N484 Module 6: Assignment


Each assignment must contain an INTRODUCTION and CONCLUSION page. Make sure you follow the Grading Rubrics to write the homework. Each paragraph must have at least 2-3 in-text APA citation from the References list.

  Learning Materials

•             Clark, M. (2015). Population and Community Health Nursing (6th ed.). Pearson. ISBN: 9780133846584. Read Chapter 13.

Additional Resources

•             Case Management Society of America. (2016). Standards of practice for case management. https://www.abqaurp.org/DOCS/2016%20CM%20standards%20of%20practice.pdf

•             Clinicient. (2017, January 20). Pay for performance initiatives: What this means for the future of healthcare [Video]. YouTube. https://www.youtube.com/watch?v=X0odGzJch0U&feature=youtu.be

•             Centers for Medicare & Medicaid Services. (2020, November 18). Home health star ratings. https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/HomeHealthQualityInits/HHQIHomeHealthStarRatings

•             Shield HealthCare. (2015, June 23). Shield HealthCare understanding the new quality of patient care star rating (HHC star rating) [Video]. YouTube. https://www.youtube.com/watch?v=6p5MdYk010I

“Please make sure to watch the two YouTube video Above”


Start by reading and following these instructions:

1.            Quickly skim the questions or assignment below and the assignment rubric to help you focus.

2.            Read the required chapter(s) of the textbook and any additional recommended resources. Some answers may require you to do additional research on the Internet or in other reference sources. Choose your sources carefully.

3.            Consider the course discussions so far and any insights gained from it.

4.            Create your Assignment submission and be sure to cite your sources if needed, use APA style as required, and check your spelling.


Read the following case study and submit a 1500 – 2000-word paper that addresses the case study and the questions at the end of the case study.

Mr. B. is an 83-year-old male referred to home health services following a hospital admission for congestive heart failure. His payor source is Medicare (traditional). He lives alone and indicates he does not have sufficient financial resources to afford private pay in home supportive care. His daughter, who lives in the neighboring county about 30 miles away, has offered her father to move in with her – he has refused, and she is not “forcing the issue”. Mr. B. is also not open to discussing moving to an assisted living environment.

This is his third hospital admission for the same problem over the last 12 months and his second admission to a home health agency. He was discharged from the previous home health agency 6 weeks ago. Physician orders are for the home health agency to provide skilled nursing for assessment of his cardiac condition and to teach him about his care and medication regime. Physical therapy has been ordered to establish a home exercise program. Home health aide services have been ordered 3 times a week to assist Mr. B. with his personal care needs.

By the end of the third week of service, it is clear to the RN Case Manager that Mr. B. is not making progress to the established goals. She reports during case conference that he is not a good candidate for teaching because of intermittent confusion and forgetfulness. According to the nurse, no matter what she has tried to teach him and regardless of the aids she has used, Mr. B. continues to take is medication incorrectly. She states, “I know he needs services, but I am not sure that he is in the right environment. I am concerned about Mr. B. – I am not sure why his daughter won’t just step up and put her foot down.”

The physical therapist reports at case conference that the “client lacks motivation”. The home exercise program has been established with Mr. B.; however, he does not complete the exercises between therapy visits.

An improvement in his personal hygiene has been noted with the Home Health Aide (HHA) services. The HHA has also been successful in decluttering his living space. The HHA reports that she is concerned that he is not eating regular meals.

This situation offers an ethical challenge to the professional caregivers and to the agency for which they work.

Discuss how you would handle this ethical dilemma. Address the following 5 questions as a part of your response:

1.            What are your concerns about this case?

2.            How does the RN Case Manager meet her ethical responsibilities to the patient and to the organization?

3.            What is the best plan of action to ensure the client’s safety and well-being?

4.            What are realistic outcomes and goals for this client?

5.            Who will provide the ongoing care needs required by this client?

Assignment Expectations

Length: 1500 – 2000 words; answers must thoroughly address the questions in a clear, concise manner.

Structure: Include a title page and reference page in APA style. These do not count towards the minimum word count for this assignment.

References: Use the appropriate APA style in-text citations and references for all resources utilized to answer the questions. Include at least three (3) scholarly sources to support your claims.

Format: Save your assignment as a Microsoft Word document (.doc or .docx).

File name: Name your saved file according to your first initial, last name, and the assignment number (for example, “RHall Assignment 1.docx”)


This table lists criteria and criteria group name in the first column. The first row lists level names and includes scores if the rubric uses a numeric scoring method. Criteria

Does Not Meet 0%

Approaches 70%

Meets 80%

Exceeds 100%

Criterion Score

Content Weight: 30%

0 points

Topic is inappropriate to assignment, inaccurate understanding of concepts, unclear and difficult to understand; does not address many assignment requirements. Information has weak or no connection to the assignment topic.

21 points

Topic is mostly covered and appropriate to assignment, but does not adequately demonstrate accurate understanding of concepts; mostly clear and understandable; lacks some of the requirements of the assignment description and/or provides little detail; Information relates to the main topic, but few details and/or examples are given.

24 points

Topic is covered completely and appropriate to assignment; overview of key concept dimensions is evident; clear and understandable; addresses all of the requirements of the assignment description, with adequate attention to detail.

30 points

In-depth coverage of topic; outstanding clarity and explanation of concepts demonstrated in information presented; approaches assignment with depth and breadth, without redundancy, using clear and focused details.

Score of Content Weight: 30%,/ 30

Organization Weight: 25%

0 points

Organization is confusing and interferes with reader’s ability to follow ideas.  Weak or no introduction of topic or purpose is unclear, weak, or missing. Conclusion lacks a summary of topic, or is missing or irrelevant.

17.5 points

Ideas are sometimes disorganized or irrelevant; Flow is sometimes choppy; somewhat clear organization. Basic introduction that states topic but is presented in an uninteresting way. Conclusion contains basic summary of topic without final concluding ideas, may inappropriately introduces new information.

20 points

Structures ideas in a coherent, organized order that has good flow and an obvious framework.  Proficient introduction that is interesting and states topic.  Conclusion contains good summary of topic with credible concluding ideas and introduces no new information.

25 points

Exceptionally clear, logical, mature, and thorough organization permitting smooth flow of ideas; Introduction that grabs interest of reader and states topic in clear, unambiguous terms.  Excellent concluding summary with succinct and precise ideas that impact reader.

Score of Organization Weight: 25%,/ 25

Logic/Argument Weight: 15%

0 points

Demonstrates little logical reasoning for the claims and thoughts within assignment; Many claims are weak or illogical.

10.5 points

Lacks some logical reasoning for the claims and thoughts within the assignment; Some claims are weak.

12 points

Uses solid logical reasoning for the claims and thoughts within the assignment.

15 points

Provides exemplary logical reasoning for the claims and thoughts within the assignment.

Score of Logic/Argument Weight: 15%,/ 15

Support Weight: 20%

0 points

Lacks support; Uses poor sources for references; Citations lack credibility, relevance, or academic quality or are not current; Does not meet the minimum number of required citations in assignment description.  APA format and style are not evident.

14 points

Provides weak support or not enough support; Citations are not consistently credible, current, relevant or academic; Meets the minimum number of required citations in assignment description   Missing APA elements; in-text citations, where necessary, are used but formatted inaccurately and not referenced.

16 points

Provides sufficient support with credible, current, relevant academic citations; Meets the minimum number of required citations in assignment description. ; In-text citations and a reference page are present with few format errors. Mechanics of writing are reflective of APA style.

20 points

Provides very strong support from credible, current, relevant, academic citations; Meets or exceeds the minimum number of required citations in assignment description.  Accurate citations and references are presented. No APA errors are evident.

Score of Support Weight: 20%,/ 20

Quality of Written Communication Weight: 10%

0 points

Style and voice inappropriate or do not address given audience, purpose, etc. Word choice is excessively redundant, clichéd, and unspecific. Inconsistent grammar, spelling, punctuation, and paragraphing. Surface errors are pervasive enough that they impede communication of meaning.

7 points

Style and voice are somewhat appropriate to given audience and purpose. Word choice is often unspecific, generic, redundant, and clichéd. Repetitive mechanical errors distract the reader. Inconsistencies in language, sentence structure, and/or word choice are present.

8 points

Style and voice are appropriate to the given audience and purpose. Word choice is specific and purposeful, and somewhat varied throughout. Minimal mechanical or typographical errors are present, but are not overly distracting to the reader. Correct sentence structure and audience-appropriate language are used.

10 points

Style and voice are not only appropriate to the given audience and purpose, but also show originality and creativity. Word choice is specific, purposeful, dynamic and varied. Free of mechanical and typographical errors. A variety of sentence structures and effective figures of speech are used. Writer is clearly in command of standard, written, academic English.

Score of Quality of Written Communication Weight: 10%,/ 10

Rubric Total ScoreTotal

/ 100

Overall Score

Overall Score

Level 10 points minimum

Level 270 points minimum

Level 380 points minimum

Level 4100 points minimum


Case study: Home Health Aide Services (Mr. B)

Case study: Home Health Aide Services (Mr. B)

Home health aide offers rudimentary services to the aged, sick or incapacitated people. Several health aides do need medical training (Sterling, et al., 2020). Such services include:

  • Assisting a patient in moving from bedroom to bathroom, driving a patient to and from a hospital, and preparing a meal aligned with dietary guidelines.
  • Washing the client’s clothes.
  • Assisting the patient clothes changing and bedding.
  • Administering rudimentary medications.

If qualified, they can operate particular medical equipment, for instance, a ventilator. This paper discusses a Home Health Aide Services case study involving Mr. B., an 83-year-old male suffering from congestive heart failure.

Concerns about this case

My concern about this case study include Mr. B living alone, financial inability to afford private pay in-home supportive care, and utter dependence on Medicare. Lack of home support is problematic since he lives alone, yet he suffers from congestive heart failure. Furthermore, he refuses to live with her daughter, residing in a neighboring state.     

            Congestive heart failure is a condition that happens when a person’s heart muscle does not pump blood as well as it should. Living alone at home and lacking a home health helper for Mr. B is risky since he might suffer from severe shortness of breath, became tired, and weak. And this might require him to take some medicines, which he might find himself in a position not being able to take medicines all by him. Lack of taking medicines due to lack of a care provider to offer Mr. B medicines might consequently result in the death of Mr. B. He might require regular exercise, but he cannot exercise due to a lack of a physical therapist. And lack of exercise can make him gain excess weight, which is the unhealthy lifestyle of living. Mr. B can also experience chest pain, ascites, rapid demand to urinate at night, difficulty concentrating, persistent coughing with pink blood, and lack of appetite, and nausea. All these are signs and symptoms of a person who suffers from cognitive heart failure (Alpert, et al., 2017). A person with heart failure requires a home health aide to provide 24/7 aid services to Mr. B. The lack of a caregiver for Mr. B can lead to worsening of his conditions and eventually cause death.

            Another concern is that Mr. B is taking his medicines wrongly despite the nurse trying hard to teach him how to takes his medicine. Improper taking of medicines by Mr. B is caused by recurrent confusion and forgetfulness. According to the nurse of Mr. B, who outlined this at the time of a case conference, suggesting that Mr. B is not a good candidate? Inappropriate medicines by Mr. B can lead to postponement of recovery and further health complications, worsening his condition.

RN Case Manager Ethical Responsibilities to the Patient and the Organization

The ethical responsibilities of nurses refer to nurses being held accountable for their nursing care and other activities. Nurses must accept all of the professional and personal consequences that can happen as the outcome of their activities. Examples of ethical responsibilities of nurses include:

  • Providing the right medicines to the patient.
  • Being honest with the patient, particularly about his or her medical condition.
  • Giving feedback to her or his superiors concerning the patient.

The RN Case manager meets her ethical accountabilities to the patient and the organization by realizing that Mr. B doesn’t make progress to the established objectives at the end of the three-week service. At the time of a case conference, the manager reports that Mr. is not a virtuous candidate for teaching (Grace, 2017). The reason being that of intermittent confusion and forgetfulness of Mr. B, she suggests that no matter how hard she attempted to teach Mr. and regardless of the helps she has utilized, Mr. B remains to take his medicine wrongly. She seems much concerned about the environment Mr. B is living. That is living alone in his home without a caregiver. She affirms this by stating that though Mr. B requires services, she is unsure that he is in the best environment. Moreover, she is unsure why Mr. B’s daughter won’t intervene and at least convince her father until he agrees to live with her.

Best plan of action to ensure the client’s safety and well-being

The best plan of action to guarantee the safety and well-being of Mr. B is for him to complete physical exercise during his physical therapy program at his home. For Mr. B to complete his exercise, he must be motivated to do so as the physical therapist noted that Mr. B does not finish his exercise due to lack of motivation. Mr. B can be motivated to complete his exercise during therapy sessions by being provided with the overall benefits of exercise for patients with congestive heart failure by the physical therapist. Some of the exercises that the physical therapist can motivate Mr. B to undertake to include:

Flexibility– this sort of exercise comprises slow movement to stretch the muscles. Exercises of flexibility, yoga, stretching, and Tai chi .they are also utilized earlier and after exercising to avert damage and straining. Advantages comprise an assortment of motion, better balance, and better movement of a person’s joints.

Cardiovascular/aerobic – this sort of exercise is steady and utilizes a person’s big muscle groups. It enhances how a person’s body utilizes oxygen and has the utmost influence on a person’s health. Instances of cardiovascular exercises comprise riding a bicycle, jogging, marathon and rope jumping, skiing, low-influence, and water workouts (Gambassi, et al., 2019). Advantages comprise lower blood pressure, lower heart rate, and healthy breathing.

Strength training– this sort of workout comprises monotonous muscle movement till the muscle becomes tired. This exercise normally comprises lifting weights such as weight machines or utilizing resistance tubes and bands. Advantages include sturdier bones, more toned muscles, weight control, good posture, and healthier balance. All the workouts mentioned above do have one common advantage. They make a person’s heart and cardiovascular structure stronger. There are stages of exercise. These include:

Warm-up-this stage must last at least five minutes. It aids a person’s body to get ready for exercise, minimizes stress on a person’s muscles and heart, and assists to avert sore muscles. Warm-up must comprise stretching; various motion workouts, and initiating your action at a low-intensity level.

Conditioning- this stage must last at least twenty to thirty minutes and comprises the real work out a person is doing. A person does burn calories and acquires the advantages of work out.

Cool down– this stage must last at least five minutes. It assists a person’s body recover from the conditioning stage (Romero, Minson & Halliwill, 2017). A person’s heart rate and blood pressure will gradually go back to normal. A person can minimize the intensity of his workout and carry out similar stretching he did at the warm-up time. In addition to the physical therapy program, the doctor requested a home health agency to offer skilled nursing to evaluate Mr. B’s heart condition and taught him about his care and medicine system that will eventually enhance his health.   

Realistic outcomes and goals for the Client

If the goals of Mr. B are to enhance his medical condition, he must accept that he needs assistance. He cannot live alone at home, yet he is suffering from congestive heart failure. To have actual results, Mr. B should recognize that his medical condition requires 24/7 care from a care provider who will assist him in his daily activities such as preparing him a meal (Mazurek & Jessup, 2017). Moreover, the caregiver will assist him in going to the bathroom, washing his clothes, dressing him, and, most importantly, assisting him in taking medicines rightly. He should finish his exercises during a physical therapy session to improve his health and safety.

Providing Ongoing Care Needs Required by the Client

Home Health Aide services should offer the continuing care requirements needed by Mr. B. As earlier on, the personal hygiene of Mr. B has improved through Home Health Aide services. The home health care provider has been effective in cleaning his residence. The home health aides noted that Mr. B is not consuming regular meals. Consuming regular meals could be improved through Home Health Aide services (Russell, et al., 2017). Some of the services that the home health aides can provide to Mr. B include supervision of prescribed medicines to Mr. B ,helping with repetitive healthcare duties of daily living such as dressing, feeding, bathing, toileting, grooming. And mobility and assisting with duties such as preparing meals, washing clothes, and performing light housekeeping and involving the patient in workouts to maintain him mentally attentive and taking Mr. B to the hospital and other appointments. Buying groceries and preparing meals to meet Mr. B’s dietary specifications, ensuring a particular care plan for Mr. B, and reporting on accomplished tasks after every visit, such as physical therapy, involves workouts.


In conclusion, the 83- year old Mr. B patient case study on home health aide services for patients with congestive heart failure is challenging. Because Mr. B lives alone at his home without a home health care provider and yet, he is unable to take care of himself, worsening his medical condition. Patients with congestive heart failure do require assistance from home health care providers since they are mostly unable to do their daily duties independently. With the help of a home health helper, many elderly patients such as Mr. B can age in place and remain in their household. Moreover, to aiding with medicines, individual services, and living actions, home health aides offer companionship. They are in a position to survey and alert a case manager if there are variations in the patient’s condition.                                   


Alpert, C. M., Smith, M. A., Hummel, S. L., & Hummel, E. K. (2017). Symptom burden in heart failure: Assessment, impact on outcomes, and management. Heart failure reviews22(1), 25-39.

Gambassi, B. B., Almeida, F. D. J. F., Almeida, A. E. A. F., Ribeiro, J. A., Novais, T. M. G., Schwingel, P. A., … & Rodrigues, B. (2019). Effects of exercise training on cardiovascular and autonomic parameters in stroke survivors: a systematic review. International Journal of Cardiovascular Sciences32(4), 408-413.

Grace, P. J. (Ed.). (2017). Nursing ethics and professional responsibility in advanced practice. Jones & Bartlett Learning.

Mazurek, J. A., & Jessup, M. (2017). Understanding heart failure. Heart failure clinics13(1), 1-19.

Romero, S. A., Minson, C. T., & Halliwill, J. R. (2017). The cardiovascular system after exercise. Journal of Applied Physiology122(4), 925-932.

Russell, D., Mola, A., Onorato, N., Johnson, S., Williams, J., Andaya, M., & Flannery, M. (2017). Preparing home health aides to serve as health coaches for home care patients with chronic illness: Findings and lessons learned from a mixed-method evaluation of two pilot programs. Home Health Care Management & Practice29(3), 191-198.

Sterling, M. R., Dell, N., Piantella, B., Cho, J., Kaur, H., Tseng, E., & Kern, L. M. (2020). Understanding the workflow of home health care for patients with heart failure: challenges and opportunities. Journal of general internal medicine, 1-9.