for the nurse to arrive after treatment or return to the infusion area.
U-M is accredited in home-based care by the Joint Commission, a nonprofit organization that accredits more than 19,000 health care organizations in the United States. A majority of state governments have come to recognize Joint Commission accreditation as a condition of licensure and the receipt of Medicaid reimbursement. Most commercial payers also require home infusion providers to be accredited.
"Patients really value home care services," says Kovacevich. "They like not being admitted to the hospital or making frequent visits to our infusion center. With our service, patients can call anytime about signs or symptoms that concern them when they are infusing drugs in the home. The nurses, pharmacists and dietitians who comprise our interdisciplinary team are very invested in our patients."
Kovacevich herself is so invested in these patients that she is involved in a number of research projects to make home infusion services even better.
"We're currently waiting for approval for a program in which we'll be training patients who want to disconnect themselves from their chemotherapy devices. And we're looking into using a two-way video program for additional education and training in the home for our antibiotic infusion patients when they are doing the procedures on their own," she says. So far, the model is a split-screen approach that will show both the nurse and the patient, which will enable staff to record patient technique as they learn the procedure.
In the meantime, Johnson says she enjoys a great deal of support from her mother, her family and her friends, many of whom she has known since junior and senior high school. And her new puppy, Cass, is a bundle of joy.
Johnson's advice to patients: "Definitely take advantage of the services available to you. And don't be afraid to ask questions."
A Guide to Home Care Services
Considerations for selecting a home care provider:
- Availability of 24-hour clinical on-call service
- Expertise in home nutrition support
- Availability of a multidisciplinary team, including a dietitian, nurse and pharmacist, to monitor home nutrition support
- Regular patient contact through telephone calls and correspondence
- Psychosocial support: contact with local and national organizations for patients on home nutrition support
- Assistance with reimbursement
- Reliable, courteous delivery; timely response to questions, changes in supplies or HPN (high-performance nutrition) formula
- Adherence to 1998 Nutrition Advisory Group guidelines
How to find home care agencies:
- Your doctor, nurse or social worker can provide information about home care services.
- Your state or local health department should have a registry of licensed home care agencies.
- The Centers for Medicare & Medicaid Services has a list of Medicare-approved agencies on its website.
How to finance home care services:
- Health insurance - coverage varies from plan to plan
- Payment plan through your hospital or home care agency
- Your local Area Agency on Aging if you are the right age or have a disability
- Veterans Affairs (if the disability was caused while on active duty); the home care service will be a VA service
- Local American Cancer Society chapters, which may have information about equipment for loan
- National Association for Home Care & Hospice
- Eldercare Locator
- Centers for Medicare & Medicaid Services
- National Cancer Institute's Home Care for Cancer Patients
For information about U-M Home Care Services, visit www.med.umich.edu/homecare/.