No Place Like It: Home Care for Patients With Cancer
It’s more than just four walls and a roof. Home is where most people find comfort, solace, and a sense of familiarity. It’s where the heart is, and there’s no place like it.
With advancements in cancer therapies, treatment care modalities, and technology, many of today’s patients are finding they can receive a large portion of their care in the home. Home care is not a new concept—rather it’s likely the oldest healthcare setting in human history—but it can be a complex and intricate care environment, especially when addressing specific needs related to cancer treatment. At its heart are expert oncology nursing professionals who safely deliver the best possible care for their patients—in the comfort of their own homes.
Recognizing the Benefits of Home Care
For providers unfamiliar with care in the home setting, conjuring an idea of what working in a patient’s home could entail might be difficult. It’s a unique environment, but one that provides benefits to both patients and providers.
“Patients can get most of the care they would normally receive in a facility at their home now: expert nursing care, nurse aid services to help with active daily life, physical therapy, occupational therapy, and more,” ONS member Rebecca McClelland, MSN-Ed, RN, clinical education specialist at the University of Pittsburgh Medical Center Hillman Cancer Center in Pennsylvania, says. “Patients are generally more comfortable in their own environment, and healthcare providers can get a better picture of patients in their environment to be able to provide the best possible care.”
ONS member Jan Hodgson, RN, BSN, PHN, infusion specialist and advanced clinician for Sharp Home Care in San Diego, CA, explains that home care offers an opportunity to provide ongoing assessment and education about treatment and side effects that can be challenging for any patient with cancer.
“When the patient is at home in our care, we are the eyes and ears for the larger healthcare team,” Hodgson says. “One of the biggest things I address in home care is patient and caregiver education. Patients receive a comprehensive lesson at their chemotherapy appointments about their treatment, the side effects to expect, and everything else. But when they get home, most of that information is lost—or we discover it was the family member who really needed the education. Home care nurses provide that ongoing education, and we’re able to emphasize the information that’s specific to those individuals and their unique circumstances.”
Hodgson also says that home care oncology nurses continually assess patients between clinic visits. By recognizing subtle changes in a patient’s condition at home, nurses work proactively to prevent serious adverse events, potentially minimizing the need for emergency department visits.
Navigating the Challenges of Cancer Care at Home
Every home is different and can present its own unique benefits and challenges. Because nurses have little control over the environment, they must be flexible, accommodating, and as safe as possible when working in a patient’s home.
“The most unique challenge I faced in home care is you never know what you will walk into,” McClelland says. “Settings can be very clean and spotless or not. It’s hard to have sterile conditions in the home—even in the cleanest homes—if that’s needed for patient care. Also, infection control is always an issue with patients with cancer, and this is even more important in the home setting. Teaching is a big part of prevention, so teaching hand washing and aseptic techniques to caregivers is a must.”
Understanding the nature of home care nursing, including the need to manage the daily workflow and operate independently without access to colleagues, is a clear departure from outpatient and clinical-based work.
“For home care nurses, it’s important to be able to work independently,” Hodgson says. “At a hospital or clinic, shifts are set to start at a specific time, you have identified tasks to complete, appointments are scheduled, and there’s a flow to your day. For home care, you need to be an independent practitioner. You set your own schedule, make your own appointments, and decide what tasks need to be accomplished. That kind of environment is not for everyone. Home care nurses also don’t have easy access to colleagues for a quick brainstorming session about a tricky patient issue. They need to problem solve efficiently on their own.”
Both Hodgson and McClelland agree that nurses are uniquely suited and prepared to work closely with patients in their homes. Through adept relationship building and self-reliance training, nurses are able to provide patients with a level of efficacy in their own care, while also seeing the big picture through a patient’s cancer journey.
Working With Family Members and Caregivers
A key component is the involvement of family members and live-in caregivers who are vital members of the at-home cancer care team.
“We work very closely with family members or caregivers when treating patients in the home,” Hodgson says. “We provide a lot of education to caregivers, sometimes several caregivers who switch on and off throughout the day. We have to make sure that everyone is on the same page and communicating with each other and with the nurses. Family members are a big part of making sure patients get the care they need at home.”
McClelland recognizes the importance of supporting caregivers and family members, most of whom are not formally trained in the demanding nature of caring for patients with cancer.
“Support for caregivers and family members is crucial,” McClelland says. “They need to be able to talk with the home health nurses about their issues or concerns with patients. They need to communicate if they’re unable to do certain procedures the patient needs or if they’re worn out from caring for the patient. The nurse is crucial to helping find solutions to caregiver problems and connecting them with more supportive care for the patient and potentially a social worker to help.”
Both Hodgson and McClelland also emphasize that home care nurses are central to their patients’ oncology care team. With regular home visits, nurses can quickly assess and respond to changes in patient status.
“In the home health setting, nurses take the lead on the interprofessional team, because they are ones with eyes on the patient,” McClelland says. “Nurses must have finely tuned assessment skills to spot problems immediately and notify the team to make adjustments.”
Embracing Home Care for Patients With Cancer
McClelland recommends that oncology nurses interested in at-home cancer care should know what separates the home setting from working in an institution.
“Home care is very different from inpatient or clinic nursing,” McClelland says. “Nurses need to meet patients where they are, in their own space, without judgment. Conditions in the home are very different from a hospital, clinic, academic institution, or even your own home. Home care nurses must be able to adapt their care in any setting.”
Hodgson encourages clinic-based nurses to reach out to their home care counterparts to better acquaint themselves with the environment, the care provided, and what home care really entails. Understanding the unique roles and responsibilities in different care settings can help demystify what patients and providers experience during their home care.
“If you have the opportunity to join a home care nurse on a joint visit, that’s a valuable experience to see everything firsthand,” Hodgson says. “If not, just speak with your home care colleagues to get a sense of the work. I’ve been a nurse for more than 30 years, and home care nursing is the right fit for me. It gives me the opportunity to not just get to know my patients one on one, but to have that relationship with their family, their friends, their pets—you name it. I see them in their most comfortable setting and deliver the care they need to navigate their disease.”
Ultimately, working in home care is a specialized setting, requiring a unique, adaptable skillset to be successful. Nurses are the driving force in patient-centered care, and they’re leading their patients through the complex cancer journey—no matter the setting.