Providing Home Care Services Research Articles

An Android-Enabled PHR-based System for the Provision of Homecare Services

Homecare is an important component of the continuum of care as it provides the potential to improve quality of life and quality of healthcare delivery while containing costs. Personal Health Record (PHR) systems are intended to reach patients outside of care settings and influence their behaviors thus allowing for more effective homecare services. To this end, these systems need to evolve well beyond providing a consolidated patient record, in ways that make it more widely applicable and valuable to health systems. The development of applications on top of PHR systems can allow them to function as a platform for both patients and healthcare professionals to exchange information and interact with the health system. This paper presents a prototype PHR-based system that aims at supporting chronic disease management at any point of care or decision making through familiar environments such as Google’s Android. In particular, it assists healthcare professionals in assessing an individual’s condition and in forming the appropriate treatment plan for him/her while it provides individuals with step-to-step guidance to their treatment plans.

Wireless Networking Credibility, Device Interoperability and Other Important Issues to Take into Consideration for the Deployment of a Homecare Service Provision Model

The proposed article aims to provide a discussion on the issue of the utilization of wireless technologies, for the deployment of monitoring wireless personal area sensor networks for the unobtrusive monitoring of patients, aiming to answer some of the fundamental questions raised by this, including which is the most appropriate technology for such a networking architecture, what is the best topology for home monitoring wireless sensor network solutions, and what is the performance of the wireless networking technologies. In addition, it aims to initiate some brainstorming as regards how many interoperability protocols are actually need, presenting the strong and weak points of most of the current interoperability standards utilized in the field of homecare, with emphasis on the encoding and formatting of ECG waveforms. Last but not least it aims to pinpoint other important issues in the field of homecare, such as legal and safety issues which are worth of consideration.

Need and Potential Use of Information Technology for Case Manager–Physician Communication in Home Care

Case management has become a popular model for providing home care services to nursing home-eligible older adults. To maximize collaborative decision making and patient outcomes, members of the case management team must engage in ongoing, open communication. However, little is known about the quality of communication between home care case managers and their clients’ physicians. This study examined geriatric home care case managers’ perceptions of their communication with their clients’ physicians. Participating case managers were employed at two large home care agencies located in the South Florida region. The findings suggest that communication between home care case managers and physicians is limited and inefficient. Implication for policy and practice are provided. Finally, we propose ways to leverage Information Technology to bridge this communication gap.

Undermining the rules in home care services for the elderly in Norway: flexibility and cooperation

This study explores the provision of home care services (home nursing and domiciliary help) for the elderly in Norwegian municipalities with purchaser-provider split model. The study draws on the assumption that flexibility in adjusting services to the care receivers' needs, and cooperation between provider and purchasers are indicators of good quality of care. Data were collected through semi-structured telephone interviews with 22 team leaders of provider units in nine municipalities. Data were collected in 2008-2009. The study has been approved by the Norwegian Social Science Data Services. We identified four different ways of organising home care services under a purchaser-provider split model: Provider empowerment, New Public Management, Vague instructions and undermining the rules. High flexibility in providing care and cooperation with the purchaser unit were identified by the team leaders as characteristics for good care. Our findings suggest that the care providers use individual strategies that allow flexibility and cooperation rather than rigidly abiding to the regulations the purchaser-provider split models implies. Ironically, in provider units where the 'rules were undermined', the informants (team leaders of provider units) seemed to be most satisfied with the quality of home care that they delivered.

Verbessert das Resident Assessment Instrument die ambulante Pflege? - Ergebnisse einer bundesweiten Studie

Effective and efficient instruments for care planning and controlling are required to optimise the nursing process and improve outcome quality despite of various lacks of quality and precarious circumstances. A cluster randomised controlled trial was conducted to assess whether the implementation of the Resident Assessment Instrument (RAI) into home care service providers can help to improve or stabilise functional abilities (ADL, IADL) and cognitive skills (MMST), improve quality of life (EQ-5D), reduce institutionalisation and thereby increase outcome quality. A comparison of mean differences between the treatment and control group showed no significant effects. Although the multilevel regression results show that clients in the treatment group fared better in terms of ADL and IADL (smaller decline) and were less likely to move to nursing homes and be hospitalised, none of these effects are significant. The lack of significance might be due to the fact that RAI was not fully implemented and even the partial implementation lasted much longer than expected. Moreover, the number of clients included in the study was smaller than originally planned.

Webcasting in Home and Hospice Care Services

The access to free live webcasting over home computers was much more available in 2007, when three military leaders from West Point, with the purpose of helping military personnel stay connected with their families when deployed, developed Ustream.tv. There are many types of Web-based video streaming applications. This article describes Ustream, a free and effective communication tool to virtually connect staff. There are many features in Ustream, but the most useful for home care and hospice service providers is its ability to broadcast sound and video to anyone with a broadband Internet connection, a chat room for users to interact during a presentation, and the ability to have a "co-host" or second person also broadcast simultaneously. Agencies that provide community-based services in the home will benefit from integration of Web-based video streaming into their communication strategy.

Precariousness, work organisation and occupational health: the case of nurses providing home care services in Quebec

AbstractSeveral of our case studies of nurses who provide home care services in the Quebec public sector have brought to light the numerous effects of precarious work on the occupational health of this group of workers. With regard to work organisation, it would seem that a large proportion of precarious nurses changed the task distribution and workload, which in turn had a negative impact on the work conditions and occupational health of permanent nurses.

Knowledge-driven delivery of home care services

Home Care (HC) assistance is emerging as an effective and efficient alternative to institutionalized care, especially for the case of senior patients that present multiple co-morbidities and require life long treatments under continuous supervision. The care of such patients requires the definition of specially tailored treatments and their delivery involves the coordination of a team of professionals from different institutions, requiring the management of many kinds of knowledge (medical, organizational, social and procedural). The K4Care project aims to assist the HC of elderly patients by proposing a standard HC model and implementing it in a knowledge-driven e-health platform aimed to support the provision of HC services. This paper focuses on two knowledge-based personalization aspects incorporated in the platform that aim to overcome the difficulties of HC delivery. The first one is the assistance to medical practitioners in the process of defining a customized treatment adjusted to the medical and social conditions of a particular patient in order to consider multiple co-morbidities. The second one is the possibility of tailoring the profiles of the care professionals according to the medical and organizational daily requirements in order to allow a flexible care delivery. Those two aspects, guided by the knowledge explicitly represented in the platform, play a crucial role in the medical and social acceptance of this kind of e-health systems. The paper also includes a real case study designed and tested by healthcare professionals and includes encouraging results from the test of the platform in a real health care environment in the city of Pollenza (Italy).

Exploring the fit between organizational culture and quality improvement in a home-care environment

Overseeing the quality of community-based, home-care services is a subject of concern in most jurisdictions confronted with population aging and the rise of chronic conditions. Although various quality management strategies have been used in different health care settings, continuous quality improvement (CQI) is still in the early stages of development among home-care service providers. What is more, some authors have raised questions as to whether CQI is suitable to the unique character of home-care and can be adequately applied to a diverse and varied range of agencies, each featuring a unique organizational culture, professional mix, and mode of operation. The article reports on how differing organizational cultures--as found in a set of public and private home-care providers--appear to affect agency receptivity to CQI during program implementation. The research methodology is characterized by a qualitative, multiple case study approach. Data were gathered from a purposive sample of four home-care agencies in Quebec, Canada, belonging to the public, private for-profit, and not-for-profit sectors. It is concluded that a core set of cultural attributes play a decisive role in determining agency receptivity to CQI, even when its effect is mediated by several contingent variables. Further, some of the levers and barriers to implementation identified in previous research seem less relevant to home-care agencies. A number of policy/management implications are discussed, which may enhance receptivity to CQI by home-care agencies and prevent implementation failure.

Canadian Home Care Policy and Practice in Rural and Remote Settings: Challenges and Solutions

ABSTRACT With the aging of the population, especially in Canadian rural areas, providing home care services will be particularly challenging as care is needed by increasingly vulnerable rural older adults in increasingly vulnerable rural settings with fewer services, supports, and caregivers. The purpose of this paper is to present examples of the federal (e.g., First Nations and Inuit Home and Community Care) and provincial (e.g., Ontario's Community Care Access Centres) home care policy context in which Canadian home care is provided, to identify the challenges faced by home care providers in meeting the needs of rural residents, and to offer solutions to these challenges. The most pressing challenges in aging rural settings are to ensure effective access to quality health care services and to address the shortage of home care providers, especially registered nurses. Provincial and federal home care models would be enhanced by an integrative model of continuing care and a national home care framework that would address the broader funding and human resource issues. Other uniquely rural recruitment and retention strategies are suggested such as maximizing the “fit” between the home care provider's attributes and the needs and expectations of the rural community. Sufficient public funding and resources for rural and remote home care programs are needed to develop and implement (1) the expanded role of case managers; (2) health care teams that include both professionals and paraprofessionals; (3) standardized assessment tools and reporting systems; (4) innovative use and training in the use of technology; and (5) partnerships that optimize resources and build support networks for rural home care providers, clients, and family and friend caregivers.

Pflegediagnose «Gefahr einer Pneumonie». Evaluierung und Vergleich evidenzbasierter und pflegepraktischer Interventionen

In home nursing care, professionally qualified nurses make decisions on their own which must be based on the latest scientific research. The goal of this systematic literature review was to examine if the interventions of the diagnosis "Risk of Pneumonia" as used by a home care service provider in Austria are based on scientific evidence. Based on the research question "Can the interventions of the diagnosis 'risk of pneumonia' be found in the scientific nursing literature?", four evidence-based guidelines from various databases and institutes were identified and evaluated using a standardized checklist. The result of the analysis is that the majority of the Nursing diagnosis interventions can be found in the guidelines. It is also recommended in the guidelines to advise and support clients to stop smoking and inoculate against influenza/pneumonia. Similarly, assessment tools should be used to estimate the severity of pneumonia. The intervention of oral hygiene as a prophylactic intervention against pneumonia should get particular attention.

The Global Emergence of Advanced Practice Nurses in Providing Home and Community Health Care Services

Organizations, health systems, and interested individuals globally are assessing and investigating issues related to community health care services, home health management, and advanced nursing practice. Scarcity of financial and human resources has motivated health care policy makers to rise to the challenge to explore skill mix in the health care workforce in the hope of improving multidisciplinary collaboration in the provision of care for the world's populations. Nurses with advanced knowledge and skills are at the forefront of providing health care in home-based and community settings. This article describes the extent of this global phenomenon as it relates to advanced nursing practice and identifies a variety of international strategies utilized to introduce advanced practice nurses into health care systems.

Nurse-Physician Collaboration in Pain Management for Terminally Ill Cancer Patients Treated at Home in Japan

Collaboration between nurses and physicians is essential for successful pain management, especially in home care settings. This study describes how physicians collaborate with nurses for the pain management of terminally ill cancer patients treated at home in Japan, and evaluates the use of standing orders in pain management. Self-administered questionnaires were sent to all 565 institutions listed in a nationwide database of home care service providers for terminally ill cancer patients; 177 responding institutions were analyzed. In general, institutions caring for fewer patients per year were less likely to make specific efforts to collaborate with nurses and less likely to use standing orders in pain management. Given that many institutions provide home palliative care services on a small scale, a standard protocol for care should be developed and applied across all institutions to ensure the availability of quality home palliative care throughout the country.

The effect of awareness on the outcome of oral health performed by home care service providers

The purpose of this study was to investigate the correlations amongst factors, such as knowledge, attitude, practice and oral health behaviour, in caregiver managers so as to improve the oral health of the dependent elderly. Data were collected from a sample of 102 caregiver managers from home care service providers using a questionnaire. The respondents were divided into two groups: the group who were aware of effective oral care (A group) and the group who were unaware of effective oral care (U group). The evaluations were frequency distribution tables followed by chi-squared tests of independence and Fisher's exact test. Ninety percent of the respondents thought that dependent elderly needed to be provided with oral care and 77% had been trained in oral care. However, only 44% thought that they could provide appropriate oral care and only 52% had experienced its effect on oral health and general health. There was a significant difference in training by dental hygienists between the A group (36%) and the U group (11%). There was also a significant difference in learning of oral care skills. The results suggested a high oral care awareness amongst caregiver managers and an inadequate oral care training system. To improve oral health of the dependent elderly, theoretical teaching alone is not sufficient when providing oral health education and a positive contact with the dental team, especially dental hygienists, is an important factor which supports oral care provided by caregivers.

Performance Evaluation of Home and Community Care

In Canada, as in most developed countries, health care dollars claim a significant proportion of government budgets, and there is increased pressure to ensure that these funds are spent in an optimal manner. As a consequence, numerous mechanisms have emerged to assess the performance of hospitals and other health care institutions for health planning and policy evaluation (Peacock et al., 2001). One such mechanism has been the assessment of technical efficiency (i.e. the ability of mangers to optimally allocate their budgets to deliver high quality care to a diverse set of patients). Despite recent shifts in the setting for health care service provision from institutions to home and community care, there has been a paucity of efforts to assess the performance of the home and community care sector. Our study uses Data Envelopment Analysis (DEA) to estimate the technical efficiency of Ontario's 43 Community Care Access Centres (CCACs) in 2000/01 in their provision of home care services, after controlling for budget size and case-mix. While the results suggest that many CCACs are technically efficient, a significant proportion of urban CCACs are functioning at too large a size than is optimal. The addition of case-mix to the analyses explained some but not all of the observed variation in efficiency. Our research provides a baseline for the efficiency measurement in the provision of home care services in Ontario, Canada and a framework within which the quality of care may also be incorporated, should such data be available. The efficiency measurement represents an additional tool that decision-makers may use to inform the funding process, make resource allocation decisions, and assess the performance of managers in the home and community care sector.

Neither seen nor heard: Children and homecare policy in Canada

Changes in public policy have led to increasing numbers of children with disabilities and complex medical needs being cared for in the homes of Canadians. Little work, however, has explored the ethical implications of these policies. This paper focuses on some of the shortcomings of current policy and describes a developing method for policy analysis with an explicit focus on ethics that could be adopted in other nations. Three forms of analyses—descriptive, conceptual and normative—conducted on Canadian homecare policy documents describe various dimensions of Canadian homecare policy. The descriptive analysis demonstrated that the jurisdiction of homecare services is dispersed across numerous programs and ministries with no single structure for policy implementation and accountability. The needs of children and youth are rarely mentioned in home healthcare policies, but instead are addressed under broader social policies that are focused upon children and family. The conceptual analysis revealed four over-arching themes that represent the predominant elements of a value-structure that underlie homecare policy. They include: (1) home and community care as ideal; (2) the importance of independence and self-care of citizens; (3) family as primary care provider; and (4) citizenship as entitlement to rights and justice. Overall, these themes tend to reflect a neoliberal ideology that shifts the responsibility of care from the state to the individual and his/her family. A normative framework based on critical healthcare ethics is used in the paper to make recommendations to redress the current imbalance between state and family support. For example, including homecare services within the Canada Health Act (CHA) or the development of separate legislation consistent with the principles of the CHA would make it possible to ensure that the principles of universality, accessibility, portability and public administration, as opposed to principles that reinforce competitive individualism, direct the provision of homecare services in Canada.

Battle on the home care front: perceptions of home care workers of factors influencing staff retention in Northern Ireland

The provision of home care services is a key component in avoiding inappropriate admission of older people to institutional care and preventing delayed discharge from hospital. However, there is a growing problem of retention of home care workers (HCWs), creating problems for delivering this increasingly essential service. The present study was based in a health and social services trust in Northern Ireland, and was designed to explore the growing problem of retention of HCWs from their own perspective. The cross-sectional survey design used a convenience sample and questionnaires were completed by 45 HCWs (response rate = 45 of 147, 31%). Responses to most questions were on five-point ordinal scales. Focus groups in which 12 HCWs participated were used to explore emerging themes. The variables studied were HCWs' perspectives on: (1) reasons for considering leaving; (2) working hours; (3) supervision and support, and qualifications and training; (4) workload pressures; (5) client attitudes; (6) pay; and (7) job satisfaction. The main reasons given by HCWs for dissatisfaction and considering leaving were (in rank order): (1) irregular and antisocial hours; (2) lack of management support; and (3) workload pressures. Commitment to caring seemed to be the reason why pay did not feature more highly for those who did not leave. Home care workers are being required to provide care for people with evermore-complex health and social care needs, and in an environment increasingly regulated in terms of quality and risk. This makes it an increasingly demanding job, which does not seem to be recognised in the training and working conditions of HCWs. The most significant factors identified give scope for service managers to improve the retention of HCWs.

Involvement of Informal and Formal Service Providers: Meeting the Home Care Needs of Older Adults with Severe Functional Impairments

ABSTRACT This study examines informal and formal service providers' involvement in each activity of daily living (ADL) of older adults with severe functional impairments and the older adults' unmet needs for ADL assistance. In addition, this study examines the relationship between the involvement of informal and formal service providers and unmet needs for ADL assistance. Using the data from the 1999 National Long-Term Care Survey, the study included 275 older adults, who experienced ADL impairments and received assistance. This study found that nearly a quarter of the older adults reported unmet needs for ADL assistance. This study also found that the involvement of informal and formal service providers was not significantly related to unmet needs. However, the factors, including the older adult's functional status, levels of assistance received, and Medicaid enrollment, were significantly related to unmet needs included. Practice implications from these study findings for home care service providers are discussed.

Options available for the infusion of lipid emulsion in home parenteral nutrition (HPN): a questionnaire survey for hospitals in Japan where HPN is practiced

Objective To understand the status of total parenteral nutritional (TPN) composition and the TPN line used for home parenteral nutrition (HPN) in Japan and to investigate how adequate nutritional support should be in HPN, we conducted a questionnaire survey. Methods From February to March 2004, questionnaires were sent by mail to the members of the Japan Society for Home Therapy Research. With the content of the questionnaire, we surveyed 1) the types of medical staff who are involved in HPN, 2) the status of the preparation of TPN fluid and its place of preparation, 3) use of the TPN line and final filter, and 4) administration of lipid emulsion and All-in-One. Results The major survey results from 66 respondents were that the 50% of the medical staff who are involved in HPN have more than 10 y of experience; however, the number of patients who used HPN and were treated by 78% of the medical staff was fewer than 50. With regard to TPN fluid, 50% was prepared in-house and 12% was prepared by home care service providers. In addition, 58% of institutions were infusing lipid emulsion from the side port of the TPN line or through a peripheral route because they used a final filter and closed system infusion line. Conclusions Because the final filter and closed system infusion line for HPN management is standard practice, lipid emulsion is not adequately used in Japan. Therefore, the All-in-One system including lipid emulsion is not used.

Home and Community Occupational Therapy for Children and Youth: A before and after Study

There has been an increased focus on home care service provision in recent years, yet there are few data available about the provision of home and community occupational therapy for children and youth. To evaluate key elements of a service provision model for home care occupational therapy in terms of occupational performance outcomes, perception of care and cost. Eleven centres in Ontario and Quebec recruited 167 children and youth up to 18 years of age to a before and after study of occupational therapy services in the home and community. Occupational performance, quality of life and costs were measured at baseline and study end. Perception of care was measured at study completion. A statistically and clinically significant improvement in occupational performance was demonstrated (p < 0.001). The clients' families gave high ratings to the process of care provided by the occupational therapists. These data did not demonstrate a clear relationship between amount of service, cost and occupational performance outcome. Children receiving home and community occupational therapy services change in their occupational performance abilities. These changes are not directly related to the amount or focus of the occupational therapy services.