Elevating Home Health Care: A Case Study

How Alliance Homecare skilled nursing services exceeded expectations and transformed the care of an aging couple.

Home health care has gained immense popularity among seniors, as it allows for more comprehensive and personalized care than received in traditional institutional settings. For individuals requiring complex medical care, a higher level of attention and service is necessary, which can only be provided by a very select number of elite home care agencies.


In 2013, a senior-aged husband and wife, referred to here as John and Jane, were both diagnosed with complicated illnesses, but wanted to remain together in the comfort and familiarity of their home. They knew a long-term home health care solution was the answer but did not know who could provide the concierge and hospital-grade services they required. 

A trusted registered nurse (RN) recommended Alliance Homecare’s 24/7 private duty nursing services to the primary care physician, because she knew the home health care agency would meet the couple’s high expectations for professional yet compassionate care. The RN also knew Alliance Homecare’s offering would allow the couple to remain together at home and had an impressive track record of reducing the frequency of hospitalizations, especially compared to those staying at nursing facilities.

For 8 years, Alliance Homecare advocated for the couple, assisted with activities of daily life, provided proactive expert and complex medical care, and maintained consistent communication  between the nursing and medical teams. And as a result, Jane was able to live as comfortably as possible until her passing and John lived 3 years longer than his doctors anticipated.

Medical Diagnosis and Care Team

Before working with the couple, John had a primary diagnosis of congestive heart failure (CHF) and was in remission from prostate cancer. Jane was diagnosed with Parkinsonism (a progressively debilitating disease similar to Parkinson’s). Eventually, as her disease progressed, she was unable to walk, talk, and relied on her nursing staff to perform all aspects of her care.

Initially, the couple tasked Alliance Homecare with creating a customized nursing plan for Jane which included an RN in the home, 24 hours a day, 7 days a week. As her condition naturally progressed,  additional RNs were hired to provide 24/7 care with 2 RNs at a time. Once John required assistance, an additional male RN was hired. At its peak, with a need of 3 RNs per shift, a total of 27 Alliance Homecare RNs – the majority with ICU experience – were caring for the couple. 

Clear Communication

Throughout the 8 years, Alliance Homecare RNs were not alone. The couple’s medical team included a primary doctor, a family office liaison (LCSW), a medical information analyst, a doctor specializing in palliative care, a chef, a physical therapist, and additional Alliance Homecare team members.

With so many medical professionals in the mix, there was opportunity for confusion. Effective health care often has the best results when communication is thorough and consistent. The Alliance Homecare team took the lead, maintaining regular contact with the couple’s medical team, family office, and children with daily reporting and a standing quarterly medical team meeting. 

When the couple needed to visit their primary medical providers in person, dedicated RNs accompanied them to all appointments and communicated all findings and recommendations to the entire nursing staff.  

And beyond being reachable by email or phone, an on-site, dedicated team phone was also established to communicate anything that needed immediate attention, ensure daily transitions were successful, and host daily check-ins with the family.

Customized Care Plan

The couple’s comprehensive personalized and proactive care plans essentially turned their apartment into a hospital-like setting to avoid admissions while remaining a comfortable home for them to share. Under the guidance of their medical doctors, new equipment and care from RNs prevented John and Jane from having to regularly travel to a medical facility to have blood drawn, take x-rays, and even receive IV antibiotics – as RNs can perform or coordinate all of these functions at home – thus improving their quality of life.

The Alliance Homecare nursing team assisted Jane and eventually John with all activities of daily life (ADLs) like bathing and dressing, as well as other activities like leading physical training exercises, reading news articles aloud, assisting with written communication, and for John, helping him finish the novel the couple worked on together for many years. Because Jane was losing her ability to swallow, RNs continuously assessed her swallowing, monitoring her for aspiration and making recommendations to adjust her diet accordingly, eventually preparing a special soft foods diet daily.

Beyond administering medications, the Alliance Homecare team also handled inventorying, coordinating, and managing all medical supplies and medications. If supplies were low, refills were called in or renewals were handled.

During each shift, the couple both received physical assessments by the Alliance Homecare RNs to assess for changes to their status. These continuous assessments and monitorizations led to early interventions which in turn reduced hospitalization and decreased complications.

Putting plans into practice

Because of the thorough care plans and Alliance Homecare RNs having experience at renowned New York hospitals, our RNs were prepared for anything that came their way. For example, one day John experienced an acute GI bleed resulting in alarmingly low blood pressure, a racing heartbeat, and a change in level of consciousness. 

His RN’s experience allowed her to know exactly how to handle the situation: 911 was called, the patient was placed in Trendelenburg position, given supplemental oxygen, and the medical team was notified. John was able to get to the ER on time and survived the incident without any complications such as a stroke or heart attack from such low blood pressures and blood volume, a feat that his doctors called a miracle).

The team approach to caring for this family proved to vastly improve and extend the patient’s quality of life. At one point, John’s heart failure was so severe that he wore an external defibrillator and had an ejection fraction of less than 20%, meaning his heart was pumping much less blood than expected. The team nursed him through the placement of an ICD, an internal defibrillator, and the adjustment of cardiac medications to improve his cardiac output. During a team meeting, the palliative care physician explained that a patient with such severe heart failure typically lives less than 6 months. The nursing team micromanaged every aspect of care, including daily weight and vital signs monitoring, physical assessments including assessing his lungs for fluid, assessing for edema in his legs, adherence to a low salt diet, and daily cardiac rehab with exercises. John’s medications were adjusted daily, as needed under the care of his physician. This exemplary care prevented exacerbation of CHF and pneumonia, reduced hospitalizations, and gave John the time to finish his life goal of publishing his novel. John lived 3 years past that clinical care meeting, exceeding everyone’s expectations, including his own doctors. Alliance Homecare has been able to effectively replicate this type of care model for many of its nursing clients over the past 15 years. 

About Alliance Homecare

Alliance Homecare prides itself on being the gold standard of long-term, home health care. Our private duty nurses are highly vetted before being hired to ensure they’re the best at what they do. Not only do they have the critical knowledge and experience required to excel in their role, but they’re also specially selected because they have qualities that go above and beyond basic care – they understand what it means to provide best in class care to their patients.


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