Cindy Farquhar, RN, BSN, CRRN
Cindy began her homecare career in June 1987.  After working in a shock/trauma unit, she jumped at the opportunity to get a day job.  Some things have stayed the same.

• Many homecare patients live in poverty, an aspect of health care that is largely hidden from hospital nurses.
  
• Patients are confused about their medications and diets.
  And other things have changed.
  
• Uniforms — There was one for spring and another for winter.  Staff would switch from one to the other on designated days.  (That would be considered “authoritarian” today.)
  
• Paperwork — There’s more now but it still needs attention.
  
• Homecare nursing practice — Today, nurses can do more, such as drawing blood, administering IVs.
  
• The involvement of other agencies in patient care — for instance, nutritionists do diet teaching because of the complexity of glycemic control.
  

Cindy is the Clinical Director for Personal Touch Home Care in Towson, MD.  Personal Touch has more than 50 locations in 13 states and is a corporate member of the Beacon Institute.

Jo Milling, RN, BC
In 1986, Jo grew tired of rotating days and nights as a labor and delivery nurse in a large hospital, so she gladly accepted a position at a small but growing homecare agency — where she still works today, 21 years later. She remembers:

• Less paperwork (just the 485, a nurse’s note, medication sheet, care plan, a 30- and 60-day progress note, teaching material, and a five-page history)
  
• Making $9 a visit (including admissions)
  
• Hand-written schedules on index cards for over 300 patients
  
• Never worrying about competition.
  
• Her husband and children helping her assist less fortunate patients chop wood, put plastic wrap over leaking trailer windows, and deliver holiday meals
  
• “Cost reimbursement” and giving the patients what they wanted
  
• The finance and payroll departments using the first computer system because the clinical staff didn’t know what to do with it then
  
• Qualified nurses who were dissatisfied with hospital work flocking to homecare and being turned away.
  In spite of the many changes, Jo believes the one constant is the rewards she and other homecare providers receive from patients.  They put their trust in the homecare staff, and work hard so they can remain in their homes.  No matter how many changes the homecare industry sees in the next 20 years, patients will remain just as grateful and receptive as they have always been.

Jo is the Administrator of Tri-County Home Health Care in Columbia, SC, has subscribed to Homecare DIRECTION since 1994.

Karen Lee, RN, BSN
Karen has worked in home health care since 1982, starting as director of a small homecare agency. For the last nine years, she has worked in compliance and quality improvement.  She has faced three big challenges over the years.

• Consultants’ tips for maximizing reimbursement:  A common rule of thumb was to see every new patient daily for three days.  Even in a per-visit reimbursement system, this was bad advice.
• Nurses who lost sight of the nursing process:  Karen believes if a nurse can plan care based on the patient’s needs, many other things, such as payment and outcomes, take care of themselves.
  
• Bad habits nurses bring with them:  It’s important for homecare nurses to know and understand the agency’s approach to caregiving.
  

Karen is glad that Beacon Health has been around for 20 years because its resources have helped her do a better job.

Karen, Director of Compliance, has been with Home Health Care Affiliates, Inc., in Jackson, MS, for nine years.  Home Health Care Affiliates, a corporate member of the Beacon Institute, has agencies in Mississippi and Colorado.