Nutritional support in home care.

Nutritional support was among the first of the high-tech therapies to make the transition from hospital to home. Growth in high-tech home care accelerated in the mid-1980s, following establishment of the prospective payment system. Rapid growth in home care continues amid acquisitions and mergers of home care companies. The HPN and HEN populations have both enlarged and evolved with time, and the current populations mirror changes in health care demographics--showing the largest increases in services to the elderly. Changes have occurred in the types of venous and enteral access devices, infusion systems, parenteral and enteral products, and infusion schedules used by HPN and HEN patients. As therapies have caused less disruption in patients' lifestyles and as services have become more widely available, adaptation to HPN and HEN has become somewhat less difficult. However, patients still report concerns over finances, respite services, and symptoms management. Nurses have a primary role in the preparation of patients for home nutritional support and in the provision of home care services. Nursing research can illuminate the unique contribution of nurses to safe, cost effective, and high quality home nutritional support.