More and more families are faced with providing their own home healthcare for loved ones due to escalating medical costs, unavailability of support, and because they want their loved one to be close to home rather than in a facility. However, this is no easy task. Two professionals in the home healthcare field provide their best tips here to help ease you into caring for your loved one.
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When taking care of someone at home, it’s not just about the everyday stuff – you also need to know how to handle emergencies. Learn basic first aid, understand when something is really wrong, and set up a plan for your family to communicate during emergencies. This way, you’re ready for unexpected situations, and it links up with the survival mindset of being prepared for anything. Experts say combining these skills makes you more confident in looking after your loved ones at home.
In this post
My Experience with Homecare Nursing
I am a Licensed Practical Nurse, EMT, Wilderness EMT, phlebotomist, and CPR/ First Aid instructor. I also instruct disaster medicine with a well known firm and am currently working on my RN. In addition to all that, I work full-time and have done this over the last several years. In addition to this training, I have had the opportunity to care for two relatives on hospice.
I have noticed that many people who are into survival and prepping want to know how to suture a wound or remove “the bullet” or some other “glamorous” task. But the more training I receive and practice in the field, the more I realize how much I do not know, in spite of all my training and experience. It’s no easy task to provide the best possible home healthcare, even during the best of times, much less during an emergency of some sort.
The first steps are to learn the basics and have the proper supplies ready.
NOTE: I strongly recommend anyone that is a caregiver to take the CPR class for medical personnel. It gives much more lifesaving info. But, if only the basic is available, then that’s better than nothing. Fire stations usually offer Basic CPR, and a good First Aid Class is a necessity.
The Most Neglected Medical Training
The most ignored area in medical training that I have seen in survival circles is homecare nursing. Per longtermcare.gov, a person age 65 has a roughly 70% chance of needing some type of long-term care services and supports before they die. However, it’s not just the elderly who may require homecare nursing. Anyone with special needs may also require more specialized care.
So while it may be a boring subject, but it’s an absolute necessity to keep your patient alive and viable.
It saddens me when I deal with a person (young or older) who has contractures, bed sores, develops pneumonia, or just fights to maintain some level of independence because no one in their life provides basic homecare nursing skills.
A Basic Overview of the Homecare Nursing Skill Set
Good basic patient care can be learned and mastered by becoming a CNA (Certified Nursing Assistant). The job of CNAs is to take temperatures and blood pressures, give bed baths, turn, and feed patients. They help monitor for bed sores, pressure areas, changing incontinent patients, and providing basic necessary care. It may not have the glamour or prestige of removing a bullet, but basic patient care is actually more necessary.
Bed Sores
Not everyone understands that a person cannot lie in bed for hours, days, or even weeks without someone really involved in their care. An immobile patient must be turned and checked every two hours. If you turn them and see a red mark on their side, butt, or back, you are probably looking at a bedsore very soon. Bedsores can kill patients!! I have seen Stage 4 pressure ulcers that go to the bone. Do not let that happen. Patients need to be clean, dry and intact – always!
The caregiver needs to study some pictures and articles on skin breakdown. It happens quickly, and once there is a breakdown, even just a small spot, it will always be the first place for the next breakdown. The tissues underneath have now been weakened and will never be strong again. Also, what you see on the surface of the skin is actually larger and deeper than you can see. It’s important to never rub the area of redness because it further breaks the skin down. It’s okay to lotion the area, but don’t rub thinking it will stimulate the blood flow to the area.
Daily Exercise
Bed-bound patients need to be exercised daily to help prevent contractures, a shortening or distortion of muscle or connective tissue. Contractures ultimately have the patient going into a fetal position. In nursing school we have worked with patients that required four adults to just change them and get them out of bed.
Very, very sad.
This exercise involves having the patient move all their joints through their full range of motion. One or more caregivers may have to help with this. Start with the head by going side to side and rotations, move to the neck, shoulders, arms, fingers, knees and toes.
It’s vital to know the correct way to do this, though. If done incorrectly, it can cause harm. Ask a doctor or physical therapist for instructions — a video format will be most helpful.
One simple technique is to use several pillows to use to prop patient into position when rolling for diaper change or for repositioning turning of patient.
Pneumonia
I also use incentive spirometers for lung exercises, which can help prevent pneumonia. If that is not available, try chest physiotherapy. Try cupping your hands and have the patients on their side. Use your cupped hands and tap on the patients back to loosen anything in the lungs. Be care to not use too much pressure but tap several times a day.
There’s a breathing exercise that I repetitively tell everyone is an excellent substitute for an Incentive Spirometer. Most people do not have a spiromete handy, don’t know how to use it, and if the patient is immobile, the person assisting will find it difficult to achieve any results. In that case, have the patient do deep breathing, hold the breath, and then breathe out slowly through whistle lips (pursed lips). This is easy to understand and accomplish, and it’s one less piece of equipment to keep track of.
Strategies for Turning Patients
The first strategy for turning patients is raising the height of the bed. I believe that Medicare/Medicaid now lets the patient have a mechanical bed so the caregiver doesn’t have to crank the bed up. In my last round of home care, I never encountered a crank bed. But, I do agree with having the bed at a higher height if the patient is totally immobile. There are some bed lift blocks that can be bought to raise the bed by about 4 inches.
The incontinence pad (CHUX), while small, does allow for some turning, but when having to change a diaper or to clean a soiled patient/soiled pad, you don’t have much material to work with. A draw sheet works for turning and when a helper not available for cleaning and lets the CNA or the caregiver clean and move the immobile person. So, add several twin sized flat sheets to this list of need to haves. You can buy twin flat sheets at resale/charity shops – stores no longer sell single flat sheets.
More Homecare Nursing Tips
Establish a routine and maintain open communication. Consistency in caregiving tasks helps create a stable environment for your loved one, and regular communication with healthcare professionals ensures you stay informed about any changes in their condition, allowing for prompt adjustments to the care plan.
Supplies
- Gloves – No latex. I prefer Nitrile for durability (available at Costco). It is impossible to have too many. I personally have 10 –12 cases. Each case has 10 boxes of 100 gloves. (Latex allergies are fairly common; there are nitrile allergies but they are far more unusual.)
- Bed pan
- Urinal – Male and female.
- Wash basin
- Emesis basin
- Bed pads for incontinence – Reusable or disposable. The reusables are strong and can be used to help turn/ reposition your patient
- Incontinence briefs (diapers) and pull-ups although these are not for immobile patients
- Baby wipes – You can never have enough.
- Thicken – Makes liquids thick for people with swallowing difficulties.
- Nosey cups – Plastic cups with the nose section cut out to help with liquids for patients with limited mobility
- Incentive spirometers – Lung exercisers.
- Walkers
- Crutches
- Cane – Carbon Fiber is far lighter than other options.
- Bedside commode
- Gait belt – Assistive belt to help a patient ambulate.
- Thermometer
- Oximeter – Necessary to keep track of blood oxygen level.
- Blood pressure cuff and stethoscope
- Manual wheelchair
- Hand Cleaner
- Clorox and sprayer
- Bed with hand cranks – I designed a “raised platform bed” for homecare nursing because I could not justify a hospital bed with hand cranks. The raised bed allows me to care for the patient without killing my back.
- Twin-sized flat sheets. Fold lengthwise for a perfect draw sheet which helps with turning patients on your own.
- Tons of inexpensive wash cloths and a diaper bin. Cleaning up a soiled patient requires a clean wash cloth with each wipe so to not spread bacteria to other parts of the body. Buy white cloths so they can be bleached with each wash.
Sourcing Supplies
Other than your typical medical supplies store, you may be able to find some items second-hand.You’ll want to check them closely for quality and function. Ask to plug items in or for batteries to test them.
Gloves, incontinence pads, diapers, wipes, and other items used repetitively can be ordered online from a DME company rather than from Walmart or Costco/SAMS. If it’s several people being cared for, the items might be able to get a discount or wholesale price. Shop around online.
NOTE: Be extra careful of allergies. If a patient is sensitive to detergents, it can start the skin irritations that end up in sores.
Mental and Emotional Health Needs
When my mother-in-law was confined to a rehabilitation center for four months during the COVID-19 lockdown, her mental health suffered greatly. As I was allowed to visit her during the last weeks of the local lockdown, I immediately put up a whiteboard with daily information and reminders for her.
I printed out large, 8×10 photos of her family members and put those on the wall where she could see them. I used her Android phone to play her favorite music and made a graph on the whiteboard so she could see improvements each week with her physical therapy.
Nothing is more discouraging and degrading than being treated like part of the furniture, so provide the types of music, podcasts, Audible books, and TV shows your patient prefers. Set regular times for conversation and visits with family and friends.
FAQ
Family caregivers should be trained in basic first aid, know how to recognize medical emergencies, and establish a family emergency communications plan. This ensures a prompt and coordinated response in critical situations.
It’s crucial for caregivers to prioritize self-care, seek respite when needed, and communicate openly with other family members to share responsibilities. Building a support network is key.
Common challenges include balancing caregiving with other responsibilities, managing emotional stress, and adapting to changing health conditions. Strategies for coping and seeking external support are essential.
Family caregivers should familiarize themselves with legal aspects, such as power of attorney and advance directives. Understanding insurance coverage and exploring available financial assistance can also be crucial.
Final Thoughts
This is just a starting point to help you begin to think about skills and supplies you may want to add to your repertoire. While it is far from complete it should give you an idea about needs for your patients. The American Red Cross may offer classes in your area to provide more training.
Remember, everyone in your family or group will need training and practice. Creating a Grab-n-Go binder with information will be helpful for you and for anyone who assists you with homecare nursing. Someday, the patient may be you, and these simple procedures may save a life, including your own. Also and most important, many of these tasks are not fun. Many are done for infants and young children without any thought. Please be kind and offer privacy and dignity to your patients. Treat them as you would want to be treated.
What homecare nursing items would you add to this list?
Original guest post by Dave, LPN, EMT, WEMT. Originally published February 3, 2011 and updated.
Great post Lisa! This is a critical skill to learn for any type of emergency. Your list of items is great!
Excellent info! Really timely and well thought out. Appreciate your post!
This is a great article, but being medically prepared could go so much farther. As a Respiratory Therapist living in the interior of Alaska, I see on a daily basis the effects of not only being unprepared, but the devastating impact of smoking, alcohol abuse, etc, on one's ability to survive and thrive in an adverse environment. Knowledge is power! The more you know, the better you can adapt and survive, and aid those around you!
Dan, thanks for the comments. You are so right about being medically prepared. I know that Dave has two other articles planned on the topic, but if you would like to add information or provide an article yourself, that would be great. Such a relatively small percentage of our population has medical training, and yet in the future, that could become the greatest area of need.
Dan,
I agree with you on how much further medical preparedness can go. The "medical" topics are massive. I was trying to cover basics and start the wheels turning for everyone. I know as a Respiratory Therapist you see the long term effects of our poor lifestyles.
Take care and stay safe!
Dave, LPN,EMT, WEMT
Another person in your community who has extensive knowledge of human anatomy and physiology is your local funeral director. Many of the classes they are required to take are pre-med classes. As they are in the business of caring for families in times of severe distress, most are very compassionate people. They are also wayyyy past any 'gross' factor. They would be a good resource if medical personnel are in short supply for whatever reason.
That's quite good advice. I'm amazed by how much medical information is retained, even by people no longer in the medical field. My sister was an RN close to two decades ago, and still remembers so much of her training. Heck, I remember all the basics of First Aid from a class I took when I was in 7th grade!
I also remember all my first aide classes I took in Girl Scouts. That id’s one reason I became a Registered Nurse. I started as a CNA, then worked as LPN and RN in both the long term care unit and the acute care unit (hospital). Now I’m in the emergency department. I noticed that I did not get any first aide training in nursing school, though.
Great point. I would never have thought of them, but it makes a lot of sense. I'd also include a couple more obvious groups – pharmacists, physical therapists and chiropractors. While none are a replacement for an MD, all bring invaluable knowledge.
Outstanding post and information ~ thank you so much! I'd add extra bedding and towels, skin lotion, lots of plastic shopping-type bags for disposing of soiled items (bags with handles so they can be "tied"), room freshener spray & laundry detergent. This isn't from a medical background, only experience but I hope it can help someone.
Excellent article. This is something I have been worried about being unable to do. Your instruction laid it all out in simple, empathetic terms. Thank you so much for taking the time to share you knowledge. I am much more confident that I would be able to care for a bed-ridden loved one. Best of all that’s good to you.
Great Article Dave! As a full-time caregiver for a family member, I have to agree that a lot of people look past the mundane (and likely!) aspects of caregiving. So you suture a wound closed, or splint that broken leg… and then what? Leave you patient laying in the yard, or expect them to get up and be back to normal? Most injuries or illness that require that level of treatment are going to require significant follow up care, and many people are unprepared (in skills and supplies.) I think you did a great job of reminding people of that an encouraging preparedness for the most likely scenarios!
Thank you for the kind words Mrs S. It became very clear to me in doing homecare for family members what is necesary in time, skills and materials.
Your family member is very blessed to have you caring for them!
Keep up the good work!
Dave
You are right on target with respect to learning the basics. Too many posts I've seen cover emergent situations and not the recovery period afterward.
Something to think about along with this is entertainment for the patient. Attitude has a huge impact on our health and healing. If you are stuck being bedridden and your caretaker has others to take care of too you are going to get bored and possibly depressed pretty quickly. When I took care of my grandpa while my mom was at work toward the end of his life he was always happier when someone could take the time to sit with him and play cards or something.
Great article Dave. I hope you have your RN by now & stayed in Home Health.
I am always teaching “clean & dry” to new caregivers & that there is little difference between granny & baby except babies cry when wet or hungry.
I am always happy when people take responsibility for their own health as it is more important to them than anyone.
Great article! I worked in home health for many years and cared for my mom for three. The things I learned from that experience involved the importance of good nutrition and cleanliness. The long term care of any patient requires vigilance and prompt care of infections. I would suggest various sizes of bandages and wound care supplies, not for the gunshots, etc, but for skin breakdowns, falls, burns and other day- to- day accidents that can become serious or deadly in an aged person, child, or those with chronic illnesses. There are a number of common products like vinegar that are excellent for antiseptic purposes. A study of wound care and herbal medicine would also be helpful in survival situations. Most wounds do not require suturing, but they do require daily cleaning and care to promote healing and prevent infection.
Just a suggestion. This would be a good topic for the Alton’s next book along the lines of their “Alton’s Antibiotics and Infectious Diseases” and similar one topic books.
Great idea! I’ll pass that along to him.
about that wound suturing–you shouldn’t do it unless you absolutely know the wound is clean. which it probably isn’t. a sutured wound that isn’t clean will soon be full of pus soup. you and your patient won’t want to deal with that. keeping a wound clean until it can heal without suturing is hard to do, so plan on lots of wound cleansing and bandaging supplies.
and if you do decide suturing is the best plan, consider butterfly tapes or steri strips instead. takes much less skill for the practicioner, is less painful for the patient, works very well for shallower wounds, and is readily available. folks wanting to learn basic emergency/disaster care can also consider the free CERT classes many communities give. that’s Citizens Emergency Response Training. there are many classes on natural disasters, medical emergencies, pandemic responses, triage, search and rescue, etc.
I agree completely. There’s a lot more to suturing than just having a needle and thread.
Ever notice how EVERY movie or TV program has the “wounded” person up and about and in the fight shortly thereafter. I suspect most folks take it for granted that we all heal quickly and get back to ‘normal’ UNTIL we don’t. Especially the elderly, they don’t heal quickly like they did when in their twenties and thirties. Thanks for the mindset of reality in this article.
Food for Thought – An additional consideration that is important to think about when you or your family is faced with this situation is to recognize this decision also comes with a requirement to watch out for and take care of the caregivers. It’s kind of like the story about the “Mechanic’s car”. The mechanic is so busy taking care of everyone else’s car that they don’t get around to taking care of their own. I know from firsthand experience that the commitment to care for another can exact a large toll on the caregiver(s) and their families. If a caregiver goes down, the situation becomes exponentially more difficult.
That is not to say that if it is possible, you shouldn’t step up. I am only saying that it is extremely important to the patient, and all concerned that you think the situation through thoroughly and understand what really will be required. And don’t forget to ADD IN a plan that includes taking care of the Caregiver(s) during that time.
also, think about dressing the invalid so as to make care easier. velcro, snaps, ties. elastic not as much. there is a reason hospital gowns are made the way they are–and it is to facilitate care. your bed patient might “dress up” with a pretty bed jacket over the gown.