Home Health Aides Play a Vital Role with Palliative Clients

May 8, 2017

Home health aides play an important but underappreciated role with clients who receive palliative care (also called “comfort care”). While clinicians certainly play a vital role in providing these services, the home health aide is typically the member of the care team to spend the most time with the client and therefore is uniquely positioned to ensure that the client experiences “comfort” in the ways that are most meaningful to them.

Unfortunately, many home health aides have not been introduced to the concept of a palliative approach. At PHI, we believe that the lives of thousands of clients could be improved if home health aides received basic training on this topic. Here are two core topics that we recommend be included:

Pain Management

Palliative care prioritizes addressing the symptoms of a disease so that clients can live the best lives possible regardless of their diagnoses. The clinical members of the team – doctors, nurses, pharmacists, therapists and social workers — each use the tools of their discipline to help clients live with as much comfort as possible. However, these clinicians must rely on caregivers for up-to-date information about the clients’ changing needs.

While home health aides are already trained to be the “eyes and ears” in the home, they may not recognize how this can help palliative clients maintain their quality of life. In particular, home health aides need to know that pain management is often very important for palliative clients.  They should receive enhanced training in recognizing the signs of pain, and should also know common side effects and complications from pain medications. In addition, home health aides should be taught that clients may differ widely in their attitudes toward pain as well as in how they express it.  All of this will help ensure that clients stay as comfortable as possible.

Person-Centered Care

Person-Centered Care focuses on the individual client and his or her unique needs and preferences. While this approach to care is beneficial to all home health clients, it is particularly important for clients receiving palliative services. Home health aides should be well-versed in these six principles of person centered care:

  1. Personhood (viewing the client is as a person, not just as a “diagnosis”)
  2. Knowing the client (understanding the client's unique history and values)
  3. Autonomy and choice (providing the client as much control as possible)
  4. Comfort care (knowing the emotional and physical needs of the client during ADLs)
  5. Nurturing relationships (helping the client to maintain relationships to reduce isolation)
  6. Safe space (safeguarding the security and safety of the physical environment)

Once home health aides are familiar with these principles, they can use them to help guide their choices with individual clients. In particular, these principles can help them answer three key questions: What does a “good day” look like for this client? What helps reduce his or her stress?  What makes this client most comfortable? 

Conclusion

The home health aide is the person who spends the most time with the client and therefore plays a critical role in a palliative approach to care.  Home health aides can ensure that clients get the most that they can out of these services—but we must make sure they have the knowledge they need to do so.  This would benefit not only palliative clients but all clients.  After all, comfort and quality of life are important to everybody. 

PHI is partnering with The Center to Advance Palliative Care to develop trainings for home health aides that will meet this critical need that will be delivered both through conventional in-services and on-line.  Stay tuned for more information about this exciting partnership in the near future!

--Renya Larson, MA, PCC, PHI Organizational Change Consultant



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