title: More than squeaky blue shoes and a black bag. Home care in a rural area.
abstract: Overall, the face of public health nursing has changed dramatically during the past several decades, and perhaps the most significant influence-for good or ill-has been the advent of managed care in this specialized domain of nursing practice. As managed care organizations supplant physicians as the gatekeepers of care, deciding when, in what form, and at what cost care is provided, three major changes have occurred in the home care arena. These changes affect patients, their families, the location of their care, and the roles and responsibilities of the health care team. The home care landscape, regardless of geographic setting, has dramatically changed for all participants. In the continuing effort to reduce the high costs of health care, managed care companies are mandating that patients be discharged from the hospital earlier, shifting care to the home. In essence, the home has become a "step-down" unit of the hospital. Patients are being sent home sicker, with higher acuity levels, and at risk for increased morbidity and readmission rates. Families are taking on more responsibility for care provided in the home. In addition, the role of the visiting nurse has changed. She is now a member of an expanded home care team. She acts in a supervisory capacity more often, must contend with complex clinical problems, and often must oversee the use of high-tech equipment. She is no longer seen as the health care team member who wears squeaky blue shoes and renders all home care from the depths of her little black bag, similar to pulling the rabbit out of the hat. She is the leader of a team that includes numerous professional providers.
authors.forename: S F
authors.initials: SF
authors.lastname: Zarbock
mesh_terms: D003152:Community Health Nursing / Q000458:organization & administration*; D006699:Home Care Services / Q000458:organization & administration*; D006801:Humans; D007587:Job Description; D008329:Managed Care Programs / Q000458:organization & administration; D019035:Rural Health Services / Q000458:organization & administration*