Home Clients Research Articles

How well do hoarding research samples represent cases that rise to community attention?

This study used archival data from three different research groups and case file data from three independent community organizations to explore how well research samples reflect cases of hoarding that come to community attention. Using data from 824 individuals with hoarding, we found that research volunteers differ from community clients in several ways: community clients are older, more likely to be male and less likely to be partnered; they have lower socio-economic status and are less likely to demonstrate good or fair insight regarding hoarding severity and consequences. The homes of community clients had greater clutter volume and were more likely to have problematic conditions in the home, including squalor and fire hazards or fire safety concerns. Clutter volume was a strong predictor of these conditions in the home, but demographic variables were not. Even after accounting for the influence of clutter volume, the homes of community-based clients were more likely to have squalor. These findings suggest limitations on the generalizability of research samples to hoarding as it is encountered by community agencies.

"That's not my job": A mixed methods study of challenging client behaviors, boundaries, and home care aide occupational safety and health.

Home care (HC) aide is among the fastest-growing jobs. Aides often work in long-term care relationships with elders or people with disabilities in clients' homes, assisting with daily activities. The purpose of this mixed-methods paper is to elucidate aides' experiences around the boundary-challenging behaviors of clients asking for services beyond aides' job duties and to identify possible interventions. A cross-sectional survey of HC aides in Massachusetts (n = 1249) provided quantitative data. Post-survey qualitative data were collected from nine HC aide focus groups (n = 70) and seven in-depth interviews with HC industry and labor representatives. Quantitatively, aides who reported often being asked to do tasks outside their job duties were more likely to report abuse (prevalence ratio [PR] = 1.93; 95%CI: 1.47-2.52 for verbal, PR = 1.81; 95%CI: 1.13-2.91 for physical/sexual) and pain/injury with lost work time or medical care (PR = 1.58; 95%CI: 1.11-2.25). They were also less likely to want to remain in their job (PR = 0.94; 95%CI: 0.89-1.00) or recommend it to others (PR = 0.94; 95%CI: 0.90-0.98). Qualitative data showed that clients' requests for tasks beyond job duties were frequent and can lead to injuries, abuse, and psychosocial stress. Yet, requests often reflected genuine need. Helping clients stay at home, compassion, and feeling appreciated contributed to job satisfaction; therefore, aides can feel conflicted about refusing requests. Client task requests outside HC services are a complex problem. Employer support, training, care plans, and feeling part of a care team can help aides navigate professional boundaries while delivering high quality care.

Comparing Changes and Transitions of Home Care Clients in Retirement Homes and Private Homes

Long-stay home care clients mostly reside in private homes or retirement homes, and the type of residence may influence risk factors for long-term care placement. This multi-state analytic study uses RAI-Home Care and administrative data from the Hamilton Niagara Haldimand Brant Local Health Integration Network to model conceptualized states of risk at baseline through a 13-month follow-up period. Modifiable risk factors in these states were client loneliness or depressive symptoms, and caregiver distress. A higher adjusted likelihood of being discharged deceased was found for the lowest-risk clients in retirement homes. Adjusting for client, service, and caregiver characteristics, retirement home residency was associated with higher likelihood of placement in a long-term care home; reduced caregiver distress; and increased client loneliness/depression. As an alternative to private home settings as the location for aging in place among these long-stay home care clients, retirement home residency represents some trade-offs between client and informal caregiver.

The use of physiotherapy in nursing homes internationally: A systematic review.

BackgroundPhysiotherapy can improve functional ability, prevent falls and reduce pain for older adults in nursing homes. However, there are no legislations or guidelines that specify the parameters of physiotherapy required in nursing homes. With the increasing healthcare demands of ageing populations worldwide, it is important to understand the current use of physiotherapy services to ensure they are both evidence-based and promote equity.Objectives(1) When and how are physiotherapy services used by older adults living in nursing homes? (2) What are the factors associated with use of physiotherapy services in nursing homes? (3) How are physiotherapy services in nursing homes documented and monitored?MethodsSeveral databases and grey literature (including MEDLINE, PubMed, Pedro and EMBASE) were searched following PRISMA guidelines in March 2018. Searches were limited to English language publications from 1997. Assessment for inclusion, data extraction and quality assessment were completed by two investigators independently using standardised forms. Studies were included if they considered any type of physiotherapy service that involved a qualified physiotherapist (such as exercise, massage and staff education) with older adults (aged 60 years and older) that were primarily permanent residents of a nursing home. Data extracted included proportion of clients that used physiotherapy services, type, frequency and duration of physiotherapy services, and factors associated with physiotherapy service use.ResultsEleven studies were included. Between 10% and 67% of nursing home clients used physiotherapy services. Factors associated with greater use of physiotherapy services included larger size facilities, and if clients had a physical impairment and mild or no cognitive impairment. Types of physiotherapy services reported were pain management and pressure ulcer management.ConclusionsPhysiotherapy service use in nursing homes varied widely. The development of physiotherapy benchmarks and quality standards are needed to support older adults in nursing homes.PROSPERO registration number: CRD42018082460.

Animal hospice and palliative care: Veterinarians' experiences and preferred practices

Given that veterinary hospice and palliative care is still in its infancy, little is currently known about veterinarians' attitudes toward, experiences with, and preferred practices relating to the provision of hospice and palliative care. This research effort seeks to fill this void by presenting the results of a survey of members of the International Association for Animal Hospice and Palliative Care. The results from the electronic survey yielded 137 responses. The average number of companion animals euthanized annually by each veterinarian was 239, with the majority of veterinarians performing the euthanasia in the client's home. Most veterinarians prefer that other animals be present for euthanasia of a pet. Most pet owners stay for the procedure (two-step method of euthanasia protocol most frequently used), and most clients ask the veterinary practice to cremate the dead animal's remains. The respondents from the survey are aware of their role in relation to grief and tend to provide the client with grief support resources. Veterinarians would have preferred more orientation in veterinary school regarding issues on end of life.

Evaluating frailty in Medicaid Home and Community-based Services clients: a feasibility and comparison study between the SHARE-FI and SPPB

BackgroundFrailty assessment most commonly occurs within health care settings by health care providers. Implementing frailty assessment within non-medical settings that provide comprehensive social services for older adults may be an opportunity for population-based frailty screening and care. One such non-medical setting in which older adults receive care is Medicaid Home and Community-based Services (HCBS). Determining the feasibility of frailty screening within this non-medical setting is the first step towards population-based frailty assessment and care. The aims of this study were to (1) determine the feasibility of evaluating frailty using two different approaches (the Survey of Health Among Retired Europeans-Frailty Instrument (SHARE-FI) and Short Physical Performance Battery (SPPB)) among HCBS clients, (2) determine the agreement between the methods, and (3) explore specific frailty deficits on these measures to provide detailed knowledge on HCBS client impairments.MethodsThis cross-sectional study occurred in HCBS client homes throughout the Chicagoland area. A research assistant with no health care provider training conducted all frailty assessments. We used the freely available SHARE-FI calculator to generate both a categorical and continuous frailty score. We used the SPPB to capture both a categorical score with frailty categories assigned as 0–6 (frail), 7–9 (pre-frail), and 10–12 (non-frail) and continuous score. We evaluated feasibility via domains of acceptability, implementation, adaptation, and practicality. We used Cohen’s kappa and Spearman’s correlation to determine agreement between frailty tools.ResultsWe enrolled n = 139 HCBS clients. Frailty assessment was feasibility via both the SHARE-FI and SPPB. The SHARE-FI was more practical given the fewer training needs, shorter administration time, and reduced equipment needs. There was a statically significant fair agreement between SHARE-FI and SPPB categorical scores with stronger agreement between SHARE-FI and SPPB continuous scores (r = − 0.448, p < .005; 95% CI, − 0.571, − 0.305). Among the five frailty criteria on the SHARE-FI, a pattern emerged of the highest frequency of positive responses to each criterion among frail clients followed by pre-frail and then non-frail.ConclusionsFrailty assessment is feasible within HCBS settings conducted by a non-medical provider. Using continuous frailty scores provides stronger agreement between measures compared with categorical scores. Frailty can be feasibly measured in a non-medical setting providing initial evidence for a mechanism for population screening and care for frailty in HCBS.

An Intelligent IoT-Based Food Quality Monitoring Approach Using Low-Cost Sensors

The evolution of multipurpose sensors over the last decades has been investigated with the aim of developing innovative devices with applications in several fields of technology, including in the food industry. The integration of such sensors in food packaging technology has paved the way for intelligent food packaging. These integrated systems are capable of providing reliable information about the quality of the packed products during their storage period. To accomplish this goal, intelligent packs use a variety of sensors suited for monitoring the quality and safety of food products by recording the evolution of parameters like the quantity of pathogen agents, gases, temperature, humidity and storage period. This technology, when combined with IoT, is able to provide a lot more information than conventional food inspection technologies, which are limited to weight, volume, color and aspect inspection. The original system described in this work relies on a simple but effective method of integrated food monitoring, right at the client home, suitable for user prepared vacuum-packed foods. It builds upon the IoT concept and is able to create a network of interconnected devices. By using this approach, we are able to combine actuators and sensing devices also providing a common operating picture (COP) by sharing information over the platforms. More precisely, our system consists of gas, temperature and humidity sensors, which provide the essential information needed for evaluating the quality of the packed product. This information is transmitted wirelessly to a computer system providing an interface where the user can observe the evolution of the product quality over time.

Understanding Dysphagia Care in the Community Setting.

Factors including health policy reform and the aging population are increasing demand for quality healthcare in the community. People with dysphagia are supported by speech-language pathologists (SLPs) in hospital and community settings; however, little is known about the nature of dysphagia services offered by SLPs in the community. The aim of this study was to investigate SLP services and practices provided to community-based adults with dysphagia. A national cohort (n = 144) of SLPs working with community-based clients with dysphagia completed an online survey. Results revealed that clients with neurological conditions comprised the largest proportion of the caseload. Primary referral sources were family doctors (42.4%) or other health professionals (37.5%), with low rates of self-referral. Services were primarily delivered via individual sessions (84.1%), usually within the client's home (80% saw clients at home). While many clinicians were using both clinical and instrumental assessments, half had to refer clients to the other services to access instrumental assessment. Most provided assessment and rehabilitation services, though a few (28.5%) reported using formal outcome or quality-of-life measures. Only 43.8% referred or encouraged clients or caregivers to access support or social groups and a few SLPs incorporated social participation or client well-being aspects in treatment. Speech-language pathology (SLP) practices in the community appear similar to what occurs in the acute setting, which are inherently biomedical. This may not be optimal care for clients with dysphagia who live at home and their caregivers. Further exploration about what clients and caregivers want from community-based SLP services is warranted.

Factors affecting outcome in participation one year after stroke: A secondary analysis of a randomized controlled trial.

To explore the importance of client characteristics (age, sex, stroke severity and participation before stroke), rehabilitation context (in-patient or client's home) and approach (enhanced client-centeredness or not) on participation in every-day life after stroke. A secondary analysis of data on 237 participants from a previous randomized controlled trial evaluating an enhanced client-centred intervention after stroke. Plausible associations between client characteristics, context and rehabilitation approach, and a positive outcome regarding participation were explored. Three different outcome measures for participation were used: Stroke Impact Scale 3.0, domain participation; Frenchay Activities Index; and Occupational Gaps Questionnaire. For all participants there was a significant association between mild stroke and a positive outcome using the Frenchay Activities Index. Among participants who had not received the enhanced client-centred approach, there was a significant association between mild stroke and a positive outcome using the Stroke Impact Scale. The context of rehabilitation, i.e. receiving home rehabilitation, was also associated with a positive outcome in the Frenchay Activities Index for the control group. In order to increase participation in every-day life for people after stroke it appears to be important to use an enhanced client-centred approach, particularly when working within in-patient rehabilitation and with people with moderate or severe stroke.

Demand-Driven Task-Scheduling in a Nursing Home Setting: A Genetic Algorithm Approach

Nursing homes face the challenge to develop task assignment strategies that enable them to timely and efficiently meet the demand of their clients. In this contribution, we analyze a practice-based task scheduling problem with small time windows and care workers with different qualification levels. A set of care tasks has to be assigned to a given number of care workers with the objective of delivering the care as close as possible to the time preferences of the nursing home clients. To solve this problem, we propose a scheduling approach in which a Genetic Algorithm is combined with an Integer Linear Program. We verified the approach using numerical experiments. The next step will be to test the algorithm with real-life data and to implement it in practice.

Developing a health interview tool for Medicaid home and community-based services clients and home care aides through a community-engaged approach

ABSTRACTWe describe a community-engaged approach to develop and pilot a home care aide (HCA) administered health interview with Medicaid Home and Community-based Services clients. Stakeholders identified five priority health topics and selected a card sorting methodology for interviews. A barrier to interviewing clients was decreased communication skills among HCAs, and we modified health interview training to include communication training. Stakeholders reported the interview methodology was feasible within usual care, acceptable to clients, and contributed to increased knowledge on providing person-centered care. Stakeholder engagement resulted in valuable insights regarding the health interview methodology and relevant training needs.

Furthering Recognition of Lift, Slip, And Trip Hazards in Home Healthcare Environments: Opportunities for Virtual Simulation Training

Home healthcare workers are exposed to numerous safety hazards within client homes. A virtual simulation training system has been developed to train home healthcare workers to recognize and remediate these hazards where possible. This paper investigates how well study participants could identify lift, slip, and trip hazards within the client’s home in the virtual simulation training system.

Impact of an Intimate Partner Violence Training on Home Visitors' Perceived Knowledge, Skills, and Abilities to Address Intimate Partner Violence Experienced by Their Clients.

The aims of this study were to (1) evaluate the effects of a statewide intimate partner violence (IPV) training on home visitors' perceived knowledge, skills, and abilities to address IPV experienced by their clients and (2) examine home visitors' perceived barriers to addressing IPV during client home visits. In 2015, five equivalent, daylong IPV trainings were held throughout West Virginia. Attendance was mandatory for all home visitors in the state. Pre- and posttraining surveys were administered to every attendee ( N = 125). The surveys assessed home visitors' perceived knowledge, skills, and abilities to address IPV experienced by their clients and perceived barriers to addressing IPV during a client home visit. The results showed (1) home visitors' knowledge, skills, and abilities significantly improved from pre- to posttraining (all p < .05) and (2) the most commonly reported barriers to addressing IPV were "the partner is present for the visit" (86.2%), "worried that asking may risk my relationship with my client" (30.2%), "not sure how to ask questions without seeming too intrusive" (25.9%), and "worried about upsetting the client" (21.6%). Our findings highlight the immediate positive effects of an IPV training on home visitors' professional capabilities to address IPV experienced by clients and the most prevalent barriers home visitors face when addressing IPV that should be targeted in future health education interventions.

Cost-Effectiveness of Parent–Child Interaction Therapy in Clinics versus Homes: Client, Provider, Administrator, and Overall Perspectives

Parent–Child Interaction Therapy (PCIT) is effective in decreasing negative child behaviors when delivered in clinics. Emerging research suggests that delivering PCIT in client homes can produce similar outcomes … but at what cost? Home PCIT still consumes valuable client time, but only for sessions. Home PCIT could reduce barriers to continued parent participation, and costs, by not requiring clients to spend time and money traveling to and from clinics. Home PCIT also does not require that parenting skills learned in clinics be generalized to homes. We assessed and compared costs of clinic and home PCIT at individual client and program levels of specificity from client and provider perspectives for 264 children and parents (clinic = 139, home = 125). We also included an administrator perspective and a client + provider + administrator = overall perspective. Multivariate analyses of covariance applied to imputed datasets found that, because significantly more sessions were held for PCIT delivered in homes than in clinics (a mean 18 versus 11 sessions, respectively), home PCIT cost significantly more from the overall perspective ($3913 versus $1821 per child receiving home versus clinic PCIT) and the provider perspective ($3326 versus $950 per child receiving home versus clinic PCIT), significantly less from the administrator perspective ($125 versus $397 per child receiving home versus clinic PCIT), and about the same from the client perspective ($352 versus $427 per child receiving home versus clinic PCIT). Cost-effectiveness ratios (CERs) calculated for individual clients were significantly better for clinic PCIT from provider and overall perspectives but not from the administrator or client perspectives.

ASSOCIATION BETWEEN THE ORGANIZATION AND ENVIRONMENTAL FACTORS AND WORK INJURIES AMONG HOME HEALTH CARE NURSES

Work-related injuries have an adverse impact on health and safety of the employees, patients, and health care organization. Nurses’ exposure to work injuries is one of the highest rates in home and community care institutions. Nurses working in home health care (HHC) encounter multidimensional risk factors, including the organizational and environmental hazards associated with HHC. The purpose of this cross-sectional study was to examine the relationship between the organization and environmental factors and the work injuries (WIs) as experienced by HHC nurses (HHCNs). A prediction of the significant factors related to work injuries was explored. A self-reported data was obtained from 74 nurses working in nine HHC units in the Makkah Region, KS, using the Safety Home Care Nursing (SHCN) questionnaire. The results showed that the supervisory support (SS) (β = -0.36, p = .009) and the access to a client's home (AC) (β = -0.25, p= 0.05) were negatively affecting the WIs as experience by HHCNs. This implies that the training of Front-line supervisors and HHC providers in safety management and safety communication would improve competence in effective implementation of safety practices. This study suggests to ensure a safe HHC through the execution of an integrative approach involving managers, nurses, and other practitioners, as well as the patients’ and their informal caregivers. Article DOI: https://dx.doi.org/10.20319/lijhls.2018.41.6581 This work is licensed under the Creative Commons Attribution-Non-commercial 4.0 International License. To view a copy of this license, visit http://creativecommons.org/licenses/by-nc/4.0/ or send a letter to Creative Commons, PO Box 1866, Mountain View, CA 94042, USA.

The need for flexibility when negotiating professional boundaries in the context of home care, dementia and end of life

ABSTRACTProfessional boundaries may help care staff to clarify their role, manage risk and safeguard vulnerable clients. Yet there is a scarcity of evidence on how professional boundaries are negotiated in a non-clinical environment (e.g. the home) by the home-care workforce in the context of complex care needs (e.g. dementia, end-of-life care). Through analysis of semi-structured interviews, we investigated the experiences of home-care workers (N = 30) and their managers (N = 13) working for a range of home-care services in the South-East and London regions of England in 2016–17. Findings from this study indicate that home-care workers and their managers have clear perceptions of job role boundaries, yet these are modified in dementia care, particularly at end of life which routinely requires adaptability and flexibility. As a lone worker in a client's home, there may be challenges relating to safeguarding and risk to both clients and workers. The working environment exacerbates this, particularly during end-of-life care where emotional attachments to both clients and their family may affect the maintenance of professional boundaries. There is a need to adopt context-specific, flexible and inclusive attitudes to professional boundaries, which reconceptualise these to include relational care and atypical workplace conventions. Pre-set boundaries which safeguard clients and workers through psychological contracts may help to alleviate to some extent the pressure of the emotional labour undertaken by home-care workers.

Design and Implementation of Smart Home Gateway Based on 433MHz Radio-Frequency Communication

Background: In view of the lack of centralized control of traditional home appliances, this paper implements an intelligent gateway based on the Linux embedded operating system as the software platform and the ARM9 processor S3C2440 as the hardware development platform to solve this problem. Methods: The intelligent gateway is equipped with Wi-Fi, CC1101, Ethernet card and other functional modules, and based on the 433MHz radio-frequency protocol stack and the Linux operating system kernel. We establish the platform of the remote control through the cloud server, so the users can log on the client to achieve smart home remote monitoring. Result: This paper introduces the hardware and software development process of intelligent gateway, which involves the realization of the 433MHz radio-frequency protocol stack, the software design of the 433MHz radio-frequency module, and the design and implementation of the smart home client and so on. Conclusion: The test results show that the intelligent gateway has the characteristics of low-cost, low-power consumption, high reliability. Keywords: Intelligent gateway, 433MHz radio-frequency communication, smart home, CC1101, Linux, S3C2440 cloud platform.

Orthostatic Hypotension and Associated Factors among Home Care Clients Aged 75 Years or Older - A Population-Based Study.

The aim of this study was to examine orthostatic hypotension (OH) and associated factors among home care clients aged 75 years or older. Non-randomised controlled study. The study sample included 244 home care clients aged 75 years or older living in Eastern and Central Finland. Nurses, nutritionists and pharmacists collected clinical data including orthostatic blood pressure, depressive symptoms (15-item Geriatric Depression Scale GDS-15), nutritional status (Mini Nutritional Assessment MNA), drug use, self-rated health, daily activities (Barthel ADL Index and Lawton and Brody IADL scale) and self-rated ability to walk 400 metres. Comorbidities were based on medical records. The prevalence of OH was 35.7% (n = 87). No association between OH and the number of drugs used or causative drug use and OH was found. In univariate analysis, coronary heart disease, systolic and diastolic blood pressure in a sitting position and lower mean MNA scores were associated with a risk of OH. Multivariate analysis showed that lower mean MNA scores (OR 1.140, 95% CI: 1.014-1.283) appeared to be independently connected to a risk of OH. One-third of the home clients had OH and it was associated with lower MNA scores.

Cleaning and disinfection in home care: A comparison of 2 commercial products with potentially different consequences for respiratory health

Home care aides perform personal care and homemaking services in client homes, including cleaning and disinfection (C&D). Although C&D are performed to remove soil and dust, they are increasingly performed for infection prevention. Many C&D products contain respiratory irritants. The objective of this study was to evaluate 2 commercial products for C&D effectiveness on common household surfaces in seniors' homes. Two C&D visits were conducted in 46 seniors' homes. One visit applied a bleach-containing cleaning product and the other applied an environmentally preferable product. Before and after C&D, the study team performed organic soil bioluminometer measurements on surfaces and collected cotton swab and wipe samples for total bacteria count, Staphylococcus aureus, and Clostridium difficile identification. Both products removed microorganisms from tested surfaces. S aureus was found in 7 households, 1 strain of which was methicillin-resistant. Both products removed S aureus from all surfaces. Bleach-containing products removed somewhat more soil than environmentally preferable products, although results were statistically significant for only 1 surface. The study showed similar, not identical, C&D performance for 2 cleaning products with potentially different consequences for respiratory health. Additional research is needed to develop robust recommendations for safe, effective C&D in home care.

Towards High-Value(d) Nursing Home Care: Providing Client-Centred care in a More Efficient Manner

Today, Dutch nursing homes are confronted with two seemingly incompatible goals. They face the challenge of providing high quality care while reducing costs at the same time. As a result, most nursing homes are looking for ways to further streamline their care and support activities. It is this challenge that is addressed in this Phd-thesis. More specific, the main objective of the work presented in this thesis is to contribute to the optimization of daily nursing home operations, where optimal is defined as meeting the healthcare needs and time preferences of the nursing home clients in the most cost-efficient manner. To achieve this objective, knowledge and insights from the field of logistics were used.