1.3: Who is Part of the Home Health Care Team

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), medical 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.

Roles of Health Care Professionals on the Home Health Care Team

This information is based on the Occupational Outlook Handbook from the U.S. Department of Labor, Bureau of Labor Statistics (2014). The information within this section is based on typical professional requirements within the United States. For requirements concerning governing laws within specific countries or states, information should be obtained from those particular countries and states.

Physician (MD or DO)

While physicians may not often provide direct health care within the home setting, they oversee patient care, diagnose and monitor conditions, and prescribe medications and treatments. Doctors have graduated from a bachelor’s degree program and medical school. They have passed a licensing exam within their state. All physicians must be licensed within the state they practice. Many doctors also have specialty certifications.

Registered Nurse (RN)

Registered nurses in a home health agency coordinate and manage the patient’s care. RNs perform assessments, monitor test and laboratory results, administer treatments and medications, monitor the patient’s condition, and provide education to the patient and family. Registered nurses supervise LPNs, Home Health Aides, and Personal Care Aides. Registered nurses have degrees from two- or four-year nursing programs, or have graduated from a diploma program, and have passed a licensing examination in order to practice within their state. RNs may have advanced academic degrees and education/certification in specialty areas.

Licensed Practical Nurse (LPN)

Working under the supervision of an RN, a LPN may administer medications, check vital signs, provide wound care, collect samples for testing such as urine and blood, and assist with patient self-care activities. LPNs must complete a state-approved educational program and apply for a license within their state after passing an examination.

Physical Therapist (PT)

Physical therapists help patients to strengthen and restore their ability to be mobile and to prevent further injury. PTs may teach patients to use special equipment such as walkers and canes, assist patients with specific exercises to help regain mobility and strength, and administer treatments such as massage, heat, or cold to help improve patient circulation, reduce pain, prevent disability, and improve muscle and joint function. PTs must obtain a Doctor of Physical Therapy (DPT) degree and pass national and state licensure exams to practice. PTs must be licensed within their state.

Occupational Therapist (OT)

Occupational therapists work with patients to help them learn to adapt to a disability so they may function as independently as possible. OTs help patients perform activities of daily living such as dressing, eating, and bathing. An OT teaches patients how to use assistive and adaptive devices such as special forks, plates, long-handled shoe horns and sponges, and raised toilet seats. OTs usually have a master’s degree in occupational therapy and have passed a national certification exam. OTs must be licensed and/or registered within their state.

Speech-Language Pathologist (SLP)

Speech-Language Pathologists or speech therapists work with patients who have communication or swallowing disorders, who have experienced strokes or accidents, or have a neurological health problem. The SLPs teach patients exercises to improve speech, to effectively communicate, and to safely swallow. They may suggest special diets to aid in swallowing, such as mechanical diets and thickened liquids. Most SLPs have a master’s degree and depending on the state in which they work, must be licensed.

Registered Dietician (RD)

A registered dietician evaluates a patient’s nutritional intake and orders special diets for the patient to follow. They provide education to patients and families about special diets to manage their illness and to improve their nutrition. RDs must have completed a bachelor’s degree and often have a master’s degree. Most states require certification or license to practice.

Medical Social Worker (MSW)

A medical social worker works with the patient and family to help them get support services such as counseling, financial assistance, and community services. An MSW provides emotional support to the family and works as an advocate to help meet the patient’s needs. Social workers typically have at least a bachelor’s degree. Clinical social workers must have a master’s degree and two years post-masters supervised clinical experience. MSWs must be licensed within the state they practice.

Home Health Aide (HHA)

Under the supervision of a nurse, a HHA provides supportive care to patients within their homes. They work to increase or maintain independence, health, and well-being of the patient. HHAs provide or assist with self-care activities such as bathing, dressing, grooming, toileting, feeding, skin care, use of medical supplies and equipment such as walkers and wheelchairs, and assisting with light housework, laundry, and home safety. Depending on the state in which they live and if they work in a certified home health agency, home health aides (HHAs) must be certified and complete training programs.

Personal Care Aide (PCA)

Under the supervision of a nurse, a PCA provides self-care and companionship to a patient. They assist with self-care activities such as bathing, dressing, grooming, toileting, feeding, skin care, and use of assistive devices such as walkers and wheelchairs. They also assist with housekeeping tasks such as laundry, changing bed linens, washing dishes, and preparing meals. Personal care aides may not perform any type of medical service or task, as a Home Health Aide may. A PCA may not take vital signs or glucose meter readings. Personal Care Aides are usually trained on the job. There are no educational requirements to become a PCA, but most PCAs have a high school diploma.

Patient/Family

The patient and their family are the most important parts of the health care team. Patients have the right to make decisions about their health care. They have a right to be informed about treatments and the care they receive. They have a right to refuse treatments, medications, and services. All patients and their families are unique and have various needs, desires, cultures, and traditions. It is important that the health care team respect these individual differences and work to meet each patient’s needs. Without the patient, there can be no health care team.

Self Check Activity \(\PageIndex{1}\)

Match the team member with the role they play:

Team Member	Role
1. Home Health Aide	a. Oversees care, makes diagnoses, and prescribes medications
2. Registered Nurse	b. Most important team member, has the right to be involved in care and refuse treatments
3. Occupational Therapist	c. Assesses a patient’s nutritional status and suggests special diets
4. Medical Social Worker	d. Teaches a patient to use assistive or adaptive devices so they may perform activities of daily living
5. Registered Dietician	e. Under supervision of an RN, administers medications, performs dressing changes, and monitors vital signs
6. Physician	f. Helps restore mobility and prevent injury by working with patients to perform exercises and use special equipment such as wheelchairs
7. Patient	g. Under supervision, provides and assists patients with self-care such as bathing, dressing, and feeding, and performs household tasks. They may not perform medically related tasks
8. Speech-Language Pathologist	h. Under supervision, provides and assists patients with self-care such as bathing, dressing, and feeding, performs household tasks, and may assist with medically related tasks
9. Physical Therapist	i. Connects the patient to community services and provides counseling
10. Licensed Practical Nurse	j. Helps the patient to improve speech and swallowing problems
11. Personal Care Aide	k. Coordinates patient care, supervises LPNS, HHAs, and PCAs, assesses patients, and administers medications

Solution

1. H
2. K
3. D
4. I
5. C
6. A
7. B
8. J
9. F
10. E
11. G