A patient's strong respiratory and endurance condition is important to Medicare because it helps the patient continue to live at home.

Its because of this that Medicare tracks and scores HHAs ability to improve respiratory and endurance function on  Quality of Patient Care Star Rating.

Patients often decline in endurance, respiratory function because of homebound status.

A condition of receiving home health care - required homebound status - can exacerbate complications already associated with immobility: loss of muscle strength and endurance, decreased respiratory capacity, increased heart rate, etc.

Recommended Policy: Any patient with cardio-respiratory or mobility deficit receives teaching on one or more breathing exercises.

1. Coughing & Deep Breathing

Post surgery patients risk developing lung conditions because of immobility. Also, surgical anesthetics can weaken lung function after surgery. 

Instructions for Deep Breathing

• Find a comfortable position
• Take a deep breath through your nose, feeling your chest expand fully
• Hold the breath for 5 seconds
• Slowly breathe out through pursed lips, as if you were blowing out a candle
• Take rests between breaths if you get lightheaded
  
  

Instructions for Coughing

• Find a comfortable position
• Take a few deep breaths to relax
• Take a deep breath in, feeling your chest fully expand
• Cough firmly, and focus on clearing all the air out of your chest
• Use a tissue to clear any mucus in your mouth
• Repeat several times, until there is no mucus coming up
  
  

2. Incentive Spirometry

Use of incentive spirometry helps prevent lung infections by expanding, strengthening, and keeping lungs inflated. Incentive spirometry also helps to clear mucus from chest and lungs and to achieve normal oxygen levels.

3. Pursed Lip Breathing

• Relax your neck and shoulder muscles.
• Breathe in (inhale) slowly through your nose for two counts, keeping your mouth closed. Don't take a deep breath; a normal breath will do. It may help to count to yourself: inhale, one, two.
• Pucker or purse your lips as if you were going to whistle or gently flicker the flame of a candle.
• Breathe out (exhale) slowly and gently through your pursed lips while counting to four. It may help to count to yourself: exhale, one, two, three, four.
• Do not force the air out.
• Always breathe out for longer than you breathe in.
• Breathe slowly, easily, and relaxed... in and out... until you are in complete control.

4. Diaphragmatic Breathing

• Sit in a comfortable position or lie flat on the floor, your bed, or another comfortable, flat surface.
• Relax your shoulders.
• Put a hand on your chest and a hand on your stomach.
• Breathe in through your nose for about two seconds. You should experience the air moving through your nostrils into your abdomen, making your stomach expand. During this type of breathing, make sure your stomach is moving outward while your chest remains relatively still.
• Purse your lips (as if you're about to drink through a straw), press gently on your stomach, and exhale slowly for about two seconds.
• Repeat these steps several times for best results.