Home-based Care Services Research Articles

Cost-Effectiveness Analysis of Home-Based Hospice-Palliative Care for Terminal Cancer Patients.

We compared cost-effectiveness parameters between inpatient and home-based hospice-palliative care services for terminal cancer patients in Korea. A decision-analytic Markov model was used to compare the cost-effectiveness of hospice-palliative care in an inpatient unit (inpatient-start group) and at home (home-start group). The model adopted a healthcare system perspective, with a 9-week horizon and a 1-week cycle length. The transition probabilities were calculated based on the reports from the Korean National Cancer Center in 2017 and Health Insurance Review & Assessment Service in 2020. Quality of life (QOL) was converted to the quality-adjusted life week (QALW). Modeling and cost-effectiveness analysis were performed with TreeAge software. The weekly medical cost was estimated to be 2,481,479 Korean won (KRW) for inpatient hospice-palliative care and 225,688 KRW for home-based hospice-palliative care. One-way sensitivity analysis was used to assess the impact of different scenarios and assumptions on the model results. Compared with the inpatient-start group, the incremental cost of the home-start group was 697,657 KRW, and the incremental effectiveness based on QOL was 0.88 QALW. The incremental cost-effectiveness ratio (ICER) of the home-start group was 796,476 KRW/QALW. Based on one-way sensitivity analyses, the ICER was predicted to increase to 1,626,988 KRW/QALW if the weekly cost of home-based hospice doubled, but it was estimated to decrease to -2,898,361 KRW/QALW if death rates at home doubled. Home-based hospice-palliative care may be more cost-effective than inpatient hospice-palliative care. Home-based hospice appears to be affordable even if the associated medical expenditures double.

Intersections of Personal Assistance Services for Rural Disabled People and Home Care Workers' Rights.

It is very difficult to find and keep workers to provide home-based care for disabled people, especially in rural places. There is a tension between the rights of disabled people and the rights of home-based personal care workers. In this brief review, we explore the intersections of historical and social forces that shaped federal-level policies for both disability rights and the rights of personal care workers, as well as the current state of the policies. This paper provides a narrow focus on federal policies relevant to both groups, while also considering how the urbancentric nature of advocacy and policymaking has failed to address important issues experienced by rural people. In addition to briefly reviewing relevant federal policies, we also explore sources of support and resistance and how urbanormativity, ableism, and sexism intersect to influence how the needs of people with disabilities and their personal care workers are conceptualized and addressed. We conclude with recommendations for how to better address the needs of rural people with disabilities using home-based personal care services and the workers who provide them.

An Evaluation Index System of Basic Elderly Care Services Based on the Perspective of Accessibility.

Population aging has become more and more severe in many countries. As a result, the demand for basic elderly care services has risen. The establishment of an evaluation index system for basic elderly care services can provide guidelines for governments to improve the quality of such services. Based on the “5A” theoretical analysis framework of Penchansky and Thomas, this paper introduces the concept of “accessibility” into evaluation. The “accessibility” model of services, through a literature review, field research, and three rounds of expert correspondence, consists of three first-level indicators, including the accessibility of home-based community elderly care services, the accessibility of institutional elderly care services, and the accessibility of administrative services. The evaluation index system of 15 s-level indicators and 70 third-level indicators, using AHP to determine the weight value of each indicator, provides a quantitative basis for the quality evaluation and improvement of basic elderly care services. Based on our quantitative results, policy recommendations are put forward: strengthen the support for the human and financial resources of community home-based elderly care services; improve the affordability of basic elderly care services; increase the types and numbers of institutional elderly care service projects; improve the availability and adaptability of institutional elderly care services; improve the accessibility of administrative services so that elderly care service institutions and elderly care administrative agencies can establish an effective communication and feedback mechanism.

Optimal Subsidy Support for the Provision of Elderly Care Services in China Based on the Evolutionary Game Analysis.

Public–private partnership is a type of cooperation that has been widely employed to alleviate contradictions between supply and demand in the elderly care industry in China. Based on evolutionary game theory, this paper mainly analyzes the effects of static subsidy and dynamic subsidy to private sectors and consumers on the evolution of the decision process for private investors, consumers, and government in the three-dimension system. The simulation results show that without active supervision, a higher subsidy to private sectors will not promote the provision of high-quality services when the cost saving is large. Furthermore, there exists a threshold value of the difference between the two types of subsidies such that elderly people will be encouraged to choose institutional care if the value exceeds the threshold. We also find that dynamic subsidy policy works more efficiently in promoting the provision of home-based care services.

Construction of a Physical and Medical Care Integrated Model for the Elderly in the Community Based on Artificial Intelligence and Machine Learning.

With the increasingly serious population aging, economic system transformation, and social transformation, the elderly have an increasingly strong demand for the elderly care service industry, but the development of China's elderly care service industry started late, and there are still many problems. For how to build a better elderly care service model, under the current situation of shortage of elderly care resources, community elderly care may become a solution. By analyzing the status quo, existing problems and development trends of home-based care services in Hangzhou's community, and learning from foreign experience, it explores the establishment of a “integrated physical, medical, and nursing care” community health management model for the elderly and provides a perfect solution for the development of Hangzhou's community elderly care services countermeasures and suggestions for mode operation. Based on the evaluation, problem analysis, and empirical research on the current situation of home care services in Hangzhou communities, this paper draws on relatively mature community care practices, proposes to build a community elderly health management model that combines medical care and care, and improves and innovates the overall design and medical care of the elderly service model measures for the health management of the elderly in the integrated community. The experimental results of this study show that, according to the demand for elderly care services, elderly people in need of care account for 86.6%, 79.5%, and 68.4% of the elderly population, especially in the areas of medical care, life care, and housekeeping services.

Impact of Socioeconomic Environment on Home Social Care Service Demand and Dependent Users

An aging population and rising life expectancy lead to an increased demand for social services to care for dependent users, among other factors. In Barcelona, home social care (HSC) services are a key agent in meeting this demand. However, demand is not evenly distributed among neighborhoods, and we hypothesized that this can be explained by the user’s social environment. In this work, we describe the user’s environment at a macroscopic level by the socioeconomic features of the neighborhood. This research aimed to gain a deeper understanding of the dependent user’s socioeconomic environment and service needs. We applied descriptive analytics techniques to explore possible patterns linking HSC demand and other features. These methods include principal components analysis (PCA) and hierarchical clustering. The main analysis was made from the obtained boxplots, after these techniques were applied. We found that economic and disability factors, through users’ mean net rent and degree of disability features, are related to the demand for home social care services. This relation is even clearer for the home-based social care services. These findings can be useful to distribute the services among areas by considering more features than the volume of users/population. Moreover, it can become helpful in future steps to develop a management tool to optimize HSC scheduling and staff assignment to improve the cost and quality of service. For future research, we believe that additional and more precise characteristics could provide deeper insights into HSC service demand.

Indigenous Sami Family Caregivers’ Experiences With Accessing and Collaborating With Municipal Health and Care Services

Previous research has indicated that Indigenous Sami families in Norway use public home-based care services less often than their non-Sami peers. Based on qualitative interviews with Sami family caregivers, we explore what they experience as barriers to accessing public care services for older adults living with dementia, and how they experience collaborating with care services providers. Through a reflexive thematic approach, we identified that rather than a cultural norm of “taking care of one’s own,” the underuse of public care services among Sami families were related to several intertwined circumstances. The Sami family caregivers reported barriers to accessing public care, such as lack of familiarity with the services and cultural and language concerns and the legacy of history, and drivers for continuing family care, such as blurred distribution of responsibility, lack of continuity of care, and culturally unsafe caring environments and marginalizing practices.

Effectiveness of home- and community-based services in decreasing health care service and expenditure in Taiwan

Background Whether long-term care service use decreases older adults’ health care service use and cost has been a strong interest among aging countries, including Taiwan. The current study examined the impact of continuous use of HCBS offered by Taiwan’s LTC plan 2.0 on older adults’ health service utilization and cost overtime. Methods This study used the LTC Plan 2.0 database and the National Health Insurance Plan claim dataset, and included 151,548 clients who had applied for and were evaluated for LTC services for the first time from 2017 through 2019 and continuously used any LTC Plan 2.0 services for six months. Outcome variables were users’ health service utilization and health care cost 12 months before and after starting to continuously use HCBS. Latent class analysis and generalized estimating equations were used to investigate the influences of different service use patterns on the changes in physical functions. Results Three subgroups of LTC recipients with different use patterns, including home-based personal care (home-based PC) services (n = 107324, 70.8%), professional care services (n = 30466, 20.1%), and community care services (n = 13794, 9.1%) were identified. When compared to care recipients in the community care group, those in the home-based PC group had more emergency room expenditures (1 point/month, p< 0.05) but less hospitalization expenditures (38 points/month, p<0.001), while the professional care group had less emergency room and hospitalization expenditures (3 and 138 points/month, p< 0.001). Conclusion Those receiving professional care and home care services spent less on health care service utilization.

The impact of HCBS use patterns on older aduts’ physical function among continuous service users

Background Taiwan, one of the fastest aging countries in the world, provides home-and community-based services (HCBS) care recipients through the second 10-Year Long-Term Care Plans (LTC Plans 2.0). The current study aimed to examine the impact of continuous use of HCBS offered by LTC plan 2.0 on older adults’ physical function change overtime. Methods This study used the LTC Plan 2.0 database and the National Health Insurance Plan claim dataset, and included 157,682 clients who had applied for and were evaluated for LTC services for the first time from 2018 through 2020 and continuously used any LTC Plan 2.0 services for six months. Outcome variables were measured by activities ofdaily living (ADLs) and instrumental activities of daily living (IADLs) between baseline assessment and the assessment after the six months of serivce utilization. Latent class analysis and generalized estimating equations were used to investigate the influences of different service use patterns on the changes in physical functions. Results Three subgroups of LTC recipients with different use patterns, including home-based personal care (home-based PC) services (n = 111,976; 71.01%), professional care services (n = 31,584; 20.03%), and community care services (n = 14,122; 8.96%) were identified. When compared to care recipients in the community care group, those in the home-based PC group improved more in IADL scores, and the professional care group improved more ADL scores. Conclusion Those receiving more professional services made more progress in ADL ability, but those in home-based PC made more progress in IADL ability.

Home- and Community-Based Services Use Patterns and Functional Improvement among Older Care Recipients in Taiwan

The new version of Taiwan’s 10-Year Long-Term Care Plan launched in 2016 aims to reinforce the integration of home- and community-based services (HCBS). The underlying HCBS use patterns and effectiveness of functional improvement among care recipients merit investigation. The purpose of the study was to examine the association of HCBS and changes in ADLs among care recipients with different levels of disabilities in Taiwan. We accessed the sub data of Taiwan’s Long-Term Care Services Management Online System. Samples were aged 65 and over and had completed records of baseline and reassessment information during 2018 (N = 4787). Latent class analysis and multivariate linear regression were applied to examine the relationship of HCBS and functional changes. Four HCBS subpatterns were found: home-based personal care services (home-based PS) (59.16%), home-based reablement services (home-based RS) (23.90%), home-based multiple services (home-based MS) (11.93 %), and community-based services (5.01%). In the cases with mild disabilities at baseline, recipients receiving home-based RS had higher probabilities of improving in ADLs among four HCBS subgroups (for example: β = 2.65, SE = 1.19 in comparison to home-based PS). Care recipients with moderate-to-severe disability at baseline, ADLs improvement was only found in home-based PS (β = 1.63, SE = 0.82 in comparison of home-based MS). In the cases with profound disabilities, home-based PS showed positive effects on ADLs improvement (β = 2.45, SE = 0.80 in ADLs, compared to home-based RS). The study suggested that HCBS subpatterns had different impacts on older adults with different disability levels.

Building an Integrated Home-based Medical Care services across the whole life course in Taiwan

The International Journal of Integrated Care (IJIC) is an online, open-access, peer-reviewed scientific journal that publishes original articles in the field of integrated care on a continuous basis.IJIC has an Impact Factor of 5.120 (2020 JCR, received in June 2021)

Impact of Home Care Services on Patient and Economic Outcomes: A Targeted Review

Patient Support Programs (PSPs) reinforce patients’ care provided by health care professionals with the aim to improve adherence and patient empowerment. PSPs may include interventions such as home-based care, individualized medication counseling, support, training, and home delivery of medicines and/or devices. This study described these services and its impact on patient-reported outcomes and health care savings. We conducted an integrative literature review which was limited to publications from the last 10 years (2009-2019) and focused on diseases that require special support and/or parenteral administration. From 7040 total citations, we identified 64 home-based care services performed worldwide. Among the home-based care services, most were provided by nurses (n = 47/64; 73.4%) and addressed to cancer patients (n = 22/64; 34.4%); 23 out of 64 services (35.9%) incorporated telepharmacy. In general, home-based services and PSPs showed a positive impact on patients’ adherence to medication, patient satisfaction, and health-related quality of life. In addition, 14 (21.9%) services reported economic results, most of which showed that home therapy led to substantial cost savings.

Needs-led research: a way of employing user involvement when devising research questions on the trust model in community home-based health care services in Norway

BackgroundThis paper presents a user involvement process, called needs-led research, conducted as a part of a doctoral degree project aiming to explore research priorities and, ultimately, to develop a final top 10 list of questions relevant to the field of research. There is evidence of a mismatch between what user groups within a research field find relevant to study and what is actually being done. User involvement is a method that can accommodate this, and there is a growing attention and amount of research in this field based on an understanding that people who receive health care services, and their next of kin and clinicians, are uniquely positioned to contribute to research in order to understand their experiences better and improve the services. This paper presents a user involvement process in a small-scale study, referred to as needs-led research, which concerns the ‘performance of the trust model in community home-based health care services’. The process was conducted as part of a doctoral degree project.MethodThe needs-led research process is inspired by the James Lind Alliance (JLA), which focuses on bringing together service users, next of kin and clinicians on equal terms to explore research priorities. The process consisted of five-steps, each of which involved representatives from service users, next of kin and clinicians: 1) narrowing down the theme; 2) steering group meeting; 3) gathering input through a survey; 4) data processing and interim priority setting; and 5) final priority setting.ResultsAlmost 200 participants contributed during the five steps, 294 inputs were gathered, and 35 participants voted for the top 10 list. The top 10 list is presented.ConclusionThis paper provides an example of how user involvement can be employed to devise research questions that are relevant for clinicians, service users, next of kin and service providers concerning the ‘performance of the trust model in home-based health care’. It also outlines some strengths and limitations of the process. The needs-led research process shows that user involvement in research is feasible for developing research questions in small-scale studies. We hope that the top 10 list presented will encourage future research to address issues of importance regarding the performance of the trust model in community home-based health care services.

Geriatric co-management and interdisciplinary transitional care reduced hospital readmissions in frail older patients in Argentina: results from a randomized controlled trial.

Hospitalization is a moment of extreme vulnerability for frail older adults. There is scarce evidence on the effectiveness of geriatric co-management or transitional care interventions in Latin America. To assess whether geriatric co-management combined with an interdisciplinary transitional care intervention could reduce 30-day hospital readmission rate compared to usual care in hospitalized frail older patients in a tertiary hospital in Argentina. Single-blinded randomized controlled trial. Usual care treatment arm: all procedures performed during hospitalization were overseen by a senior internal medicine specialist and complied with pre-defined protocols. Patients had access to specialist care if needed, as well as hospital-at-home or home-based primary care services after discharge. Intervention treatment arm: in addition to usual care, a geriatric co-management team performed a comprehensive geriatric assessment during hospitalization, provided tailored recommendations to minimize geriatric syndromes and planned transition of care. A health and social care counselor oversaw continuity of care in patients' homes after discharge. We included 120 participants in each of the intervention and usual care (control) arms. Thirty-day hospital readmissions were 47.7% lower in the intervention arm (18.3% vs 35.0%; P = 0.040); and emergency room visits within the first 6months after discharge were 27.8% lower (43.3% vs 60.0%; P = 0.010). There was a non-statistically significant decrease in 6-month mortality in the intervention arm (25.0% vs 35.0%; P = 0.124). Geriatric co-management of frail older patients during hospitalization combined with an interdisciplinary transitional care intervention reduced 30-day hospital readmissions and emergency visits 6months after discharge. Trial registration number: RENIS IS003081.

Adaptations to palliative home care in India in a COVID pandemic: An experiential narrative

India is in the midst of a fierce pandemic with a rapid surge of cases and the health-care system in a quandary. Care of patients with life-limiting illness needing palliative care has been compromised due to limitations in palliative care access and a paradigm shift in the hospital toward care of COVID. Therefore, it is imperative to augment the home-based services so that patients continue to remain at home with their care needs met so that their access to hospitals is restricted for acute and complex needs. To overcome practical aspects of home-based care service delivery, several adaptations were needed. An urban standalone home-based palliative care service provider made adaptations to personal protection, personal protection equipment, and team self-care that facilitated an effective service delivery and satisfaction.

Profiles of Frailty among Older People Users of a Home-Based Primary Care Service in an Urban Area of Barcelona (Spain): An Observational Study and Cluster Analysis.

Background: The multidimensional assessment of frailty allows stratifying it into degrees; however, there is still heterogeneity in the characteristics of people in each stratum. The aim of this study was to identify frailty profiles of older people users of a home-based primary care service. Methods: We carried out an observational study from January 2018 to January 2021. Participants were all people cared for a home-based primary care service. We performed a cluster analysis by applying a k-means clustering technique. Cluster labeling was determined with the 22 variables of the Frail-VIG index, age, and sex. We computed multiple indexes to assess the optimal number of clusters, and this was selected based on a clinical assessment of the best options. Results: Four hundred and twelve participants were clustered into six profiles. Three of these profiles corresponded to a moderate frailty degree, two to a severe frailty degree and one to a mild frailty degree. In addition, almost 75% of the participants were clustered into three profiles which corresponded to mild and moderate degree of frailty. Conclusions: Different profiles were found within the same degree of frailty. Knowledge of these profiles can be useful in developing strategies tailored to these differentiated care needs.

A Summary of Researches on the Quality of Home-based Care Services in China

With the increase of the aging of the population in china, the demand of the elderly continues to increase, which has brought great challenges to the elderly care service industry. As a new type of elderly care service, home-based care services directly affect the quality of the elderly&amp;rsquo;s health and daily life in their later years. Therefore, improving the product and quality of elderly care services has become the goal and purpose of the development of home-based care service for aged. This article uses Cite Space software to perform visual analysis of keyword clustering on existing literature, and concludes that scholars focus on the integration of medical care, social elderly care service system, service quality, and influencing factors, but the impact of service quality models and indicator systems is low. Then through the integration and induction of scholars&amp;rsquo; research progress on home care services, existing problems in service quality, and service quality evaluation index systems, in order to continue to innovate on the basis of existing knowledge, improve the service quality index system, and focus on combing process indicators with outcome indicators effectively, thereby improving the quality of community home care services.

Evaluation of an initiative to improve advance care planning for a home-based primary care service

BackgroundAdvance care planning (ACP) is a process that enables individuals to describe, in advance, the kind of health care they would want in the future. There is evidence that ACP reduces hospital-based interventions, especially at the end of life. ACP for frail older adults is especially important as this population is more likely to use hospital services but less likely to benefit from resource intensive care. Our study goal was to evaluate whether an approach to ACP developed for frail older adults, known as the Palliative and Therapeutic Harmonization or PATH, demonstrated an improvement in ACP.MethodsThe PATH approach was adapted to a primary care service for homebound older adults in Vancouver, Canada. This retrospective chart review collected surrogate measures related to ACP from 200 randomly selected patients enrolled in the service at baseline (prior to June 22, 2017), and 114 consecutive patients admitted to the program after implementation of the PATH ACP initiative (October 1, 2017 to May 1, 2018). We compared the following surrogate markers of ACP before and after implementation of the PATH model, chart documentation of: frailty stage, substitute decision-maker, resuscitation decision, and hospitalization decision. A composite ACP documentation score that ascribed one point for each of the above four measures (range 0 to 4) was also compared. For those with documented resuscitation and hospitalization decisions, the study examined patient/ substitute decision-maker expressed preferences for do-not-resuscitate and do-not-hospitalize, before and after implementation.ResultsWe found the following changes in ACP-related documentation before and after implementation: frailty stage (27.0% versus 74.6%, p < .0001); substitute decision-maker (63.5% versus 71.9%, p = 0.128); resuscitation decision documented (79.5% versus 67.5%, p = 0.018); and hospitalization decision documented (61.5% versus 100.0%, p < .0001); mean (standard deviation) composite ACP documentation score (2.32 (1.16) versus 3.14 (1.11), p < .0001). The adjusted odds ratios (95% confidence intervals) for an expressed preference of do-not-resuscitate and do-not-hospitalize after implementation were 0.87 (0.35, 2.15) and 3.14 (1.78, 5.55), respectively.ConclusionsResults suggest partial success in implementing the PATH approach to ACP in home-based primary care. Key contextual enablers and barriers are important considerations for successful implementation.

Adequacy of Improved Sources of Drinking Water, Sanitation, and Hygiene Practice for the Reduction of Diarrheal Disease Among People Living with HIV/AIDS, Harar Region, Ethiopia

BackgroundHome-based care services like improved water supply, sanitation, and hygiene (WaSH) practice are vital for people living with HIV/AIDS (PLWHA) to improve their quality of life. The negative impact of inadequate WaSH services is more pronounced among HIV-infected individuals leading them to low economic productivity, poor-nourished, immuno-compromised, and death. The aim of this study was to investigate the adequacy of improved sources of drinking water, sanitation, and hygiene practice for the reduction of diarrheal disease among people living with HIV/AIDS, Harar region, Ethiopia.MethodsA cross-sectional study was conducted on 422 PLWHA in the Harar region related to WaSH as home-based care services and the prevalence of diarrheal disease using a standardized survey questionnaire. Descriptive statistics and multivariate Poisson regressions models were performed by SPSS Version 25. Using generalized linear models, adjusted prevalence ratio (APR) with 95%Cl and p-value were computed to assess the strength of association between the outcome and explanatory variables. A significant association was assured when the p-value is less than 0.05.ResultsIn the present study, the two-week prevalence of diarrheal disease was 25%, of which 16% experienced two or more diarrheal episodes. Moreover, 87% of PLWHA used an improved source of drinking water, 66% used improved sanitation facilities, and 68% have good hygiene practices. Only 37% of the respondents acquired a basic water service level (≥20lcd) and 58% of PLWHA acquired the recommended quantity of safe water for drinking (≥1.5lcd). In multivariate analysis, the adjusted prevalence ratio of the 2-week prevalence of diarrhea was lower by 8% (APR =1.08; 95%Cl: 1.02, 1.14), 7% (APR =1.07; 95%Cl: 1.01, 1.14), and 5% (APR =1.05; 95%Cl: 1.00, 1.11) among PLWHA who have good hygiene practice, wash their hand with soap 24 hours before the survey, and used sanitation facility consistently, respectively.ConclusionThe current study results showed that PLWHA has inadequate access to improved drinking water sources, improved sanitation facilities, and hygienic practice; these triggers stakeholders for proper interventions, effective integration of adequate WaSH services to the HIV/AIDS program to enhance the quality of life of PLWHA.

Home-based care in the community

Treatment gap in mental health is vast and continues to remain a grim reality. Amongst community mental health care, one approach available is home based care (HBC). However, HBC services are almost lacking in India. Nevertheless, the limited evidence points towards a successful utility of HBC till date. In this article, the Chandigarh experience of HBC is presented and discussed in detail in order to demonstrate its utility and effectiveness. Lastly, recommendations are provided for the future of HBC.