The care model at Pediatric Home Service has undergone a dramatic transformation, driven largely by â€œpretty extensive nursing shortages,â€ according to Karletta Crawford, Director of Nursing. â€œItâ€™s not just home careâ€”itâ€™s nursing in general. The elderly are getting older. There are more retiring Baby Boomers than new nurses. Babies are being sustained at a lower gestational age. Weâ€™ve had to look at how we do things. Where are we going to use our precious resources?â€
The major change from the nursing shortage, Crawford said, is that home care by nurses wonâ€™t be provided to lower acuity patients on a permanent basis. â€œItâ€™s more of a transitional modelâ€”you might come home with quite a bit of support, then your child stabilizes and you learn more. Some families can transition to themselves providing care. There will be those children who do still need a paraprofessionalâ€”a certified nurseâ€™s aid, a patient care assistant (PCA) or a community member who wants to be trained. You might need support forever, but not at the level of the past,â€ Crawford said. Pediatric Home Service offers home care nursing, registered dieticians, infusion nurses, pharmacists and respiratory staff, but no PCAs or other paraprofessionals.
The new model has required assessments, interventions and education for existing patients. â€œWeâ€™ve taken it in steps,â€ Crawford said. â€œBecause the patient experience is different, thereâ€™s not a set number of days or months that theyâ€™re going to have a certain amount of nursing.â€ Factors considered include hospitalizations or setbacks in the patientâ€™s situation. â€œBlack and white guidelines would be nice,â€ Crawford said, but patient wellbeing comes first.
Some existing patients have â€œtaken this very hard,â€ Crawford said. â€œIt is a major change. We have been the ones that have been there and for the most part guarantee that we will be there. Theyâ€™ve grown up with that philosophy.â€
Crawford expects that new patients will find it easier to adapt to the â€œnew normalâ€ of nursing shortages in home care. â€œThe ones coming home are just to happy to be home. When we give them that expectation upfront, they go into it with a different mindset. We think of it as glass half full for medical dollars. If weâ€™re able to empower families, weâ€™re saving on medical dollars, too. We have to have a safe care plan and positive outcome.â€