Quality Of Care In Homes Research Articles

THE MEDIATING EFFECT OF CULTURAL PARTICIPATION ON THE QUALITY OF HOME CARE AND WELL-BEING OF THE ELDERS

The purpose of this study was to determine the mediating effect of cultural participation on the relationship between the quality of home care and the well-being of the elderly. Utilizing quantitative, non-experimental design via correlational technique and mediation analysis, data were obtained from 300 elderly, in one of the cities in Davao Province. The researcher utilized a stratified sampling technique in selecting study participations and survey mode of data collection through standardized questionnaires. The researcher also utilized the statistical tools mean, Pearson r and Med-graph using Sobel z-test. From the results of the study, it was found out that there is a very high level of mean scores for quality home care, and well-being of the elderly while a high level of cultural participation. Also, results revealed that there are significant relationships between quality home care and cultural participation, between cultural participation and the well-being of the elderly and between quality home care and the well-being of the elderly. Further, it was revealed that cultural participation partially mediates the relationship between quality home care and the well-being of the elderly.<p> </p><p><strong> Article visualizations:</strong></p><p><img src="/-counters-/soc/0091/a.php" alt="Hit counter" /></p>

Investigating the Connections Between Delivery of Care, Reablement, Workload, and Organizational Factors in Home Care Services: Mixed Methods Study.

Home care is facing increasing demand due to an aging population. Several challenges have been identified in the provision of home care, such as the need for support and tailoring support to individual needs. Goal-oriented interventions, such as reablement, may provide a solution to some of these challenges. The reablement approach targets adaptation to disease and relearning of everyday life skills and has been found to improve health-related quality of life while reducing service use. The objective of this study is to characterize home care system variables (elements) and their relationships (connections) relevant to home care staff workload, home care user needs and satisfaction, and the reablement approach. This is to examine the effects of improvement and interventions, such as the person-centered reablement approach, on the delivery of home care services, workload, work-related stress, home care user experience, and other organizational factors. The main focus was on Swedish home care and tax-funded universal welfare systems. The study used a mixed methods approach where a causal loop diagram was developed grounded in participatory methods with academic health care science research experts in nursing, occupational therapy, aging, and the reablement approach. The approach was supplemented with theoretical models and the scientific literature. The developed model was verified by the same group of experts and empirical evidence. Finally, the model was analyzed qualitatively and through simulation methods. The final causal loop diagram included elements and connections across the categories: stress, home care staff, home care user, organization, social support network of the home care user, and societal level. The model was able to qualitatively describe observed intervention outcomes from the literature. The analysis suggested elements to target for improvement and the potential impact of relevant studied interventions. For example, the elements "workload" and "distress" were important determinants of home care staff health, provision, and quality of care. The developed model may be of value for informing hypothesis formulation, study design, and discourse within the context of improvement in home care. Further work will include a broader group of stakeholders to reduce the risk of bias. Translation into a quantitative model will be explored.

Health System Quality and Performance Indicators for Evaluating Home Care Programming: A Scoping Review

A systematic scoping review of health system Performance and Quality Indicators (PQI) related literature for evaluating publicly funded home care programming was conducted. Through the scoping review we identify PQIs, map these based on quadrants of the Institute for Healthcare Improvement’s (IHI) Quadruple Aim, classify these PQIs under general “areas of focus” categories, and present recommendations for use. We selected all articles that identified, referenced, proposed, and/or described at least 1 PQI to measure home care service programming. Minimum inclusion criteria were a description of 1 or more PQIs designed to evaluate and/or measure home care programming, outcomes of home care clients and/or caregivers, or overall system impacts of home care service provision. The review identified 3,475 citations. A review of the abstracts led to the retrieval of 510 full-text articles for assessment of which 105 articles were selected for detailed review and extraction of identified PQIs. Of the 105 identified articles a total of 829 unique PQIs were gathered. Based on the IHI Quadruple Aim, 661 unique measures were identified as Clinical Outcome, 35 as Healthcare Provider Satisfaction, 99 Patient Experience, and 34 in the Financial/Sustainability quadrants. Many patient outcome specific PQIs exist, followed by patient experience measures. Very few PQIs exist in the financial or healthcare provider experience quadrants. The lack of indicators across all the IHI Quadruple Aim quadrants is an opportunity for further development supporting home care quality oversight.

Floor Cleaners as Helper Pets: Projecting Assistive Robots’ Agency on Zoomorphic Affordances

Care of ageing adults has become a dominant field of application for assistive robot technologies, promising support for ageing adults residing in care homes and staff, in dealing with practical routine tasks and providing social and emotional relieve. A time consuming and human intensive necessity is the maintenance of high hygiene quality in care homes. Robotic vacuum cleaners have been proven effective for doing the job elsewhere, but—in the context of care homes—are counterproductive for residents’ well-being and do not get accepted. This is because people with dementia manifest their agency in more implicit and emotional ways, while making sense of the world around them. Starting from these premises, we explored how a zoomorphic designed vacuum cleaner could better accommodate the sensemaking of people with dementia. Our design reconceptualises robotic vacuum cleaners as a cat-like robot, referring to a playful behaviour and appearance to communicate a non-threatening and familiar role model. Data from an observational study shows that residents responded positively to our prototype, as most of them engaged playfully with it as if it was a pet or a cat-like toy, for example luring it with gestures. Some residents simply ignored the robot, indicating that it was not perceived as frightening or annoying. The level of activity influenced reactions; residents ignored our prototype if busy with other occupations, which proves that it did not cause significant disturbance. We further report results from focus group sessions with formal and informal caregivers who discussed a video prototype of our robot. Caregivers encouraged us to enhance the animal like characteristics (in behaviour and materiality) even further to result in richer interactions and provoke haptic pleasure but also pointed out that residents should not mistake the robot for a real cat.

A qualitative study of the interaction experiences between family caregivers and community nurses for disabled elderly people at home

BackgroundFamily members are currently the main caregivers of the disabled elderly people at home. With declining health and increasing frailty, caregiving of disabled elderly people becomes a task of family caregivers in conjunction with community nurses. Interaction between family caregivers and community nurses can effectively improve the quality of home care for the disabled elderly people. This study aimed to investigate the interaction experiences between family caregivers and community nurses for disabled elderly people at home.MethodsThis research was a study of qualitative descriptions based on semi-structured face-to-face interviews. This study was to purposefully select family caregivers of the disabled elderly and community nurses in Zhengzhou city, Henan Province and explore the interaction patterns between them. Directed content analysis method was used to generate qualitative codes and identify themes.ResultsA total of 12 interviews were completed, including 7 family caregivers and 5 community nurses. Four themes were identified: 1) Information interaction; 2) Emotional interaction; 3) Practical interaction; 4) Factors that promote and hinder the interaction.ConclusionsIt was found that the interaction between family caregivers and community nurses was not optimistic. Lack of communication and collaboration between community nurses and caregivers. Providing a new perspective that we can develop and implement intervention to facilitate positive interactions, which will reduce the burden of family caregivers, bring the highest quality of care to older adults with disabilities and improve the quality of care for disabled elderly people.Trial registrationRegistered in the Chinese Clinical Trial Registry on April 19, 2021, number ChiCTR2100045584.

247 Private equity acquisition of nursing homes and the impact on long stay residents and racial disparities in care outcomes

OBJECTIVES/GOALS: To investigate nursing homes (NHs) acquired by private equity (PE) firms and estimate the effect of PE NH acquisitions on NH care quality for NH residents and whether PE NH acquisitions exacerbate racial inequities in quality of care. METHODS/STUDY POPULATION: My research estimates the causal effect of NH PE acquisitions on NH access and quality of care for NH residents and whether acquisitions exacerbate racial disparities in NH care for about 115 PE-owned NHs in the US, measuring the quality of care at the facility survey year level, and using an array of NH-level data sources. I identified 115 PE-owned NHs (treatment group) and 665 non-PE-owned NHs between 2003 and 2010, using the Online Survey Certification and Reporting database to obtain facility characteristics. I compare facility characteristics (e.g., payer mix, staffing levels, and quality measures such as pressure ulcers, unexpected weight loss, acuity, and health deficiencies). I will then test whether effects differ by race, with hypotheses informed by Public Health Critical Race Praxis approach. RESULTS/ANTICIPATED RESULTS: Preliminary results show that staffing levels differ between PE and non-PE-owned NHs in a way that aligns with a shift in focus toward the Medicare population i.e. short stays. We also find that deficiencies increased in PE-owned NHs compared to non-PE-owned NHs. We expect that PE acquisitions may lead to slightly widening racial disparities in NH care quality. Results may show that PE-owned NHs have a higher share of low-rated, high-BIPOC facilities. In weak markets, PE-owned NHs may have a higher share of BIPOC residents compared to highly competitive markets. This is because PE managers may prioritize cost over quality by cutting services. However, since quality measures are self-reported, except for measures related to deficiencies, this predicted lower quality of care may not be evident in observed data. DISCUSSION/SIGNIFICANCE: Understanding how PE ownership impacts nursing home care quality for long-stay residents, especially those funded by Medicaid, can help develop intervention strategies to effectively mitigate racial inequities in NH care, as Medicaid funded NH residents are more likely to be Black, Indigenous, and people of color.

The Impact of Wages on Care Home Quality in England.

In many countries, a large proportion of long-term care staff are paid at, or near, minimum wage, leading to concerns of negative effects on care outcomes. This study analyzed the effect of staff wages on care home quality ratings in England. A national staffing database of long-term care providers was matched with local-area information on needs and supply to construct a 3-year panel (2016-2018) of English care home observations. Using multiple imputation methods to address missing data provided a data set of 12,055 observations of 5,556 care facilities (both residential and nursing homes). We analyzed the effect of the facility-level average hourly wage of care staff on national regulator quality ratings. A measure of the impact of exogenous changes in the national minimum wage on care facilities was used as an instrument for wage. We find that wages positively affect care home quality ratings. Other things equal, a 10% increase in the average hourly wage of direct care workers would lead to a 7.1% increase in the likelihood that a care home will have a high-quality rating. The wage effect on quality was significant when controlling for staff skill mix, measured as the share of registered nurses in nursing home staff. This study provides important evidence of the positive impact that staff pay can have on the quality of long-term care. Our finding has important implications for appropriate levels of pay and the funding of long-term care.

Analysis of the attractiveness of outdoor leisure landscape design of nursing homes to the outdoor activities of the elderly in nursing homes

Outdoor rest is a key indicator to ensure the life satisfaction of the elderly and measure the quality of home care. The number of elderly care facilities is increasing. However, there are few studies on the benefit s of outdoor entertainment for the elderly, and the factors affecting outdoor entertainment and landscape activities of the Therefore, I chose the actual case, used the environmental behavior monitoring method to understand their Therefore, I chose the actual case, used the environmental behavior monitoring method to understand their living needs and their preferences for some outdoor space and landscape factors, and then made a clear analysis of the types and elements of space to I used the environmental behavior monitoring method to understand their living needs and their preferences for some outdoor space and landscape factors, and then made a clear analysis of the types and elements of space to attract the elderly.

Care delivery approaches and perceived barriers to improving quality of care: A national survey of skilled nursing facilities.

Nursing home quality of care is a persistent challenge, with recent reports calling for increased reforms to improve quality and safety. Less is known about the clinical approaches currently used and the barriers perceived by skilled nursing facilities (SNFs) to provide care for their short-stay residents. We conducted a nationally representative survey of SNFs from October 2020 to May 2021 to understand their care delivery approaches and perceived barriers. Our primary outcomes were the reported number of 23 separate care delivery approaches and the reported number of 12 separate barriers to reduce spending or improve care for SNF short-stay residents. We also performed stratified analyses by facility participation in bundled payments and other SNF characteristics. We received 377 responses from 693 SNFs contacted (response rate=54%). SNFs reported an average of 16.8 care delivery approaches and an average of 5.0 barriers. While there were some differences observed in SNF characteristics, such as by bundled payments participation or ownership type, there were common care delivery approaches and barriers shared by most facilities. Care management practices, including reviewing the patient census and medication reconciliation on discharge, were the most common delivery approaches reported. SNFs were less likely to ensure the completion of a follow-up appointment with a primary care provider or track repeat emergency room visits. Issues concerning staffing, such as staff turnover and/or burnout, and lack of resources to provide patients social support, mental health, and substance use services, were the most cited barriers to care delivery. Nationally, SNFs implemented a wide array of care delivery approaches, but challenges with staffing and limited resources to address patients' social and mental health needs were dominant. Individual SNFs may have limited ability to address these key barriers, so the involvement of many stakeholders across the entire healthcare system may be necessary.

Forskningscirklar med hemtjänstmottagare och personal

Research circles with home care recipients and care staff - a method to increase understanding of what quality in home care impliesA research circle is a method in participatory research, which aims to strengthen the bottom-up perspective and thereby establish a more democratic process for common knowledge formation. The methodology means that more voices and perspectives are made visible, as well as identifying concrete proposals for change. A shared knowledge formation requires that all participants experiences, and knowledge contributions are taken into account and the researchers role as circle leader is to contribute by connecting to current research and other sources of knowledge in the area of study. The purpose of the present study is to explore and if so, how to the research circle method is useful as an initial stage of a research and development process. The article describes research circle about quality in home care, i.e interventions that take place in the individual’s home outside of assisted living facilities. Quality is a complex concept and often a subjective experience. To find answers to the question of what the meaning of quality in home care services is, research circles are conducted with home care recipients and caregivers separately. As the research circles are ongoing, the results are still preliminary. To highlight the method, two themes about what quality in home care means, have been chosen to describe the joint knowledge formation, which is based on an interaction between theory and practice. Our ambition is that the results produced by the research circle as a method should also be used as a basis for organizational learning within home care and thus contribute to increased quality.

Quality and Safety of Proximity Care Centered on the Person and Their Home: A Systematic Review Protocol.

The quality and safety of health care is a priority, a requirement and a demand of health organizations and social institutions with concrete purposes of progressively providing people with a higher level of health and well-being. It is in the development of this path that home care currently represents an area of gradual investment and where health care services and the scientific community have shown interest in building circuits and instruments that can respond to needs. It is essencial that care must be centered and in close proximity to the person and their family, their context. On the other hand, in Portugal, there are already quality and safety models for the institutionalization context however it is non-existent for home care. In this sense, our objective is to identify, through a systematic review of the literature, particularly from the last 5 years, areas of quality and safety in home care.

Correlations between care users' and the healthcare inspectorate's ratings of the quality of care in long-term care homes.

Increasing emphasis is being placed on person-centredness as a quality requirement for long-term care (LTC). Although healthcare inspectorates value the importance of care users' experiences, they struggle to address these experiences in regulatory practice. The aim of this study is to explore the correlations between care users' and the healthcare inspectorate's ratings of the quality of LTC in The Netherlands. The correlations between care users' ratings from a public Dutch online patient rating site and the Dutch Health and Youth Care Inspectorate's ratings of the quality of care were examined using Spearman rank correlations. The inspectorate's ratings cover three themes: 'attention to person-centred care', 'working towards sufficient and competent care staff' and 'focusing on quality and safety'. Ratings of the quality of care were obtained for 200 LTC homes in The Netherlands between January 2017 and March 2019. These LTC homes had 6 to 350 residents (M=89; SD=57) and belonged to organisations with 1-40 LTC homes in total (M=6; SD=6). Publicly available anonymous ratings of the perceived quality of care by care users were extracted from the Dutch patient rating website 'www.zorgkaartnederland.nl'. Care users' ratings were available for the 2 years prior to an assessment by the inspectorate for 200 LTC homes. We found a weak, significant correlation between the mean care users' ratings and the inspectorate's aggregated scores for the theme 'person-centred care' (r=0.26, N=200, padj<0.01); no other correlations were significant. This study showed only a weak correlation between care users' ratings and ratings of the Dutch Inspectorate of the quality of 'person-centred care' in LTC homes. Therefore, it may be fruitful to intensify or innovate approaches to involve care users' experiences in regulation to do them justice.

Implementing A person-centred CommunicaTION (ACTION) educational intervention for in-home nursing assistants – a study protocol

BackgroundIn this study, the focus is on how to support the competence development needed for nursing assistants in home care. Home care services for older persons can be challenging concerning the nature of the interpersonal interaction and communication needed to care for and respond to the diverse needs of older people who seek to live well in our communities. This implies a need to offer more person-centred care (PCC) to older persons. However, there is a lack of knowledge on how to develop such competence. We, therefore, developed A Person-centred CommunicaTION (ACTION) programme, which is a web-based educational intervention aimed at supporting competence development for nursing assistants. The research objective is to evaluate the ACTION programme with respect to participants’ responses to and the effect of the intervention.MethodsA multicentre case–control study with pre- and post-assessments was designed. The ACTION programme will be implemented at home care units, in two different geographic areas in Sweden. A total of 300 nursing assistants will be recruited: 150 for the intervention group and 150 for the control group. We will evaluate the impact measures and the process. Pre- and post-assessments will be performed with data collected via a) audio recordings of communication, b) a questionnaire on self-efficacy communication skills, PCC, empathy and job satisfaction, c) user data, evaluation forms, field notes and observations, and d) interviews. The data will be analysed with descriptive and analytic statistics and/or qualitative methods for meanings.DiscussionThis study has the potential to contribute to the evidence supporting competence development required to offer person-centred and quality home care to older persons and to meet upcoming needs for flexible and easily accessible competence development.Trial registrationISRCTN64890826. Registered 10 January 2022, https://www.isrctn.com/ISRCTN64890826

A typology of integrated care policies in the care home sector: A policy document analysis.

Health and social care systems in many countries have begun to trial and adopt "integrated" approaches. Yet, the significant role care homes play within the health and social care system is often understated. A key first step to identifying the care home integration interventions that are most (cost-)effective is the ability to precisely identify and record what has been implemented, where, and when-a "policy map." To address gaps relating to the identification and recording of (cost-)effective integrated care home interventions, we developed a new typology tool. We conducted a policy mapping exercise in a devolved region of England-Greater Manchester (GM). Specifically, we carried out systematic policy documentary searches and extracted a range of qualitative data relating to integrated health and social care initiatives in the GM region for care homes. The data were then classified according to existing national ambitions for England as well as a generic health systems framework to illustrate gaps in existing recording tools and to iteratively develop a novel approach. A combined total of 124 policy documents were identified and screened, in which 131 specific care home integration initiatives were identified. Current initiatives emphasized monitoring quality in care homes, workforce training, and service delivery changes (such as multi-disciplinary teams). There was comparatively little emphasis on financing or other incentive changes to stimulate provider behavior for the care home setting. We present a novel typology for capturing and comparing care home integration policy initiatives, largely conceptualizing which part of the system or specific transition point the care home integration is targeting, or whether there is a broader cross-cutting system intervention being enacted, such as digital or financial interventions. Our typology builds on the gaps in current frameworks, including previous lack of specificity to care homes and lack of adaptability to new and evolving initiatives internationally. It could provide a useful tool for policymakers to identify gaps in the implementation of initiatives within their own areas, while also allowing researchers to evaluate what works most effectively and efficiently in future research based on a comprehensive policy map.

Paying for Nursing Home Quality: An Elusive But Important Goal.

Paying for Nursing Home Quality: An Elusive But Important Goal.

Home Care Nurses' Experiences of the Use and Introduction of the Subacute Functional Decline in the Elderly Instrument.

Registered nurses are crucial in home care nursing for elderly patients, as detecting geriatric conditions can be difficult due to age-related changes or communication barriers. Disability is often overlooked in elderly care, requiring different assessment tools to determine patient status and necessary nursing interventions. During the COVID-19 pandemic, the subacute functional decline in the elderly (SAFE) instrument was implemented in some Oslo districts to detect early signs of sub acute functional decline in hospital and home care settings. However, the nurses' perception of this new assessment tool and its effectiveness has not been evaluated. This study aims to explore home care nurses' experiences and perceptions regarding the introduction and use of the new assessment tool, SAFE. Objectives were to conduct focus group interviews and perform qualitative analysis. The study followed Consolidated Criteria for Reporting Qualitative Research guidelines, had a qualitative design, and included 15 out of 60 permanently employed RNs at Oslo municipality's home care service in Frogner district. Data was collected via three focus group interviews and analyzed thematically. The study identified three themes: (1) Nurses learned to use SAFE through direct experience due to a lack of standard introduction or training. (2) SAFE supported patient-centred care by enabling communication, preventive work, and identifying patients' needs. (3) Integrating SAFE into electronic databases and daily clinical work could improve nursing efficiency. Overall, using SAFE can improve patient outcomes and care quality in home care, but clear guidelines, ongoing support, and standardized procedures are crucial for its effectiveness. Regular updates and complete management support are also necessary. The study's findings align with previous research and can guide the development and implementation of tools in home care to enhance patient outcomes and the quality of care delivered.

Sustainable Improvements in Dementia Care for an Expectably Increasing Number of Dementia People: Challenges and Opportunities

Background: Aging, low literacy, and vascular risk factors are agents to boost or maintain the numbers, with more and more elevated costs for informal caregivers and society. Widely public health priority recognition implies changes and challenges in some European countries involving political engagement, needs that in dementia care are unmet. A preliminary diagnosis of the gaps and a prioritization of strategies to be implemented in Portugal should be addressed. The World Health Organization framework for meaningful engagement could work, as it has already done for other chronic diseases to reach some of the goals to improve healthcare. Methods: A review of the current situation and some of the initiatives delivered through healthcare professionals with recognized experience in dementia areas and patients’ associations, in a South Europe country over the last few years. In view of the remaining gaps, proposals from the literature will be provided to improve care experiences. Conclusion: We defend that is essential that Portugal deepen patient-centered care, integrated care pathways, and equal access for rural or marginalized populations to specialist assessment for an early diagnosis. Improving the quality of dementia care in care homes or managing a dementia care program to link resources for patients and caregivers, are key themes that need proactive preparation for the coming years. We present 8 recommendations for dementia care in Portugal.

ACHIEVING QUALITY PATIENT-CENTERED CARE IN THE NURSING HOME SETTING

Abstract In 1987, The Nursing Home Reform Act was enacted as part of the Omnibus Reconciliation Act of 1987 (OBRA 87). At that time, the Health Care Finance Administration (now Centers for Medicare and Medicaid Services) issued comprehensive regulations and survey processes to “ensure that residents of nursing homes receive quality care that will result in their highest practicable physical, mental, and social well-being.” Despite this landmark legislation, nursing homes struggle to provide quality care, and are additionally challenged by natural disasters and pandemics. This presentation will report on recommendations that examine, structures, policies, and care models that promote change and innovation, with a focus on safety, environmental modifications, patient centered approaches, and quality care. Dr. Colleen Galambos, a professor at University of Wisconsin-Milwaukee, with expertise in nursing home care delivery and quality improvement will present the care delivery recommendations from the NASEM report.

FACTORS ASSOCIATED WITH HOME CARE AIDES' JOB SATISFACTION DURING COVID-19

Abstract The COVID-19 pandemic has pronounced already high turnover rates among home care aides (HCAs). High turnover negatively affects home care quality. Job satisfaction among HCAs is a major driver of turnover, but little is known about factors associated with HCAs’ job satisfaction during COVID-19. Using survey data, the purpose of this study was to identify variables associated with job satisfaction among HCAs during the pandemic (N=114). Correlational analyses show that lower job satisfaction is associated with experiencing financial hardship, lack of PPE and employer protocols/guidance, understaffing, lower quality of employer communication related to COVID-19, and HCAs’ lower perceived preparedness to care for clients with COVID-19. In a regression analysis, experiencing financial hardship and lower quality of employer communication remained significant predictors. Findings underscore the importance of employer supports in HCAs’ job satisfaction and provide important lessons for how employers can support HCAs during the pandemic and beyond.

Quality and safety in home care with the Vidaza cooperation protocol

In a context of tense bed management in hospitals, the implementation of cooperation protocols between hospital services and home care providers has become necessary in recent years. The Albi hospital in the Tarn region has set itself the objective of developing care pathways in conjunction with the city in order to better structure the supply of care in the region and also to encourage exchanges between healthcare professionals. The "Vidaza (Azacitidine®) cooperation protocol for day hospital - home hospitalization" illustrates this approach in the field of oncology.