It is a privilege to watch our home care process in action. I recently joined Rafael, one of our Florida-based nurses with Southeast Homecare, on a home assessment for a patient just discharged from the hospital for cardiovascular and diabetes related complications. This patient had a recovery journey ahead, and Rafael’s compassionate, hands-on care represented the best of what IHCS has to offer.
Our unparalleled home care management process is built on a foundation of cutting-edge patient monitoring technology, personalized data insights, and coordinated transitions of care. These elements unite to ensure our patients receive the high-quality care and peace of mind they need in the home setting. Even with the best of these digital elements, the ultimate driving factor is the personal touch our team brings: the home health nurse or other clinician/caregiver providing care in the home is the one who ultimately ensures that our patients can achieve their recovery, chronic care maintenance, or other health goals.
That’s why, at IHCS, we believe there are three critical elements of any successful home care program: the EYES, EARS, and HEART. Together, they create a complete, hands-on care management program that ensures delivery of consistently high-quality care. On my home visit tagalong, I watched Rafael provide cohesive patient care that demonstrates the value of our three pillars:
- EYES – A first-hand view of the home environment is the first step toward any successful home care process. While claims and discharge data provide valuable medical information, they are incomplete views of an individual’s situation, needs, and potential care barriers that impede recovery in the home – which can contribute to future hospitalizations and ER visits. These visits are so critical, because they allow the home nurse or clinical caregiver to identify and mitigate risks and ensure that together with the patient and loved ones, they can develop a comprehensive care plan that can evolve over time. In this visit, Rafael immediately identified an open sore, which was not previously documented. Knowing his patient has diabetes and other comorbidities, healing this wound became a priority. Rafael’s specialized training in wound care informed the situation, and together with a physician, he crafted a modified care plan. Without this first step, and his “eyes” to assess the situation, this risk factor would have been missed entirely.
- EARS – Next, we believe it is crucial to approach each patient case with the unique attention it deserves by listening with open ears. As Rafael reviewed the patient’s discharge care plan and medication list, he noticed that his patient seemed confused about the intent of certain care requirements and prescribed medications. In typical discharge scenarios, it is easy to miss this subtle sign of confusion – which could impede protocol adherence and recovery. By actively listening to not just what the patient said – but how he said it – Rafael was able to read in between the lines and discern gaps in understanding. Without Rafael’s trained and open ear, this tell-tale sign would have been missed, likely leading to improper medication use and potentially missing important follow-up appointments.
- HEART – Creating connections quickly with patients is critical, especially when they are returning to the home or recovering from a major medical event. Compassionate, open-hearted service is key to our care, which enables our teams to develop deep and personal relationships with every patient. By taking in the scene, listening openly, and showing this patient’s recovery was important to him, Rafael demonstrated that he truly cared – and his patient felt it. This fostered a level of comfort, which encouraged his patient to feel comfortable opening up. I watched a trust-based dialogue emerge, which resulted in the patient better understanding what not only what he needed to do for recovery – but also saw that he was on board with his care plan and that he was fully committed to recovery. This all stemmed from the patient sensing Rafael’s heart was 100% committed to his needs, as though he were a family member or beloved friend.
For high-value care at home, the right technology and a team with unparalleled clinical expertise are critical. Our three-pronged EYES, EARS, and HEART approach makes all the difference in the world for our patient populations who rely on us for specialized, high-quality care from the comfort of their own homes. I am truly honored to work with team members such as Rafael, who bring their whole heart – and open eyes and ears to each and every patient care appointment. Thank you, Rafael, and the rest of our home health team. None of this would be possible without you; you help us unlock the full potential of care in the home, one patient – and one family – at a time.