The changing scene in community health nursing.

The DRGs and their aftermath have had an effect on all who are involved with home health care services, including the patient and provider. The staff of home health agencies must be competent, caring professionals who must also be able to cope with the regulatory issues that affect patient care. The effects on patients and families have also increased. Today's health care environment is requiring that they be responsible for self-care programs for many hi-tech procedures as well as care for those who are terminally ill. They are discovering that reimbursement is not available for the many services that they consider necessary, but that third-party payers consider these services to be of a custodial nature and, therefore, nonreimbursable. The effect on physicians is an increased amount of paperwork for home care services, as a result of frequent admissions to and discharges from service and changes in the frequency of visits or treatment plans. There is also the need for the timely signing of the required forms for agencies to meet the requirements of the Medicare program. The effects on the agencies include attempting to maintain financial solvency while providing quality health care services; maintaining staff morale and productivity; making hi-tech services available at an increased cost on a 24-hour basis by qualified staff to remain competitive; and guaranteeing safe, sound policies and procedures for patients and staff. Certainly the advent of DRGs has also had an impact on the nursing profession as it relates to home health care. The benefits of community health nursing identified in the past are no longer applicable in 1988. The job characteristics have changed and are no longer as attractive as they once were to nurses. In a recent publication I said there are times when I feel that I know what a swimmer experiences when being pounded by unrelenting waves in a rough surf. There is hardly time to catch your breath before the next wave hits. The DRG aftermath is just one of these waves. In spite of these never-ending waves, and the multiple internal and external changes, administrators must manage in an effective and efficient manner. We can survive the present turmoil and help to shape the future of the home care industry. Peter Drucker suggests in Managing in Turbulent Times that one should feed the opportunities and starve the problems. The challenge is to view our never-ending waves as opportunities that can take us to new heights in 1988.