Homecare in the Moment
 by Jane Miles
When I began this article about the past 20 years in homecare, many things quickly came to mind. Those were the “big events,” such as the implementation of OASIS, the PPS, the HHABN, and OBQI. It would be hard to think about homecare without considering those.
When I thought a little longer, though, what really struck me were the “moments” that I associate with homecare. As with many things, it’s often the moments that have the real impact on us. By 1987, I had already worked in homecare for several years, so some of my moments go back a little further, but I can trace connections between each of these moments and the way I function today.
- Orientation to my first job as a home health nurse and the enlightening moment my boss explained that the home health RN was the “captain of the ship” — Her approach and that concept have had a lasting effect on the way I’ve oriented others.
- In 1987, while teaching a nurse to fill out a 485, the perplexing moment that she told me she wasn’t a “box person” — Who knew? I began to realize the importance of learning styles.
- After becoming complacent about delays in OASIS implementation, innocently returning from lunch one day to find that, in a moment, OASIS was finalized and life in homecare was forever changed — Advance preparation was a lifesaver.
- All of those “ah ha” moments since the PPS started — These signify the many times we’ve realized that no amount of advance training could have prepared us for all the issues we’d face.
- The first meeting I attended about legal risks in homecare — A scary moment! I began to grasp the complexity of the issues facing home health agencies.
- The interesting moments I’ve been involved in agency ownership changes — Learning about business cycles in this industry made me realize the importance of flexibility and adaptability.
And… the moment in 1994, when I watched a videotape about Medicare regulations, realizing what a wonderful resource I had found, and that the speaker had a very familiar accent. Familiar because it was so much like my own! I discovered that Beacon Health was located in Wisconsin. I wouldn’t be writing this article if it weren’t for that moment! (Thanks, Rich and Diane.)
A big anniversary is always a good time to take stock. Looking back at these moments reminds me that homecare, even at the low points, has been an experience that I wouldn’t trade. The best moments, the fun moments, the “people moments” have made me sure of that.
Jane Miles, MSN, RN, CNAA, BC, is currently a consultant with Beacon Health and a nursing instructor at East Carolina University in Greenville, NC. She began her homecare career in 1978 as a nurse in the field, and has held positions from supervisor to agency director, to Assistant Vice-President for Clinical Operations with a multi-state corporation. Her focus has been on developing clinical managers, policies, staff education, and management processes to ensure delivery of effective clinical services. She has been an active committee member for home health industry organizations.
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