Home Health and Rehabilitation: Concepts of Care.

May BJ. Philadelphia, PA 19103-1493, FA Davis Co, 1993, hardback, 381 pp, illus, $60.

Despite an explosion in home health care over the past decade, there has been little written specifically for home health care providers. This book goes a long way toward filling this literature void by offering a resource for occupational therapists and physical therapists working in home health care. The text addresses the concern that home care workers must work as a team yet rarely encounter other team members. It provides guidelines for practice and ideas for treatment progression, and can serve as a companion in the field, usable almost as one would consult with another therapist for new ideas.

The 16 chapters of this book can be divided into four sections. The first section deals with background issues for home health care including its history, the roles of practitioners, and clinical decision making in home health. The second section deals with the specifics of evaluation and treatment of home care clients, including functional assessment, exercise, mobility training, selection of home equipment, and assessment of the home environment. Social and emotional aspects of home care are addressed in the third section. Such factors as multicultural issues, cognitive disorders, and caregiver concerns are covered. The final section includes a variety of issues related to home care, including documentation and reimbursement, special concerns of the pediatric homebound client, and hospice care.

Overall, the book is well written and the content flows smoothly. Most chapters use case studies to exemplify the content and enhance understanding. These case studies are clear and concise; several chapters use the same cases to illustrate important points throughout a given chapter. Tables and figures are used generously in the book, supplementing the text well. Most chapters are well-referenced with current citations, and many include bibliographies.

Much of the content presented in this text is written in very general terms, making it applicable to many treatment settings, rather than specific to home health care. This means, however, that much of the information is not new. The chapter on therapeutic exercise, for example, includes guidelines for setting up exercise programs that are no different from guidelines for setting up any home exercise program, regardless of the therapy setting. Aside from noting the caregiver's role in monitoring or assisting in home exercise sessions, few helpful tips that are specific to the home care setting are included in the guidelines. As just one example, one might mount diagrams of the home exercise program on the walls in the area in which the patient will exercise to help guide the exercise sessions and ensure that written instructions do not become lost. This is not something that a therapist can do when giving exercises to a patient seen in a clinic. Similar tips would be a welcome inclusion in this chapter, especially for therapists new to the home health care field. Still, as a resource for home health care therapists, the exercise guidelines offered are helpful, and the exercises provided are clearly illustrated and concisely described. When the chapter on therapeutic exercise is combined with the chapter on mobility training, the reader is provided with a framework for exercise prescription and treatment progression.

Although the book as a whole is an excellent resource, three chapters bear special mention. The chapter on clinical decision making is clearly the highlight of the book. Two seemingly similar case studies are presented and followed throughout the chapter to illustrate differences in the ways that decisions are made. The authors also draw on prior research on problem solving in the health care professions to identify a model of the relevant variables affecting clinical decisions. In short, the authors describe the complex cognitive processes that therapists engage in as they work with patients in such a way as to make the process completely comprehensible. This chapter is clearly relevant to therapists and other health care practitioners in all practice settings.

Next, the chapter on assessing client function provides an excellent reference for home therapists. This chapter provides a strong rationale for functional assessment and describes a broad array of functional assessment tools. With the emphasis on Medicare and other third-party payers on functional outcomes, assessments in this area are, perhaps, the most important parts of home health physical therapy examination. This chapter provides suggestions for relevant types of functional tests and guidelines for gaining access to standardized functional assessment instruments.

As therapists enter a client's home, they often seem to enter another world, where values and beliefs are very different from their own. Issues of multiculturalism abound in all treatment settings, but in no setting more so than in the client's own home. The chapter on cultural considerations clearly describes why these issues are important, and provides specific examples of how the same action can be interpreted in very different ways, depending on the client's background. Although this chapter does not make use of recent literature on cultural diversity, its inclusion in this text is important if only to increase therapists' awareness of the importance of understanding and respecting clients' value systems.

In summary, this book not only meets its goal of serving as a resource in the home health field, but adds much to the professional literature in this long-neglected area of health care. The text compiles information related to home care into a convenient source and, through references, appendixes, and bibliographies, directs the reader to more sources of information in specific areas. It is well written, completely comprehensible, and practice oriented. I recommend this book for all therapists who work in home care, as well as for those therapists and students considering working in this area.