Nurse and client perceptions of home health wound care effectiveness after a change in Medicare reimbursement.

The purpose of this study was to begin to explore client and nurse perceptions related to how a change in a Medicare reimbursement, Prospective Payment System (PPS), affects home health care. The target population included home health clients with stage III or greater decubitus ulcers, age 65 years or older. Six Virginia home health agencies were randomly selected. From those sites, all 39 charts that met population criteria were accessed and analyzed, and then 16 care recipients were purposely selected. In addition, 26 home health nurses with pre- and post-PPS experience were purposefully selected. Semistructured, audiotaped interviews were conducted, transcribed, and analyzed using thematic content analysis. Results demonstrated PPS adaptive behavior and an increase in use of education and family caregivers related to wound care. Themes that emerged included professional competence, caregiver as key, and sense of support. Perceptions emphasize the necessity for resource management, collaboration, and patient advocacy.