Community Home Care Research Articles

Diabetes, Care Homes, and the Influence of Technology on Practice and Care Delivery in Care Homes: Systematic Review and Qualitative Synthesis

BackgroundDiabetes is increasing in prevalence and complexity in the care home setting, affecting up to a quarter of care home residents. Health outcomes for these residents are impacted by management of the disease, health care professionals (HCPs)’ decision-making skills within the care home setting, and access to specialist services. The use of technology has the potential to recognize opportunities for early intervention that enables efficient responsive care, taking a fundamental role in linking the care home community to wider multidisciplinary teams for support.ObjectiveThe aim of this paper was to identify evidence that explores factors relevant to the use of technology in and around the care home setting to aid in the management of diabetes.MethodsDatabases searched using a structured prespecified approach included: PubMed, CINAHL (Cumulative Index to Nursing and Allied Health Literature), OVID Nursing database, Scopus, MEDLINE, the Cochrane Library, and the King’s Fund from 2012 to 2017: handsearching was undertaken additionally for any gray literature. Preferred Reporting Items for Systematic review and Meta-Analysis Protocol was used as protocol with Risk of Bias in Systematic reviews a tool to assess the risk of bias across studies. Studies had to include interventions that combined technology to or from the care home setting to support residents living with diabetes.ResultsThe combined search strategy identified a total of 493 electronic records. Of these, 171 papers were screened for eligibility, 66 full papers were accessed, and 13 have been included in this study. Qualitative synthesis has identified different strands of research evidence in what and how technology is currently being used in and around care homes to enhance diabetes management. New initiatives and implementations of technology and emerging models of care that included the use of technology have also been included.ConclusionsBy triangulating the perspectives of HCPs, practitioners, specialists, and members of the care home community, the authors anticipate that this review will represent an up-to-date, evidence-based overview of the potential for using technology within the care home setting for diabetes management as well as stimulate research in this area.

The Exploratory Experiment of Introducing Time Currency into Community Home Care

The Exploratory Experiment of Introducing Time Currency into Community Home Care

INTERVENTIONS TO COMBAT LONELINESS FOR OLDER ADULTS: A REVIEW OF REVIEWS

Loneliness is concept that is associated with later life and there is a considerable investment in both North America and Europe in interventions to combat loneliness. We undertook a review of reviews to identify effective interventions to alleviate loneliness in adults and included systematic reviews conducted on loneliness between 2008–2018. Unpublished grey literature published between 2008–2018 and in the form of evaluation reports is also included. We report the findings from studies using controlled study designs and measuring loneliness as reported in the source reviews. After duplicates were removed, the electronic searches returned 364 published reviews for screening, 14 of which meet our inclusion criteria. These reviews yielded 40 papers and 4658 participants all of whom were older adults (aged 55+). Studies were undertaken in a range of countries including The United States, the United Kingdom (England, Northern Ireland, Scotland, Wales), the Netherlands. Finland, Japan, New Zealand, Sweden and Taiwan. Interventions in the included studies varied and included animal interventions, technology of many kinds, gardening, physical activity, reminiscence therapy, befriending, residential and school-based camps. Delivery took place in community and care home contexts but few of the source reviews provided details of the content of the intervention and its, duration, intensity and frequency. Study quality was generally low. Interventions were poorly described in terms of content, duration, frequency and intensity. Sample sizes were small (mean = 125) and post-intervention follow-up rare. Results from controlled study designs in both community settings and care homes showed no effect of interventions on loneliness.

Advanced Nurse Practitioners impact across Primary Care

Primary Care in an Integrated System: NHS Lanarkshire has recognised the need to redesign general practice to ensure its services meet the health needs of the people of Lanarkshire now and in the future. Our innovative Primary Care and Mental Health Transformation Programme PCMHTP is a major improvement programme that aims to improve patient access to general medical practice in Lanarkshire. The Lanarkshire approach to transforming primary care got underway 18months ago and is reflected in the recent proposal for the new Scotland-only GP contract. General Practice and Community Redesign work stream of this programme is exploring how an advanced practice, multi-disciplinary team MDT approach improves access for patients to health services in the community , maximising the contribution of all health and social care professionals in delivering the ‘right person, first time’ outcome for patients. This work includes a team of nine trainee Advanced Nurse Practitioners ANPs recruited by NHS Lanarkshire to support primary care. ANPs are highly experienced nurses who are working towards completing a competency framework that will support and evidence their learning in Advanced Nursing Practice. The trainee ANPs are currently enhancing their clinical skill set, and are supported in developing their clinical skills by General Practitioners GPs, whilst undertaking Masters level study in Advanced Clinical Practice. The aim of the project is to develop the team in order to test and evidence how they can support MDTs as a resource for supporting complex care delivery, releasing time for GPs to focus on care delivery as the lead clinicians in primary care. The project is utilising quality improvement methodology in testing and developing the approach and has a comprehensive set of evidence data. ANPs are currently being supported within out-of-hours primary care centres and general, testing how they can best support an MDT approach to patient care in community hospitals and care homes. ANPs will be able to assess life-span as generic practitioners with advanced clinical assessment skills, and prescribing qualification. Following further development they will have full access to diagnostics to enable them to manage the full clinical care of the individual requiring assessment of health needs. The development of ANPs in primary care in Lanarkshire is demonstrating the considerable impact they can make as part of a multi-disciplinary team, and supported by the Scottish Government’s commitment to invest in training an additional 500 ANP’s by 2021. The ANPs are developing in key areas of practice through leadership, facilitating change and improvement in patient experience creating better easier access to GP’s. Through the ANPs leading on research within their areas, they are building up an evidence base that provides confirmation of improved patient experience and quality person-centred care across all age groups. Whilst learning and developing as a new service within NHS Lanarkshire, the team members have a clear governance structure that supports their clinical practice and identifies limitations of practice. The team are developing as a sought-after resource to support person centred care delivery in general practice as autonomous practitioners in the near future.

An update on dementia training programmes in home and community care.

Many people living with dementia (PLWD) wish to continue living at home. The quality of home care services directly influences their ability to stay at home, their quality of life, and can promote independence for PLWD, and reduce burden for the family carer. For high-quality, effective, person-centred community-based dementia care, a knowledgeable and empathetic workforce is crucial. This article presents an up-to-date review and summary of the literature investigating dementia training programmes for community home care professionals and care workers, referred to collectively as home care workers (HCWs). We reviewed the literature between October 2016 and April 2018 on dementia training for HCWs. We found a significant lack of evidence-based, codesigned specialist dementia training programmes for HCWs that address the needs of all stakeholders in home care, and which formally measure outcomes. In order to enable PLWD to maintain living at home in the community, dementia-friendly and knowledgeable HCWs are needed. This review highlights the need for more research into the design and evaluation of evidence-based dementia specialist training programmes for community care.

Home care needs and service content among the aged of a community in Tianjin

Objective To investigate the health status of the permanent aged over 60 years old of a community in Tianjin, their home care needs and service content as well as apply the results to develop home care services of community so as to provide a theory evidence and to guide development direction. Methods From September to December 2016, a total of 105 aged people over 60 years old of a community of Hedong District in Tianjin were selected as subjects by convenience sampling. The home health care needs questionnaire of aged people was used to investigate health status of the aged over 60 years old, their home care needs and service content. Results A total of 105 aged people participated in the survey and 29.5% of them thought that care of caregivers could absolutely satisfy their care needs. There were 98.1% of them with one or more home care service needs. In turn, the needs in service content included blood pressure monitoring, electrocardiogram, rehabilitation training, mental nursing and guidance for caregivers. Conclusions The aged of the community in Tianjin have poor health condition and have great demands in community medicine and home care. Government should perfect health economic policy, community care as well as home care mode and solve nursing needs of the aged wit home based care. Key words: Aged; Home care needs; Service content

Training informal caregivers to care for older people after stroke: A quasi-experimental study.

This study aimed at evaluating whether training on practical skills involved in providing care reduces the burden experienced by informal caregivers and improves their general health condition. A substantial number of informal caregivers lack skills to deliver poststroke assistance to older people after hospital discharge, which leads to burden situations as well as mental and physical health deterioration of the former. A quasi-experimental design. This study involved 174 informal caregivers of older people who overcame a stroke. The control group (N=89) received the usual type of care delivered in healthcare units. The experimental group (N=85) adopted the InCARE programme for 1week (T0), 1month (T1) and 3 (T2) months and received telephone support by counselling caregivers on the subsequent 3rd, 6th, 8th and 10th weeks to hospital discharge. It aimed at facilitating the caregiver's adjustment to the demands of a poststroke stage and at increasing knowledge and practical skills to support the decision-making. Data collection occurred between February-December 2014 at the Community Home Care Services in northern Portugal. The experimental group obtained significantly better results regarding practical skills as well as lower burden levels and a better general mental health condition when compared with the control group 1 (T1) and 3 (T2) months after intervention. Findings suggest that our programme improved practical skills, helped reduce burden levels with better scores and improvement regarding general mental health condition of informal caregivers.

Leveraging supply chain infrastructure to advance patient safety in community health-care settings

PurposeThe purpose of this paper is to examine the opportunity for supply chain processes and infrastructure to reduce the risk of medical error and create traceability of adverse events in community care settings. Patient safety has become an important area of focus over the past few decades, with medical error now accounting for the third most common cause of death in Canada and the USA. The majority of patient safety studies to date have focused specifically on safety in hospital settings; however, deaths and harm experienced by patients in the community (home care, long-term care, complex care and rehabilitation settings) are not well understood.Design/methodology/approachThis paper discusses the evidence that adverse events occur at similar, if not more, frequent rates in community care settings.FindingsThe authors propose that above and beyond current efforts to increase awareness and promote a “safety culture” in health-care settings, system infrastructure should be designed in a way that enables clinicians to provide the safest care possible. There is currently no line of sight across the health-care continuum. The authors suggest that improving system infrastructure would reduce the occurrence of adverse events.Originality/valueSuch visibility across the continuum of care holds the potential to transform health-care in Canada from a fragmented system, where information is inadequately captured and transferred from provider to provider, to a system that provides complete, accurate and up-to-date information regarding patient care, procedures, medications and outcomes so as to provide the best and safest care possible. System visibility achieves quality and safe care, which is transparent and accountable and achieves value for patients.

THE DEVELOPMENT OF SOCIAL SKILLS OF YOUNG PEOPLE LIVING IN COMMUNITY CARE HOMES

The purpose of the article is to reveal the need for the social skills of young people living in community care homes based on the experience of young people. Problematic study questions: What social skills, which are important to a person‘s independent living, do the adolescents lack? How do opportunities to develop social skills change while living in the community care homes? Eight young people aged 17-18 years old from three community care homes, which are in different parts of Lithuania, participated in the study. The study revealed that young people lack communication skills: they have difficulty establishing and maintaining contact, communicating politely, being empathetic (careful, attentive and understanding to others), addressing emerging issues and conflicts constructively. The study found out that young people lack intrapersonal skills: self-control, responsibility, and self-confidence. Young people lack activity organisation skills: activity planning and activity realisation skills. The study reveals that, while living in community child care homes, opportunities to develop social skills change in a positive way. In everyday practical activities, more opportunities to solve problems and plan and organise various activities occur. By communicating and cooperating in the family environment, young people acquire more empathy, building rapport and maintaining it, polite communication and conflict resolution skills. A family atmosphere and close and positive mutual relationships, which are built in the community child care homes, contribute to the strengthening of self-confidence and trust in others.

Palliative care volunteerism across the healthcare system: A survey study

Background: Volunteers fulfil several roles in supporting terminally ill people and their relatives and can positively influence quality of care. Healthcare in many countries faces resource constraints and some governments now expect communities to provide an increasing proportion of palliative care. However, systematic insights into volunteer presence, tasks and training and organisational challenges for volunteerism are lacking. Aim: Describe organised volunteerism in palliative direct patient care across the Flemish healthcare system (Belgium). Design: A cross-sectional postal survey using a self-developed questionnaire was conducted with 342 healthcare organisations. Setting/participants: The study included full population samples of palliative care units, palliative day-care centres, palliative home care teams, medical oncology departments, sitting services, community home care services and a random sample of nursing homes. Results: Responses were obtained for 254 (79%) organisations; 80% have volunteers providing direct patient care. Psychosocial, signalling and existential care tasks were the most prevalent volunteer tasks. The most cited organisational barriers were finding suitable (84%) and new (80%) volunteers; 33% of organisations offered obligatory training (75% dedicated palliative care, 12% nursing homes). Differences in volunteer use were associated with training needs and prevalence of organisational barriers. Conclusion: Results suggest potential for larger volunteer contingents. The necessity of volunteer support and training and organisational coordination of recruitment efforts is emphasised. Organisations are encouraged to invest in adequate volunteer support and training. The potential of shared frameworks for recruitment and training of volunteers is discussed. Future research should study volunteerism at the volunteer level to contrast with organisational data.

Caring for patients on home enteral nutrition: Reported complications by home carers and perspectives of community nurses.

To explore the experiences of community nurses and home carers, in caring for patients on home enteral nutrition. The number of patients on home enteral nutrition is on the increase due to advancement in technology and shift in focus of providing care from acute to community care settings. A mixed-method approach was adopted. (i) A face-to-face survey design was used to elicit experience of carers of patients on home enteral nutrition. (ii) Focus group interviews were conducted with community nurses. Ninety-nine carers (n=99) were recruited. Patient's mean age that they cared for was aged 77.7years (SD=11.2), and they had been on enteral feeding for a mean of 29months (SD=23.0). Most were bed-bound (90%) and required full assistance with their feeding (99%). Most were not on follow-up with dietitians (91%) and dentists (96%). The three most common reported gastrointestinal complications were constipation (31%), abdominal distension (28%) and vomiting (22%). Twenty community nurses (n=20) were recruited for the focus group interviews. Four main themes emerged from the analysis: (i) challenge of accessing allied health services in the community; (ii) shorter length of stay in the acute care setting led to challenges in carers' learning and adaptation; (iii) transition gaps between hospital and home care services; and (iv) managing expectations of family. To facilitate a better transition of care for patients, adequate training for carers, standardising clinical practice in managing patients with home enteral nutrition and improving communication between home care services and the acute care hospitals are needed. This study highlighted the challenges faced by community home care nurses and carers. Results of this study would help to inform future policies and practice changes that would improve the quality of care received by patients on home enteral nutrition.

Bundling Care for Cardiac Surgery Patients

Patients returning to the community after surgery often experience a disconnect when transitioning from hospital to community home care. Many receive little organized/planned care following discharge sometimes resulting in unplanned expensive care in hospital emergency departments and inpatient readmissions. Trillium Health Partners, a large community/teaching hospital, in partnership with community care provider Saint Elizabeth Health Care, designed and implemented a seamless "bundled care program" for cardiac surgery patients extending from hospitalization to 30 days after discharge. With a risk/gain sharing model, the bundled care program enabled a novel integrated clinical patient care model. This included integrated care coordinators embedded within the hospital team, 24/7 patient phone line, integrated medical records and a tracking board that enabled performance monitoring and improvement. Evaluation results revealed: a 16% reduction in post-operative length of stay; a 38% reduction in readmission rates; and a 13% decrease in total system cost per patient, together with markers of improved patient experience.

Digitalization of Patient Information Process from Hospital to Community (Home) Care Nurses: International Perspectives.

For older people who transition from hospital to home, home care is an increasingly important and effective way of managing chronic illness with skilled nursing care in the home. Communication between clinicians across care settings is fundamental for continuity of care. Poor communication of patient information is acknowledged to be a root cause of sentinel events. In Scandinavia and the United States, researchers study the communication of patient information from hospital to home care. The health care systems of these two countries differ. Differences are reflected in the characteristics of patients transferred from hospital to home care, as well as the characteristics of health information systems (ICT). These differences help to elucidate key issues related to the transfer of patient information from hospital to home care.

浅谈广州市社区居家养老服务与老年社会工作

浅谈广州市社区居家养老服务与老年社会工作

Impact of Pharmacists in a Community-Based Home Care Service: A Pilot Program.

Historically, pharmacists have not been included on home care teams, despite the fact that home care patients frequently experience medication errors. Literature describing Canadian models of pharmacy practice in home care settings is limited. The optimal service delivery model and distribution of clinical activities for home care pharmacists remain unclear. The primary objective was to describe the impact of a pharmacist based at a community home care office and providing home visits, group education, and telephone consultations. The secondary objective was to determine the utility of acute care clinical pharmacy key performance indicators (cpKPIs) in guiding home care pharmacy services, in the absence of validated cpKPIs for ambulatory care. The Winnipeg Regional Health Authority hired a pharmacist to develop and implement the pilot program from May 2015 to July 2016. A referral form, consisting of consultation criteria used in primary care practices, was developed. The pharmacist also reviewed all patient intakes and all patients waiting in acute care facilities for initiation of home care services, with the goal of addressing issues before admission to the Home Care Program. A password-protected database was built for data collection and analysis, and the data are presented in aggregate. A total of 197 referrals, involving 184 patients, were received during the pilot program; of these, 62 were excluded from analysis. The majority of referrals (95 [70.4%]) were for targeted medication reviews, and 271 drug therapy problems were identified. Acceptance rates for the pharmacist's recommendations were 90.2% (74 of 82 recommendations) among home care staff and 47.0% (55 of 117 recommendations) among prescribers and patients. On average, 1.5 cpKPIs were identified for each referral. The pilot program demonstrated a need for enhanced access to clinical pharmacy services for home care patients, although the best model of service provision remains unclear. More research is warranted to determine the optimal pharmacy service for home care patients and the most appropriate cpKPIs to measure its effects.

Decision-making experiences of family members of older adults with moderate dementia towards community and residential care home services: a grounded theory study protocol

BackgroundCaring and supporting older people with dementia have become a major public health priority. Recent reports have also revealed a diminishing number of family carers to provide dementia care in the future. Carers who are engaged in the caring role are known to bear significant psychological, practical and economic challenges as the disease advances over time. Seemingly, evidence indicates that the burden of care can be relieved by formal services. This study aims to explore decision-making experiences of family members of older adults with moderate dementia towards the use of community support (CS) and residential care home (RCH) services.MethodA large multi-site constructivist grounded theory in a range of non-government organizations and a private aged home will frame this Hong Kong study. Purposive sampling will begin the recruitment of family members, followed by theoretical sampling. It is estimated that more than 100 family members using CS and RCH services will participate in an interview. The process of successive constant comparative analysis will be undertaken.DiscussionThe final product, a theory, will generate an integrated and comprehensive conceptual understanding which will explain the processes associated with decision-making of family members for dementia sufferers. Deeper understanding of issues including, but not exclusive to, service needs, expectations and hopes among family carers for improving service support to serve dementia sufferers in CS and RCH services will also be revealed. Importantly, this study seeks to illustrate the practical and strategic aspects of the theory and how it may be useful to transfer its applicability to various service settings to better support those who deliver formal and informal care to the dementia population.

Measuring oral health impact among care home residents in Wales.

To explore inequalities in oral health impact among care home residents using OHIP-14 and ADHS criteria. Cross-sectional survey with structured interview and clinical examination using 2009 ADHS criteria including OHIP-14. Comparisons were made between groups of residents and with findings from the ADHS 2009. Care homes and residents were randomly selected. Those without capacity and non-English/Welsh speakers were excluded. 447 residents answered all OHIP-14 questions and had full oral examination. OHIP-14. Reporting of OHIP problems was more common among care home residents compared with older people examined in the ADHS 2009 (50% vs 40%). There was no difference in the mean number of impacts between residents who were: dentate/edentate; denture wearing/non-denture wearing; with/without caries. Residents reporting 'problems and pain in your mouth at the moment', or 'occasional or more frequent dry mouth', more often experienced OHIP-14 impacts. Compared with peers living in the community, both dentate and edentate care home residents are more likely to live with one or more impacts. Two simple questions related to 'Any problems and pain in your mouth?' and 'Do you have frequent dry mouth?' may help to target care home residents more likely to experience oral health impacts.

Technology Enabled Care (TEC) provision for the care home sector in the Scottish Highlands: video conferencing in care homes

Introduction : Public service reform in Scotland is focusing on prevention and early intervention with the aim of breaking cycles of inequality and poverty. Public bodies are expected to play a full part in delivering these improved outcomes with leaders and their teams working collaboratively across organizational boundaries to ensure that services are shaped around the needs and demands of individuals and communities. The Scottish Government's 2020 Vision is that by 2020 everyone is able to live longer healthier lives at home, or in a homely setting. NHS Highland health board in Scotland covers an area of over 32,500 square km. With a population of 320,000 it is one of the largest and most sparsely populated Health Boards in the UK. NHS Highland care home places for older adults are provided by care homes owned and managed by a mixture of local authority/health board, private organisations and the voluntary sector. In the care home sector improved outcomes for individuals are expected to come about by preventing adverse situations through the use of anticipatory care and planned care models. Latest care home census data indicates that close to 57% of care home residents in the NHS Highland area are affected by dementia (both medical and non-medically diagnosed). Access to specialist psychiatric expertise for staff and for residents affected by dementia presents challenges in this rural context due to long gaps between consultant visits and the anxiety and stress related to travel to secondary care for appointments in between consultant visits. TEC psychiatric clinics have been introduced to address these challenges. Practice Change Implemented : Nurse led TEC older adult psychiatry clinics were introduced in three rural care homes in NHS Highland with the aim of providing improved access to psychiatric care services, reducing unnecessary admissions, reducing antipsychotic use for people with dementia and improving the management of behavioural and psychiatric symptoms of dementia. Stakeholder groups involved in the psychiatric clinics included the service provider (NHS Highland), technology enabler and facilitator (Scottish Centre for Telehealth and Telecare, SCTT), care home managers and staff, care home residents/family members, occasional care home users (day care and lunch clubs) and other wider community users such as GPs, social workers, hospital consultants, pharmacists, community nurses. Key Findings and Highlights : The direct impact on residents has been quicker assessment, treatment review and regular monitoring. Residents and family members believe that it is more responsive to their needs. In addition to direct impacts on residents, the development of greater knowledge and understanding by care home staff through access to specialist knowledge, experience and advice has led to increased confidence and skills, enabling staff to feel more confident and be more actively involved in care. Care homes have become more able to manage complex cases and challenging behaviours locally and are less likely to admit patients to hospital. Prevention of hospital admissions has allowed residents to remain within their local care setting. Where hospital admission has been necessary, sooner and more frequent follow up has been possible after discharge back to the care home. Frequent reviews have enabled more rapid adjustment in medication, with some residents becoming managed through behavioural plans only. Overall, participation in the clinics has led to staff feeling more valued in their role. Although the initiative emerged following consultation and collaboration between SCTT and secondary care psychiatric clinicians in response to a redesigning of outreach services, involvement by the care home staff from an early stage facilitated a successful introduction. Provision of training for as wide a group of potential users as possible promoted and enabled use of the technology for applications other than psychiatric clinics. Conclusion : An equivalent level of input and support for residents without utilising TEC would involve a significant amount of time travelling for specialist secondary care staff with associated high travel costs. For care home staff, accessing an equivalent amount of relevant training would be unachievable due to resourcing issues. While residents and their families have clearly benefited directly from individual consultations, a significant impact on residents has come about through the knowledge and confidence gained by care home staff. This has resulted in improved patient outcomes by early intervention through participatory care planning. Wider community impacts are beginning to emerge with the launch of other initiatives using the care home based TEC including polypharmacy review clinics, hospice palliative care and the way the local community are using the equipment to access a range of specialist services (eg weight management classes) in one care home community.

A Pregnant Teen Living in an Area With Active Zika Virus Transmission

“For the past week or so during the night I feel hot and then I feel chilled. This morning I saw a rash on my face and stomach,” stated a 16-year-old female patient at a visit to her local health clinic. The patient, at 20 weeks' gestation, is halfway through her first pregnancy. She had been in her usual good state of health until 1 week ago, when she noticed mild, flu-like symptoms. Jane Cox, Director of Nursing, NCH Community Home Care, Naples, FL.

Aging at home with telecare in Spain. A dicourse analysis

Caring for the elderly is turning to forms of community care and home care. Telecare is one of those emergent modalities of caring. This article will explore the meanings that older people give to the experience of staying at home in later life by using telecare. Discourse analysis is used to examine a set of focus groups and interviews with telecare users from different cities of Catalonia (Spain). The outcomes include three interpretative repertoires that we called: "Aging at home", "normal aging" and "unsafe aging". For each repertoire we examine how the permanence of older people in their homes is accounted, and which role telecare plays in such experience.