Under the Medicare home health prospective payment system, agencies could make large profits by targeting the 10th therapy visit. The objective of this study is to examine the influence of market competition on home health agencies’ targeting the 10th therapy visit. This article uses changes in competition rates within each market over time to examine whether home health agencies were more likely to target the 10th visit under greater competition. No significant associations were found between competition and agencies’ targeting behavior on average, but competition effects on targeting behavior were significantly greater for freestanding agencies that were likely to be in relatively financially disadvantageous positions. These findings suggest that competition might increase financially unstable agencies’ 10th-visit targeting behavior, potentially leading to unnecessary Medicare spending.
A rapidly changing health care payment system creates opportunities for optimizing home health and home-based care for patients needing cardiac rehabilitation (CR). Home health agencies are poised to play a significant role in episode payment models in the context of post–acute care for patients with cardiovascular conditions. As the Medicare program expands its episode payment models to include patients with cardiovascular conditions, hospitals and other health care stakeholders that will be engaged in these bundled payment arrangements should consider use of home health care in the delivery of CR as a bridge to outpatient therapy and patient self-management.
The aim was to investigate the prevalence of using the reactive approach to patient safety event prevention in home-visit nursing agencies and explore factors associated with this approach. Multiple logistic regression analysis was conducted to investigate possible reactive approach-related factors. Two hundred forty-five agencies (71.0%) reported using the reactive approach to prevent event recurrence. Use of the reactive approach in agencies was significantly associated with having administrators who had attended an education course before employment in an administrative position (odds ratio = 1.95). To increase patient safety knowledge and awareness, administrator candidates must attend a course on home-visit agency management. Nursing researchers and policy makers should reexamine and adjust prerequisites for administrator registration at home-visit nursing agencies in Japan.
A criticism of Medicare’s home health prospective payment system is its partial reliance on cost-based reimbursement of therapy services provided by home health agencies (HHAs) to Medicare fee-for-service (FFS) beneficiaries, potentially overincentivizing the provision of therapy services. Using Medicare FFS home health claims and assessment data, we estimated a model to predict therapy use as a proxy for clinical need and replace actual therapy use with the prediction in the home health payment system. We estimated a $1.178 billion (95% confidence interval, $1.171-$1.184) decrease in home health payments relative to levels under the current system. The majority of the decrease was due to the model predicting fewer high therapy episodes than actually occurred. It may therefore be more appropriate to predict both therapy and nontherapy use, requiring an overhaul of the current system.
The focus of this article is scientific merit and how to embed this information in a compelling but brief way into research proposals. We begin by discussing why scientific validity is an important focus of an Institutional Review Board and describe what is scientifically meritorious (good science). We end with a simple checklist and practical template that can be used to strengthen the scientific rigor of proposed research apart from its compliance with safeguards for human subjects’ rights and welfare.
To empirically measure the quality of home visiting nursing (HVN) agencies in Japan, we longitudinally observed the duration of clients’ HVN use and identified the factors correlated with hospitalization/institutionalization. Medical and long-term care insurance data were analyzed from 1,722 persons with disabilities aged at least 75 years who began using an HVN. At the 12-month follow-up, 67.7% of clients were no longer using the HVN; among these, 48.9% were hospitalized/institutionalized and 23.6% had died. Cox regression analysis showed that risk of hospitalization/institutionalization in HVN agencies depends on client characteristics at service commencement. Measuring the quality of HVN agencies by weighting clients’ characteristics as risk factors for hospitalization and/or institutionalization may be appropriate.
The main aim of this study is to present the socio-demographic, clinical, and functional characteristics of home medical care patients admitted into one of the oldest home care service over a 10-year period. Data were manually retrospectively extracted from the non-computerized medical records of all patients admitted into Code 4 Home Medical Service from January 1, 2000, to December 31, 2009. Records of 1,069 patients were examined. Over the 10-year period, there was an increasing proportion of patients older than 70 years (B [95% CI], 1.08 [0.43, 1.73]) and dependency on foreign domestic workers as primary caregivers (B [95% CI], 4.65 [3.71, 5.58]). Cognitive impairment and functional dependency of the patients increased over the years, as assessed using Abbreviated Mental Test score < 7 (B [95% CI], 1.73 [0.71-2.76]) and Barthel Index = 0 (B [95% CI], 4.32 [2.74-5.91]). Knowledge about these trends may be helpful to project future demands for home medical care in Singapore.
To support the transition from hospital to community for adults 65 years and older, a restorative care unit was introduced within a regional health authority in Newfoundland and Labrador. A pre-post study design was used to evaluate the impacts of restorative care. This article describes the impact of restorative care on client outcomes and health system utilization. All patients discharged from restorative care during the first year of operation were included in the study. A total of 54 clients were discharged during the first year, with 70% being discharged to a community setting. Consistent with previous studies, statistically significant improvements were noted in function as measured using the modified Barthel Index of Activities of Daily Living and fear of falling as measured using the Fall Efficacy Scale–International. The number of alternate level of care patients in acute care and their length of acute care stay did not decrease during our study period. However, an interesting change was observed: The number of applications for long-term care initiated in acute care decreased. Further examination of the long-term outcomes of discharged patients and of the factors influencing health system outcomes is suggested.
The number of persons seeking medical treatment during a public health emergency could quickly overwhelm the capacity of hospitals and emergency rooms. The amount of surge capacity home health care could provide during a public health emergency is unknown. The purpose of this research is to quantify the surge capacity of the home health sector in four emergency scenarios. According to the model developed, routine demand will exceed scenario capacity for almost all home health agencies in all pessimistic cases for the four scenarios discussed. However, home health agencies have the surge capacity to contribute to the provision of care for patients during times of demand under routine operating conditions as well as in conditions where demand may be moderately increased.
Baccalaureate community health education often includes clinical practice in home care agencies. Complexity with securing home care agency practice sites has led to the proliferation of alternative models for community health clinical. Nurse-managed wellness centers (NMWCs) are one such alternative that provides robust clinical experience for students and valuable home health services for vulnerable population groups. Despite anecdotal evidence of the value of the NMWC home care service, sustainability was dependent on the ability to report outcomes. An effort to quantify emergency department and hospital cost and utilization outcomes was unsuccessful. This resulted in failure to obtain financial support, and NMWC services were terminated in one community. In retrospect, the NMWC model was identified as having potential for integration into home care agency services.
Antibiotic resistance has led to the development of so-called "superbugs" that no longer respond to the current treatment modalities. The array of antibiotics available to treat these infections is dwindling with very few antibiotics in the pipeline. This article discussed the pathogens the Centers for Disease Control and Prevention (CDC) has placed in their urgent category: (1) Clostridium difficile, (2) Carbapenem-resistant Enterobacteriaceae, and (3) Neisseria gonorrhoeae. In addition, a few suggestions for prevention of resistance are offered.
Up to 25% of patients hospitalized with heart failure (HF) are re-admitted within 30 days. The highest risk of re-admission is within the first days after discharge. Transitional care programs usually only involve nurses and physicians. The purpose of this study was to describe a post–acute care program including physical therapists and to evaluate re-admission rates following program implementation. The program provided HF-specific training encouraging nurses and physical therapists to assess HF status and instruct on self-monitoring. Thresholds for communication with medical providers were established. Patient groups before (n = 162) and after implementation (n = 300) were similar. Following implementation, there was a 16% decrease in re-hospitalization with little change in the number of visits. Similar multidisciplinary programs may impact re-hospitalization rates and health care costs for HF.
The connection between oral and systemic health is becoming more obvious. Oral infections, specifically periodontitis, have been associated with diseases such as diabetes, cardiovascular disease, respiratory infection, erectile dysfunction, metabolic syndrome, and rheumatoid arthritis, to name a few. As people age, they become more susceptible for developing both oral and systemic diseases. This article discusses the oral-systemic relationship as well as sheds light on preventive measures that can be taken.
Little is known about the significance of gardening services for frail elderly people. This study explored the value of a gardening service for frail older people and people with a disability living in the community. Using qualitative and quantitative data collected from pre-gardening (n = 38) and post-gardening service delivery interviews (n = 35) and the Housing Enabler, the value of a gardening service was examined. Findings suggest that the service had a positive impact on the independence and emotional well-being of frail aged people and younger people with a functional disability, with little impact on physical health. Results indicate that gardening services should be fundamental to planning for these populations to remain or return to living in the community.
There is a widespread belief among the public and policy makers that quality of care in terms of user satisfaction can be improved with increased spending. However, recent research indicates that structural resources (e.g., budget per elderly) in elderly home care do not predict quality of care in terms of older persons’ satisfaction with care. In the present study, we analyzed the longitudinal trends in costs and perceived quality of care across 3 years using nationwide data in Swedish elderly home care. The results showed that although costs have been steadily increasing, perceived quality of interpersonal treatment in care has remained at the same level. An important implication is that future research and policy efforts to improve quality should more directly target the mechanisms generating satisfaction.
The aim of this study was to determine the association of active depressive symptoms in older home health care (home care) patients and discharge to the hospital. This study was based on a cross-sectional secondary data analysis. The data were from the Montefiore Home Healthcare Agency, Bronx, New York. Patients 65 years and older who were admitted to home care in 2010 (N = 3,761) with a valid depression screen in the medical record were included. Disposition at discharge and the Patient Health Questionnaire–2 depression screen were collected from the home care nursing assessment. Demographic and clinical factors were collected from the medical record. The adjusted odds ratio (AOR) was greater for discharge resulting in hospitalization (AOR = 1.70, 95% confidence interval = [1.29, 2.25]) among those with positive depression screens compared with those with a negative screen at the time of admission. Conclusion: Active depressive symptoms at the time of admission to home care were associated with increased odds of hospitalization at discharge. Interventions to reduce depression during the home care admission may have implications for readmission rates and overall health care utilization.
Falls have a detrimental impact on home care outcomes. This study investigated home care clinicians’ perspectives on (1) how the currently adopted health information technology (IT) solutions supported fall-risk management activities, (2) various shortcomings of these solutions, and (3) ways to improve upon them. Within a case study design, qualitative data were collected through interviews and focus groups at one suburban home health agency in the United States. The clinicians mainly used the electronic health record but experienced substantial difficulties with documenting and accessing fall-related information. Improvement opportunities include providing better workflow support and usability, implementing medication alerts, facilitating fall-related information exchange, and leveraging the IT capabilities at patients’ homes. Additional IT solutions can improve the awareness, assessment, and intervention dimensions of fall-risk management.
Late-life depression is becoming increasingly prevalent among older adults in the United States and is predictive of a wide range of negative health-related outcomes. Fourteen home care agencies participated in a quasi-experimental, pre-test, post-test design of a depression screening training program nested within a two-cycle, phased introduction of the intervention. The primary aim of this study was to evaluate the effects of the program at three levels of outcomes: the trainers, the trainees, and the agencies. There was a significant increase in the knowledge and self-efficacy of the trainers and trainees and a trend toward decreased hospitalization.
How home care workers adapt what they learn in manual handling classroom training sessions to their workplaces (i.e., their clients’ homes) is central to their own safety, as their musculoskeletal injuries continue to occur at unacceptably high rates. For this inquiry, new workers were directly observed in their workplaces following classroom training. Findings from these observations propose three environmental considerations for supporting new workers to learn safe manual handling techniques: (1) The physical setting for manual handling is important, (2) clients and their significant others may offer a valuable form of learning support, and (c) when initially learning the requirements for their roles, new workers should be encouraged to focus only on the manual handling tasks at hand.
A common debilitating condition in older adults which impact their level of independence involve conditions interfering with the ability to walk freely. Podiatric conditions develop over decades of wearing ill-fitted shoes, heels or as a result of chronic systemic conditions which impact the feet. This article will discuss the most common podiatric conditions frequently observed in older adults and steps that home health care providers should take to eliminate the threat of impaired mobility
We evaluated whether community-level home health agencies and nursing home performance is associated with community-level hospital 30-day all-cause risk-standardized readmission rates for Medicare patients using data from the Centers for Medicare & Medicaid Services from 2010 to 2012. Our final sample included 2,855 communities that covered 4,140 hospitals with 6,751,713 patients, 13,060 nursing homes with 1,250,648 residents, and 7,613 home health agencies providing services to 35,660 zip codes. Based on a mixed-effect model, we found that increasing nursing home performance by 1 star for all of its four measures and home health performance by 10 points for all of its six measures is associated with decreases of 0.25% point (95% confidence interval [CI], 0.17-0.34) and 0.60% point (95% CI, 0.33-0.83), respectively, in community-level risk-standardized readmission rates.
Home health care agencies provide services to some of the most vulnerable patients and must encourage influenza vaccinations of their employees. The current study assessed the impact of increasing employee compliance with vaccinations and aimed to determine why certain employees refuse vaccinations. This was an observational study that looked at employee vaccination rates, employee sick days, and responses to an employee survey of those who refused vaccinations. Data were collected at a large not-for-profit home health care agency in the northeast that provides services primarily to Medicare patients. Vaccination compliance and sick days information were collected on all employees of the home care agency over three flu seasons (2012-2015). Survey data were collected on employees (n = 240) who refused the influenza vaccination during the 2014-2015 flu season. The agency more than doubled vaccination rates from 38% to 88% and found a corresponding reduction in staff sick time. By surveying the "refusers," it was found that the common reasons for avoiding vaccinations were beliefs of not being in a high-risk group, not needing vaccine, being healthy and never getting the flu, and not liking injections. It is clear that a concerted effort to increase employee influenza vaccination rates can be successful and possibly decrease staff sick days. However, there seems to be a small group of employees who refuse vaccination. Better education of these employees should help eliminate the common reasons people decline vaccination.
In Thailand, individuals with stroke prefer to return home after being discharged from hospital and most of them have inconveniences to get to hospitals or clinics to receive physical therapy. Thus, home-based physical therapy (HBPT) might be an option. A retrospective pre-test and post-test study was conducted among 2,412 individuals with first stroke after receiving HBPT. It showed significant (p < .0001) improvement in voluntary movement, postural balance, and activities of daily living (ADLs) in individuals with after-stroke duration of ≤20 years. Those with after-stroke duration of >20 years demonstrated significant development in voluntary movement (p = .005) and postural balance (p = .037), but not ADLs. In conclusion, HBPT improves voluntary movement, postural balance, and ADL in individuals following any period of first stroke, and might be an alternative service for them in Thailand.
The study explored how 125 older patients and 92 next of kin experienced and assessed continuity in long-term home health care. Data were collected by means of structured interviews. A majority of the patients indicated that having a high number of health care personnel involved in their care was not problematic. For patients, informed and skilled health personnel along with knowing the visiting personnel may compensate for a high number of personnel. For next of kin, accepting a high number of personnel was related to the carers being informed about the patient’s situation. This study indicates that, in terms of patient satisfaction, the overall quality of care is more important than the number of people providing the care.
In recent years, health service affordability for elderly people has been significantly improved within the Georgia State Health Insurance Program, although home care services for elderly people are not envisaged in any of state health care programs. Home care services for elderly people were mainly provided by nongovernmental organizations and family members (nonformal services). The objective of a survey was to study home care services rendered by nongovernmental organizations and family members in Georgia, living conditions of elderly people dependent on home care, and cost for home care services incurred by them. For study purposes, a method of direct interviews through specially constructed questionnaires was used, covering health conditions of elderly people, period of depending on care, care needs, and costs for care services. In Georgia, home care services for elderly people are mainly provided by nongovernmental organizations. The majority of interviewees (73.1%) more often use home care services rendered by nongovernmental organizations than the services envisaged by state health care programs (26.9% of interviewees use these services). Elderly people are more dependent on the assistance provided by their relatives and they give priority to the services rendered at home, rather than to institutional care (in special clinics or retirement homes). Families make a big contribution to assisting and supporting home care services for elderly people. If needed, they represent key home care service providers in Georgia. This fact should be recognized and considered while elaborating the care policy for elderly people in Georgia.
To supply sustainable health care to cancer patients, it is important to continuously deliver appropriate information regarding community health care resources and to develop an accessible medical system. We developed an information-sharing system using geographical data called the "Resource Map for Community Cooperation in Cancer Care" (http://cancerqa.scchr.jp/shizuoka/ganmap/). This system is based on registered public data available in Shizuoka Prefecture and provides the user with information concerning more than 7,000 medically related facilities (e.g., hospitals, clinics, and pharmacies). The system’s information database was derived from existing official regional data. After a probation period, we identified three factors that promote Information technology (IT) system usage for sustainable health care management: (1) visual presentation of information and usability, (2) information management, and (3) contribution to social innovation.
Until recently, palliative care was synonymous with hospice care and as such was initiated when treatments were terminated because all alternatives are exhausted. In the past few years, early initiation of palliative care has demonstrated positive outcomes in terms of treatment cost, improved quality of life, and longer survival rates for patients with serious illness. This article discusses the issues surrounding the concept of early initiation of palliative care.
Using a pre-training and post-training survey research design, 683 participants completed a personal/home care aide (P/HCA) training program. After training, participants chose a career goal and were placed in one of the following groups: (1) only goal to be a P/HCA, (2) become a certified nurse aide/assistant or home health aide, (3) become a licensed vocational nurse, or (4) go to college to earn a degree in a health-related area. Factor analysis of home care commitment items indicated two measures: home care intent and stepping stone. Group 2 trainees had a significantly higher home care intent than trainees in Groups 1 and 4. However, Groups 2, 3, and 4 were each more likely to view P/HCA training as a "stepping stone to higher level jobs" than Group 1.
Heart failure (HF) affects 5.7 million Americans and is the most common reason for 30-day readmissions. While evidence supports incorporating home telehealth (HT) programs within health care organizations to support HF patient care, it is essential to carefully map HT into existing care pathways to promote successful outcomes. The purpose of this evidence-based project was to increase enrollment in an existing Veteran’s Administration HT HF program through a strategically designed HT program plan. The outcomes included a 300% enrollment and no project participant readmissions during the 9-month project. Given the competency development in strategic and program planning, advanced practice registered nurses are ideally suited to provide the leadership in designing, implementing, and evaluating HT programs.
The discovery of the prostate specific antigen (PSA) was a landmark achievement of the 20th century according to the American Cancer Society. As a result of this discovery, the PSA screening test was developed. Over the past few years, the mounting controversy over the specificity of this test led to revisions of the screening guidelines by several organizations. This article reviews the new PSA screening guidelines.
The aim was to determine the prevalence of work-related musculoskeletal disorders (WMSDs) and health profile among urban versus rural continuing care aides (CCAs) in Canada. This cross-sectional study of 42 urban and rural CCAs assessed WMSDs and health profiles using the Nordic Musculoskeletal Questionnaire (NMQ), Cornell Musculoskeletal Discomfort Questionnaire (CMDQ), and a health background questionnaire. CCAs were generally unhealthy, with rural CCAs somewhat healthier. Greatest WMSD complaint was reported at the neck. Urban CCAs were more likely to report foot complaints (p < .05). No other statistically significant differences were found. Back and shoulder scores were correlated with poorer nutrition status, higher body mass index, and more years worked. Workplace wellness programs should address the health issues faced by CCAs through active surveillance and practical interventions to improve CCAs’ health status, prevent and manage WMSDs, and lost workdays.
With the advances made in modern medical treatments older adults are living longer. Approximately 80% have at least one chronic disease condition, which can affect their independence and quality of life if not managed appropriately. Much of chronic disease care centers on patients attending to lifestyle modifications and sustaining non-medical care routines. Consistent self-management is difficult to sustain. This article discusses some of the most frequently used integrative approaches to help patients manage their own disease condition.
The aim of our research is to evaluate the rate, the type, the severity, the causative factors, and the pathogenesis of complications during the course of myelodysplastic syndromes (MDS). Complications among MDS patients on outpatient management were prospectively recorded and classified. During an 18-month observation period, complications emerging in 48 outpatients with MDS, of whom 15 (31%) were on active treatment and 33 (69%) were receiving best supportive care alone, were recorded and analyzed. Out of 48 patients (median age, 72 years), 34 (71%) experienced complications; a total number of 92 events were recorded; most frequently observed events were infections (43 events, 47%) and bleeding (11 events, 12%). Complications are a frequent issue in MDS; preventive measures should be directed toward the most frequently observed complications.
This article is the second in a two-part series that addresses the scientific literature on the contributing factors and preventive strategies for anterior cruciate ligament (ACL) injuries. Part 1, which was presented in a previous edition of Home Health Care Management & Practice (HHCMP), covered contemporary research on the functional anatomy of the knee and precipitating factors to ACL injuries. Part 2, presented here, addresses contemporary trends evident in the peer-reviewed literature on the topic of the rehabilitation of ACL injuries, and it offers suggestions home health care professionals may find useful in the prevention and rehabilitation of this injury.
This article addresses the scientific literature on contributing factors and preventive strategies for anterior cruciate ligament (ACL) injuries, and it offers suggestions home health care professionals may find useful in the prevention and rehabilitation of this injury. More specifically, this two-part article summarizes contemporary research on the functional anatomy of the knee, precipitating factors to ACL injuries, and current strategies in the rehabilitation of these injuries. Part 1—covered here—addresses the knee’s functional anatomy and precipitating factors to ACL injuries noted in the scientific literature. Part 2—covered in a subsequent issue of Home Health Care Management & Practice (HHCMP)—addresses contemporary trends evident in the peer-reviewed literature on the topic of the rehabilitation of ACL injuries.
This article provides a brief overview of the selection, training, roles, and impact on family caregivers of community-based hospice palliative care volunteers in Canada. In many Canadian communities, carefully selected and well-trained volunteers are available to provide emotional support, companionship, practical assistance, and other kinds of help and comfort to dying persons and their families, mostly at home. Unfortunately, these services are often underutilized. Anecdotal and empirical evidence suggests that lack of awareness and/or understanding of this beneficial community resource is a major reason for the underutilization of volunteers. Education is the key to promoting awareness. Hopefully, this article will serve to inform both the general public and health care professionals about the volunteers’ background, preparation, roles, and impact on patients and family caregivers.
The primary aim of this pilot study was to develop, implement, and test the feasibility and efficacy of the Home Care Education, Assessment, Remote-Monitoring, and Therapeutic Activities (HEART) trial, a nurse-directed multicomponent home care intervention. A total of 50 patients with a primary diagnosis of heart failure (HF) were assigned to the intervention (n = 26) or control group (n = 24) according to geographical location in a large multibranch Medicare-certified home health agency. Forty-six patients completed the study. Patients participating in the HEART intervention demonstrated significantly improved HF knowledge (F = 1.31, p < .001) in comparison with control group patients’ at the study endpoint. There was a non-significant trend toward improved quality of life (QOL) and lower hospital readmission rates (6 patients vs. 9 patients) in the intervention group.
The recommendations for influenza and pneumococcal vaccines are widely known yet the rates of both immunizations for home health care patients are 70% or less. The purpose of this study was to identify the facilitators and barriers to immunizations ultimately to improve vaccination rates among home health care patients. Using a multi-case study approach with five agencies and one group of administrators, facilitators included providing patients with a vaccine "card" and using the agency’s electronic medical record (EMR) for decision support/reminders. We determined that there were patient barriers (misperceptions about vaccines in general, difficulty in recalling vaccine status) and provider barriers (misperceptions about vaccines among health care workers, home health care agencies not receiving accurate information from other providers or difficulty in determining vaccine status).
Most Western countries aim to enable dementia sufferers to live at home for as long as possible. Person centeredness, continuity of care, and competence level are all important for the quality of home health care (HHC). The aim of this qualitative study is to describe staff’s experiences of providing care to home-dwelling dementia clients through HHC services. The study used a phenomenological-hermeneutic interpretation of focus group interviews. This study supports the value of continuous interpersonal relationships in HHC services. The findings show that specialized teams facilitate continuity and person-centered care, and that after training, staff become more holistically oriented, involve clients in daily care, and experience greater job confidence.
This study aims to unfold the resultant changes in the lives of the elderly by examining the data from three Asian countries: China, the Philippines, and Japan. All of these countries lie in the Asia-Pacific region, which is by and large a very dynamic area of the world, not only economically, socially, and politically but also in terms of its demography and population profile. By analyzing the census data, the study mainly focuses on the changing practices of household elderly care in different countries, which will help us better understand the elderly care change in developing and developed nations.
The role of home nurses as providers of health care has changed and will continue to change. To guide appropriate decision making and future policy planning, it is important to have a clear picture of the activity profile of home nurses. A systematic literature review was conducted in the databases Cinahl, Cochrane, Embase, and Medline for the literature published between January 1990 and November 2013. Nine reports were identified: six quantitative studies and three literature reviews. Home nurses provide multidimensional care. However, a glaring omission in these reports was a consideration of the physiological aspects of home care. This is probably due to the questionable validity of existing nursing intervention classification schemes and the lack of scientific evidence on technical and complex interventions in home nursing care.
The objective of this study is to analyze the impact of home care services on patients with congestive heart failure. After receiving home care services, the mean hospitalization rate for patients decreased as did symptoms such as paroxysmal nocturnal dyspnea, orthopnea, dyspnea upon exertion, and pedal edema. Home care resulted in a statistically significant increase in adherence for recommended medication regimen and diet/fluid restrictions and a significant improvement in functional capacity class. The data seem to suggest that a proper home care service can reduce the number of hospitalizations and increase the overall quality of life for patients with congestive heart failure. This will simultaneously reduce the ever-increasing health expenditures and appears to be a preferable cost-effective route to care for these patients.
Home health care faces challenges that could affect job satisfaction and quality of care. The aim of the study was to describe nurses’ experiences of competence in home health care. The study sample comprised of interviews with six nurses and was analyzed using manifest qualitative content analysis. The category "Being prepared" and subcategories "Importance of leadership strategies," "Training promotes safety and independence," and "Co-operation for professional development" were identified. Organizing and planning continuous learning activities at a managerial level, such as collaborations with a focus on supervision and sense of coherence (SOC) training, could develop patient safety within home health care. The results demonstrate that professionally competent nurses working in home health care environments contribute to safe working practices to meet quality care outcomes.
High-quality nursing care in the home setting is one approach to improving outcomes in patients with heart failure (HF). This study describes home health care nursing care of patients with HF from the perspectives of home health care nurses (HHNs). Using an emergent, qualitative design, 14 HHNs were interviewed and six major themes emerged: (1) HF care is unique, (2) HF patients’ needs exceed imposed limitations, (3) listening to HF patients is key, (4) HF education is critical, (5) eyes and ears of physicians, and (6) high reward/high commitment. Overall, HHNs felt that patients with HF have nursing care needs that exceed imposed limitations on HHN services. HHNs need time to educate patients and family caregivers about HF.
This study is the first to examine how home health agency ownership and other determinants affect patient satisfaction with Medicare home health agency care. For the first time, data residing in three separate Medicare databases have been integrated for analysis. Multiple linear regression was used with independent variables that measure seven categories of home health agency characteristics and services: ownership type, costs, cost-related ratios, revenue, quality, years certified, and visits. Results show five variables statistically significant in a model predicting home health agency patient satisfaction; the two largest contributors are total home health costs and years of agency certification. The study gives policymakers and home health agencies insights into the key determinants of patient satisfaction and demonstrates the value of integrating multiple Medicare databases.
Alcohol abuse among older adults is known as the hidden epidemic as the number of individuals who suffer from dependency and abuse has about doubled in the last decade. Because baby boomers were more liberal substance users during the 1960s and 1970s, experts anticipate the epidemic will increase even further by 2020. Definition of abuse and screening as a preventive measure to identify alcohol abuse in older adults are explored.
Case management (CM) is a client-level approach to treatment that promotes the integration of human services across service providers. This approach has been adopted for home health care–based services through the case manager role. Few studies have explored the nonclinical competencies needed for case managers to be effective in their roles. This research documents the design and validation of a nonclinical competency model for case managers. Five competencies were identified: systems thinking, personal and professional accountability, facilitating creative thinking, communicating, and building relationships. Behavioral statements for each competency were assessed by a sample of case managers (for clarity, frequency of use, and experience needed) and generally supportive of the model structure. Implications for competency-based research and practice in CM are discussed.
With the advancements in medical technology, individuals are living longer with multiple chronic illnesses. This translates to aging adults providing care to loved ones as informal caregivers. When caregiving extends into years and even decades, the caregiver can suffer from caregiver syndrome. Identifying those suffering from this condition is the necessary first step to providing them the care they require to live more fulfilling lives.
A phenomenological approach of the home can inspire research of the ways in which female cancer survivors experience the transition from the oncology care setting to home. Ten gynecological cancer survivors were interviewed. The analysis was inspired by the hermeneutic approach described by Ricoeur, and followed an interpretive structure that consisted of naïve reading, structural analysis, and comprehensive understanding. Based on the women’s stories, we argue that we are beings for whom home is a developed extension of ourselves, and one that is particularly significant insofar as it provides us with a basis from which we find ourselves able to expand into a larger "space"—a world. Information from this study could provide guidelines for health care staff members.
Research has identified demographic, clinical, and technological characteristics that are associated with recurrent pediatric hospital admissions. However, research focusing on risk factors for hospitalization among pediatric home care patients is lacking. The purpose of this study was to identify characteristics associated with 60-day hospitalization among pediatric home care patients. To address this objective, we used information collected from pediatric home care patients, age 6 months to 17 years, who were served by a large not-for-profit home care agency in New York City between 2008 and 2012 (N = 6,187). Results showed that 5.4% of patients in our study population were hospitalized. Specific characteristics that were significantly associated with hospitalization are described in detail.
Currently, a large number of home health care episodes end in acute care hospitalization (ACH). The Centers for Medicare and Medicaid Services reports publically a set of quality measures, including ACH rate, for home health agencies. The objective of this study was to determine the relationship between reported Home Health Compare metrics and ACH rates. Using beta regression and controlling for urban/rural classification, median household income, and state levels of rehospitalizations, we modeled the multivariate relationship between acute hospital utilization and each separate measure of home care processes and outcomes. From our analysis, we found that two measures addressing the issue of pain management and improvement in bathing ability had strong associations with a decrease in ACH rate.
We discuss how to think about qualitative and quantitative approaches to research in general and the value of home health research in particular. We describe several lesser known research or pernicious biases and the challenge of reasoned interpretations of data from research studies. We advocate policies that allow individuals to receive home-based care grounded in strong, objective scientific evidence and support critical thinking about implementation of care.
Depression is a major mental health problem that robs affected individuals of their quality of life and increases their morbidity and mortality including suicides in older White males. The current thinking is that vulnerable individuals are at risk of major depressive disorders, which are the result of genetic, age, gender, ethnicity, and environmental factors. According to Healthy People 2020 mental health objective for intervention for depression,health care providers should be provide early screening so multiple treatment modalities can be initiated. This column discusses the recent thinking of depressive disorder and secondary and tertiary treatment options.
In Australia, veterans are a vulnerable group, because of ageing, and high rates of chronic or life-threatening illnesses and poor mental health .This retrospective pilot study explored the home-based palliative care needs of veterans as they face the end of their life, compared to non-veterans. Medical records of ten deceased veterans and ten non-veterans in a home-based palliative care service were analyzed both for demographic data, and qualitative content. Veterans had significantly more comorbidities and were older at death. Qualitative data indicated common concerns, including the role of families and practical aspects of care. Some differences were found between veterans and non-veterans in their end-of-life care requirements. More awareness of veterans’ status may assist in care more tailored to their specific needs.
Parkinson’s disease (PD) is a progressive neurological condition with no known cure. This disease progression is characterized by severe motor degeneration that often limits functional mobility during gross motor skills common in activities of daily living, work, and recreation. Exercise programs have been shown to slow symptom onset and lessen the progression of PD, helping to improve quality of life of individuals with this condition. This article provides an overview of recent studies addressing the impact of exercise programs on individuals with PD, and also provides home health care professions with suggestions for exercise program implementation within this clinical population.
The large number of individuals affected by dementia entails major challenges for home health care (HHC) and dementia-affected families. The aim of the study was to explore and describe relatives’ experiences of people with dementia living at home and to reveal the relatives’ needs for support. Focus group interviews (10 people) were used for data collection. The analysis was qualitative content analysis. The results show that relatives are unable to escape the situation and that the dignity of the person with dementia is threatened. Relatives experience a sense of powerlessness due to fragmented services. The continuity of HHC services constitutes a major challenge. Personnel should focus more on ethical considerations and on dialogue between formal and informal caregivers.
Home care is implemented internationally on a large scale. However, in Greece, home care services are underdeveloped, especially in public sector. The economic evaluation of home care for patients with terminal-stage malignant neoplasms and the comparison with the cost of hospital care. A socioeconomic evaluation was conducted comparing the cost of home care with the cost of hospital care for patients with terminal-stage malignant neoplasms. The study population included 66 patients in home care group and 64 patients in hospital care group. Both medical cost of care and carers’ lost productivity were evaluated. The 3-month medical cost of home care was estimated at 2424.3 per patient, while the corresponding cost in hospital care group was 6665.4. The monthly carers’ lost productivity in home care group was estimated at 523.9 per patient (6.7 days out of work), while in hospital care group it was 1071.3 (13.7 days out of work). Home care provides services at lower cost compared to hospital care and contributes in cost containment of public health expenditure.
Calcium is an abundant mineral found in the body, 99% found in bone and teeth and 1% to 2% used to maintain proper metabolic functions. This column examines the forms of calcium found in foods and supplements and discusses some of the research on health as a result of calcium intake.
By 2030, one in every eight people will be above age 65 and the worldwide population is projected to increase to one billion. Ages 85 and older are the fastest growing part of the aging population. New reforms like the Independence at Home Act and the Affordable Care Act make home care visits a more viable option. This literature review demonstrates nurse practitioners can provide home care visits as an extension of the medical home model. This will allow frail, elderly patients to receive quality patient-centered care in their home, thereby decreasing emergency room visits, rehospitalization, and workload on office-based primary care providers.
A randomized, retrospective chart review of 228 patients referred to Catholic Home Care; January 1, 2009 to June 30, 2009, was conducted to determine concurrent based validity of the Missouri Alliance for Home Care Tool (MAHC-10) with the Performance Oriented Mobility Scale (Tinetti), and to determine the benefit of the "Balanced Approach" rehabilitation program. A weak but significant negative relationship between the MAHC-10 and pre- (r = –.21, p < .01) Tinetti scores was found. Significant differences in Tinetti scores pre and post intervention was found with mean improvement of 5.2 points (t = –19.60, df, 181, p < .001; 95% CI[–5.72, –4.67]). Results of this study indicate the effectiveness of the MAHC-10–driven interdisciplinary program in the identification and management of fallers in the home.
Home-based case managers face many challenges to collaborating with primary care physicians, including for management of depression. To obtain physicians’ perspectives regarding optimal collaboration strategies, we conducted a mail survey of randomly selected primary care physicians (N = 74). The survey described a home-based depression care management program to be delivered by case managers and assessed physicians’ preferred collaboration strategies. Most respondents perceived the services described as useful, including having the case manager send a list of medications and send psychotropic medication recommendations per consulting psychiatrist. Most physicians reported being likely to read a written summary sent by the case manager, reply, and send it back to the case manager. Preferred communication procedures varied widely. By considering physicians’ preferences, case managers may enhance collaboration.
This study investigates how the use of an electronic messaging system influences patient safety in the medication information process between home health care nurses and general practitioners. Focus group interviews and semistructured interviews with 34 nurses and general practitioners were applied, and the results show that using a messaging system in the clinical communication and collaboration led to nurses in home health care and general practitioners more easily connecting, medication information being more accessible and medication information having a higher quality. The results also revealed that the use of a messaging system caused errors in the medication information. However, according to the nurses in home health care and general practitioners, the overall conclusion was that medication information improved and thereby patient safety increased.
Patients with heart failure (HF) who have been discharged from a home care agency are a particularly vulnerable group at risk for poor outcomes and high rehositalization rates. The primary aim of this experimental study was to determine the efficacy of a telemonitoring and self-care education intervention in reducing hospitalization and improving quality of life and patient’s knowledge of HF after home care discharge. Ninety-three participants completed the study. The primary outcome of 90-day post–home care discharge hospitalization was significantly reduced in the intervention group compared to controls (9 vs. 18, p - .046). HF knowledge (p = .013) and QOL (p = .004) were significantly increased in intervention group patients in comparison to control group patients’ at the study endpoint.
Background: Identification of medical and nonmedical requirements for outpatient treatment and/or early hospital discharge have potential to decrease health care costs. Method: On admission and before discharge, physicians and nurses, patients, and their relatives were interviewed about requirements over five domains (medical, nursing, organizational, and patients’ and their relatives’ preferences) for outpatient management and/or early discharge. Results: From a total of 550 included patients, 136 (24.7%) potential outpatients and 265 (48.2%) potential patients for early discharge were identified. Specific medical and nursing factors and factors related to patients and relatives were identified as being important for initial outpatient treatment and/or early discharge. Conclusion: This survey shows important requirements from the perspective of different heath care workers, patients, and relatives, which could allow initial outpatient treatment and/or early discharge of a large proportion of lower respiratory tract infection (LRTI) patients.
This project focused on the development of a clinical research council in a home health and hospice organization. Strengths of establishing a council included enhanced use of evidence-based practice, an increase in cross-discipline collaboration, and recruitment and retention. Council members evaluated their learning needs to establish a research education program. An organizational evaluation reviewed library and institutional review board access, system research departments, internal policies, electronic database, and clinical tools. Planning for sustainability included developing an organizing framework, creating community collaborations, and establishing a research pathway.
Recognition of the signs and symptoms that are common in the final hours of life and a basic understanding of how to manage these signs and symptoms are important to helping the patient and family experience a good death in the home setting. The most common signs and symptoms, including pain, dyspnea, and terminal restlessness or delirium, and their management are discussed. Also addressed are other signs and symptoms, such as cardiovascular signs and symptoms including cold extremities, mottling, and changes in vital signs; respiratory signs and symptoms such as changes in breathing pattern, noisy breathing, and mandibular breathing; and neurological signs and symptoms such as disorientation, sensory changes, and semicomatose state. Changes in metabolism such as fatigue, surge of energy, and increased temperature are presented, along with decreased intake, excretion, and communication changes.