Home care, especially for the ailing seniors, is not easy. The home caregivers need to follow a lot of set guidelines and rules for making sure that care services provided are just as needed by the patient. Whether it is treating a general patient or dressing the wound of someone who has met with an accident, there are specific processes to follow for every care process and therapy.
The same is applicable for providing Inotropic therapy, especially in a home setting. However, the rules to follow in such types of care processes seem to be more severe simply due to the complicacies involved in it, aimed for the treatment of HF or heart failure. These guidelines of Inotropic therapy are designed by different agencies and organizations such as:
· The National Institute for Health and Clinical Excellence, NICE
· The Heart Failure Society of America, HFSA
· The American College of Cardiology Foundation, ACCF and
· The American Heart Association, AHA.
These guidelines provide all of the home healthcare providers with the necessary clinical resources and therapies to use in the treatment of HF.
However, at this point, it is important and motivating to note that only the ACCF or AHA Task Force guidelines mention the use of an intravenous inotrope therapy in the home setting, though the comments are in brief and not very specific.
The AHA comments
According to this specific guideline it is stated that the decision to go with and continue with the intravenous infusions at home should not be made until all other alternative attempts are made and are proved to have failed repeatedly and substantially in achieving stability in the patient.
· This is because applying such an approach and therapy in a home setting may present a major problem to the family as well as the health care provider.
· There is also an increased risk of death of the patient that may ultimately increase due to this therapy.
Therefore, make sure that the health care provider discusses the matter with the physician and the proper clinical judgment is made with the collaboration with the patient. Remember, all possible treatment options are paramount.
The background of the therapy
It is also required by you as well as your home caregiver to know at least a little bit of the background of the Inotropic therapy before using it of the HF patient at home.
· One of the earliest intravenous inotropes used was Epinephrine and dates as early as the early 20th century.
· The inotropic therapy, however, started to be used routinely in hospitals for treating advanced diseases since the 1950s to 1960s.
· The therapy needs to be given intermittently to the patient over 72 hours and at specific intervals. However, it can also be given continuously.
The ACCF or AHA guidelines, however, do not recommend such therapy using sporadic outpatient infusions of vasoactive drugs such as positive inotropic drugs or Nesiritide. This is because these drugs have not really shown any effectiveness in improving the symptoms and may even jeopardize the survival of patients suffering from advanced HF conditions.
Use of inotropic therapy in homes
The use of inotropes for home care Philadelphia is however more recent. Ideally, this type of therapy is normally reserved for those patients on whom all other traditional therapies and care processes have failed to improve the symptoms in HF patients.
There are different indicators used for this purpose and includes:
· Higher Type B natriuretic peptide
· N-terminal pro b-type natriuretic peptide levels and
· Left ventricular ejection fraction levels that are either less than or equal to 35%.
In order to ensure better results, along with the inotropic therapy, allied patient symptomatology must also be followed by the home care nurse.
Oral inotropes, on the other hand, however, developed in the last couple of decades. These drugs have shown positive results and can immensely improve several symptoms. It is due to its special ability that includes:
· Increasing cardiac output
· Decreasing filling pressures and
· Enhancing the quality of life as seen in most of the cases.
However, the use of chronic oral inotrope has been accompanied by higher mortality rates thereby raising the concerns regarding the intravenous formulations on the whole, which ideally is the prime factor to increase mortality.
With all these diverse possibilities and concerns, the guidelines state that the patients must be fully informed about the therapy and its effects. They must also be adequately informed about the fact that although inotropic therapy may make them feel somewhat better, it still has the potential risk to shorten life expectancy, even if they survive the initial impact of the therapy and the inotropic drugs.
The cost factors
Apart from the consequences, both positive and negative, of the inotropic therapy, another thing that may raise your concerns is the cost factor associated with this therapy.
Though a bit on the higher side of the cost scale, you can still afford such treatments if it is absolutely necessary. This is because you can avail Medicaid waivers and different state funding as well, provided you qualify for it.
Therefore, check out in your area whether you can avail of such benefits in such services and care coordination. Typically, the Medicaid programs are aimed at providing help to older adults and other people with disabilities to remain independent in their homes or in their communities.
These programs include different types such as:
· Assisted Living Waiver
· Home Care Waiver and
· Specialized Recovery Services Program.
In addition to that, there are also specific programs such as state Alzheimer's and Senior Community Service funds. This type of program is designed to provide services to older adults and people with disabilities in specific regions that include:
· Caregiver respite
· Personal care
· Adult daycare
· Transitional care and
· Evidence-based wellness programming.
All you have to do is a little bit of research to find the right type of program that will support your inotropic therapy needs and cost. If you are lucky, you can even earn tax levies by the local government that is also provided to benefit the seniors.