Home Care Agencies Research Articles

Factors influencing self-reported facial-protective equipment adherence among home care nurses and personal support workers: A multisite cross-sectional study

Facial-protective equipment (FPE) use increased during the SARS-CoV-2 pandemic. This study explored factors influencing home care personal support workers' (PSWs) and nurses' self-reported adherence to FPE. A cross-sectional, electronic, survey was distributed to PSWs and nurses (1,108 complete responses) at 3 home care agencies in Ontario, Canada, in May to June 2022. Descriptive, bivariate, and multivariable analysis were used to assess individual, environmental, and organizational factors influencing adherence. Among participants (786 PSWs, 322 nurses), 64% reported being adherent to both respiratory and eye FPE (Respiratory: 96%, Eye: 64%). Higher adherence was associated with facility-based work; better knowledge of FPE; prepandemic FPE use; good availability and convenient access; strong organizational support for health and safety; and Caribbean identity. Lower adherence was found for men; nurses with 2-year diplomas; shorter length of employment; communal transportation; and experiencing negative mental health effects from workplace infectious disease exposure. Agencies should prioritize increasing providers' knowledge of FPE, supporting mental well-being, fostering a supportive culture, and ensuring availability of FPE. The influences of gender, ethnicity, and role require further exploration. FPE adherence may be improved by addressing modifiable factors and developing population-specific strategies.

Reducing ambulatory central line-associated bloodstream infections: A family-centered approach.

Ambulatory central line-associated bloodstream infections (CLABSIs) cause significant morbidity and mortality, especially in pediatric oncology. Few studies have had interventions directed toward caregivers managing central lines (CL) at home to reduce ambulatory CLABSI rates. We aimed to reduce and sustain our ambulatory CLABSI rate by 25% within 3years of the start of a quality improvement intervention. Plan-do-study-act cycles were implemented beginning April 2016. The main intervention was a family-centered CL care skill development curriculum for external CLs. Training began upon hospital CL insertion, followed by an ambulatory teach-back program to achieve home caregiver CL care independence. Other changes included: standardizing ambulatory nurse CL care practice (audits, a train the nurse trainer process, and workshops for independent home care agencies); developing aids for trainers and caregivers; providing supplies for clean surfaces; wide dissemination of the program; and minimizing opportunities of CLABSI (e.g., standardizing timing of CL removal). The outcome measure was the ambulatory CLABSI rate (excluding mucosal barrier injury laboratory-confirmed bloodstream infection), compared pre intervention (January 2015 to March 2016) to post intervention, including 2years of sustainability (April 2016 to June 2023), using statistical process control charts. We estimated the total number of CLABSI and associated healthcare charges prevented. The ambulatory CLABSI rate decreased by 52% from 0.25 to 0.12 per 1000 CL days post intervention, achieved within 27months; 117 CLABSI were prevented, with $4.2 million hospital charges and 702 hospital days avoided. Focusing efforts on home caregivers CL care may lead to reduction in pediatric oncology ambulatory CLABSI rates.

Problematizing Dominant Assumptions about Unpaid Support through Exploring Case Study Profiles of Older Home Care Clients

Despite efforts to acknowledge diversity among unpaid caregivers, Canadian research, advocacy, practice, and policy tend to be based in and to reproduce dominant social and institutional expectations and assumptions about who provides unpaid support and why, and what this support looks like. The objective of thtudinal, qualitative research study. In that study, qualitative case study interviews were conducted with twelve home care clients, their identified family or friend caregiver, home care aide, case coordinator, and agency supervisor (129 interviews in total). Case study profiles compiled over time generated deeper information about the availability and capacity of informal sources of support for these clients, which prompted abductive analysis in relation to dominant assumptions typically made about caregivers in research, policy, and practice. Specifically, only one case (participant) had a caregiver whose profile closely matched dominant conceptualizations. In the remaining eleven cases, we found situations wherein: (a) caregivers grappled with physical or mental health challenges limiting their participation in care (sometimes meaning the client is themselves a caregiver, or the caregiver is also receiving home care services); (b) caregivers facing burnout sought to delimit their participation in care; (c) caregivers’ participation was limited by older adults’ reluctance to accept their help; (d) caregivers were largely unavailable, unreliable, or peripheral; or (e) client’s unpaid support networks were diffuse without a clearly central or identifiable “caregiver.” Findings are used to nuance and problematize widely held assumptions about caregivers, particularly their availability and capacity. Discussion highlights the need for research, policy, and programs related to unpaid caregiving to better reflect the lived realities of this support for older adults and often overlooked sources of diversity in caregiver circumstances and roles.

Caring for Older Patients: Quality and Efficiency of Australia's Healthcare System

AbstractWith population ageing and increased longevity, Australia faces pressing policy issues on caring for older people. As Medicare turns 40, it is timely to assess how the system has been performing, and what changes are needed to modernise Medicare. This article examines the quality and efficiency of care using hospital administrative data. We find that the current system provides good quality and efficient care for older patients, except for those living in residential aged care homes. These patients receive lower quality care yet stay longer in hospitals. We suggest alternative approaches designed around bundled payments and a single budget holder to provide incentives for integrated team‐based care.

A process evaluation of the NIDUS-Professional dementia training intervention for UK homecare workers.

This process evaluation was conducted in parallel to the randomised controlled feasibility trial of NIDUS-Professional, a manualised remote dementia training intervention for homecare workers (HCWs), delivered alongside an individualised intervention for clients living with dementia and their family carers (NIDUS-Family). The process evaluation reports on: (i) intervention reach, dose and fidelity; (ii) contexts influencing agency engagement and (iii) alignment of findings with theoretical assumptions about how the intervention might produce change. We report proportions of eligible HCWs receiving any intervention (reach), number of sessions attended (dose; attending ≥4/6 main sessions was predefined as adhering), intervention fidelity and adherence of clients and carers to NIDUS-Family (attending all 6-8 planned sessions). We interviewed HCWs, managers, family carers and facilitators. We integrated and thematically analysed, at the homecare agency level, qualitative interview and intervention recording data. 32/141 (23%) of eligible HCWs and 7/42 (17%) of family carers received any intervention; most who did adhered to the intervention (89% and 71%). Intervention fidelity was high. We analysed interviews with 20/44 HCWs, 3/4 managers and 3/7 family carers, as well as intervention recordings involving 32/44 HCWs. All agencies reported structural challenges in supporting intervention delivery. Agencies with greater management buy-in had higher dose and reach. HCWs valued NIDUS-Professional for enabling group reflection and peer support, providing practical, actionable care strategies and increasing their confidence as practitioners. NIDUS-Professional was valued by HCWs. Agency management, culture and priorities were key barriers to implementation; we discuss how to address these in a future trial.

‘How long do you think?’ Unresponsive dying patients in a specialist palliative care service: A consecutive cohort study

Background: Predicting length of time to death once the person is unresponsive and deemed to be dying remains uncertain. Knowing approximately how many hours or days dying loved ones have left is crucial for families and clinicians to guide decision-making and plan end-of-life care. Aim: To determine the length of time between becoming unresponsive and death, and whether age, gender, diagnosis or location-of-care predicted length of time to death. Design: Retrospective cohort study. Time from allocation of an Australia-modified Karnofsky Performance Status (AKPS) 10 to death was analysed using descriptive narrative. Interval-censored survival analysis was used to determine the duration of patient’s final phase of life, taking into account variation across age, gender, diagnosis and location of death. Setting/participants: A total of 786 patients, 18 years of age or over, who received specialist palliative care: as hospice in-patients, in the community and in aged care homes, between January 1st and October 31st, 2022. Results: The time to death after a change to AKPS 10 is 2 days (n = 382; mean = 2.1; median = 1). Having adjusted for age, cancer, gender, the standard deviation of AKPS for the 7-day period prior to death, the likelihood of death within 2 days is 47%, with 84% of patients dying within 4 days. Conclusion: This study provides valuable new knowledge to support clinicians’ confidence when responding to the ‘how long’ question and can inform decision-making at end-of-life. Further research using the AKPS could provide greater certainty for answering ‘how long’ questions across the illness trajectory.

The Safe Home Care Intervention Study: Implementation Methods and Effectiveness Evaluation.

Home care (HC) aides experience numerous safety hazards in clients' homes; many hazards also put clients at risk. We hypothesized that safety coaching led by nurse managers (NMs) during their initial HC needs assessment could prompt clients to improve safety conditions in their homes. Following a 2-arm proof-of-concept intervention study design, intervention NMs used motivational interviewing (MI), facilitated by a safety handbook and video, to coach clients on home safety improvements. Control arm NMs performed intake assessments with no changes to usual practices. Intervention effectiveness was assessed by NMs and aides. Three HC agencies and two elder services contributed 35 intervention and 23 control homes. NMs coached 97% of clients and reported that 94% were engaged; 63% implemented improvements. NMs' and aides' assessments were consistent; homes with clients reported by NMs as resistant to safety changes had higher aides' hazard scores. Client coaching can be effective for improving HC safety.

The effectiveness of the buddy program training module to enhance the daily living function, social participation and emotional status of older adults in residential aged care homes.

The Compeer Model, which was originally designed to match individuals recovering from mental illness with volunteers from their community, served as the basis for the development of the buddy program. However, limited research was available related to the buddy program among older adults in a Malaysian context. The study aimed to identify the effectiveness of the buddy program training module to enhance the daily living function, social participation and emotional status of older adults in residential aged care homes. A quasi-experimental study was conducted with 30 pairs of buddies and older adults for both the experimental group and control group in two randomly selected residential aged care homes. The buddies in the experimental group received the buddy program training module related to activities of daily living (basic and instrumental) while the buddy-older adults pairs in the control group continued to perform their usual daily life activities in residential aged care homes. Baselines were performed before intervention and at eight weeks post-intervention. Over the eight weeks, for the older adults in the experimental group, there was a significant main effect of time after the intervention on BADL (p = 0.010). There were no significant interaction effects for the experiment group and control group on IADL and social participation. Also, there were no significant interaction effects for all domains in emotional status: depression, anxiety and stress. For buddies, there was a significant interaction effect for depression (p = 0.045) in the control group. The buddy program training module can be used as a guideline for older adults with more significant disabilities in residential aged care homes in managing activities of daily living. Future studies could be implemented to explore the intergenerational buddy program among older adults and young children in the community.

Reducing hip and non-vertebral fractures in institutionalised older adults by restoring inadequate intakes of protein and calcium is cost-saving

Older adults in aged care homes account for 30% of the population burden of hip fractures(1). Nutritional interventions to correct protein and calcium inadequacies reduce these and other debilitating fractures, perhaps partly by reducing falls and slowing deterioration in bone morphology. We aimed to determine whether a nutritional approach to fracture risk reduction in aged care homes is cost-effective. Costing was estimated based on results of a prospective two-year cluster-randomised controlled trial involving 3313 residents in 27 aged care homes (intervention using high dairy menus), 3911 residents in 29 aged care homes (controls consuming from normal menus) and cost of ambulance, hospital, rehabilitation, and residential care incurred after fracture. The incremental cost-effectiveness ratios per fracture averted within a 2-year time horizon were estimated from the Australian healthcare perspective applying a 5% discount rate on costs after the first year. Intervention resulted in a total of 3.5 servings of milk, yoghurt and/or cheese daily, achieving 1,142mg calcium and 69g protein versus usual daily intakes of 700mg calcium and 58g protein consumed by controls. This intervention reduced all fractures by 33% at a daily cost of AU$0.66 per resident. The base-case results showed that intervention was cost-saving per fracture averted, with robust results in a variety of sensitivity and scenario analyses. Scaling the benefits of intervention to the Australian community equated to a saving of AU$66,780,000 annually in Australia and remained cost saving up to a daily food expenditure of AU$1.07 per aged care resident. Averting hip and other non-vertebral fractures in older adults in aged care homes by restoring nutritional inadequacies of protein and calcium is cost saving and supports the wide-spread implementation of this type of nutritional intervention in similar settings.

Increasing consumption of milk, yoghurt, and cheese in older adults in aged care reduces falls and fractures without adverse effects on serum lipids: a cluster randomised controlled trial

Correction of dietary calcium and protein undernutrition using milk, yoghurt, and cheese in older adults in aged care homes is associated with reduced fractures and falls(1). As these foods contain potentially atherogenic fats, we aimed to determine whether these dietary changes adversely affect serum lipid profiles. Sixty aged care homes in Australia were randomised to intervention (n = 30 milk, yoghurt, and cheese enriched menu) or control (n = 30 regular menu) for 2 years. A sample of 159 intervention and 86 control residents (median age 87.8 years) had dietary intakes recorded using plate waste analysis and fasting serum lipids measured at baseline and 12 months. Diagnosis of cardiovascular disease and use of relevant medications were determined from medical records. Data were analysed using mixed effects linear regression model adjusting for clustering (aged care home) and other confounders. Intervention increased daily dairy servings from 1.9 ± 1.0 to 3.5 ± 1.4 (p<0.001) while controls continued daily intakes of £ 2 servings daily (1.7 ± 1.0 to 2.0 ± 1.0 (p<0.05). No group differences were observed for serum total cholesterol/high-density lipoprotein-C (TC/HDL-C) ratio, Apoprotein B/Apoprotein A (ApoB/ApoA) ratio, low-density lipoprotein-C (LDL-C), non-HDL-C, or triglycerides (TGs) at baseline and 12 months. Among older adults in aged care homes, correcting insufficiency in the daily intake of calcium and protein using milk, yoghurt and cheese does not alter serum lipid levels, suggesting that this is a suitable intervention for reducing the risk of falls and fractures.

How external and agency characteristics are related to coordination in homecare – findings of the national multicenter, cross-sectional SPOTnat study

BackgroundHomecare client services are often distributed across several interdependent healthcare providers, making proper care coordination essential. However, as studies exploring care coordination in the homecare setting are scarce, serious knowledge gaps exist regarding how various factors influence coordination in this care sector. To fill such gaps, this study’s central aim was to explore how external factors (i.e., financial and regulatory mechanisms) and homecare agency characteristics (i.e., work environment, workforce, and client characteristics) are related to care coordination in homecare.MethodsThis analysis was part of a national multicentre, cross-sectional study in the Swiss homecare setting that included a stratified random sample of 88 Swiss homecare agencies. Data were collected between January and September 2021 through agency and employee questionnaires. Using our newly developed care coordination framework, COORA, we modelled our variables to assess the relevant components of care coordination on the structural, process, and outcome levels. We conducted both descriptive and multilevel regression analyses—with the latter adjusting for dependencies within agencies—to explore which key factors are associated with coordination.ResultsThe final sample size consisted of 1450 employees of 71 homecare agencies. We found that one explicit coordination mechanism (“communication and information exchange” (beta = 0.10, p <.001)) and four implicit coordination mechanisms—“knowledge of the health system” (beta = -0.07, p <.01), “role clarity” (beta = 0.07, p <.001), “mutual respect and trust” (beta = 0.07, p <.001), and “accountability, predictability, common perspective” (beta = 0.19, p <.001)—were significantly positively associated with employee-perceived coordination. We also found that the effects of agency characteristics and external factors were mediated through coordination processes.ConclusionImplicit coordination mechanisms, which enable and enhance team communication, require closer examination. While developing strategies to strengthen implicit mechanisms, the involvement of the entire care team is vital to create structures (i.e., explicit mechanisms) that enable communication and information exchange. Appropriate coordination processes seem to mitigate the association between staffing and coordination. This suggests that they support coordination even when workload and overtime are higher.

PROTOCOL: Factors influencing the implementation of non-pharmacological interventions for behaviours and psychological symptoms of dementia in residential aged care homes: Asystematic review and qualitative evidence synthesis.

This is a protocol for a Cochrane Review. The objectives are as follows.This paper aims to describe a protocol for a systematic review that will synthesise the qualitative evidence regarding factors influencing the implementation of non-pharmacological interventions (NPIs) for behavioural and psychological symptoms of dementia (BPSD) management in residential aged care homes (RACHs). The planned systematic review aims to answer the research question: 'What are the factors influencing the implementation of NPIs in the management of BPSD at RACHs?'. Additionally, the planned systematic review also aims to generate recommendations to guide stakeholders (e.g., clinicians and aged care staff) and policymakers in the implementation of NPIs for managing BPSD at RACHs.

Specialised residential care for older people subject to homelessness: experiences of residents and staff of a new aged care home in Australia

BackgroundThe number of older people experiencing homelessness in Australia is rising, yet there is a lack of specialised residential care for older people subject to homelessness with high care and palliative needs. To address this significant gap, a purpose-built care home was recently opened in Sydney, Australia.MethodsThis qualitative study explores the experiences of both residents and staff who were living and working in the home over the first twelve months since its opening. Residents were interviewed at baseline (n = 32) and after six months (n = 22), while staff (n = 13) were interviewed after twelve months. Interviews were analysed using a reflexive thematic analysis approach informed by grounded theory.ResultsThree main themes emerged: (1) Challenges in providing care for older people subject to homelessness with high care needs; (2) Defining a residential care service that supports older people subject to homelessness with high care needs, and (3) Perception of the impact of living and working in a purpose-built care home after six months (residents) and twelve months (staff) since its opening. A key finding was that of the complex interplay between resident dependency and behaviours, referral pathways and stakeholder engagement, government funding models and requirements, staff training and wellbeing, and the need to meet operational viability.ConclusionThis study provides novel insights into how the lives of older people subject to homelessness with high care needs are affected by living in a specifically designed care home, and on some of the challenges faced and solved by staff working in the care home. A significant gap in the healthcare system remains when it comes to the effective provision of high care for older people subject to homelessness.

Drivers of Home Care Agency Closure: Evidence from England

Drivers of Home Care Agency Closure: Evidence from England

Disaster Preparedness in Home Care: Moving Beyond Checklists.

Disasters have become increasingly common, with hurricanes off the southern, eastern, and western coasts, fires in the northwest, earthquakes, mass shootings, and continuing cases of COVID-19 looming over healthcare systems. Home care agencies have a history of meeting patients' needs during disasters and are strategically positioned to support communities during public emergencies and disasters. However, the "who" and the "how" of engaging the disaster cycle of mitigation, preparedness, response, and recovery is not always understood by clinicians and leadership. A gap in the literature cries out for better preparedness strategies for home care leadership and staff that go beyond the broad guidance of regulatory and accreditation organizations. This article aims to examine current literature and offer direction to home care leaders and staff as they seek to understand the "who" and the "how" in preparing for disasters in an increasingly unstable world.

Implementation of an intervention to reduce urine dipstick testing in aged care homes: a qualitative study of enablers and barriers, and strategies to enhance delivery

ObjectiveThe ‘To Dip or Not to Dip’ (TDONTD) intervention aims to reduce antibiotic prescribing for urinary tract infection (UTI) by reducing low-value dipstick testing. The aims of this study were...

Having a Say in Patient Care: Factors Associated with High and Low Voice among Home Care Workers

ObjectivesTo identify factors associated with high and low “voice”—or level of input in patient care decisions—among home care workers (HCWs), an often marginalized workforce that provides care in the home to older adults and those with chronic conditions. DesignWe conducted a secondary analysis of data from a cross-sectional survey assessing experiences of HCWs in caring for adults with heart failure. The survey measured HCWs’ voice using a validated, 5-item instrument. Setting and ParticipantsThe survey was conducted virtually from June 2020 to July 2021 in partnership with the 1199 Service Employees International Union (1199SEIU) Training and Employment Funds, a union labor management fund. English- or Spanish-speaking HCWs employed by a certified or licensed home care agency in New York, NY, were eligible. MethodsHCW voice was the main outcome of interest, which we assessed by tertiles (low, medium, and high, with medium as the referent group). Using multinominal logistic regression, we calculated odds ratios (ORs) and 95% CIs for the relationship between participant characteristics and low and high levels of voice. ResultsThe 261 HCWs had a mean age of 48.4 years (SD 11.9), 96.6% were female, and 44.2% identified as Hispanic. A total of 38.7% had low voice, 37.9% had medium voice, and 23.4% had high voice. In the adjusted model, factors associated with low voice included Spanish as a primary language (OR 3.71, P = .001), depersonalization-related burnout (OR 1.14, P = .04), and knowing which doctor to call (OR 0.19, P < .001). Factors associated with high voice included Spanish as a primary language (OR 2.61, P = .04) and job satisfaction (OR 1.22, P = .001). Conclusions and ImplicationsOrganizational factors such as team communication practices—including among non-English speakers—may play an important role in HCW voice. Improving HCW voice may help retain HCWs in the workforce, but future research is needed to evaluate this.

Home Care Worker Continuity in Home-Based Long-Term Care: Associated Factors and Relationships With Client Health and Well-Being.

Despite the importance of provider continuity across healthcare settings, continuity among home care workers who provide hands-on long-term care is understudied. This project describes home care worker continuity, identifies factors associated with increased continuity, and examines associations between continuity and client outcomes. We conducted a retrospective cohort study of clients receiving Medicaid-funded home-based long-term care (n = 3,864) using insurance plan and home care agency data from a large nonprofit organization. We estimated home care worker continuity for clients between 6-month clinical assessments using Bice-Boxerman scores. We then used generalized estimating equations to model associations between home care worker continuity and (1) client characteristics (e.g., cognitive impairment), and (2) client functional, health, and psychosocial outcomes. While home care worker continuity was lowest for clients receiving the most weekly care hours, a range of continuity existed across all levels of care need. Those who were male, older, Asian/Pacific Islander/Native American, cognitively impaired, and functionally impaired had lower continuity. Higher home care worker continuity was significantly associated (p < .05) with fewer falls, a higher likelihood of functional improvement/stabilization, and fewer depressive symptoms. The finding that home care worker continuity is associated with the health and well-being of home-based long-term care clients underscores the importance of building high-quality relationships in long-term care. Continued efforts are necessary to understand and advance home care worker continuity and to identify other aspects of the home care experience that benefit those receiving long-term care at home.

A pilot study of an intergenerational program for people in residential aged care with cognitive impairment and children from a co-located early learning centre during COVID-19.

Intergenerational programs in residential aged care may improve well-being and combat loneliness and social isolation in older people with cognitive impairment. This pilot study investigated the effects of a semi-structured intergenerational group, including children from a co-located early learning centre and people living in residential aged care with cognitive impairment. This 9-week study used a mixed methods pre- and post-program design. Sessions were designed and delivered once per week by Occupational Therapists and took into account residents' interests and children's developmental needs and interests, identified in pre-program interviews. Nine older people with cognitive impairment and 13 children participated. The program was well attended despite disruptions and complications caused by COVID-19 and weather conditions. Older people valued the opportunity to engage with the children. Children were observed to gain confidence in communicating and forming friendships with older people with different levels of ability. There did not appear to be any change in loneliness or neuropsychiatric symptoms. The intergenerational program benefited participants and received strong support from family members and staff of the early learning centre and aged care home.

Home Care Clinicians' Perspectives on Advance Care Planning for Patients at Risk for Becoming Incapacitated With No Evident Advance Directives or Surrogates.

Advance care planning is important and timely for patients receiving home health services; however, opportunities to facilitate awareness and engagement in this setting are often missed. This qualitative descriptive study elicited perspectives of home health nurses and social workers regarding barriers and facilitators to creating advance care plans in home health settings, with particular attention to patients with few familial or social contacts who can serve as surrogate decision-makers. We interviewed 15 clinicians employed in a large New York City-based home care agency in 2021-2022. Participants reported a multitude of barriers to supporting patients with advance care planning at the provider level (eg, lack of time and professional education, deferment, discomfort), patient level (lack of knowledge, mistrust, inadequate support, deferment, language barriers), and system level (eg, discontinuity of care, variations in advance care planning documents, legal concerns, lack of institutional protocols and centralized information). Participants noted that greater socialization and connection to existing educational resources regarding the intended purpose, scope, and applicability of advance directives could benefit home care patients.