Home Health Programs

Falls are one of the top reasons for hospitalization among seniors. Every year, one in three adults over the age of 65 experiences a fall, which results in more than 2.8 million injuries, more than 800,000 hospitalizations, and 27,000 deaths annually.

To help reduce the risk of a fall, Family Home Health Network has an extensive Fall Prevention Program.

Program Goals

• Fall awareness
• Risk reduction through early assessment, intervention, and education
• Identification of fall risk factors through comprehensive screenings
• Improved quality of life for clients
• Individualized care plans to help improve strength, mobility, gait, and balance
• Evaluation of a client’s activities of daily living, goals, and priorities
• Recommend home modifications to support independence
• Consistent monitoring of vital signs, medications and pain management 
• Educate on the use of medical equipment
• Conduct vision, hearing and vertigo screenings

More than 5 million Americans live with Congestive Heart Failure (CHF). Our care plans, developed with physicians, include comprehensive assessments, patient education, and self-management. Our CHF Program, combined with telehealth monitoring and clinical protocols, results in better patient outcomes and reduced rehospitalizations.

Program Goals

• Smoother transitions between health care settings and home
• Patient education
• Recording daily weight and blood pressure using telehealth monitoring
• Medication reconciliation and administration
• Develop a care plan that includes nutrition and exercise
• Assist in communicating with health care providers
• Ongoing review and adjustment of the care plan 

According to the American Heart Association, 11 million Americans are living with Chronic Obstructive Pulmonary Disease (COPD) and estimates show that millions more are living with undiagnosed COPD. In fact, COPD is the third leading cause of death in the U.S. Family Home Health Network’s clinical team works collaboratively with physicians to administer comprehensive treatment plans that minimize symptoms and increase a client’s quality of life.

Program Goals

• Manage symptoms of COPD
• Smoking cessation
• Ensure proper medication therapies and immunizations
• Improve nutrition, along with airway clearance techniques
• Increase home air quality
• Minimize the risk of infection and pneumonia
• Education on lung functions, oxygen use, and proper breathing techniques
• Stress reduction
• Decrease hospital visits
• Ongoing review and adjustment of the care plan

The Orthopedic Program is designed to improve mobility and function after joint replacement surgery. The program incorporates comprehensive physical therapy, occupational therapy and nursing care and services, according to the surgeon’s protocols. Services begin as soon as the client transitions to home following their hospital or rehab stay to help them get back to doing the things they want as quickly and safely as possible.

Program Goals

• Pre-surgical education
• Smoother transitions between health care settings and home
• Individualized care plan and home exercise program 
• Anti-coagulant monitoring and medication management
• Pain management evaluation and education
• Monitoring of surgical wounds 
• Home safety assessment and modification recommendations
• Assist with the ordering and use of home medical equipment 
• Therapeutic management of arthritis, osteoporosis, fractures and other orthopedic conditions
• Coordination of outpatient therapy services

Chronic pain from arthritis, diabetic neuropathy, joint stiffness or swelling, cancer, sciatica or any other medical condition affects 80% of older adults. And such debilitating pain can lead to anxiety, decreased sleep, nutritional problems and diminished quality of life. Family Home Health Network’s Pain Management Program offers safe and effective interventions to address self-care challenges associated with pain.

Program Goals

• Pain and symptom management
• Assistance with personal care and activities of daily living (ADLs) 
• Fall prevention education 
• Enhanced quality of life and independence

Therapy maintenance is offered to individuals who live with chronic conditions such as Parkinson’s, ALS, MS, stroke, and dementia to help them continue to be able to perform their activities of daily living. The goal of this Medicare-approved program is to treat individuals in their homes with the therapies they need to achieve maximum functioning and independence.

Program Goals

• Maintain maximum functioning and independence
• Care plan development and management
• Provide education
• Design a customized home exercise program
• Provide at-home therapy services that encourage aging in place
• Minimize unnecessary hospitalizations

The team at Family Home Health Network is trained in managing memory care issues such as dementia and its symptoms. Staff members work directly with clients and their caregivers to develop personalized plans of care to maintain or increase mobility, cognitive status, and independence. We also partner with hospitals, physicians, and senior care facilities to provide an integrated continuum of care.

A client’s care team may include physical, occupational and speech therapists; registered nurses; social workers; home health aides; and a clinical psychologist who oversees the program.

Program Goals

• Home modifications to increase safety and independence
• Cognitive training and stimulation
• Enhance balance, muscle strength and stability to prevent falls
• Provide training and education
• Identify adaptive techniques to improve day-to-day functioning
• Implement a wellness dining program
• Improve medication management
• Coordinate additional in-home assistance

The Telehealth Monitoring Program uses a proactive approach to help reduce hospital readmissions for individuals with high-risk chronic conditions.

Telehealth clients are given a monitor that prompts them to collect vital signs at predetermined times each day. The information is then securely transmitted and monitored by the clinical team at Family Home Health Network. The team has the ability to contact clients in real time and communicate with their physicians regarding the need for additional nursing visits, medication adjustments or the need to visit their doctor.

Telehealth monitoring is one of many programs used to assist us in helping our clients better manage their chronic medical conditions.

Program Goals

• Improve clinical efficiency and outcomes, compliance and quality of care
• Real-time monitoring of clients’ conditions
• Detection of early warning signs and symptoms
• Implementation of early interventions
• Reduce hospitalizations 

The Care Transition Program offers continuity of care through more efficient care coordination. Family Home Health Network staff communicates with health care professionals, including physicians, social workers, and case managers at the hospital or short-term/post-acute care facility, to make the transition to home as safe and smooth as possible. The program is designed to meet clients’ needs, with the goal of improving client outcomes and long-term independence.

Program Goals

• Smoother transitions from the hospital or short-term/post-acute care facility to home
• Coordinate and deliver medical equipment in the home
• Effective communication with other health care providers to coordinate care and services
• Assist with scheduling follow-up visits