Nursing Home Visit

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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Center for Medicare Advocacy

Advancing Access to Medicare and Healthcare

Updated Factsheet | CMS Nursing Home Visitation Guidance

December 2, 2021

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Since approximately 86% of nursing home residents and 74% of staff at those facilities in the United States are vaccinated [1] , the Centers for Medicare & Medicaid Services (CMS) has revised its COVID-19 nursing home visitation guidelines. [2] The Center for Medicare Advocacy is committed to ensuring that the rights of older adults and people with disabilities are protected and known. We hav e updated the visitation Fact Sheet to outline CMS’s latest guidance, which firmly outlines that “visitation is now allowed for all residents at all times.” [3] In the event that a nursing home refuses to allow visitation, this Fact Sheet could be used to help residents and their visitors navigate their rights.

[1] CMS. COVID-19 Nursing Home Data . Updated Nov. 14, 2021). Available at: https://data.cms.gov/covid-19/covid-19-nursing-home-data

[2] The Center for Medicare Advocacy originally reported the CMS’s revised visitation guidelines on November 18, 2021. It is available here .

[3] CMS. Nursing Home Visitation – COVID-19 (REVISED) . Available at: https://www.cms.gov/files/document/qso-20-39-nh-revised.pdf

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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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Why Home Visiting?

The evidence base for home visiting, including its cost effectiveness, is strong and growing. Below are examples of home visiting's demonstrated impact on critical needs and why home visiting is a key service strategy for improving infant, maternal, and family outcomes.

Home visiting has measurable benefits.

By meeting families where they are, home visiting programs have demonstrated short- and long-term impacts on the health, safety, and school-readiness of children; maternal health; and family stability and financial security. Home visitors are able to meet with families in their home and provide culturally competent, individualized needs assessments and services. This results in measured improvements in the following outcomes:

Healthy Babies 

Home visitors work with expectant mothers to access prenatal care and engage in healthy behaviors during and after pregnancy. For example—

  • Pregnant participants are more likely to access prenatal care and carry their babies to term.
  • Home visiting promotes infant caregiving practices like breastfeeding, which has been associated with positive long-term outcomes related to cognitive development and child health.

Safe Homes and Nurturing Relationships 

Home visitors provide caregivers with knowledge and training to reduce the risk of unintended injuries. For example—

  • Home visitors teach caregivers how to “baby proof” their home to prevent accidents that can lead to emergency room visits, disabilities, or even death.
  • They also teach caregivers how to engage with children in positive, nurturing ways, thus reducing child maltreatment .

Optimal Early Learning and Long-Term Academic Achievement

Home visitors offer caregivers timely information about child development and the importance of early childhood in establishing the building blocks for life. For example—

  • They help caregivers recognize the value of reading and other activities for early learning. This guidance translates to improvements in children’s early language and cognitive development, as well as academic achievements in grades 1 through 3 .

Supported Families

Home visitors make referrals and coordinate services for children and caregivers, including job training and education programs, early care and education services, and— if needed—mental health and domestic violence resources. Research shows that—

  • Compared with their counterparts, caregivers enrolled in home visiting have higher monthly incomes, are more likely to be enrolled in school , and are more likely to be employed .

Home visiting is cost effective.

Studies have found a return on investment of $1.80 to $5.70 for every dollar spent on home visiting. This strong return on investment is consistent with established research on other types of early childhood interventions.

Learn more in our Primer and annual Yearbook .

define nursing home visit

Stay up to date on the latest home visiting information.

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The Practice of Home Visiting by Community Health Nurses as a Primary Healthcare Intervention in a Low-Income Rural Setting: A Descriptive Cross-Sectional Study in the Adaklu District of the Volta Region, Ghana

Kennedy diema konlan.

1 Department of Public Health Nursing, School of Nursing and Midwifery, University of Health and Allied Sciences, Ho, Ghana

2 College of Nursing, Yonsei University, 50-1, Yonsei-ro, Seodaemun-gu, Seoul 03722, Republic of Korea

Nathaniel Kossi Vivor

Isaac gegefe, imoro a. abdul-rasheed, bertha esinam kornyo, isaac peter kwao, associated data.

The data used to support the findings of this study are included within the article.

Home visit is an integral component of Ghana's PHC delivery system. It is preventive and promotes health practice where health professionals render care to clients in their own environment and provide appropriate healthcare needs and social support services. This study describes the home visit practices in a rural district in the Volta Region of Ghana. Methodology . This descriptive cross-sectional study used 375 households and 11 community health nurses in the Adaklu district. Multistage sampling techniques were used to select 10 communities and study respondents using probability sampling methods. A pretested self-designed questionnaire and an interview guide for household members and community health nurses, respectively, were used for data collection. Quantitative data collected were coded, cleaned, and analysed using Statistical Package for Social Sciences into descriptive statistics, while qualitative data were analysed using the NVivo software. Thematic analysis was engaged that embraces three interrelated stages, namely, data reduction, data display, and data conclusion.

Home visit is a routine responsibility of all CHNs. The factors that influence home visiting were community members' education and attitude, supervision challenges, lack of incentives and lack of basic logistics, uncooperative attitude, community inaccessibility, financial constraint, and limited number of staff. Household members (62.3%) indicated that health workers did not adequately attend to minor ailments as 78% benefited from the service and wished more activities could be added to the home visiting package (24.5%).

There should be tailored training of CHNs on home visits skills so that they could expand the scope of services that can be provided. Also, community-based health workers such as community health volunteers, traditional birth attendants, and community clinic attendants can also be trained to identify and address health problems in the homes.

1. Introduction

Home visit practice is a healthcare service rendered by trained health professionals who visit clients in their own home to assess the home, environment, and family condition in order to provide appropriate healthcare needs and social support services. The home environment is where health is made and can be maintained to enhance or endanger the health of the family because individuals and groups are at risk of exposure to health hazards [ 1 , 2 ]. At home visit, conducted in a familiar environment, the client feels free and relaxed and is able to take part in the activity that the health professional performs [ 1 ]. It is possible to assess the client's situation and give household-specific health education on sanitation, personal hygiene, aged, and child care. The important role the health professional plays during home visits (HV) cannot be overemphasized, and this led Ghana to adopt HV as a cardinal component of its preventive healthcare delivery system. This role is largely conducted by community health nurses (CHN) [ 2 ]. Health education given during HVs is more effective, resulting in behavioural change than those given through other sources such as the mass media [ 3 ].

In the home, the health professionals, mostly CHN monitor the growth, development, and immunization status of children less than 5 years and carry out immunization for defaulters. Care is given to special groups such as the elderly, discharged tuberculosis, and leprosy patients as well as malnourished children [ 1 , 2 ]. It is also possible to carry out contact tracing during HVs [ 2 ]. These services may prevent, delay, or be a substitute for temporary or long-term institutional care [ 4 , 5 ]. HV has potential for bringing health workers into contact with individuals and groups in the community who are at risk for diseases and who make ineffective or little use of preventive health services [ 2 ]. Several factors influence the conduct of HVs. These factors include location of practice, general practitioners age, training status, and the number of older patients on the list and predicts home visiting rate [ 6 ].

The concept of HV has remained in Ghana over the decades, and yet, its very essence is imperative [ 3 ]. In Ghana, home visiting is one of the major activities of CHN. The health visitors, as CHNs were then called, went from house to house, giving education on sanitation and personal hygiene [ 3 ]. These nurses attempt to promote positive health and prevent occurrence of diseases by increasing people's understanding of healthy ways of living and their knowledge of health hazards [ 7 ]. HVs remain fundamental to the successful prevention of deaths associated with women and children under five; yet, there still remain certain gaps in the successful implementation of this innovative intervention in Ghana [ 4 ]. In Sekyere West district in Ashanti Region of Ghana, although nurses had knowledge of home visiting and had a positive opinion of the practice, they could not perform their home visiting tasks or functions up to standard [ 8 ]. Home visiting practice in that district among nurses was found to be very low, even though community members desired more [ 8 ]. The findings indicate that there is a need for HV [ 9 ]. Also identified were several health hazards, such as uncovered refuse containers, open fires, misplaced sharp objects, open defecation, and other unhygienic practices that a proper home visiting regiment can address [ 8 ]. At the service level, lack of publicity about the service, the cost of the service, failure to provide services that meet clients' felt needs, rigid eligibility criteria, inaccessible locations, lack of public transport, limited hours of operation, inflexible appointment systems, lack of affordable child care, poor coordination between services, and not having an outreach capacity were identified as the challenges associated with this kind of service [ 9 – 13 ].

Home visiting is a crucial tool for enhancing family healthcare and the health of every community. Ghana Health Service through home visiting services has supported essential community health actions and address gaps in knowledge and community practices such as reproductive behaviour, nutritional support for pregnant women and young children, recognition of illness, home management of sick children, disease prevention, and care seeking behaviours [ 4 ]. As many interventions are implemented by stakeholders in health to ensure that home visiting practices actually benefit community members, recent studies have not delved into the practices of home visiting in poor rural communities especially in the Volta Region of Ghana. This study assessed the home visiting practices in the Adaklu district (AD) of the Volta Region.

This study assessed the practice of home visiting as a primary healthcare (PHC) intervention in a poor rural district in the Volta Region of Ghana.

2. Methodology

2.1. study design.

This mixed method study employed a descriptive cross-sectional study design as the study involved a one-time interaction with the CHNs and the community members to assess the practice of HVs.

2.2. Study Setting

The AD is one of the districts in the Volta Region of Ghana and has about 40 communities. The district capital and administrative centre is Adaklu Waya. The estimated population of the district was 36391 representing 1.7% of the Volta Region's population before the Oti Region was carved out [ 14 ]. The district is described as a rural district [ 14 ] as no locality has a population above 5000 people. The economically active population (aged 15 and above) represents 67% of the population [ 14 ]. The economically inactive population is in full-time education (55.1%), performed household duties (20.6%), or disabled or too sick to work (4.6%), while the employed population engages in skilled agricultural, forestry, and fishery workers (63.1%), service and sales (12.6%), craft and related trade (14.6%), and 3.4% other professional duties [ 14 ]. The private, informal sector is the largest employer in the district, employing 93.9% [ 14 ]. There are 15 health facilities in the district government health centres [ 4 ], one health centre by Christian Health Association of Ghana, and 10 community health-based planning services (CHPS) of which 5 are functional [ 15 ]. The housing stock is 5629 representing 1.4% of the total number of houses in the Volta Region. The average number of persons per house was 6.5 [ 14 ], and the houses are mostly built with mud bricks [ 15 ]. The most common method of solid waste disposal by households is public dumping in the open space (47.5%). Some households dump solid waste indiscriminately (17.3%), while other households dispose of burning (13.3%) [ 14 ].

2.3. Study Population, Sample, and Sampling Technique

There are about 36391 inhabitants with 6089 households in AD [ 14 ]. This study mainly involved adult members of the household and CHNs from randomly sampled communities in the district. These sampled communities included Abuadi, Anfoe, Ahunda, Dawanu, Goefe, Helekpe, Hlihave, Tsrefe, Waya, and Wumenu. An adult member of the household is a person above the age of 18 years who has the capacity to represent the household. CHN [ 11 ] from the selected communities in the district was recruited. A CHN is a certified health practitioner who combines prevention and promotion health practices, works within the community to improve the overall health of the area, and has a role to play in home visiting.

Estimating for a tolerable error of 5%, with a confidence interval of 95%, and a study population of 6089 households, with a margin of error of 0.05 using Yamane's formula for calculating sample for finite populations, a sample of 375 households were computed. The sample size was increased to 390 to take into consideration the possible effect of nonresponse from participants. Multistage sampling technique was adopted to eventually select study participants. Each community was stratified into four geographical locations: north, south, east, and west with respondents being selected from every second house using a systematic sampling approach. In each household, an adult member of the household responded to the questionnaire.

A whole population sampling method was used to select eleven [ 11 ] CHNs from the specific communities [ 10 ] where the study took place in the district. The CHN that served the 10 selected communities were selected. The numbers selected from each community were Helekpe (18.2%), Waya (18.2%), Anfoe (9.1%), Tsrefe (27.3%) and Wumenu (27.3%). This represented 42.3% of the total CHN community of the district at the time of the study.

2.4. Pretesting

The questionnaire and interview guide were piloted using 30 adult household members and 5 CHNs, respectively, at Klefe CHPS in the Ho municipality. The data collected through the questionnaire were subjected to a reliability test on SPSS (version 22). The pretesting ascertained the respondent's general reaction and particularly, interest in answering the questionnaire. The questionnaire was modified until it produced a Cronbach alpha coefficient of 0.790. It can therefore be concluded that the questionnaire had a high reliability in measuring the objectives of the study. The pretesting helped in identifying ambiguous questions and revising them appropriately. It also helped to structure and estimate the time the respondents used to answer the questionnaires and to respond to the interview.

2.5. Data Collection

Researchers from the University of Health and Allied Sciences School of Nursing and Midwifery were involved in data collection. Five researchers received two days training in data collection, the study tools, and research ethics for social sciences prior to the commencement of data collection. All researchers had a minimum of a bachelor degree in CHN with at least three years' data collection experience.

Respondents were assisted to respond to a questionnaire within their homes. The household questionnaire had four [ 4 ] sections comprising personal details and how HV practice is carried out in the home such as frequency of visit, duration, and activities. Subsequent sections had respondents answer questions on the challenges, benefits, and factors that could promote the HV practice. It took an average of about 15 minutes to complete a single questionnaire.

A semistructured interview guide was used to interview CHNs. This guide was in four sections; the first section was personal details with subsequent sections on practice of home visits, constraints to the practice, the benefits, and promotion factors to HVs. An interview section lasted 20–25 minutes to complete.

2.6. Data Analysis

2.6.1. quantitative data.

Each individual questionnaire was checked for completeness and appropriateness of responses before it was entered into Microsoft Excel, cleaned, and transferred to the Statistical Package for Social Sciences (version 22) for analysis. The data were basically analysed into descriptive statistics of proportions. There were also measures of central tendencies for continuous variables.

2.6.2. Qualitative Data

In data analysis, thematic analysis was engaged that embraces three interrelated stages, namely, data reduction, data display, and data conclusion [ 16 ]. CHNs views were summarised based on the conclusions driven and collated as frequencies and proportions. Guest, Macqueen, and Namey summarised the process of thematic analysis as construing through textual data, identifying data themes, coding the themes, and then interpreting the structure and content of the themes [ 17 ]. In using this scheme, a codebook was first established, discussed, and accepted by the authors. The nodes were then created within NVivo software using the codebook. Line-by-line coding of the various transcripts was performed as either free or tree nodes. Double coding of each transcript was carried out by two of the researchers. Coding comparison query was used to compare the coding, and a kappa coefficient (the measurement of intercoder reliability) was generated to compare the coding that was conducted by the two authors. The matrix coding query was performed to compare the coding against the nodes and attributes using NVivo software that made it possible for the researchers to compare and contrast within-group and between-group responses.

2.7. Ethical Consideration

Ethical clearance was obtained on the 19th September, 2018, from the Research and Scientific Ethics Committee of the Institute of Health Research, University of Health and Allied Sciences (UHAS-REC A.2 [13] 18-19). Permission was sought from the district health authorities, chiefs, and assembly members of each study community. Preliminary to the administration of the questionnaires, an informed consent was obtained as respondents signed/thumb printed a consent form before they were enrolled into the study. Participants could withdraw from the study anytime they wished to do so.

3.1. Household Members' Views regarding Home Visit

The household representatives surveyed (375) had a mean age of 41.24 ± 16.88 years. The majority (26.5%) of household members were aged between 30 and 39 years. Most (75.1%) were females. The majority (97.1%) of people in households were Christians, while 38% was farmers. The majority (69.9%) of household members were married as 47.2% had schooled only up to the JHS level as at the time of this survey as given in Table 1 .

Demographic characteristics of household members.

The majority (73.3%) of adult household members had ever been visited by a health worker for the purpose of conducting HVs as a significant number (26.7%) of household members had never been visited by health workers in the community. Most (52.6%) household members had had their last visit from a health worker during the past month. Within the past three months, some (48.2%) community members were visited only once by a health worker. The majority (93.4%) of community members were usually visited between the time periods of 9am and 2pm as given in Table 2 . The community members contend that home visiting was beneficial to the disease prevention process (65%). The people that need to be visited by CHNs include children under five (25%), malnourished children's homes (14%), children with disabilities (14%), mentally ill people (11%), healthcare service defaulters (22%), people with chronic diseases (9%), and every member of the community (5%).

Practice of home visits in AD (household members).

Most (87.9%) community members were given health education during HVs conducted by the CHN. In describing the nature of health education that is most frequently given by CHNs during HVs, household members indicated fever management (14%), malaria prevention (20%), waste disposal (11%), prevention and management of diarrhoea (22%), nutrition and exclusive breastfeeding (14%), hospital attendance (14%), and prevention of worm infestations (5%). The majority (62.3%) of community members did not receive a minor ailment management during HVs as most (66.5%) of community members received vaccination during HVs by CHNs. Describing the type of minor ailment treatment given during the HV include care of home accidents (13%), management of minor pains (22%), management of fever (45%), and management of diarrhoea (20%). Household members (24.5%) did identify bad timing as a barrier for home visiting, while some (13.1%) did identify the attitude of health workers as a barrier to home visiting. However, most (67.3%) of the household members attributed their dislike for home visiting to the duration of the visit. The majority (95.2%) of household members indicated health workers were friendly. Some household members (78%) indicated they benefited from HVs conducted in their homes. The majority (91.4%) of household members showed that time for home visiting was convenient. Indicating if household members will wish for the conduct of the HV to be a continuous activity of CHNs in their community, the respondents (82%) were affirmative.

3.2. CHNs Views on Home Visit in AD

The mean age of CHNs was 30.44 ± 4.03 years as some (33.3%) were aged 32 years as the modal age. The CHNs (90.9%) were females with the majority (81.8%) being Christians as given in Table 3 .

Demographic characteristics of CHN.

In assessing the home visiting practices of CHNs, the researchers had some thematic areas. These thematic areas that were discussed include but not limited to the concept of HV by CHN, factors that influence the conduct of HVs, ability to visit all homes within CHN catchment area, reasons for conducting or not able to conduct HV, frequency of conducting home visits by CHN, and activities undertaken during HVs. This view that was expressed was simply summarised based on the thematic areas and presented in Table 4 as descriptive statistics related to the CHN conduct of HVs.

Summary of CHNs home visit practice in AD.

3.2.1. Concept of Home Visit by CHN

CHNs have varied descriptions of the concept of HV as it is conducted within the district. The description of HV was basically related to the nature and objective that is associated with the concept. The central concept expressed by participants included a health worker visiting a home in their place of abode or workplace, providing service to the family during this visit, and this service is aimed at preventing disease, promoting health, and maintaining a positive health outcome. These views were summarised when they said

“HVs are a service that we (CHNs) rendered to the client and his family in their own home environment to promote their health and prevent diseases. The central idea is that during the HV, the CHN is able to engage the family in education and services that eventually ensure that diseases are prevented and health is promoted.”

“HV is the art when the CHNs visit community members' homes to provide some basic curative and largely preventive healthcare services to clients within their own homes or workplaces. During this visit, the CHN helps the entire family to live a healthy life and give special attention or care to the vulnerable members of the society.”

“It is the processes when at-risk populations are identified; then, the CHN provides services to this cadre within their own home environment and sometimes workplaces as the case may be. Essentially, the CHN assists the family to adopt positive behaviours that will ensure they live with the vulnerable person in a more comfortable way.”

3.2.2. Factors that Influence the Conduct of Home Visits

The CHNs enumerated a cluster of factors that influence the conduct of HVs within the district. These factors ranged from community members education, attitude, supervision challenges, lack of incentives, and lack of basic logistics to conduct HVs. The uncooperative attitude of community members was identified by CHNs (36.4%) as a barrier to HVs. As they indicate, some community members did not support the continued visit to their homes or did not give them the necessary attention needed for the provision of services.

“Some community members do not understand the importance of HVs in the prevention of disease and for that matter are less receptive to the conduct of HVs. They just do not see the need for the service provider to come to their homes to provide services.”

“The client is the master of his own home; when you get into a home for a HV, the owner should be willing to talk or attend to you. Sometimes, you get into a home and even if you are not offered a seat, or you are just told we are busy, come next time. You know community service is not a paid job, so because the community members do not directly pay for the services we provide, essentially less premium is placed on the activities we conduct.”

“There is some resistance to HVs by some community members. Sometimes, you come to a house and can feel that you are not wanted; meanwhile, the home is part of the home that needs and has to get a HV because of the special needs they have. This is particularly specific in homes that believe that the particular problem is a result of supernatural causes.”

3.2.3. The Ability to Visit All Homes within CHN Catchment Area

The conduct of HVs is a basic responsibility for all CHNs as they remain as an integral part of the PHC delivery system in Ghana. Based on the nature and problems in the community, CHNs strategizes various means that will aid them to provide this essential service efficiently. CHNs (81.8%) are able to visit all homes in the catchment areas during a quarter. Some of the responses included the following:

“We do organise HVs, this is part of our routine schedule. As a community health nurse, to enjoy your work, you will need to organise HVs from time to time.”

“As for the HV, it depends on the strategies a particular CHPS compound is using. Irrespective of the community that one works in, you can always provide full and adequate care and service to the community if you plan well. First, you have to identify the “at need people” then the distance to their homes and put this in your short-term strategic plan for execution.”

“HVs are basic responsibilities of community health nurses, and we ought to execute it. In spite of the challenges, we cannot let those particularly hinder on our ability to conduct our very core mandate.”

Some CHNs were not able to visit all homes in their catchment areas, citing “hard to reach areas” and “Inadequate equipment” as the reasons for not being able to visit all households.

“Sometimes it is the distance to the clients' homes that makes it impossible to visit them. There are some homes if you actually intend to visit them, then you must be willing to spend the whole day doing only that activity.”

“Some clients' problems are such that you will need to have special tools before you visit them. For example, what use will it be to a diabetic client if you visit him/her and you are unable to monitor the blood sugar level or to a hypertension patient, you are not able to check the blood pressure because you do not have the required equipment?”

“To have a successful HV practice, I think the authorities should be willing to provide the basic logistics that will aid us to work. Without this basic logistics, we cannot.”

3.2.4. The Reasons for Conducting or Not Able to Conduct Home Visits

CHNs (72.7%) carried out both routine and special HVs. For those community health nurses who were not able to conduct HVs, several reasons were ascribed. Some of the reasons described included the lack of basic amenities to conduct HVs. The majority (18.2%) of CHNs also did attribute inaccessible geographical areas as a barrier to HV. Also, CHNs (63.6%) identified inadequate logistics and financial constraints as barriers to HV. All of the CHNs report on their activities regarding home visiting to the district health authorities.

“We basically lack the simple logistics that will assist us to conduct HVs. We do not have simple movable equipment like weight scales, thermometers, sphygmomanometers, and stethoscopes.”

“We do not have functionally equipped home visiting bags, so even if we decide to visit the homes, how much help will we be to the client?”

The other reasons included large catchment areas and lack of reliable transportation for the conduct of HVs in the AD.

“The catchment area is quite wide and practically impossible to visit every home. Looking from here to the end of our catchment area is more than 5 kilometers, without a means of transport, one cannot be able to visit all those homes.”

“I remember in those days; community health nurses were given serviceable motor cycles to aid in their movement and especially the conduct of HVs. Today, since our motorbike broke down 5 years ago, it has since not been serviced, yet we are expected to conduct HVs.”

“To conduct home visits, whose money will be used for transportation? The meagre salary I earn? Or the families or beneficiaries of the service have to pay?”

“The number of staff here is woefully inadequate, we are only two people here, how can we do home visiting and who will be left in the facility to conduct the other activities. For this reason, we are not able to conduct HVs.”

CHNs tried to visit the homes at various times depending on the occupation of the significant other of the homes, so that they can provide services in the presence of the significant others. CHNs (63.6%) visit 6–10 homes in a week as 90.9% CHNs conduct HVs in the morning. The reasons given for conducting some HVs in the evenings included the following:

“This place is largely a farming community, most people visit their farms during the mornings, so if you visit the home in the morning, you may not meet the significant others of the vulnerable person to conduct health education.”

“We do HVs because of the clients, so anytime it is possible, we will meet them at home, we conduct the visits at that time. For me, even if the case is that I can only meet the important people regarding the client at night, I visited them at that time. For community health nursing work, it is a 24-hour work and we must be found doing it at all time.”

3.2.5. Frequency of Conducting Home Visits by CHN

Various schedule periods were used based on health facilities for the purpose of HVs. Most (45.5%) conducted HVs three times in a week. CHNs (90.9%) had conducted HVs the week preceding the interview. Indicating that the last time HV was conducted, CHNs conducted a HV at least within the last week:

“HV is a weekly schedule in this facility; for every week, we have a specific person who is assigned to do HV just as all other activities that are conducted in this facility”.

“Yes, last week, we had a number of HVs; we made one routine HV and the other was a scheduled HV from a destitute elderly woman who was accused as a witch by some of her family members.”

Indicating if they sometimes get fatigued for conducting HVs weekly because of the limited number of staff, a community health nurse indicated that,

“I think it is about the plan we have put in place. There are about four people in this facility. We plan our activities that we all conduct HVs. In a month, one may only have one or two HVs, so it is unlikely that you will be fatigued in conducting HVs.”

“Yes, sometimes, it is really tedious, but we cannot let that be a setback. We have a responsibility to execute and we must be doing so to the best of our ability.”

3.2.6. Activities Undertaken during Home Visits

CHNs conducted health education (90.9%), management of minor ailments (54.6%), and vaccination/contact tracing (63.6%) during HVs. Describing if they are able to conduct the management of small ailments and home accidents at home, CHNs were divided in their ability to do this. Those were not able to do so indicated,

“…. And who will pay? Since the introduction of the national health insurance, we are not able to provide management of minor ailments during HVs. In those days, we were supplied with the medicines to use from the district, so we could provide such free services. But with the insurance now in place, we do not get medicine from the district, so whose medicine will you use to conduct such treatment?”

“I think our major goal is on preventive care. We have a lot to do with preventing diseases. Let us leave disease treatment to the clinical people. When we get ailments, we refer them to the next level of care to use their health insurance to access service.”

Identification of cases, defaulter tracing, and health education were identified as benefits and promotion factors of HVs. Identification of cases and defaulter tracing were both mentioned by CHNs as benefits and promotion factors of HVs.

“I think HVs should be continued and encouraged to be able to achieve universal, sustainable PHC coverage for all. Not only do we visit the homes, we also identify vaccination defaulters, tuberculosis treatment defaulters, and prevention of domestic violence against women and children and health education on specific diseases and sometimes we do immunisation.”

“In the home, we have a varied responsibility, treatment of minor ailments, immunization and vaccination, contact tracing, education on prevention of home accidents, etc.” It will be a disservice, therefore, if anyone tries to downplay the importance of HVs in our PHC dispensation.”

“Through HVs, we have provided very essential services that cannot be quantified mathematically, but the community members know the role of the services in their everyday lives. Even the presence of the community health nurse in the home is a factor that promotes girl child education and leads to woman empowerment.”

4. Discussion

This study assessed the home visiting practices in the AD of the Volta Region of Ghana. The concept of home visiting has been enshrined in Ghana's health history and executed by the CHN or public health nurses (PHN). In AD, only CHNs among all the various cadres of health professionals conducted HVs. This was contrary to the practice in the past when both CHN and PHN conducted HVs [ 18 ]. Notwithstanding the limited numbers of CHNs in the district, the majority of households (73.3 %) have a history of visits from a CHN. Home visiting is central in preventive healthcare services, especially among the vulnerable population. In children under five years, it is plausible that nurse home visiting could lead to fewer acute care visits and hospitalization by providing early recognition of and effective intervention for problems such as jaundice, feeding difficulties, and skin and cord care in the home setting [ 19 ]. Home visiting emphasizes prevention, education, and collaboration as core pillars for promoting child, parent, and family well-being [ 20 ].

In Ghana, under the PHC initiative, communities are zoned or subdivided and have a CHN to manage each zone by conducting HVs, including a cluster of responsibilities mainly in the preventive care sectors [ 4 ]. As rightly identified, HV is one of the core mandates of the CHN. Most of the community members who had received more than one visit in a week lived close to the health facilities indicating that there are homes which have never been visited, and CHNs are not able to cover all homes in their catchment areas. Factors that deter the conduct of HVs by CHN ranged from community members' level of education, attitude, supervision challenges, lack of incentives, and lack of basic logistics to conduct HVs. It is imperative that CHNs HVs especially those with newborn children to assess the home environment and provide appropriate care interventions and education as it was reported that 2.8% of 2641 newborns who did not receive a HV were readmitted to the hospital in the first 10 days of life with jaundice and/or dehydration compared with 0.6% of 326 who did receive a HV [ 21 ]. CHNs need to be provided with the right tools including means of transport to reach “hard to reach” communities and homes to provide services.

In rural Ghana such as the AD, community members leave the home to their places of work or farms during the morning sessions and only return home in the evening or late afternoon. HVs (93.4%) were conducted between 9am and 2pm, while some homes (6.6%) were visited between 3pm and 6pm. One problem faced by this timing difference is further expressed when CHNs indicated that they did not meet people at home during HVs. It is important for CHNs to be wary of their safety in client's homes as they show enthusiasm to visit homes at any time, and they could meet significant others. Therefore, to ensure safety, it is important to cooperate with clients and their families [ 22 ] in providing these services especially outside the conventional working hours. The need to use alternative timing of visits is essential as it is known that client participation is required to determine the scope of quality and safety improvement work; in reality, it is difficult for them to participate [ 23 ]. Also, some respondents indicated the time spent during HVs was too short (32.7%), and others (24.5%) wished the CHNs could spend more time with them. Community members have problems they wished could be addressed by the CHNs during HVs, but because of the number of households compared to the limited number of CHNs available, the CHNs could not spend much time during HVs and the respondents were not satisfied with the services rendered. It is likely that services will be better implemented by households if the CHN spends much time with the household and together implements thought health activities. Amonoo-Lartson and De Vries reported that community clinic attendants who spent more time in consultation performed better [ 24 ].

CHNs (8.2%) indicated they could not visit all households that needed the home visiting services in their catchment areas. Home visiting nurses are required to be mindful of the time and environment where they are performing care [ 22 ], so that they can allow for maximum benefit to the community. This notwithstanding, some community members (26.7 %) were not available during the HVs. The determination of suitable time between the CHN and the client is critical in ensuring that a positive relationship is established for their mutual benefit. The interval associated with HVs varied from one community or a health centre to another, and this was planned based on the specific needs of each community or CHPS catchment zone. There is actually no one-size-fits-all approach to home visiting [ 20 ] as several strategies can be adopted in providing services. The number of weeks or months elapsing between the visits ranged from one week to four months. The ministry of Health Ghana per the PHC system encourages CHN to conduct at least one contact tracing and/or HV session within a week within their communities [ 25 ]. All CHNs indicated that in their catchment area, they conducted at least one HV in a week and sometimes even more depending on the exigencies of the time.

Various activities are expected to be conducted by CHNs during HVs. These activities include the provision of basic healthcare services such as prevention of diseases and accidents, disease surveillance, tracing of contacts of infectious disease, tracing of treatment defaulters such as tuberculosis, diabetes mellitus, and hypertension and management of minor ailments at home. Community members (62.3%) did not receive a minor ailment management during HVs. CHNs are expected to be equipped with requisite knowledge, tools, and skills to be able to conduct these services in the homes. Also, the level of care that can be identified as a minor ailment as per the guidelines of the Ministry of Health needs to be specific as community members had varied classification of minor ailments and the level of care to be provided. Home visitors have varying levels of formal education and come from a variety of educational backgrounds marked by different theoretical traditions and content knowledge [ 20 ]. Other jurisdiction HV nurses drew blood for bilirubin checks and set up home phototherapy if indicated; they provided breastfeeding promotion and teaching on feeding techniques and skin and cord care [ 19 ]. Also, CHNs are expected to be able to provide baby friendly home-based nursing care services during a visit to the clients' home. HV nurses should also discuss the schedule of well-baby visits and immunizations [ 19 ] with families.

Important challenges associated with the conduct of HVs were identified as a large catchment area, lack of basic logistics, lack of the reliable transportation system, uncooperative community members, inadequate staff, and “hard to reach” homes due to geographical inaccessibility. Health education, management of minor ailment, and vaccination or contact tracing were the activities carried out in the homes. Home visiting nurses are under pressure to complete a job within an allotted time frame, as determined by the contract or terms of employment [ 22 ]. Time pressure significantly contributes to fatigue and depersonalization, and adjustments to interpersonal relationships with nurse administrators can have notable alleviating effects in relation to burnout caused by time pressure [ 26 ]. CHNs (63.6%) identified inadequate equipment and financial constraints as challenges to HV. Given evidence suggesting that relationship-based practices are the core of successful home visiting [ 27 – 29 ], with a natural harmony between the home visitor and the community members to the home, she renders her services [ 20 ]. A report published by the National Academy of Sciences (1999) also identified staffing, family involvement, language barrier, and cultural diversities as some of the barriers to a HV [ 30 ].

Health education (87.9%) dominated the home visiting activities. Health education helps to provide a safe and supportive environment and also build a strong relationship that leads to long lasting benefits to the entire family [ 5 ]. Face to face teaching in the privacy of the home is an excellent environment for imparting health information [ 31 ]. The CHNs stated that health education, tracing of defaulters, and identification of new cases are the benefits and promotion factors for conducting HVs. This implies that there are other critical aspects of HV that CHNs neglect such as prevention of home accidents and ensuring a safe home environment and care for the aged. Early detection of potential health concerns and developmental delays, prevention of child abuse, and neglect are also other benefits and promotive factors of HV. HV helps to increase parents' knowledge, parent-child interactions, and involvement [ 5 ]. The conduct of HV was not reported among all community members as some community members (22.0%) in the AD indicated their homes have never been visited. This is, however, an improvement over the rate of HVs that was reported in the Assin district in Ghana [ 32 ]. In the Assin district, about 84% of the respondents said they gained benefits from HVs [ 32 ]. In this study, respondents who were visited indicated the CHNs just inspected their weighing card while giving them no feedback. CHNs should implement various interventions to ensure that community members directly benefit from health interventions that are implemented during HVs to reduce the consequences that are usually associated with poor access to healthcare services especially in poor rural communities such as the AD.

5. Conclusion

The activities carried out in the homes were mainly centred on health education, contact tracing, and vaccination. Health workers faced many challenges such as geographical inaccessibility, financial constraints, and insufficient equipment and medications to treat minor ailments. If HV is carried out properly and as often as expected, one would expect the absence of home accidents, child abuse, among others in the homes, and a reduction in hospital admissions.

The need for strengthening HV as a tool for improving household health and addressing home-based management of minor ailment in the district cannot be over emphasized. It is important to forge better intersectoral collaboration at the district level. The District Assembly could assist the District Health Management Team with transport to support HVs. In addition, community-based health workers such as community health volunteers, traditional birth attendants, and community clinic attendants should also be trained to identify and address health problems in the homes to complement that which is already conducted by healthcare professionals.

Acknowledgments

The authors wish to express their profound gratitude to the staff and district health management team of the AD of the Volta Region of Ghana for providing them with the necessary support and assisting in diverse ways to make this study possible. They thank their participants for the frank responses.

Abbreviations

Data availability, conflicts of interest.

The authors declare that they have no conflicts of interest.

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Reps. Schneider & Wenstrup Introduce Bipartisan Primary and Virtual Care Affordability Act to Make Telehealth & Primary Care Visits More Affordable

Washington, D.C.  - Following  yesterday’s House Ways and Means committee hearing on increasing access to care at home in rural and underserved communities, Reps. Brad Wenstrup (R-OH) and Brad Schneider (D-IL) introduced the Bipartisan Primary and Virtual Care Affordability Act to enhance the affordability of primary care and telehealth for patients with High-Deductible Health Plans (HDHPs).

“Improving Americans’ health spans through preventative care will not only lengthen their lives, but will also lower their out-of-pocket costs,” said Rep. Wenstrup.  “That’s why I am proud to lead the Primary & Virtual Care Affordability Act, which will build off the telehealth flexibilities introduced during the COVID-19 pandemic to encourage patients to engage in preventative care by ensuring access to telehealth for those with High Deductible Health Plans.”

“Cost should never be a barrier to health care,” said Rep. Schneider.  “Too often, high up-front costs discourage Americans from seeing their doctor and discussing critical health care needs, leading to delays in diagnoses and treatments, and ultimately suboptimal health outcomes. By removing the financial burden of primary care and telehealth services for individuals with high-deductible health plans, Americans will no longer have to choose between their health and their pocketbook.” “The American Academy of Family Physicians applauds the reintroduction of the Primary and Virtual Care Affordability Act, which would extend flexibilities for telehealth services and ensure patients can utilize primary care services before they reach their deductible in high-deductible plans. This bipartisan legislation protects patients from increasing health care costs and supports their primary care needs that, if left untreated, could result in emergency room visits, hospitalizations, or other avoidable costly outcomes,” said Steven P. Furr, MD, FAAFP, President, American Academy of Family Physicians. “Patients and providers now rely on the option of virtual care services," said Rachel Stauffer, Executive Director of the Partnership to Advance Virtual Care (PAVC).  "We need to continue to support policies that increase access and affordable care options across public and private payors. To that end, we applaud the reintroduction of The Primary and Virtual Care Affordability Act which enables beneficiaries with certain high deductible health plans to continue to utilize virtual care services without worry of financial tradeoffs and we thank Representatives Schneider and Wenstrup for their leadership on this important issue.”

Access to care through telehealth proved to be a lifeline for Americans throughout the pandemic. Telehealth can increase access to care in areas with provider shortages and ensures that patients who cannot travel are still able to see a doctor. By allowing HDHPs to waive the deductible for primary care and telehealth, this bill increases patient access and gives patients and clinicians the freedom to choose the right care.

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Building and preserving over 2 million new homes to lower rents and the cost of buying a home

President Biden believes housing costs are too high, and significant investments are needed to address the large shortage of affordable homes inherited from his predecessor and that has been growing for more than a decade. During his State of the Union Address, President Biden will call on Congressional Republicans to end years of inaction and pass legislation to lower costs by providing a $10,000 tax credit for first-time homebuyers and people who sell their starter homes; build and renovate more than 2 million homes; and lower rental costs.  President Biden also announced new steps to lower homebuying and refinancing closing costs and crack down on corporate actions that rip off renters.

We are starting to see some progress. More housing units are under construction right now than at any time in the last 50 years, rents have fallen over the last year in many places, and the homeownership rate is higher now than before the pandemic. But rent is still too high, and Americans who want to buy a home still have difficulty finding one they can afford. That is why President Biden has a landmark plan to build over 2 million homes, which will lower rents, make houses more affordable, and promote fair housing.

Lowering Costs of Homeownership For many Americans, owning a home is the cornerstone of raising a family, building wealth, and joining the middle class. Too many working families feel locked out of homeownership and are unable to compete with investors for a limited supply of affordable for-sale homes. President Biden is calling on Congress to enact legislation to enable more Americans to purchase a home, including:

  • Mortgage Relief Credit. President Biden is calling on Congress to pass a mortgage relief credit that would provide middle-class first-time homebuyers with an annual tax credit of $5,000 a year for two years. This is the equivalent of reducing the mortgage rate by more than 1.5 percentage points for two years on the median home, and will help more than 3.5 million middle-class families purchase their first home over the next two years. The President’s plan also calls for a new credit to unlock inventory of affordable starter homes, while helping middle-class families move up the housing ladder and empty nesters right size. Many homeowners have lower rates on their mortgages than current rates. This “lock-in” effect makes homeowners more reluctant to sell and give up that low rate, even in circumstances where their current homes no longer fit their household needs. The President is calling on Congress to provide a one-year tax credit of up to $10,000 to middle-class families who sell their starter home, defined as homes below the area median home price in the county, to another owner-occupant. This proposal is estimated to help nearly 3 million families.
  • Down Payment Assistance for First-Generation Homeowners. The President continues to call on Congress to provide up to $25,000 in down payment assistance to first-generation homebuyers whose families haven’t benefited from the generational wealth building associated with homeownership. This proposal is estimated to help 400,000 families purchase their first home.

The President isn’t waiting for Congress to lower costs for homebuyers and homeowners. Last year, the Department of Housing and Urban Development (HUD) reduced the mortgage insurance premium for Federal Housing Administration (FHA) mortgages, saving an estimated 850,000 homebuyers and homeowners an estimated $800 per year. And today, the President is announcing new actions to lower the closing costs associated with buying a home or refinancing a mortgage.

  • Lowering Closing Costs for Refinancing. The Federal Housing Finance Agency has approved policies and pilots to reduce closing costs for homeowners, including a pilot to waive the requirement for lender’s title insurance on certain refinances. This would save thousands of homeowners up to $1500, and an average of $750, and the lower upfront fees will unlock substantial savings for homeowners as mortgage rates continue to fall and more homeowners are able to refinance. According to independent analysis , across the market title insurance typically pays out only 3% to 5% of premiums in claims to consumers, compared to more than 70% in other types of insurance. Homeowners can still purchase their own title insurance policies if they choose to do so.
  • Lowering Closing Costs for Home Mortgages. The Consumer Financial Protection Bureau will pursue rulemaking and guidance to address anticompetitive closing costs imposed by lenders on homebuyers and homeowners.  These charges—which benefit the lender but not the borrower—can add thousands to the upfront costs of a mortgage.  Those upfront costs cut into the amount of homebuyers’ down payments and reduce homeowners’ available equity.

In the coming months, the Department of Treasury’s Federal Insurance Office will convene a roundtable of relevant industry stakeholders, including consumer advocates and academics, in order to discuss the title insurance industry and analyze potential reforms. Building on today’s announcements, President Biden is calling on federal agencies to take all available actions to lower costs for consumers at the closing table and help more Americans access homeownership.

Lowering Costs by Building and Preserving 2 Million Homes America needs to build more housing in order to lower rental costs and increase access to homeownership. That’s why the President is calling on Congress to pass legislation to build and renovate more than 2 million homes , which would close the housing supply gap and lower housing costs for renters and homeowners. This legislation would build on executive actions in the Biden-Harris Administration’s Housing Supply Action Plan that contributed to record housing construction last year.

  • Tax Credits to Build More Housing. President Biden is calling for an expansion of the Low-Income Housing Tax Credit to build or preserve 1.2 million more affordable rental units. Renters living in these properties save hundreds of dollars each month on their rent compared with renters with similar incomes who rent in the unsubsidized market. The President is also calling for a new Neighborhood Homes Tax Credit, the first tax provision to build or renovate affordable homes for homeownership, which would lead to the construction or preservation of over 400,000 starter homes in communities throughout the country.
  • Innovation Fund for Housing Expansion. The President is unveiling a new $20 billion competitive grant fund as part of his Budget to support communities across the country to build more housing and lower rents and homebuying costs. This fund would support the construction of affordable multifamily rental units; incentivize local actions to remove unnecessary barriers to housing development; pilot innovative models to increase the production of affordable and workforce rental housing; and spur the construction of new starter homes for middle-class families. According to independent analysis, this will create hundreds of thousands of units which will help lower rents and housing costs.
  • Increasing Banks’ Contributions Towards Building Affordable Housing. The President is proposing that each Federal Home Loan Bank double its annual contribution to the Affordable Housing Program – from 10 percent of prior year net income to 20 percent – which will raise an additional $3.79 billion for affordable housing over the next decade and assist nearly 380,0000 households. These funds will support the financing, acquisition, construction, and rehabilitation of affordable rental and for-sale homes, as well as help low- and moderate-income homeowners to purchase or rehabilitate homes.

Lowering Costs for Renters President Biden is also taking actions to lower costs and promote housing stability for renters. The White House Blueprint for a Renters Bill of Rights lays out the key principles of a fair rental market and has already catalyzed new federal actions to make those principles a reality. Today, President Biden is announcing new steps to crack down on unfair practices that are driving up rental costs:

  • Fighting Rent Gouging by Corporate Landlords . The Biden-Harris Administration is taking action to combat egregious rent increases and other unfair practices that are driving up rents. Corporate landlords and private equity firms across the country have been accused of illegal information sharing, price fixing, and inflating rents. As part of the Strike Force on Unfair and Illegal Pricing announced by President Biden on Tuesday, the President is calling on federal agencies to root out and stop illegal corporate behavior that hikes prices on American families through anti-competitive, unfair, deceptive, or fraudulent business practices. In a recent filing , the Department of Justice (DOJ) made clear its position that inflated rents caused by algorithmic use of sensitive nonpublic pricing and supply information violate antitrust laws. Earlier this month, the Federal Trade Commission and DOJ filed a joint brief further arguing that it is illegal for landlords and property managers to collude on pricing to inflate rents – including when using algorithms to do so.
  • Cracking Down on Rental Junk Fees . Millions of families incur burdensome costs in the rental application process and throughout the duration of their lease, from “convenience fees” simply to pay rent online to fees charged to sort mail or collect trash. These fees are often more than the actual cost of providing the service, or are added onto rents to cover services that renters assume are included—or that they don’t even want. Last fall, the FTC proposed a rule that if finalized as proposed would ban misleading and hidden fees across the economy, including in housing rental agreements. Last month, HUD released a  summary of banned non-rent fees within their rental assistance programs. These actions build on voluntary commitments the President announced last summer from major rental housing platforms to provide customers with the total, upfront cost on rental properties on their platform.
  • Expanding Housing Choice Vouchers . Over the last three years, the Administration has secured rental assistance for more than 100,000 additional households. The President is calling on Congress to further expand rental assistance to more than half of a million households, including by providing a voucher guarantee for low-income veterans and youth aging out of foster care – the first such voucher guarantees in history. Receiving a voucher would save these households hundreds of dollars in rent each month.

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Press Releases CMS Announces New Guidance for Safe Visitation in Nursing Homes During COVID-19 Public Health Emergency

  • Nursing facilities

Today, the Centers for Medicare & Medicaid Services (CMS) issued revised guidance providing detailed recommendations on ways nursing homes can safely facilitate visitation during the coronavirus disease 2019 (COVID-19) pandemic. After several months of visitor restrictions designed to slow the spread of COVID-19, CMS recognizes that physical separation from family and other loved ones has taken a significant toll on nursing home residents. In light of this, and in combination with increasingly available data to guide policy development, CMS is issuing revised guidance to help nursing homes facilitate visitation in both indoor and outdoor settings and in compassionate care situations.  The guidance also outlines certain core principles and best practices to reduce the risk of COVID-19 transmission to adhere to during visitations.

“While we must remain steadfast in our fight to shield nursing home residents from this virus, it is becoming clear that prolonged isolation and separation from family is also taking a deadly toll on our aging loved ones,” said CMS Administrator Seema Verma. “With the Trump administration’s unprecedented efforts to bolster testing resources and deploy infection control support, we believe nursing homes should be able to resume visitations reuniting residents with their families within the recommendations outlined in our guidance.”

The vulnerable nature of the nursing home population, combined with the inherent risks of congregate living in a healthcare setting, have required aggressive efforts to limit COVID-19 exposure, including limiting visitation.  As a result, in March 2020 , CMS issued guidance instructing facilities to restrict visitation except for certain compassionate care situations.  In May 2020, CMS released Nursing Home Reopening Recommendations , which provided guidance on visitation as nursing homes progress through the phases of reopening.  In June 2020, CMS also released a Frequently Asked Questions document on visitation, which expanded on previously issued guidance on outdoor visits, compassion care situations, and communal activities.

In the revised guidance issued today, CMS is encouraging nursing homes to facilitate outdoor visitation because it can be conducted in a manner that reduces the risk of transmission.  Outdoor visits pose a lower risk of transmission due to increased space and airflow. The guidance released today also allows for indoor visitation if there has been no new onset of COVID-19 cases in the past 14 days and the facility is not conducting outbreak testing per CMS guidelines.  Indoor visitation is subject to other requirements as well as indicated in the guidance.

The guidance also clarifies additional examples of compassionate care situations.  While end-of-life situations have been used as one example, there are other examples including: 

  • When a resident who was living with their family before recently being admitted to a nursing home is struggling with the change in environment and lack of physical family support.
  • When a resident who is grieving after friend or family member recently passed away.
  • When a resident needs help and encouragement with eating or drinking, previously provided by family, is experiencing weight loss or dehydration.
  • When a resident who used to talk to others, is experiencing emotional distress, seldom speaking, and crying frequently (when he/she had rarely cried in the past).

For additional details on the revised nursing home visitation guidance released today, visit here: https://www.cms.gov/medicareprovider-enrollment-and-certificationsurveycertificationgeninfopolicy-and-memos-states-and/nursing-home-visitation-covid-19

The full list of CMS Public Health Actions for Nursing Homes on COVID-19 to date is in the chart below.

Get CMS news at cms.gov/newsroom , sign up for CMS news via email and follow CMS on @CMSgov

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Ireland Rejects Constitution Changes, Keeping ‘Women in the Home’ Language

Two proposed amendments, which voters considered on Friday, were intended to reflect the more secular, liberal values of the nation’s modern era.

People sitting behind desks checking voter rolls.

By Megan Specia

Reporting from London

Voters in Ireland rejected two proposed changes to the country’s Constitution that would have removed language about women’s duties being in the home and broadened the definition of family beyond marriage, dealing a blow to the government that analysts said suggested the weakness of their campaign to pass the proposals.

After a series of referendums in recent years had reshaped Ireland’s Constitution in ways that reflect the country’s more secular and liberal modern identity, the result came as a surprise to some, including the government. But analysts said that rather than signaling a step back from those values, the results reflected a confusing, disjointed campaign that had left many voters reluctant to vote yes.

Each proposal was defeated by a wide margin, according to the results, which were announced on Saturday, an unexpected defeat for equality campaigners and for the coalition government of Leo Varadkar, the taoiseach, or prime minister.

Despite the fact that all of the country’s major political parties supported both proposals, some critics said the proposed clauses did not go far enough, while others faulted phrasing that they said was too broad.

Mr. Varadkar, speaking Saturday after the votes had been tallied, said the defeat was clear.

“As head of government and on behalf of the government, we accept responsibility for the result,” he said. “It was our responsibility to convince the majority of people to vote ‘Yes,’ and we clearly failed to do so.”

Irish citizens went to the polls on Friday, International Women’s Day, to vote in two referendums to amend the country’s 87-year-old Constitution, which was drafted when the Roman Catholic Church’s influence on many aspects of life in Ireland was immense.

Supporters viewed the proposed amendments as vital to ensuring that the Constitution reflected the country’s more secular and liberal modern identity. But many voted “no” to both referendum questions.

Analysts and politicians said the results were more complex than a simple rejection of the proposed changes. A lower-than-expected voter turnout and confusing messaging by the “Yes” campaign may have contributed to the proposals’ failures, they said.

Still, 44 percent of the population turned out for the vote, 67.7 percent of voters refused the changes on the family question, and 73.93 percent on the care question, according to the official results.

Laura Cahillane, an associate professor at the University of Limerick’s law school, who has written about the confusion around the referendums, said that people had concerns about wording from the start.

”When people are confused, they are a lot more likely to vote no and reject change,” Ms. Cahillane said in an interview on RTÉ, the public broadcast network, on Saturday night.

The government must now look into what went wrong, she added, pointing to the long process by a Citizens’ Assembly that led to recommendations for the proposals, which were then evaluated by a legislative committee set up specifically for the purpose. But some recommendations had been ignored, and the government had introduced its own wording.

Opposition parties and others had warned that the language was confusing, according to Ms. Cahillane, and the government and the political parties did little campaigning to drum up support for the referendums.

“There seemed to be very little interest in the government in listening to the concerns of people on the wording," she said, “And maybe a certain amount of arrogance in that they believed that people might get carried away on a wave of feminism on International Women’s Day and simply pass these two referendums.”

The first referendum question voters were asked to consider was whether to amend the Constitution’s Article 41, to provide for a wider concept of family. The suggested language would have recognized a family, “whether founded on marriage or on other durable relationships, as the natural primary and fundamental unit group of society,” and would have eliminated another clause.

The second question concerned Article 41.2, which equality activists and women’s rights groups have opposed for decades. That article says that the state “recognizes that by her life within the home, woman gives to the state a support without which the common good cannot be achieved” and that the state will “endeavor to ensure that mothers shall not be obliged by economic necessity to engage in labor to the neglect of their duties in the home.”

The public voted against replacing that language with a new article that recognized all family caregivers. The proposed article stated, “The state recognizes that the provision of care, by members of a family to one another by reason of the bonds that exist among them, gives to society a support without which the common good cannot be achieved, and shall strive to support such provision.”

Some opponents of the amendments had argued that the proposed language about “durable relationships” was too broad. Others said that the care provisions did not go far enough toward compelling the state to protect caregivers regardless of their gender.

The retention of Article 41.2, especially the “life within the home” clause, was met with disappointment from women’s rights groups that had long campaigned for its removal on the grounds that it was a relic of a patriarchal past.

The National Women’s Council of Ireland, a charity that promotes women’s rights and equality and had campaigned in favor of the proposals, issued a statement expressing “deep disappointment” about the “No” vote. The charity said that “while the reasons for this are complex, the result is a clear wake-up call that we cannot be complacent about equality and women’s rights.”

Even before the Constitution was first ratified in 1937, some women had demonstrated against the introduction of the language, and this year, the National Women’s Council of Ireland recreated their protest outside government buildings .

In recent decades, the Irish public has made a series of significant changes that rolled back socially conservative policies. In 1995, Ireland voted to end its ban on divorce , and a referendum in 2019 further liberalized divorce laws. In 2015, the country voted to legalize same-sex marriage , and in 2018, a referendum was held that repealed the amendment that had prohibited abortion .

The latest referendums were called after a Citizens’ Assembly in 2020 and 2021 on gender equality that made a series of recommendations, including the changes to the Constitution.

Michael McDowell, a lawyer who is an Independent member of the Seanad, the upper house of Ireland’s legislature, and was once deputy head of government, had campaigned for a “No” vote.

“The government misjudged the mood of the electorate and put before them proposals which they did not explain, proposals which could have serious consequences,” he told RTÉ

Megan Specia reports on Britain, Ireland and the Ukraine war for The Times. She is based in London. More about Megan Specia

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A majority of family medicine visits should qualify for the visit complexity add-on code. Here's how to start using it in your practice.

THOMAS J. WEIDA, MD, FAAFP, AND JANE A. WEIDA, MD, FAAFP

Fam Pract Manag. 2024;31(2):6-10

Author disclosures: no relevant financial relationships.

define nursing home visit

Primary care is unique in that it is based on an ongoing relationship with patients. Effective Jan. 1, 2024, traditional Medicare (and some Medicare Advantage plans) will recognize the value of that relationship by reimbursing for HCPCS code G2211, which clinicians can add on to an office/outpatient visit evaluation and management (E/M) code. G2211 documents that the longitudinal relationship has complexity beyond that captured in the work of standard E/M codes. This complexity exists for chronic care and even some acute care visits. The deciding factor is the continuing relationship between the clinician and the patient.

DEFINITION OF G2211

The Centers for Medicare & Medicaid Services (CMS) defines G2211 as follows:

Visit complexity inherent to evaluation and management associated with medical care services that serve as the continuing focal point for all needed health care services and/or with medical care services that are part of ongoing care related to a patient's single, serious condition or a complex condition. (Add-on code, list separately in addition to office/outpatient evaluation and management visit, new or established.) 1

There are two aspects to this definition. The first part underscores that the basis for G2211 is not the patient's clinical condition but the clinician's continued responsibility for the patient. The second part acknowledges that an ongoing relationship may exist for a single, serious condition or a complex condition even if the clinician is not the focal point for all services; CMS provides the example of a patient with HIV who receives ongoing care from an infectious disease doctor. 2

CMS created the new G2211 add-on code to recognize that the longitudinal relationship with a patient has complexity beyond that captured in the work of standard E/M codes.

Code G2211 can be added to office/outpatient E/M visits (99202-99205 or 99211-99215) based on the clinician's continued responsibility for the patient, not based on the patient's clinical condition.

Additionally, even if the clinician is not the focal point for all services for the patient, an ongoing relationship may exist for a “single, serious condition or a complex condition,” justifying use of G2211.

USING G2211

G2211 may only be added to a new or established patient office/outpatient visit E/M code (99202-99205 or 99211-99215). It may be added whether medical decision making or time is used to select the level of service. G2211 may be used for either chronic care visits (with no minimum number of chronic conditions needed to qualify) or acute visits as long as a longitudinal relationship exists or will exist with the patient. Therefore, a new patient visit can qualify when the patient will be establishing with the clinician as their medical home, and an acute care visit with an established patient can qualify if the clinician's practice serves as the continuing focal point for all needed health care services.

CMS has not required any additional documentation to support code G2211. However, if there might be any doubt about the longitudinal patient relationship (or intent to provide longitudinal care), it may be helpful to demonstrate it in the visit note. Particularly for acute problems, documenting the longitudinal relationship's impact on the acute visit could be helpful. For example, the assessment and plan could read as follows: Influenza A, X prescribed, call if not improved in X days; make an appointment to return for influenza immunization in about 2 weeks; next visit as needed for new or worsening problem, already scheduled annual wellness visit .

G2211 may also be used in instances where a “patient's overall, ongoing care is being managed, monitored, and/or observed by a specialist for a particular disease condition.” 1 G2211 is an add-on code to the E/M visit, and modifier 25 does not need to be added to the E/M code. (In fact, G2211 cannot be billed if the visit requires modifier 25; see the exclusions section below.) G2211 can be billed with an office visit E/M service provided via telehealth.

EXAMPLES WHERE G2211 WOULD QUALIFY

A 65-year-old established patient on Medicare whom you have been treating for diabetes, hypertension, and hyperlipidemia presents to your office for a routine check. You order an A1C, comprehensive metabolic panel, lipid panel, and urine for microalbumin, and you adjust the patient's blood pressure medication. This would qualify for a 99214 E/M code as well as the G2211 add-on code because you have an ongoing relationship with the patient.

A 72-year-old patient on Medicare who is new to the practice visits your office to establish ongoing care and also has sinus congestion. This would qualify for an appropriate E/M code as well as the G2211 add-on code. In this example, “the complexity that code G2211 captures isn't in the clinical condition — the sinus congestion.

The complexity is in the cognitive load of the continued responsibility of being the focal point for all needed services for this patient.” 3 The intent to establish ongoing care for this new patient suffices.

A 68-year-old established patient who sees you yearly for a Medicare annual wellness visit and periodically for acute problems presents at this visit with complaint of a cough and concern for influenza. You order a rapid test for influenza and recommend influenza vaccination after the patient recovers from this illness and each season thereafter. This would qualify for an appropriate E/M code as well as the G2211 add-on code because you serve as the continuing focal point for all of the patient's health care.

An endocrinologist has been managing a Medicare patient's uncontrolled diabetes and complications for years, and the patient returns for a recheck. This would qualify for an appropriate E/M code as well as the G2211 add-on code because the physician has an ongoing relationship with the patient that involves care of a “single, serious condition or a complex condition” (diabetes, in this instance).

CMS will not pay for G2211 when the E/M service is reported with modifier 25 (significant, separately identifiable E/M service by the same physician or other qualified health care professional on the same day of the procedure or other service). 4 The intent was to exclude G2211 from instances where minor procedures are performed on the same date as an office visit, which often occurs outside of primary care and does not reflect the visit complexity and ongoing relationship otherwise envisioned by G2211. In those instances, CMS considers the additional work and complexity to be part of the procedure code. Unfortunately, the unintended effect of CMS's decision is to exclude the use of G2211 in primary care when modifier 25 is applicable, such as medication administration (e.g., 96372) or spirometry (e.g., 94010 or 94060) in addition to an E/M service. CMS may make additional clarifications on this issue in upcoming rules as they monitor the use of G2211 and have further discussions with interested parties.

Because G2211 may only be reported in addition to office/outpatient E/M visits (99202-99215), it cannot be attached to Medicare annual wellness visits or transitional care management visits. Complexity is already factored into the work and codes for these visits. G2211 also cannot be added to any non-office-visit E/M codes, such as inpatient, emergency department, nursing home, or home visit codes. G2211 would not be appropriate for most urgent care center visits, given the one-off nature of those encounters.

Additionally, CMS considers G2211 to be inappropriate when the visit “is provided by a professional whose relationship with the patient is of a discrete, routine, or time-limited nature; such as, but not limited to, a mole removal” — unless comorbidities are present or addressed, or unless the clinician has taken (or plans to take) responsibility for ongoing care for the patient. 5

CMS has not clarified in writing whether G2211 can be billed by a physician covering for a colleague who is the patient's ongoing source of care or by a nonphysician provider billing for an acute visit with a patient whose ongoing physician is in the same practice. However, based on statements from CMS staff at a Jan. 24, 2024, Open Door Forum , CMS seems inclined to think of clinicians in the same specialty and same group interchangeably for purposes of reporting G2211. (We will update the online version of this article when CMS publishes more guidance.)

EXAMPLES WHERE G2211 WOULD NOT QUALIFY

A 65-year-old established patient on Medicare whom you have been treating for diabetes, hypertension, and hyperlipidemia presents to your office for a routine check. You order an A1C, comprehensive metabolic panel, lipid panel, and urine for microalbumin, and you adjust the patient's blood pressure medication. You also order injection of a medication reported with 96372. This would qualify for a 99214 but would not qualify for G2211 because adding the injection code, 96372, requires that you add modifier 25 to the E/M code.

A 67-year-old Medicare patient sees you for a subsequent Medicare annual wellness visit. G2211 cannot be added because the proper code for this visit is G0439, a HCPCS code, which is not one of the applicable E/M codes. If you had provided the annual wellness visit in addition to an office/outpatient E/M service, modifier 25 would have been required, which would also disqualify the visit for code G2211.

A 70-year-old Medicare patient sees a gastroenterologist for a screening colonoscopy exam without expectation of an ongoing relationship. G2211 cannot be added as there is no ongoing relationship established (or expected to be established).

G2211 DOs AND DON'Ts

Do use G2211 for:

✓ Office/outpatient E/M visits (99202-99205 or 99211-99215) if you are the “continuing focal point for all needed health care services” for the patient, whether the condition is acute or chronic. (If you are not the continuing focal point, use G2211 only if you provide ongoing care for a serious or complex condition.)

Don't use G2211 for:

✗ Non-office E/M visits,

✗ Urgent care center visits (i.e., one-off visits),

✗ Transitional care management visits,

✗ Medicare annual wellness visits,

✗ Visits requiring modifier 25 (i.e., services that when reported on the same date as an office/outpatient E/M service necessitate adding modifier 25 to the E/M code). Examples:

  • Annual wellness visit (G0438-G0439),
  • Injection of medication (96372),
  • Spirometry, inhalation treatment, or other pulmonary function services (94010-94799),
  • Osteopathic manipulative therapy (98925-98929),
  • Annual alcohol misuse screening (G0442),
  • Annual depression screening (G0444),
  • High-intensity behavioral counseling to prevent sexually transmitted infection (G0445),
  • Annual, face-to-face intensive behavioral therapy for cardiovascular disease (G0446),
  • Face-to-face behavioral counseling for obesity (G0447).

USE IN FAMILY MEDICINE RESIDENCY PROGRAMS

Unlike many other specialty residency programs, where patients may see different residents but the same attending physician who is established with the patient and bills for the visit, family medicine patients may see the same resident but have multiple attending physicians who bill for the visits. G2211 is not included in the primary care exception, so that would suggest that in order to use this code for visits that normally qualify for the primary care exception (straightforward and low complexity medical decision making), the attending physician would also need to see the patient. CMS has offered no written guidance in this area. However, at the Jan. 24 Open Door Forum , CMS staff suggested that guidance may be forthcoming allowing G2211 to be billed with E/M services on the primary care exception list if the resident is serving as the focal point for the patient's care.

Until specific guidance is released, given the intent of CMS to recognize the value of the longitudinal relationship between the physician and patient, the following billing practices seem appropriate. If the patient sees the resident who usually provides their care, then it would seem appropriate to use G2211. This would apply to continuity of care issues or acute issues where ongoing care influences the decision-making. If a resident doesn't usually see the patient for care but is seeing the patient for a continuity-type visit, it would seem appropriate to use G2211, as billing would be submitted under one Tax Identification Number (TIN) for the residency practice. Additionally, this would fulfill the intent of the longitudinal relationship for the practice. It would be important for the resident to document the ongoing relationship they have with the patient or the impact the patient's total health has on the current issue. The attending physician would also need to see the patient and document appropriately. Again, this is simply what seems appropriate given the intent of the code, but we look forward to guidance from CMS.

Medicare's national payment amount for G2211 is $16.05; the actual allowance will vary geographically. This value will be subject to the patient's deductible and coinsurance. A Medicare patient often has a 20% coinsurance; therefore, if this code reimburses $16, the patient will be responsible for $3.20. Practices should be prepared to explain to patients what this additional charge is.

CMS estimates that practices will use G2211 with more than half of office/outpatient E/M services once physicians become familiar with the code. So, assuming you provide 20 visits per day, 200 days per year, and half of your visits qualify for the new code, it could bring in $32,080 per year. Some Medicare Advantage plans may pay for this code, while others may consider the work to already be included in capitation rates or other services paid to the practice. Private insurers' coverage of G2211 will also vary because it is not a CPT code, but a Medicare HCPCS code. Each individual insurer sets its own payment policy, just as each state sets its own Medicaid payment policy.

OVERALL, IT'S A WIN

Although limited by legislative actions and budget neutrality, CMS is recognizing the contribution primary care (and other longitudinal care that consists primarily of E/M services) makes to the overall management of Medicare patients. The visit complexity add-on code, G2211, will be valuable for family physicians. Given that Medicare will be paying less per visit in 2024 because the Medicare RVU conversion factor has decreased by $1.14 per RVU, adding this new code will provide a positive net payment for office/outpatient E/M visits. Practices should check the payment policies of their Medicare Advantage plans and private insurers to determine whether they will be paying for this code.

Medicare and Medicaid Programs; CY 2024 Payment Policies Under the Physician Fee Schedule and Other Changes to Part B Payment and Coverage Policies. 88 FR 78970. https://www.federalregister.gov/d/2023-24184/p-1379

Medicare and Medicaid Programs; CY 2024 Payment Policies Under the Physician Fee Schedule and Other Changes to Part B Payment and Coverage Policies. 88 FR 78974. https://www.federalregister.gov/d/2023-24184/p-1397

How to use the office & outpatient evaluation and management visit complexity add-on code G2211. MLN Matters , 13473. Jan. 18, 2024.

Current Procedural Terminology 2024 Professional Edition. American Medical Association. Appendix A:971.

Medicare and Medicaid Programs; CY 2024 Payment Policies Under the Physician Fee Schedule and Other Changes to Part B Payment and Coverage Policies. 88 FR 78971. https://www.federalregister.gov/d/2023-24184/p-1385

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define nursing home visit

Deion Sanders' unique recruiting style at Colorado: Zero home visits since hiring in 2022

I n his first 14 months on the job as head football coach at Colorado, Deion Sanders has reeled in some of the top recruiting prospects in the nation, including offensive lineman Jordan Seaton and cornerback Cormani McClain .

Records obtained by USA TODAY Sports also show he never even had to leave campus to seal the deal with them or any others.

The university confirmed that "Coach Prime" has made no off-campus contacts with recruiting prospects since he was hired there in early December 2022.

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"Coach Prime did not conduct any off-campus recruiting visits," the school said in an email Feb. 28.

That means no visits to the homes or schools of recruiting prospects – which normally has been a traditional staple of the recruiting process in college sports.

By contrast, former Michigan head coach Jim Harbaugh had 145 off-campus contacts with recruits or their family members from Dec. 1, 2022 until he left for an NFL job earlier this year, according to data obtained by USA TODAY Sports in public-records requests submitted to several universities.

Texas coach Steve Sarkisian had 128 of these off-campus recruiting contacts since Dec. 1, 2022.

Former UCLA coach Chip Kelly had 55 of his own during that time, including seven home visits.

More coverage: Grandpa Prime? Sanders set to become grandfather

The data since Dec. 1, 2022 covers the last two winter contact periods on the NCAA recruiting calendar, which generally restricts head coaches from making off-campus recruiting contacts beyond the months of December and January.

In Sanders’ case, his employment contract with Colorado also gives him an annual budget of $200,000 to use a private air travel service for recruiting called Wheels Up.

He didn’t use it.

"The football staff have not used this service for recruiting since Coach Prime started his term as coach," the school said in response to a records request this month.

But what does this all mean exactly?

It depends on the viewpoint.

How has this been working for Deion Sanders?

Colorado didn’t return messages seeking comment from Sanders, who is on a national book tour this week before starting his second spring practice season in Boulder on Monday.

He does things differently, as he showed when he overhauled Colorado’s roster to an unprecedented degree in 2023, when the Buffaloes finished 4-8.

Sanders, 56, arguably didn’t need to go on the road to recruit and has had physical mobility issues since 2021 because of blood clots in his legs and pain in his foot. He also didn’t recruit very many high school players and instead mostly has recruited transfer players – older players who already have moved out of their family homes and might not need to be wooed by a home visit from another prospective new coach.

The university didn't say why Sanders hasn't used the private air travel service stipulated in his contract. Asked who was using it in athletics if not football, the school said the men's basketball program has used it for recruiting, as did the previous head football coach.

What are his recruiting results so far?

According to several metrics, it’s a style that’s worked for him. He upgraded the talent on the roster from 2022, when the Buffaloes finished 1-11. Sanders’ class of transfer recruits last year ranked No. 1 in the nation.  His overall recruiting class for 2024 also ranks No. 22, including 24 transfer players and only seven high school players, according to 247Sports.

Virtually all of them were lured by his fame and football history as a Pro Football Hall of Famer. They came to him, visiting him on recruiting trips to Boulder.

"I ain’t hard 2 find" is even one of his recruiting mottos, currently for sale on Colorado T-shirts.

In the meantime, Sanders’ assistant coaches have put in legwork for him on the road and had more than 90 off-campus, face-to-face conversations with recruits or their family members during this time period, according to records from CU.

But this approach still is completely different than the traditional model of head coaches traveling to meet with recruits and their families to convince them to sign with their teams.

What is the risk of this approach?

Straying from this traditional approach can become a focus point for critics if the team’s fortunes turn for the worse. In the case of Kelly at UCLA, his record there (35-34) and perceived dislike of recruiting led to grumbling among the fan base before he left to take an assistant coach’s job at Ohio State .

Records provided by UCLA show he didn’t log as much road contact as Harbaugh or Sarkisian, whose data from Texas shows him making multiple off-campus contacts per day during the NCAA contact periods in December and January. For example, on Dec. 6, 2022, Sarkisian made 20 off-campus recruiting contacts, according to the data.

Kelly still was on the road making contacts for a total of 19 days during his contact periods since Dec. 1, 2022. He made 46 contacts at recruits’ schools, seven at their homes and two where contact was made at a meal.

Why else do off-campus visits matter?

It’s generally important to make in-home visits with recruits for two reasons, former coach Jackie Sherrill told USA TODAY Sports. One is to learn more about the player. The other is potentially to gain an edge over competitors.

"I would never offer a player (a scholarship) unless I went into the home and saw the recruit in the presence of his mother," said Jackie Sherrill, the former head coach at Washington State, Pittsburgh, Texas A&M and Mississippi State. "If he was not respectful to his mother, then I would not recruit him. I signed a lot of players because the mother would say you are the first head coach to come to my house or that you are the only head coach that has come to my house. I could tell more about the recruit's character in front of his mother in five minutes than talking to all the coaches and teachers."

Those who don’t show for off-campus visits risk losing recruits to those who do.

One time, Sherill said he had a player at Mississippi State who asked him, “Do you know why I came here? Because you’re the only coach who didn’t flinch when cockroaches crawled across your feet” during his home visit.

What are the rules for off-campus visits?

A head football coach is generally limited to only one off-campus contact day with a recruit or their family members per year starting during a prospect's junior year of high school and including transfer recruits, according to the NCAA.

The assistant coaching staff has more leeway and often does the grunt work of mining for talent on the road. Assistant coaches also can accompany head coaches on their off-campus visits. For example, Ohio State coach Ryan Day and his assistants made a home visit with Alabama safety Caleb Downs before he transferred to play with the Buckeyes.

By contrast, the rules are different for recruits who want to visit the campus of the college they’re considering. They generally can make unlimited unofficial, unpaid visits to campus and one paid official visit per school.

These limits are why schools log their coaches’ number of off-campus contacts, which USA TODAY Sports requested from various public schools.  The ones who responded so far show a range and didn’t include Georgia, whose head coach, Kirby Smart, has become known for his extensive helicopter travel on recruiting trips.

In January 2023, Smart traveled by helicopter on recruiting trips in eight states on eight days and helped ring up expenses of more than $145,000 on the “Kirby Copter,” including other trips, according to the Athens Banner-Herald .

Do recruits even care about home visits?

It varies, but other factors are a bigger part of the equation for recruits now, including earning potential from their names, images and likenesses (NIL). In one case, a wide receiver recruit out of Calabasas, Calif., committed to play for Sanders at Colorado before reneging on his commitment and signing with Texas.

That recruit, Aaron Butler, told USA TODAY Sport that neither Sanders nor Sarkisian visited with him at his home in person.

"I’m not really too much into that," Butler said. "My receivers coach is the one who is going to develop me."

At Texas, that was Chris Jackson, a former NFL player who did visit Butler in California. Before he changed his mind about Colorado, Butler said Sanders called and asked to talk to his parents, including his father Robb-Davon, who crossed paths with Sanders years ago with the Baltimore Ravens.  The call went well, but Butler later said a communication breakdown led him to change his mind about Colorado.

Another factor with home visits

Sometimes the home visit is for the parents. Former Colorado coach Bill McCartney knew this and used home visits to land several top recruits out of Southern California and Texas, eventually building the team into a national contender before his retirement 30 years ago. Sometimes he’d get into personal discussions about his religious faith with a parent.

"In a single-parent household, the mom is the decision-maker," former Buffs linebacker Alfred Williams said on a documentary about McCartney that aired on ESPN in 2015. "So he recruited my mom."

McCartney explained it like this in the same film:

"What that mom wanted to hear is what every mom wants to hear − is that she knows she can trust her son to you."

Follow reporter Brent Schrotenboer @Schrotenboer . Email: [email protected]

This article originally appeared on USA TODAY: Deion Sanders' unique recruiting style at Colorado: Zero home visits since hiring in 2022

Deion Sanders led Colorado to a 4-8 record in his first season as head coach.

2018 Primetime Emmy & James Beard Award Winner

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A History of Moscow in 13 Dishes

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7 Reasons You Should Visit Moscow Over St. Petersburg

Moscow City at night

In their more than three century-long rivalry, Russia ’s Moscow and St. Petersburg are very much like New York and Los Angeles . Despite St. Petersburg’s stunning architecture, one-of-a-kind bar culture and the most polite people in the country, there are still things Moscow does better – here are just a few.

Accessibility.

Even though Pulkovo in Saint Petersburg is one of the world’s most beautiful airports, it serves significantly fewer global flights than Moscow, which has five international airports. Unless you live in Finland, which is a train ride from Russia’s northern capital, you’ll probably have to get to Moscow first to visit Saint Petersburg, because it’s either impossible or to expensive to fly there directly.

Domodedovo International Airport, Moscow, Russia

Famous for its vibrant bar culture, Saint Petersburg is much less versatile when it comes to clubbing. Decent clubs are scarce and even then they rarely score internationally-acclaimed DJs. So if you’re up for a party, you should head to Moscow, which reportedly never sleeps.

people cheering on a mountain

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Vidfest 2016t, Moscow, Russia

While being an attraction in its own right, Moscow’s metro is arguably the cheapest and most reliable way to move around the city. With 206 metro stations and counting, it can get you basically anywhere. The metro in Saint Petersburg comprises 67 stations and is somewhat less spectacular, although it is home to the world’s deepest metro station – Admiralteyskaya.

Arbatskaya of Moscow Metro

Cleanliness

Russia’s capital invests heavily into its appearance: Moscow streets are impressively clean and lavishly decorated. Saint Petersburg tries to keep up, and though anything further than the city center is still pretty romantic, it’s not exactly visually appealing.

Moscow State Historical Museum

Cycling infrastructure

Moscow is working hard to become the country’s most cycle-friendly city: there are 380 government-sponsored bike rental stations, and in 2016 Russia’s capital had 250 km (155 miles) of cycle lanes. Saint Petersburg’ s cycling infrastructure is a work in progress: there are only five cycle lanes in the suburbs and a few cycle routes in the city parks. If you love exploring cities by bike, Moscow is a better place to do so.

Moscow, Russia. Rental bikes of the bike-sharing system VeloBike at Serafimovicha Street

Restaurants

As of 2016, Moscow is home to 2,393 restaurants, while Saint Petersburg has 1,450. New food places pop up almost every week, so Russia’s capital is faster at adopting emerging culinary trends. If a gastronomic experience is what you’re looking for, Moscow is the place for you.

Café Pushkin, Presnya, Moscow

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  4. Making Nursing Home Visits Meaningful

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  5. Updated guidance on nursing home visits

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COMMENTS

  1. Nursing Home Visit

    The 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 this activity, it is essential to prepare a plan of visit to meet the needs of the client and achieve the best results of desired outcomes.

  2. PDF Nursing Home Visitation Frequently Asked Questions (FAQs)

    Nursing Homes. 4. Can visits occur in a resident's room if they have a roommate? A: Yes. Ideally an in-room visit would be conducted when the roommate is not present, howeverif that is not an option and as long as physical distancing can be maintained, then a visit may be conducted in the resident's room with their roommate present.

  3. Home care visits: how they work, and what to expect

    A home care visit is when a professional carer comes to your home, often for between 30minutes to a few hours a day, to provide support with day to day tasks. This can range from personal care such as washing and dressing, to more practical task such as cooking meals or getting you moving. Its often referred to as hourly care, or domiciliary ...

  4. PDF How to Safely Conduct Visits to Nursing Homes

    Visits to Nursing Homes. Host outdoor visits Create dedicated visitation space indoors Allow in-room visits when the resident's roommate is not present, if possible (visits may still occur if a roommate is present as long as physical distancing can be maintained) *The resident and visitor should wear a well-fitting mask, perform frequent

  5. CMS Updates Nursing Home Guidance with Revised Visitation

    Mar 10, 2021. Home health agencies. The Centers for Medicare & Medicaid Services (CMS), in collaboration with the Centers for Disease Control and Prevention (CDC), issued updated guidance today for nursing homes to safely expand visitation options during the COVID-19 pandemic public health emergency (PHE). This latest guidance comes as more ...

  6. What Is Home Visiting?

    Early childhood home visiting is a service delivery strategy that matches expectant parents and caregivers of young children with a designated support person—typically a trained nurse, social worker, or early childhood specialist—who guides them through the early stages of raising a family. Services are voluntary, may include caregiver ...

  7. Updated Factsheet

    Since approximately 86% of nursing home residents and 74% of staff at those facilities in the United States are vaccinated, the Centers for Medicare & Medicaid Services (CMS) has revised its COVID-19 nursing home visitation guidelines. The Center for Medicare Advocacy is committed to ensuring that the rights of older adults and people with disabilities are protected and known.

  8. Effectiveness of home visit nursing for improving patient-re... : JBI

    fessionals. Reviews on the effectiveness of home care services differ in definition and scope, and the unique contribution of home visit nursing services for older people has not been clearly identified. Inclusion criteria: This review will consider systematic reviews of quantitative studies assessing the effectiveness of home visit nursing for older people. Home visit nursing will include the ...

  9. Home Visit

    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.

  10. Home Visit: Opening the Doors for Family Health

    Definition. A home visit is a purposeful interaction in a home (or residence) directed at promoting and maintaining the health of individuals and the family (or significant others). The service may include supporting a family during a member's death. ... Barrett (1982) demonstrated that postpartum home visits by nursing students reduced ...

  11. Why Home Visiting?

    Home visitors work with expectant mothers to access prenatal care and engage in healthy behaviors during and after pregnancy. For example—. Pregnant participants are more likely to access prenatal care and carry their babies to term. Home visiting promotes infant caregiving practices like breastfeeding, which has been associated with positive ...

  12. The Home Visit

    Physician home visits have largely been supplanted by the extensive use of home health care services, a $22.3 billion industry that augments a medical system largely comprising facility-based ...

  13. Empowering Public Health Nurses and Community Home Visitors through

    Background. The health of mothers and that of their families is influenced primarily by the economic and social conditions they experience in their daily lives [16,17].Public Health Nurses (PHNs) have a historic tradition of home visiting that supports the health of the most marginalized families including mothers who have been affected by their economic and social conditions.

  14. The Practice of Home Visiting by Community Health Nurses as a Primary

    Home visit practice is a healthcare service rendered by trained health professionals who visit clients in their own home to assess the home, environment, and family condition in order to provide appropriate healthcare needs and social support services. ... Hollenbeak C. S. Cost-effectiveness of postnatal home nursing visits for prevention of ...

  15. Coding for E/M home visits changed this year. Here's what you ...

    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 ...

  16. Defining Home Health Visits

    Defining Home Health Visits. Medicare Benefit Policy Manual (CMS Pub. 100-02, Ch. 7, § 70.2A) A visit is an episode of personal contact with the beneficiary by staff of the home health agency, or by others under contract or under arrangement with the home health agency, for the purpose of providing a covered home health service. Telehealth ...

  17. The 2023 Hospital and Nursing Home E/M Visit Coding Changes

    Initial nursing home visits are coded with 99304-99306. CPT is deleting the code for nursing home annual exams (99318), which will instead be coded as subsequent nursing home visits (99307-99310 ...

  18. Respiratory Virus Guidance

    This guidance provides practical recommendations and information to help people lower risk from a range of common respiratory viral illnesses, including COVID-19, flu, and RSV. Preventing Respiratory Viruses. Immunizations for Respiratory Viruses. Hygiene and Respiratory Virus Prevention. Taking Steps for Cleaner Air for Respiratory Virus ...

  19. CMS Updates Nursing Home Guidance with Revised Visitation

    Nursing homes have been severely impacted by COVID-19, with outbreaks causing high rates of infection, morbidity, and mortality. [1] The vulnerable nature of the nursing home population, combined with the inherent risks of congregate living in a healthcare setting, have required aggressive efforts to limit COVID-19 exposure and to prevent the spread of COVID-19 within these facilities.

  20. Leadership in Nursing: Qualities & Why It Matters

    Nurse leaders make a difference in workplace culture and drive positive changes in health care legislation. When a team admires the qualities of their leader, it boosts morale and promotes a psychologically safe workplace, which leads to higher job satisfaction and retention rates. Influential leaders in nursing ensure that the organization's ...

  21. Reps. Schneider & Wenstrup Introduce Bipartisan Primary and Virtual

    Washington, D.C. - Following yesterday's House Ways and Means committee hearing on increasing access to care at home in rural and underserved communities, Reps. Brad Wenstrup (R-OH) and Brad Schneider (D-IL) introduced the Bipartisan Primary and Virtual Care Affordability Act to enhance the affordability of primary care and telehealth for patients with High-Deductible Health Plans (HDHPs).

  22. Visit Moscow

    Visit A City is all about the fun of planning the details of your trip. We believe that your own personal trip requires you to have your own personal travel guide. Starting with one of our adjustable guides is the easiest way to decide what to do, where to dine and where to put your head down after an enjoyable day.

  23. FACT SHEET: President Biden Announces Plan to Lower Housing Costs for

    Building and preserving over 2 million new homes to lower rents and the cost of buying a home President Biden believes housing costs are too high, and significant investments are needed to address ...

  24. On this Day in 1972: Nixon Visits Moscow

    President Nixon returned to the United States on May 30. Nixon's visit to Moscow on this day in 1972 was a step toward conciliation (in the form of space cooperation and the signing of the SALT arms control treaty) in the depths of the Cold War. Today, the United States and Russia may be over two decades removed from the Cold War, but there ...

  25. CMS Announces New Guidance for Safe Visitation in Nursing Homes During

    Today, the Centers for Medicare & Medicaid Services (CMS) issued revised guidance providing detailed recommendations on ways nursing homes can safely facilitate visitation during the coronavirus disease 2019 (COVID-19) pandemic. After several months of visitor restrictions designed to slow the spread of COVID-19, CMS recognizes that physical separation from family and other loved ones has ...

  26. Ireland Rejects Constitution Changes, Keeping 'Women in the Home

    Still, 44 percent of the population turned out for the vote, 67.7 percent of voters refused the changes on the family question, and 73.93 percent on the care question, according to the official ...

  27. G2211: Simply Getting Paid for Complexity

    There are two aspects to this definition. ... G2211 also cannot be added to any non-office-visit E/M codes, such as inpatient, emergency department, nursing home, or home visit codes. G2211 would ...

  28. Deion Sanders' unique recruiting style at Colorado: Zero home visits

    Zero. None. "Coach Prime did not conduct any off-campus recruiting visits," the school said in an email Feb. 28. That means no visits to the homes or schools of recruiting prospects - which ...

  29. 21 Things to Know Before You Go to Moscow

    1: Off-kilter genius at Delicatessen: Brain pâté with kefir butter and young radishes served mezze-style, and the caviar and tartare pizza. Head for Food City. You might think that calling Food City (Фуд Сити), an agriculture depot on the outskirts of Moscow, a "city" would be some kind of hyperbole. It is not.

  30. 7 Reasons You Should Visit Moscow Over St. Petersburg

    The metro. While being an attraction in its own right, Moscow's metro is arguably the cheapest and most reliable way to move around the city. With 206 metro stations and counting, it can get you basically anywhere. The metro in Saint Petersburg comprises 67 stations and is somewhat less spectacular, although it is home to the world's ...