on home visit definition

Nursing Home Visit

Description

A nursing home visit is a family- nurse contact which allows the health worker to assess the home and family situations in order to provide the necessary nursing care and health related activities. In performing  home visits, it is essential to prepare a plan of visit to meet the needs of the client and achieve the best results of desired outcomes.

• To give care to the sick, to a postpartum mother and her newborn with the view teach a responsible family member to give the subsequent care.
• To assess the living condition of the patient and his family and their health  practices in order to provide the appropriate health teaching.
• To give health teachings regarding the prevention and control of diseases.
• To establish close relationship between the health agencies and the public for the promotion of health.
• To make use of the inter-referral system and to promote the utilization of community services

The following principles are involved when performing a home visit:

• A home visit must have a purpose or objective.
• Planning for a home visit should make use of all available information about the patient and his family through family records.
• In planning for a home visit, we should consider and give priority to the essential needs if the individual and his family.
• Planning and delivery of care should involve the individual and family.
• The plan should be flexible.

The following guidelines are to be considered regarding the frequency of home visits:

• The physical needs psychological needs and educational needs of the individual and family.
• The acceptance of the family for the services to be rendered, their interest and the willingness to cooperate.
• The policy of a specific agency and the emphasis given towards their health programs.
• Take into account other health agencies and the number of health personnel already involved in the care of a specific family.
• Careful evaluation of past services given to the family and how the family avails of the nursing services.
• The ability of the patient and his family to recognize their own needs, their knowledge of available resources and their ability to make use of their resources for their benefits.
• Greet the patient and introduce yourself.
• State the purpose of the visit
• Observe the patient and determine the health needs.
• Put the bag in a convenient place and then proceed to perform the bag technique .
• Perform the nursing care needed and give health teachings.
• Record all important date, observation and care rendered.
• Make appointment for a return visit.
• Bag Technique
• Primary Health Care in the Philippines

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Thanks alots for the impressive lessons learnt from the principal of community health care and nursing home

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KEY COMPONENTS IN HOME VISITS

1. Assessment:

• Conduct a thorough assessment of the home environment, including living conditions, safety hazards, and available support systems.

2. Purpose of the Visit:

• Clearly define the purpose of the home visit, whether it is for routine check-ups, health education, medication management, post-discharge follow-up, or addressing specific health concerns.

3. Appointment and Consent:

• Schedule home visits at convenient times for the client and obtain consent for the visit. Respect the client’s privacy and autonomy.

4. Communication:

• Establish effective communication with the client and their family. Listen actively, address concerns, and encourage open dialogue to better understand their needs.

5. Cultural Competence:

• Be culturally competent and respectful of the client’s cultural practices, beliefs, and values. Consider cultural factors when planning and delivering care.

6. Safety Precautions:

• Assess and address safety concerns in the home, including fall risks, fire hazards, and other environmental factors. Provide education on maintaining a safe living space.

7. Medication Management:

• Review medications with the client, ensuring proper administration and understanding. Address any concerns or questions regarding medications.

8. Health Education:

• Provide individualized health education on topics such as chronic disease management, nutrition, hygiene, and preventive care. Use visual aids and written materials as needed.

9. Family Involvement:

• Involve family members or caregivers in the care plan, as appropriate. Consider their support and collaboration in maintaining the client’s health.

10. Health Promotion: – Encourage and facilitate healthy lifestyle choices. Discuss strategies for maintaining or improving health and preventing illness.

11. Assessment of Activities of Daily Living (ADLs): – Evaluate the client’s ability to perform daily activities, such as bathing, dressing, and eating. Provide assistance or make recommendations for improvement as needed.

12. Monitoring and Follow-up: – Establish a plan for ongoing monitoring and follow-up. Determine the frequency of home visits based on the client’s needs and the nature of the healthcare issue.

13. Documentation: – Document the home visit thoroughly, including assessments, interventions, education provided, and any changes in the client’s health status. Maintain accurate and up-to-date records.

14. Collaboration with Other Healthcare Providers: – Collaborate with other healthcare professionals involved in the client’s care, such as physicians, therapists, and social workers. Ensure a coordinated and holistic approach.

15. Respect for Autonomy: – Respect the client’s autonomy and involve them in decision-making regarding their care. Encourage them to express their preferences and goals for health and well-being.

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Complete list of nursing notes link, concurrent & terminal disinfection, cardiopulmonary resuscitation (cpr), back care / back massage / back rub.

Your first task is creating and maintaining a relationship with the family. You partner with the family to understand their hopes and expectations for their child. As you observe and interact with the family and child together, you help the parents maintain an accurate understanding of their child's learning and development. Research studies consistently show the most important role of a home visitor is structuring child-focused home visits that promote parents' ability to support the child's cognitive, social, emotional, and physical development.

When a parent is distracted by personal concerns or crises, you balance listening to the parent and honoring their choice to share concerns with you with eventually bringing the focus back to the child. After assisting a parent in exploring relevant resources and supports, you might say, "This sounds like a very hard time for you. I can see how upset you are. In fact, I've been watching the baby and he looks very concerned about your feelings now. What do you think it's like for him to see you so upset?"

You also take every opportunity to notice and remark on positive actions or interactions on the part of the parent. You bring a strength-based perspective, building on the parent's role as their child's first and most important relationship. For example, "It's wonderful you already know how to comfort her."

In addition to your work on child development, you work with other program staff and community partners to coordinate such services as health, mental health, and oral health services for the family. You offer annual health, vision, hearing, and developmental screening. An important aspect of your work with some families is having strategies and resources for managing a crisis.

In an ongoing way, you help the family move forward with their goals for well-being, economic stability, and self-sufficiency.

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Last Updated: December 3, 2019

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Brief Home Visiting: Improving Outcomes for Children

What is Home Visiting?

Home visiting is a prevention strategy used to support pregnant moms and new parents to promote infant and child health, foster educational development and school readiness, and help prevent child abuse and neglect. Across the country, high-quality home visiting programs offer vital support to parents as they deal with the challenges of raising babies and young children. Participation in these programs is voluntary and families may choose to opt out whenever they want. Home visitors may be trained nurses, social workers or child development specialists. Their visits focus on linking pregnant women with prenatal care, promoting strong parent-child attachment, and coaching parents on learning activities that foster their child’s development and supporting parents’ role as their child’s first and most important teacher. Home visitors also conduct regular screenings to help parents identify possible health and developmental issues.

Legislators can play an important role in establishing effective home visiting policy in their states through legislation that can ensure that the state is investing in evidence-based home visiting models that demonstrate effectiveness, ensure accountability and address quality improvement measures. State legislation can also address home visiting as a critical component in states’ comprehensive early childhood systems.

What Does the Research Say?

Decades of research in neurobiology underscores the importance of children’s early experiences in laying the foundation for their growing brains. The quality of these early experiences shape brain development which impacts future social, cognitive and emotional competence. This research points to the value of parenting during a child’s early years. High-quality home visiting programs can improve outcomes for children and families, particularly those that face added challenges such as teen or single parenthood, maternal depression and lack of social and financial supports.

Rigorous evaluation of high-quality home visiting programs has also shown positive impact on reducing incidences of child abuse and neglect, improvement in birth outcomes such as decreased pre-term births and low-birthweight babies, improved school readiness for children and increased high school graduation rates for mothers participating in the program. Cost-benefit analyses show that high quality home visiting programs offer returns on investment ranging from $1.75 to $5.70 for every dollar spent due to reduced costs of child protection, K-12 special education and grade retention, and criminal justice expenses.

Maternal, Infant and Early Childhood Home Visiting Grant Program

The federal home visiting initiative, the Maternal, Infant and Early Childhood Home Visiting (MIECHV) program, started in 2010 as a provision within the Affordable Care Act, provides states with substantial resources for home visiting. The law appropriated $1.5 billion in funding over the first five years (from FYs 2010-2014) of the program, with continued funding extensions through 2016. In FY 2016, forty-nine states and the District of Columbia, four territories and five non-profit organizations were awarded $344 million. The MIECHV program was reauthorized under the Medicare Access and CHIP Reauthorization Act through September 30, 2017 with appropriations of $400 million for each of the 2016 and 2017 fiscal years. The Bipartisan Budget Act of 2018 ( P.L. 115-123 ) included new MIECHV funding. MIECH was reauthorized for five years at $400 million and includes a new financing model for states. The new model authorizes states to use up to 25% of their grant funds to enter into public-private partnerships called pay-for-success agreements. This financing model requires states to pay only if the private partner delivers improved outcomes. The bill also requires improved state-federal data exchange standards and statewide needs assessments. MIECHV is up for reauthorization, set to expire on Sept. 30, 2022.  

The MIECHV program emphasizes that 75% of the federal funding must go to evidence-based home visiting models, meaning that funding must go to programs that have been verified as having a strong research basis. To date,  19 models  have met this standard. Twenty-five percent of funds can be used to implement and rigorously evaluate models considered to be promising or innovative approaches. These evaluations will add to the research base for effective home visiting programs. In addition, the MIECVH program includes a strong accountability component requiring states to achieve identified benchmarks and outcomes. States must show improvement in the following areas: maternal and newborn health, childhood injury or maltreatment and reduced emergency room visits, school readiness and achievement, crime or domestic violence, and coordination with community resources and support. Programs are being measured and evaluated at the state and federal levels to ensure that the program is being implemented and operated effectively and is achieving desired outcomes.

With the passage of the MIECHV program governors designated state agencies to receive and administer the federal home visiting funds. These designated  state leads provide a useful entry point for legislators who want to engage their state’s home visiting programs.

Advancing State Policy

Evidence-based home visiting can achieve positive outcomes for children and families while creating long-term savings for states.

With the enactment of the MIECHV grant program, state legislatures have played a key role by financing programs and advancing legislation that helps coordinate the variety of state home visiting programs as well as strengthening the quality and accountability of those programs.

During the 2019 and 2021 sessions, Oregon ( SB 526 ) and New Jersey ( SB 690 ), respectively, enacted legislation to implement and maintain a voluntary statewide program to provide universal newborn nurse home visiting services to all families within the state to support healthy child development. strengthen families and provide parenting skills.    

During the 2018 legislative session New Hampshire passed  SB 592  that authorized the use of Temporary Assistance to Needy Families (TANF) funds to expand home visiting and child care services through family resource centers. Requires the development of evidence-based parental assistance programs aimed at reducing child maltreatment and improving parent-child interactions.

In 2016 Rhode Island lawmakers passed the Rhode Island Home Visiting Act ( HB 7034 ) that requires the Department of Health to coordinate the system of early childhood home visiting services; implement a statewide home visiting system that uses evidence-based models proven to improve child and family outcomes; and implement a system to identify and refer families before the child is born or as early after the birth of a child as possible.

In 2013 Texas lawmakers passed the Voluntary Home Visiting Program ( SB 426 ) for pregnant women and families with children under age 6. The bill also established the definitions of and funding for evidence-based and promising programs (75% and 25%, respectively).

Arkansas lawmakers passed  SB 491  (2013) that required the state to implement statewide, voluntary home visiting services to promote prenatal care and healthy births; to use at least 90% of funding toward evidence-based and promising practice models; and to develop protocols for sharing and reporting program data and a uniform contract for providers.

View a list of significant  enacted home visiting legislation from 2008-2021 . You can also visit NCSL’s early care and education database which contains introduced and enacted home visiting legislation for all fifty states and the District of Columbia. State officials face difficult decisions about how to use limited funding to support vulnerable children and families.

Key Questions to Consider

State officials face difficult decisions about how to use limited funding to support vulnerable children and families and how to ensure programs achieve desired results. Evidence-based home visiting programs have the potential to achieve important short- and long-term outcomes.

Several key policy areas are particularly appropriate for legislative consideration:

• Goal-Setting: What are they key outcomes a state seeks to achieve with its home visiting programs? Examples include improving maternal and child health, increasing school readiness and/or reducing child abuse and neglect.
• Evidence-based Home Visiting: Have funded programs demonstrated that they delivered high-quality services and measureable results? Does the state have the capacity to collect data and measure program outcomes? Is the system capable of linking data systems across public health, human services, and education to measure and track short and long-term outcomes?
• Accountability: Do home visiting programs report data on outcomes for families who participate in their programs? Do state and program officials use data to improve the quality and impact of services?
• Effective Governance and Coordination: Do state officials coordinate all their home visiting programs as well as connect them with other early childhood efforts such as preschool, child care, health and mental health?
• Sustainability:  Shifts in federal funding make it likely that states will have to maintain programs with state funding. Does the state have the capacity to maintain the program? Does the state have the information necessary to make difficult funding decisions to make sure limited resources are spent in the most effective way? 

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Home visits and family engagement.

• Barbara Wasik Barbara Wasik University of North Carolina at Chapel Hill
•  and  Donna Bryant Donna Bryant University at North Carolina at Chapel Hill
• https://doi.org/10.1093/acrefore/9780199975839.013.1237
• Published online: 22 March 2023

The importance of engaging families in home visiting was recognized more than a century ago as M. E. Richmond provided guidelines for involving families in the visiting process. She stressed individualizing services and helping families develop skills that would serve them after the home visiting services ended. During the 20th century, early organized efforts in home visiting in the United States built on methods used in other countries, especially European countries. Although interest fluctuated in the United States during the past century, since 2010 interest has increased due primarily to the passage of the Patient Protection and Affordable Care Act that provided for home visiting services to respond to the needs of children and families in order to improve health and development outcomes for vulnerable children and their families.

Engaging families is essential for a productive home visiting experience requiring thoughtful program activities as well as knowledge and skills on the part of the visitor. Program responsibilities begin with the need to make good employment decisions regarding home visitors and then to provide effective training, supervision, and ongoing professional development. Providing professional training in helping skills such as observation, listening, and ways of asking questions to gain or clarify information is essential to ensure visitors can engage families. Using principles for effective home visiting—including establishing a collaborative relationship with the family; individualizing services; being responsive to family culture, language, and values; and prompting problem-solving skills—can enhance the ability of the visitor to engage the family. Programs can provide opportunities for visitors to enhance their skills in developing relationships with and engaging families. Engaging families is a reciprocal process. Some families will have a positive orientation toward working with visitors to accomplish their own goals and objectives; others may be less willing to engage. Although the program and visitors have the main responsibility for engagement, they will face challenges with some families and may need to seek creative solutions to actively engage.

Just as home visitors need to engage parents in order to facilitate new knowledge and skills, parents need to engage their children to foster development. Recent research identified a set of parent–child interactions that visitors can incorporate to foster parent engagement with young children. These challenges are shared across home visit programs, as well as across cultures and countries, regardless of the professional training of the visitors or the goals and procedures of the programs.

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National Research Council (US) and Institute of Medicine (US) Board on Children, Youth, and Families; Geyelin Margie N, Phillips DA, editors. Revisiting Home Visiting: Summary of a Workshop. Washington (DC): National Academies Press (US); 1999.

Revisiting Home Visiting: Summary of a Workshop.

• Hardcopy Version at National Academies Press

CHALLENGES FACED BY HOME VISITING PROGRAMS

The workshop participants identified several critical challenges that face virtually all home visiting programs. They include family engagement, staffing, cultural and linguistic diversity, and conditions, such as maternal depression, that are experienced by many of the participating families.

• Family Engagement

The engagement of families in home visitation programs includes the combined challenges of getting families to enroll, keeping them in the program, and sustaining their interest and commitment during and between visits. Parental engagement is essential to the effectiveness of programs and to the validity of research efforts. For example, ongoing reanalyses conducted by Margaret Burchinal, of the University of North Carolina at Chapel Hill, Jeanne Brooks-Gunn, of Columbia University’s Teachers College, and Michael Lopez, of the Administration on Children, Youth, and Families, of data from the Comprehensive Child Development Program revealed that families at two sites that successfully provided more home visits per participating family showed significant effects on child cognitive outcomes compared with control group families; families at sites that offered less home visiting were significantly below the control group in child outcomes. As noted in the Spring/Summer 1999 issue of The Future of Children, programs “rely to some extent upon changes in parental behavior to generate changes in children’s health and development. If parent involvement flags between visits, then changes in children’s behavior will be much harder to achieve” (Gomby et al., 1999). This general conclusion was repeated throughout the workshop by both practitioners and researchers.

Mildred Winter, of the Parents as Teachers National Center, Inc., cited one of the main barriers to the success of home visiting programs to be the lack of motivation of parents to commit to the program. Many others acknowledged that home visiting is a relatively invasive procedure that entails a huge commitment of time and energy on behalf of parents, primarily mothers. It is therefore not surprising that The Future of Children review indicated that families typically received only half the number of visits prescribed. “The consistency with which this occurs across the models suggests that this is a real phenomenon in implementation of home visiting programs” (Gomby et al., 1999). Even when motivated and eager to participate, as noted by workshop participants, families miss visits because of difficulties associated with rescheduling, given busy families and home visitors with large caseloads.

Workshop participants were in agreement that one of the keys to keeping the family engaged throughout the duration of the program is a good relationship between the home visitor and the family. In the Infant Health and Development Program, home visitors’ ratings of parental engagement in the visits were highly predictive of program effects. As noted by Janet Dean, of the Community Infant Program in Boulder, Colorado, “Home visitors need to create a good relationship -- a safe context -- with the family before they can help the family.” Although some programs target children directly, most home visiting programs are premised on the belief that parents are effective mediators of change in their children, and therefore target the parents directly. Despite the positive findings of some evaluations (such as the reanalysis of data from the Comprehensive Child Development Program), Brooks-Gunn noted that, in general, there is not much evidence to back up the belief in this premise, nor is there a good appreciation for the difficulty of creating sufficient behavioral change in parents to actually improve child functioning. Workshop participants were in agreement that what is needed is better measurement and understanding of the relationship between the home visitor and the mother.

Attrition is endemic to home visitation. Many families not only miss visits, but also leave the program altogether before it is scheduled to end. For example, of the programs reviewed in Spring/Summer 1999 issue of The Future of Children, attrition rates ranged from 20 to 67 percent. Anne Duggan, of Johns Hopkins University’s School of Medicine, reported that the program’s approach to retention can affect attrition rates. The three Hawaii Healthy Start programs that she studied had highly variable attrition rates (from 38 to 64 percent over one year). The program with the lowest attrition rate actively and repeatedly tracked down families that tried to drop out, whereas the program with the highest attrition rate assumed that if the parent did not want to be involved, it was not the program’s responsibility to push her.

What can programs do to increase engagement? Olds surmised that enrolling mothers into the Nurse Home Visiting Programs while they were still pregnant with their first child and therefore highly motivated to learn about effective parenting strategies improved retention rates. Another strategy, which was mentioned by many at the workshop, is to make parents part of the program planning process. This may help parents “buy into” the program from the beginning, in addition to ensuring that the program really addresses the needs of the families it intends to serve. Parents need to believe that the home visiting services will help them accomplish goals that they have set for themselves and that warrant an extensive commitment. Answering the question of how to improve engagement is still a big challenge and an issue that needs much more systematic examination as part of implementation studies.

Virtually every speaker at the workshop commented that the home visitor’s role is critical. As noted by Melmed, “Any service program is only as good as the people who staff it.” In the case of home visiting, the demands on the staff are diverse and often stressful. They must have “the personal skills to establish rapport with families, the organizational skills to deliver the home visiting curriculum while still responding to family crises that may arise, the problem-solving skills to be able to address issues that families present in the moment when they are presented, and the cognitive skills to do the paperwork that is required” (Gomby et al., 1999). Workshop participants identified challenges associated with finding appropriate staff, retaining staff, offering the necessary training and supervision, and matching staff to families with differing needs and predilections, some of which are culturally based and others that are not.

Program designers differ in their views about appropriate staff. Some programs, such as the Nurse Home Visitation Program, rely heavily on professionals (people with degrees in fields relevant to home visiting, such as nursing), but the majority of home visiting programs use paraprofessionals who often come from the community being served and typically have less formal education or training than professional staff beyond that provided by the program. There is an active debate in home visiting over which type of staff is most effective at delivering the curriculum and achieving results. The Nurse Home Visitation Program is based on the premise that nurses are more effective home visitors than paraprofessionals. An evaluation of the Nurse Home Visitation Program in Denver, Colorado, found that families visited by nurses have a lower rate of attrition and complete more visits than families visited by paraprofessionals, even though the paraprofessionals worked just as hard as the nurses to retain families. Olds speculated that the families conferred greater authority upon the nurses and that the nurses were better equipped to respond to the mothers’ needs and feelings of vulnerability. As a result, the mothers may have complied more willingly with the nurses’ guidance.

Others see paraprofessionals as better than professionals at creating the essential relationship with the family, because there is less social distance between paraprofessionals and the families they serve. Pilar Baca, of the Kempe Prevention Research Center for Family and Child Health and a trainer of staff for the Nurse Home Visitation Program, noted that the choice of staff is really a question of “for whom, for what?” She argued for the development of “robust paraprofessional models” as an alternative to assuming that professionals will be the preferred or even feasible option for all circumstances.

Regardless of the prior background of the visitors, they invariably face extremely complex issues when working with families and require appropriate preparation, ongoing information, and constant feedback to perform their jobs well. Many at the workshop commented on the need for more extensive and higher-level staff training, both before the home visitor begins working with families as well as during the course of their employment. Two aspects of training were mentioned often at the workshop. The first pertained to ensuring that the home visitors are well versed and accepting of the desired objectives and the philosophy of the particular home visiting program that they are responsible for implementing. The second had to do with the relatively poor ability of some home visitors to recognize conditions such as maternal depression, substance abuse, and domestic violence that interfere with program implementation, family engagement, and effectiveness.

Staff turnover is a significant problem for many programs. For example, the Nurse Home Visitation Program in Memphis had a 50 percent turnover rate in nurses due to a nursing shortage in the community. Other programs relying more on paraprofessionals reported even higher turnover rates. The Nurse Home Visitation Program in Denver, for example, had no turnover among the nurses who were providing home visits, but substantial turnover among the paraprofessionals. The specific impact of turnover on the effectiveness of programs is unknown, but it is likely to present a real problem since the quality of the home visitor/mother relationship is so predictive of program efficacy.

In this area, home visiting may be able to learn from the experiences of the child care field, since both have similar levels of turnover. In the child care field, turnover has been linked to the low wages earned by child care workers as well as to the quality of care received by children and families. Home visiting positions are also typically low-paying and stressful, and it makes sense that many staff will leave if they find a better-paying opportunity. Other keys to staff retention discussed at the workshop include good supervision and good morale. Providing home-based services can be isolating for the home visitor and, as such, requires a higher, more intense level of supervision. At the same time, because supervisors do not typically accompany staff on home visits and therefore do not observe home visitors performing the intervention, it can be difficult for them to help the home visitor reflect on and learn from their experiences. Despite these difficulties, home visitors need supervision that goes beyond “did you do your job or not” to include elements of social and emotional support, teamwork, and recognition of staff effort. Terry Carrilio, of the Policy Institute at the San Diego State University School of Social Work, aptly observed that the “process needs to reflect what you are trying to do. If a program does not treat its staffwell, how can we expect the staff to deliver a supportive service?”

• Cultural and Linguistic Diversity

Cultural and linguistic considerations are also involved in the decision of who can best deliver home visiting services, but they encompass many other complex issues as well. Home visiting programs deal with fundamental beliefs about how a parent interacts with a child. These beliefs, which are heavily imbued with cultural meaning, provide the foundation for the design and implementation of any program. As noted by Baca, for example, it is likely to be more difficult for a home visitor from a culture different from that of the family to distinguish between practices and beliefs that are culturally different and those that are culturally dysfunctional. This applies as well to evaluators. Linda Espinosa, of the Department of Curriculum and Instruction at the University of Missouri, cautioned that there are possible ripple effects when “we start changing highly personal, highly culturally embedded ways of interacting and socializing children within the family unit. We hope the effects are positive, but we cannot ignore the possibility that they could be negative.” In this context, Espinosa specifically mentioned the potential for programs to upset “the fragile balance of power within the family.”

Decisions about using bicultural and bilingual home visitors are often determined by forces beyond the control of the program. For example, the Family Focus for School Success program in Redwood City, California, chose to hire paraprofessionals because, as Espinosa described, “there were no certificated or B.A.-level people who were bilingual and bicultural and who were floating around in the community waiting to be hired.” Program developers made the decision that having bilingual and bicultural staff was more important than having professional staff. This issue creates certain challenges when programs are expanded since it may not be possible to find enough people willing to be home visitors with the necessary qualifications. The basic question, as for all interventions, is: “Do our goals and outcomes align with the hopes, dreams, and aspirations of the families we serve?”

• Domestic Violence, Maternal Depression, and Substance Abuse

Three conditions that can significantly impede the capacity of a home visiting program to benefit families were identified and discussed at the workshop: domestic violence, maternal depression, and substance abuse. Home visiting programs generally set goals that are preventive in nature: to prevent child abuse and neglect, to improve the nutrition and health practices of the mother, to reduce the number of babies born with low birthweight, and to promote school readiness and prevent school failure. However, the families that are targeted by home visiting programs often experience other problems, such as maternal depression, substance abuse, and domestic violence, that need to be addressed before the prevention goals of the program can be achieved.

For example, an evaluation of the Nurse Home Visitation Program in Elmira, New York, found that the program did not significantly reduce the reported incidents of child abuse and neglect for families who were also experiencing other forms of domestic violence; however, in families where domestic violence was not a confounding factor, the program was effective at reducing child abuse and neglect. Douglas Teti, of the Department of Psychology at the University of Maryland at Baltimore County, commented in his presentation on maternal depression and mental health on the importance of recognizing the true needs of the parent. He used the example of a parent who possesses very good parenting skills, but whose depression reduces her capacity to use them. Only when the depression is treated can the mother’s parenting skills be accurately assessed and, if necessary, addressed. This is particularly important because research has shown that the longer and deeper maternal depression becomes, the worse things become for the child. However, it has also been shown that if a mother’s depression lifts in her child’s early years, negative effects on the child can be mitigated.

Home visitors can play important roles with families in these circumstances. Although it is not an easy task, if they are properly trained and especially if they work as part of a team that includes mental health professionals, home visitors can identify serious problems, break through families’ isolation, provide essential social support, and connect families to appropriate services. Addressing underlying issues is also important for the implementation and evaluation of home visiting programs, since depression, for example, interferes with engagement and motivation to follow up on visits, which makes it more likely that a family will not fully experience the program. Depressed or substance-abusing parents are also poor providers of data about the child. Given the heavy reliance in home visiting on parent report measures, these conditions can compromise the validity of the data used to evaluate effectiveness.

Problems such as depression, substance abuse, and domestic violence often occur along with poverty, compounding the challenges of delivering effective home visiting services. Brooks-Gunn presented evidence from the Infant Health and Development Program that a home visiting and center-based intervention was not effective for poor mothers who were not employed at least part of the time during their children’s first three years of life. She speculated that this is probably due to the relatively high incidence of maternal depression, substance abuse, and/or domestic violence among poor mothers who are long-term welfare recipients who are not engaged in any work activities (including off-the-book activities). Such mothers probably would benefit from a different mix (or intensity) of services or from more treatment-oriented services, rather than the more child-focused home visiting and center-based services typically offered. Several workshop participants agreed that, among these multirisk families, altering the life trajectories of children by altering parenting is an extremely challenging proposition.

• Cite this Page National Research Council (US) and Institute of Medicine (US) Board on Children, Youth, and Families; Geyelin Margie N, Phillips DA, editors. Revisiting Home Visiting: Summary of a Workshop. Washington (DC): National Academies Press (US); 1999. CHALLENGES FACED BY HOME VISITING PROGRAMS.

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Coding for E/M home visits changed this year. Here’s what you need to know

CPT has revised codes for at-home evaluation and management (E/M) services as of Jan. 1, 2023. Services to patients in a private residence (e.g., house or apartment) or temporary lodgings (e.g., hotel or shelter) are now combined with services in facilities where only minimal health care is provided (e.g., independent or assisted living) in these code families:

Home or residence E/M services, new patient

• 99341, straightforward medical decision making (MDM) or at least 15 minutes total time,

• 99342, low level MDM or at least 30 minutes total time,

• 99344 (code 99343 has been deleted), moderate level MDM or at least 60 minutes total time, 

• 99345, high level MDM or at least 75 minutes total time.

Home or residence services, established patient   

• 99347, straightforward MDM or at least 20 minutes total time,

• 99348, low level MDM or at least 30 minutes total time,

• 99349, moderate level MDM or at least 40 minutes total time,

• 99350, high level MDM or at least 60 minutes total time. 

Select these codes based on either your level of medical decision making or total time on the date of the encounter , similar to selecting codes for office visits . The E/M codes specific to domiciliary, rest home (e.g., boarding home), or custodial care (99324-99238, 99334-99337, 99339, and 99340) have been deleted, and the above codes should also be used in those settings.

When total time on the date of the encounter exceeds the threshold for code 99345 or 99350 by at least 15 minutes, you can add code 99417 to report prolonged services. The exception to this is for patients with Medicare. For those patients, report prolonged home or residence services to Medicare with code G0318 in addition to 99345 (requires total time ≥140 minutes) or 99350 (requires total time ≥110 minutes). Code G0318 is not limited to time on the date of the encounter, but includes any work within three days prior to the service or within seven days after.

Services provided in facilities where significant medical or psychiatric care is available (e.g., nursing facility, intermediate care facility for persons with intellectual disabilities, or psychiatric residential treatment facility) are reported with codes 99304-99310 .

— Cindy Hughes, CPC, CFPC

Posted on Jan. 19, 2023

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Homeowners score victory against squatters in New York after landlord handcuffed in $1M home heist

New york lawmakers changed the definition of a 'tenant' to exclude squatters staying on properties without permission after a rash of home takeovers.

New York homeowner on court battle against squatters: 'I want justice'

Juliya Fulman, a Queens, New York, homeowner, whose property was taken over by two squatters in March, discussed the legal battle to regain control of her home.

The "optics" of a homeowner handcuffed after changing the locks on a squatter in her Queens home worth $1 million pushed New York lawmakers to enact a harsh new law to protect property owners, a real estate attorney told Fox News Digital.

A portion of New York's 2024 state budget agreement, signed into law by Gov. Kathy Hochul Monday, specifically excludes squatters from tenant protections under state law. 

The language defines a squatter as someone staying on a property without permission from its owner or the owner's representative. This wording, lawmakers said, will make it easier for police to intervene in squatting cases, sparing homeowners months or even years in housing court.

Real estate lawyer Michael Romer told Fox News Digital the case of Brian Rodriguez pushed lawmakers "over the finish line" to pass anti-squatter legislation. Rodriguez had allegedly commandeered and subletted a home in Queens and summoned police to detain owner Adele Andaloro after she tried to change the locks.

SQUATTER CHARGED AFTER ALLEGEDLY TAKING OVER $1M PROPERTY, GETTING HOMEOWNER ARRESTED FOR CHANGING LOCKS

Adele Andaloro's home in Flushing, Queens, was allegedly taken over by Brian Rodriguez and a group of subletting squatters. Andaloro was removed from the home in handcuffs by police after she changed the locks, according to the Queens District Attorney's Office. (Google Maps)

"I think this is what pushed it over the finish line, the investigation surrounding this case and the media surrounding this case. The optics of a homeowner being taken from their own home in handcuffs. That picture is what inspired Albany to act earlier today," Romer said.

"If somebody was effectively squatting or staying in a property that didn't belong to them and that happened for at least 30 days, then according to the prior laws, that squatter would effectively be considered a tenant and would have to be evicted in the court system," Romer explained. "What this bill change effectively does is it changes the definition as to what a squatter is and no longer affords them tenant's rights.

"It's a game changer." 

Rodriguez, 35, pleaded not guilty to second-degree burglary, fourth-degree grand larceny, fourth-degree criminal possession of stolen property, second-degree criminal trespass and fourth-degree criminal mischief last week, according to the Queens District Attorney's office. 

The Dyker Heights home before it burned to the ground in November. Squatter Cheng Chen, who was arrested for arson and criminal mischief, told police a candle started the inferno. (Google Maps)

NYC HOMEOWNER ARRESTED AFTER STANDOFF WITH SQUATTERS SHE SAYS ILLEGALLY TOOK OVER HER $1 MILLION PROPERTY

On Feb. 29, the office said, Rodriguez forced his way back into Andaloro's home after she changed the locks and tried to hold the door closed. When he claimed that he was a legal tenant, police had no choice but to remove Andaloro from the property. 

The subsequent press coverage, Romer said, prompted the district attorney's office to build a case against the 35-year-old squatter. At least four lawmakers penned legislation to protect homeowners from squatters after his arrest, ABC 7 reported. 

Andaloro was removed from the property but is not facing criminal charges, the Queens District Attorney's Office told Fox News Digital. 

Rodriguez's arrest followed a series of high-profile squatting incidents covered by Fox News Digital.

QUEENS SQUATTERS FLEE $1 MILLION HOME AFTER STAND-OFF WITH HOMEOWNER, VISIT FROM 'VIGILANTES': REPORT

Squatters set fire to a home in Brooklyn's Dyker Heights Nov. 29 after a months-long campaign of terror against their neighbors. Politicians cited the incident as another indication that loopholes enabling squatters needed to be closed.  (LLN NYC)

One squatter, Cheng Chen, was arrested after allegedly starting the fire that burned a home in Dyker Heights, Brooklyn, to the ground earlier this year, causing $900,000 in damage, according to the New York Post.

But even after the 67th Street home became uninhabitable, neighbors said at a rally earlier this month, his fellow squatters took up residence in its backyard.

THE LEFT IS ALL ABOUT SQUATTERS' RIGHTS PUTTING HOMEOWNERS LIKE YOU AT RISK

Owner Zafar Iqbal, 53, told the New York Post he was left powerless by the squatters who "have more rights" than homeowners. He continues to try to refurbish the property , but the unwelcome guests just "keep coming back." 

"I got a call from the fire department that the house is burnt out. Somebody got in there and torched my house," he said. "That’s when I found out it was a squatter living there. The squatters have more rights than the homeowners. I’m the owner of the house. How much more can I do? I need help."

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Romer told Fox News Digital he has seen an "uptick" in instances of squatting complaints from clients compared to his earlier 20 years practicing real estate law. 

State Sen. Jessica Scarcella-Spanton said "no one should return home to find their property seized by squatters, who now have more rights on their property than they do.

"For too long, my constituents have grappled with the current reality where individuals unlawfully occupy their spaces without any recourse. We witness distressing scenarios unfold in the news week after week — hardworking homeowners facing legal repercussions for rightfully reclaiming their own property from individuals who brazenly occupy it without consent." 

Christina Coulter is a U.S. and World reporter for Fox News Digital. Email story tips to [email protected] .

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VP Kamala Harris talks abortion in La Crosse, announces minimum nursing home staff levels

LA CROSSE — In a visit to a purple region of Wisconsin on Monday, Vice President Kamala Harris announced new rules for nursing home staffing and rallied voters around abortion as the race for the presidency remains extremely tight in the battleground state.

"This is a moment where we must stand up for foundational, fundamental values and principles," Harris told supporters during a campaign event at the La Crosse Center. "Here's the other piece that I will say: When we think about what is at stake, it is absolutely about freedom."

The trip to La Crosse reflects Democrats' efforts to make abortion a key factor in motivating turnout for President Joe Biden, including among voters in purple areas or even the traditionally red Milwaukee suburbs.

Women affected by abortion bans in other states campaigned for Biden in Waukesha County last week , and Harris brought a similar message to the area in January . Biden administration officials have also made frequent trips to Milwaukee and Madison this year, both Democratic strongholds.

Democrats have focused blame on former President Donald Trump, who has so far visited Wisconsin once this election cycle. Trump held a two percentage point lead over Biden in the most recent statewide poll by the Marquette University Law School, 51% to 49%, well within the poll's margin of error.

Trump in a video statement earlier this month said abortion restrictions should be left up to the states . Abortions are currently being provided in Wisconsin, but the state Supreme Court could soon weigh in .

"There is a clear line between where we are now and who is to blame," Harris said. "The former president was very clear with his intention — he would fill and appoint three members of the U.S. Supreme Court with the intention that they would overturn the protections of (Roe v. Wade)."

More: Wisconsin abortion laws: What to know after Arizona ruling

Harris announces new rules for staffing levels at nursing homes

Before speaking at the campaign event, Harris met with home health care workers at the Hmoob Cultural & Community Agency, where she announced two new federal rules.

One sets minimum staffing levels in nursing homes that receive federal funding through Medicare and Medicaid — about 3 1/2 hours of staffing per resident per day, a requirement that will be phased in. A registered nurse will also be required on site at all times.

Another rule provides that more Medicaid payments for home care services go toward workers' wages.

"The two announcements that we are making today recognize that we owe you, those workers, so much more than applauding you," Harris said, referencing praise for health care workers during the beginning of the COVID-19 pandemic. "Let's recognize the gift that these talented professionals give to families and to all of us as a society."

Ron Johnson says nursing home rules should be handled locally

In Madison, Republican U.S. Sen. Ron Johnson spoke to reporters about Harris' visit following a roundtable discussion hosted by the state's largest business lobby, Wisconsin Manufacturers & Commerce.

"Anybody who's following me realizes I'm not a real fan of the federal government," Johnson said when asked about the new federal rules for nursing homes.

"So I would much rather allow or have the state government and local governments in charge of the requirements of nursing care facilities, and — anything to do with the citizens of this state, I'd rather have state governments and local governments handle that than some dictate from the federal government that causes more problems or exacerbates more problems than it solves."

New Marquette poll shows abortion is top issue for Democratic voters

In the latest Marquette University Law School poll released last week , 24% of Democratic voters said they consider abortion their most important issue in deciding who to vote for, followed by the economy. For independent and Republican voters, 5% of those groups saw abortion as their top issue.

"People will say to me, 'Well, Sarah, aren't folks just over that whole abortion issue? Haven't they just moved on?" Secretary of State Sarah Godlewski said before Harris' speech. "I am just as mad today as when I heard about the Supreme Court overturning Roe, and I know that I'm not alone."

While abortion was the leading issue among Democratic participants, the economy was the No. 1 issue for all respondents in the survey, followed by immigration and abortion policy. Voters saw Biden better at handling abortion and health care, and Trump better on the economy and immigration.

A majority of registered voters in Wisconsin, 54%, also said they favor a national ban on abortion after 15 weeks of pregnancy with exceptions for rape, incest and the life and health of the mother.

Johnson, in comments to reporters at the Wisconsin Manufacturers & Commerce, again called for a statewide referendum that would put the question of when to ban abortion to voters.

Democrats campaigning on abortion outside of blue strongholds

While Democrats have also highlighted abortion access in suburban Milwaukee, the La Crosse area is much more purple and voted for Biden in 2020. In 2020 , La Crosse County voted 56% for Biden, compared to Trump's 42%.

While Biden officials have stopped in Milwaukee and Madison most frequently, they've also visited Superior on the Minnesota border , Green Bay and the Menominee Nation in northeastern Wisconsin.

More: Did the 2020 presidential election in Wisconsin really come down to a few votes per ward?

La Crosse is located in the 3rd Congressional District, one of two truly competitive U.S. House districts in Wisconsin. The seat is currently held by Republican Rep. Derrick Van Orden. Democrats are focusing more energy on the race compared to the last cycle.

Van Orden has raised much more money than his prospective Democratic challengers, small-business owner Rebecca Cooke and state Rep. Katrina Shankland from Stevens Point.

Neither were spotted at the campaign event, though Democratic U.S. Rep. Mark Pocan from Madison praised Shankland alongside other state legislators from the area in his remarks at the campaign event. Pocan has endorsed Shankland in the race.

Pocan called Van Orden a "chauvinist" and said western Wisconsin is "represented in Congress by someone who has been endorsed by the most extreme groups on abortion."

Jessie Opoien contributed to this report from Madison.

UK home secretary to visit Italy to discuss stopping migrants arriving on boats

LONDON — Britain’s Home Secretary, James Cleverly, is visiting Italy as part of the U.K. government’s efforts to crack down on migrants arriving by small boats.

Cleverly will meet his Italian counterpart, Interior Minister Matteo Piantedosi, and discuss how Italy and Britain can expand their joint work to stop migrants in north Africa from making often perilous journeys across the Mediterranean Sea, officials said Tuesday.

Cleverly will also visit Lampedusa , the southernmost island of Italy which receives the majority of migrants arriving in the country. In September, some 7,000 people arrived from Tunisia on the tiny island in a span of roughly 24 hours, overwhelming the local migrant reception center.

The visit comes as British Prime Minister Rishi Sunak stepped up his calls for the U.K. Parliament to approve his plan to deport some asylum-seekers to Rwanda.

Sunak signed a deal with the east Africa nation two years ago and insisted that his deportation plan is a key deterrent that will help “stop the boats” — small unseaworthy vessels carrying migrants across the English Channel. But the proposal has been repeatedly blocked by court rulings and human rights campaigners who say it is illegal and inhumane.

British officials say the U.K. and Italy are both “global leaders in forging bold and novel solutions to illegal migration.”

“Our countries have shown we are willing to challenge the status quo and use innovative solutions to tackle the issues, while ferociously going after the people-smuggling gangs,” Cleverly said in a statement.

His office referred to a five-year deal recently agreed between Italy and Albania that will see Albania — which is not part of the European Union — house up to 3,000 migrants in two centers for Italy while their asylum requests are being processed.

Like Sunak’s Rwanda plan, that deal was also widely criticized by rights groups.

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Statement from President Joe   Biden on 25 Years Since the Columbine High School   Shooting

Twenty-five years ago today, two students walked into Columbine High School with assault weapons and other firearms they obtained without background checks. They killed twelve of their fellow students and one teacher, injuring nearly two dozen others, and transforming classrooms into crime scenes. Jill and I continue to pray for the survivors and families impacted by this traumatic event, as well as a community that was forever changed. We know that pain never goes away.  Since Columbine, over 400 school shootings have exposed over 370,000 students to the horrors of gun violence. From Newtown to Parkland to Uvalde, we have seen communities across the nation be torn apart by senseless violence. Students across the country now learn how to duck and cover before they learn how to read and write. This violence must end.  I’ve met with countless families who’ve lost loved ones because of gun violence. Their message is always the same: do something. My Administration has answered their call. We created the first-ever White House Office of Gun Violence Prevention, overseen by Vice President Kamala Harris. I signed into law the Bipartisan Safer Communities Act, the most significant gun safety legislation in decades. Last week, my Administration implemented the largest expansion of the gun background check requirement since 1993, addressing the loophole that allowed the Columbine shooters to obtain guns. This action means fewer guns will end up in the hands of domestic abusers, felons, minors prohibited from purchasing firearms, and other dangerous individuals. My Administration will continue taking action, but Congress must do their part. We need universal background checks, a national red flag law, and we must ban assault weapons and high-capacity magazines. We need Congress to do something—do something—so that communities won’t continue to suffer due to the epidemic of gun violence.

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• Final regulations: Definition of domestically controlled qualified investment entity under section 897

When foreign persons are considered to directly or indirectly hold stock in a QIE

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The U.S. Treasury Department and IRS today released final regulations (T.D. 9992) regarding when foreign persons, including qualified foreign pension funds, are considered to directly or indirectly hold stock in a qualified investment entity (QIE) for purposes of determining whether a QIE is domestically controlled and thus not treated as a United States real property interest (USRPI) under section 897.

The final regulations finalize portions of proposed regulations (REG-100442-22) published on December 29, 2022 (read TaxNewsFlash ), other than those portions addressing the section 892 exemption for foreign governments which will be addressed in a separate rulemaking.

The final regulations retain the general approach and structure of the proposed regulations, with certain revisions. The domestic corporation look-through rule was not withdrawn, but its scope was narrowed. In particular, the amount of foreign ownership required to look through a non-public domestic C corporation was increased from 25% or more to more than 50%. In addition, the final regulations adopt a transition rule for existing QIE structures.

The final regulations are effective on the date they are published in the Federal Register, which is scheduled to be April 25, 2024.

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