5.1 Respiratory Care in Alternative Settings

Home care or home health care is supportive care that is provided in the home. Home care allows a person to remain in the comfort of their home while they are receiving services to recover from illness, injury, or disability. Home care services are also provided for people who have chronic conditions such as ventilator-dependent individuals, oxygen-dependent individuals, and individuals with chronic obstructive pulmonary disease (COPD). Home care may also be provided for patients who are on hospice. Hospice home care is for patients who have been diagnosed with a terminal illness (an illness that cannot be cured) and who have a prognosis of six months or less. Hospice home care allows people with a terminal illness to remain in the comfort of their homes, surrounded by familiar people and things.

People who receive home care have a variety of needs depending on their physical condition and specific disease or injury. Patients may need assistance with ventilator/noninvasive ventilation equipment or oxygen equipment.

Home health care may be provided by licensed medical personnel such as physicians, registered nurses (RNs), licensed practical nurses (LPNs), physical therapists (PTs), occupational therapists (OTs), speech language pathologists (SLPs), registered dieticians (RDs), social workers (MSWs), respiratory therapists (RTs), wound care specialists, and unlicensed, but certified workers such as home health aides, nursing assistants, and personal care aides. Unlicensed personnel such as home health aides and personal care aides are vital members of the home health care team. Every member of the home health care team has a role to play. When all members work together, they can achieve the goal of caring for the patient^[1].

Respiratory therapists who work in the home care setting should be aware of hazards in the home and adapt a care plan to assist patients in maintaining safety, especially when using oxygen. The following are guidelines for patients who use oxygen in their home:

1. Never smoke while using oxygen and warn visitors not to smoke near you when you are using oxygen.
2. No smoking signs should be posted in your home or on exterior doors to alert visitors that oxygen is being used and/or stored in the home.
3. Stay at least five feet away from open flames, including lighted cigarettes, gas stoves, candles, lighted open fireplaces, or other heat sources.
4. Do not use any flammable products like grease, oils, aerosol sprays, or any petroleum-based lubricants or personal hygiene products while using your oxygen.
5. Store your oxygen system in a clean, secure area away from flammable items. Oxygen cylinders should be secured to prevent accidental falling.
6. Have a fire extinguisher close by. You may wish to notify your fire department that you have oxygen in your home.
7. When using an oxygen concentrator: Avoid using an extension cord. Store the oxygen concentrator in an area that will allow proper air circulation and prevent overheating (not a closet). Store an oxygen concentrator 12-18 inches from any drapes or walls^[3].