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Nurses in the Home Environment

Tuesday, March 14, 2017

As the baby-boomer population continues to age, understanding the different types of home care and what each can provide will become a more important issue for families. A report prepared by the U.S. Senate Special Committee on Aging described long-term care as:
It [long-term care] differs from other types of health care in that the goal of long-term care is not to cure an illness, but to allow an individual to attain and maintain an optimal level of functioning….

According to Caregiver.org, long-term care encompasses a wide array of medical, social, personal, supportive, and specialized housing services needed by individuals who have lost some capacity for self-care because of a chronic illness or disabling condition. So regardless if a loved one needs assistance for a short period of time or long-term care, a nurse at home could be the perfect solution.

What is the difference between an RN and an LPN?

Registered Nurse: An individual becomes a Registered Nurse (RN) by acquiring a Bachelor of Science in Nurse (BSN) or an Associate Degree in Nurse (ADN). Both programs will include courses in social, behavioral, and physical science, in addition to clinical experience in a variety of clinical workplaces. An RN will learn how to properly administer medication to patients as well as other treatments. They will need to perform patient assessments to develop a plan of care and then coordinate that care plan with other caretakers. Registered Nurses are able to perform some diagnostic tests as well as analyze and interpret results. If an RN is caring for a patient with a specific illness, they can instruct patients and family on how to better manage their condition so they are properly prepared when their RN care ends. Additionally, they are able to supervise other caregivers, such as Licensed Practical Nurses (LPN) and home healthcare aides.

Licensed Practical Nurses: A Licensed Practical Nurse (LPN) must complete a practical nursing program with course topics that include nursing, biology, and pharmacology. Additionally, to become an LPN, the candidate must complete supervised clinical training. Under the direction of an RN, an LPN will be able to provide basic medical and nursing care, measure vital signs, and administer medications and treatments to patients. Additionally, they will be able to assist patients with bathing and dressing and report back to RNs and doctors on the status of their patient.

In-Home Nursing Care

The care provided will vary whether an RN or an LPN is attending to the patient. For example, care from an LPN can include catheter, ostomy, and feeding tube care, as well as tracheostomy and ventilator care. If the patient suffers from a traumatic brain injury or spinal cord injury, an LPN will be able to meet the needs of the patient on a day-to-day basis. If the patient requires respiratory treatment, an LPN will be able to provide treatments so the patient’s breathing remains comfortable. Additionally, if the patient requires nutritional support through a nasogastric tube, an LPN will make sure the process is functioning properly and is as comfortable as possible for the patient. An LPN can also administer medication, which will ensure the patient is taking the proper dosages at the correct times.

Since a Registered Nurse has a more advanced level of education, they are able to provide the care an LPN can and more. For example, they are able to both administer medication as well as manage a patient’s medication. They can also manage and administer wound care for patients as needed. If a patient requires IV therapy, an RN can ensure it is handled properly. They are also able to perform needs assessments on a patient in order to help determine what care is required in the future. An RN may be required for post-surgical care at home. A newly diagnosed patient will require education about their disease or aliment, so an RN can help with reinforcement education of needs to both the patient and the family.

Working with In-Home Nursing Staff

The need for in-home nursing care can be a shock to both the patient and their family. The RN or LPN that assists the patient will be a great source of comfort during what can often be a difficult time. This type of care offers a more personal, one-on-one form of treatment for a better patient experience. In-home nursing staff provides often much-needed support to families and allows for collaboration in planning care for their loved one. When a family works with an RN or LPN at home, it allows the patient and the care provider the opportunity to develop their own rapport and routine. This is especially important for the patient, as they will feel they have some control over their life and care while the family is reassured their loved one is getting the level of care they require.

Helpful Resources

There are a number of resources that will help prepare the patient and the family for what in-home care can provide as well as educational materials.

Administration for Community Living: Established in 2012, the Administration for Community Living (ACL) is part of the U.S. Department of Health and Human Services. ACL’s Principal Deputy Administrator serves as Senior Advisor to the HHS Secretary for Disability Policy. Their primary focus is to ensure people with disabilities and older adults can live where they choose and have the opportunity to participate in their communities.

Family Caregiver Alliance: Founded in the late 1970s, the Family Caregiver Alliance is a community-based nonprofit organization focused on the needs of families and friends providing long-term care for loved ones at home. They offer education programs and resources for caregivers and offer support, information, and tools to manage the demands of caregiving.

National Alliance for Caregiving: Established in 1996, the National Alliance for Caregiving is a non-profit coalition that focuses on advancing family caregiving through research, innovation, and advocacy. Recognizing that family caregivers provide important contributions toward maintaining the well-being of those they care for, the Alliance provides support and national advocacy for family caregivers.

Caregiver Action Network: Caregiver Action Network (CAN) is a non-profit organization providing education, peer support, and resources to family caregivers across the country. CAN works to improve the quality of life for the more than 90 million Americans who care for loved ones with chronic conditions, disabilities, disease, and the elderly.


According to The Center for American Progress, the number of Americans over the age of 75 will more than double and the number of those over 85 will roughly quadruple in the first half of this century, overwhelming the nation’s long-term care services with 80 million elderly by 2050—up from the 34 million today who are already mostly underserved. While family support is an important part of in-home care for the elderly or sick, in-home nursing care can help by providing skilled care a layperson does not have. This level of care is critical to keeping a patient home in comfortable surroundings while receiving the care they require.

Staff Writer, Julie Cowan, RN BSN
Director of Nursing