Use Of Home Care Services Research Articles

Transitions between SNF and home-based care in patients with multiple sclerosis

To assess patient characteristics and risk factors associated with care transitions between skilled nursing facility (SNF) and home care for patients with multiple sclerosis (MS) in an effort to improve outcomes and optimize patient care pathways. MS is a chronic neurologic illness of younger adults that is associated with physical disability, cognitive impairment and a high need for supportive services. The study was based on the 2005 Nursing Home Minimum Data Set and the Outcome and Assessment Information Set data (n = 10,064). We performed multivariate evaluation of patient risk factors for skilled nursing facility (SNF) admission and disposition while controlling for potential patient self-selection and other characteristics that affect care utilization. MS patients with recent history of home care use were less likely to be admitted to an acute care hospital and had higher physical disability at SNF admission than SNF patients who did not use home care. Insurance type (Medicaid) and availability of informal caregivers were associated with the use of homecare services after a SNF stay, while patient demographic and clinical characteristics did not explain SNF disposition. Future studies should explore the association between the local availability and affordability of home-based services and physician attitude about community-based care management of disabled patients.

Measurement properties of the Client-centered Care Questionnaire (CCCQ): factor structure, reliability and validity of a questionnaire to assess self-reported client-centeredness of home care services in a population of frail, older people

The increasing and specific use of home care services by frail, older people asks for the evaluation of the client-centeredness of these services. To our knowledge, no instrument that measures client-centeredness of home care from this group's unique perspective exists. We therefore tested the factor structure, reliability, content validity and acceptability of the Client-centered Care Questionnaire (CCCQ), an existing instrument developed for general home care users, in a population of frail, older people in the Netherlands. We used data from a 2-year clinical trial. frail, older people who received home care. Data were collected at baseline (n=600) and 24-month measurements (n=389); retest data (n=67) were collected 7-14days after the 24-month measurements. We performed confirmatory factor analysis, investigated reliability and validity parameters and assessed acceptability. The factor analysis yielded a bifactor model with essential unidimensionality. Internal consistency was high (omega total .88). We found a test-retest reliability of total test scores of .81; the standard error of measurement was 2.61 (total score range 15-75) and the limits of agreement were -7.03 and 7.86. We rejected three out of four hypotheses for construct validity. The CCCQ is sufficiently unidimensional to permit the use of total test scores. We found acceptable reliability values, but considered our results on construct validity inconclusive. Respondents found the CCCQ questions challenging to answer, which is indicative of a high degree of respondent burden. Future instruments that measure client-centeredness of home care from the frail, older client's perspective should therefore be tailored to the specific circumstances of this population.

The role of primary care in the organisation of home care services

Purpose: To understand the use of primary care and the preference of the patients and the families in order to be registered/included in home care services. Theory: Health care delivery is a complex system that combines many different parties around a shared topic. The “chronic diseases” is a subject topic in medicine that has a great economic and emotional burden with the high hospitalisation rates and palliative care need. All the family members, care givers, health professionals, social security system, pharmacology industry besides the patients are the members of the chronic disease management procedure. Home care is a new area for Turkey that may help this procedure to flow in a more humanistic and cost efficient way. It is beneficial to administer the home care health services from the primary care level but neither the roles and the responsibilities of the health professionals nor the organisational patterns are defined in Turkey. Method: A questionnaire is applied to 46 new respondents of home care about how they learnt about the home care services, their registration way, possible reasons of the problems that they were confronted and their solution suggestions. Findings: Most of the care givers were over 45 years of age (70%), female (61%), with a monthly income of 1500-2500TL (900-1500USD). Most commonly the patients' children or the children inlaw were the caregivers (78%, n=36). Primary health care units and family physicians were the first source of information for the 48% of the participants. Main problems were defined as the lack of coordination and communication of the hospital units with the family physicians (20%) and also with the families (15%) so to be late and inefficiency was the main outcome of dissatisfaction. Discussion: Use of home care services is a new health behaviour for Turkey and “changes” need to convince and motivate the all partners to adopt the new way. So a collaborative study period is needed to be established.

Family functioning, health and social support assessed by aged home care clients and their family members

The aim of this study was to describe aged home care clients' and their family members' experiences of their family functioning, family health and social support received. An additional purpose was to determine which factors are connected with social support. Increasing life expectancy and ageing of the population require consideration of the adequacy of home care services and the role of family members as care providers. The older population is a very heterogeneous group because of their variable needs and several disabilities. To ensure the quality of home care, experimental information is needed from clients and their family members. A survey design with convenience sampling. The home care client and a family member of his/her answered a questionnaire together, including background questions, the Family Functioning, Health and Social Support instrument and an open question about support received from home care. Statistical methods were used to describe quantitative data, and content analysis was used in analysing the replies to the open question. Family health was noted as good, and family functioning and overall social support fairly good. An older person's higher basic education, higher age of the family member, better family health and male gender were connected with better social support received. The relationship of the older person and the family member as well as the duration of home care service use had an effect on social support received. The content analysis raised expectations related to time, planning of service, organisational factors and caring practise. Home care clients' and families' needs for support vary, and therefore, the assessment of needs, care planning and updating are important. The variable support needs of older people and their family members require flexible and adaptable home services. Cooperation between all participants involved in care would promote the well-being of the older person and the entire family.

Health Services Utilization Associated With Cognitive Impairment and Dementia in Older Patients Undergoing Post-Acute Rehabilitation

To investigate the relationship between levels of cognitive impairment and health services utilization in older patients undergoing post-acute rehabilitation. Cross-sectional study. Post-acute rehabilitation facility. Patients (N = 1764) aged 70 years and older admitted over 3 years. Sociodemographic, medical, and functional data were collected upon admission. Based on discharge diagnoses, patients were classified as cognitively intact, cognitively impaired with no dementia (CIND), and demented. Dementia and CIND were diagnosed in 425 (24.1%) and 301 (17.1%) patients, respectively. Gradients from cognitively intact to cognitively impaired to demented patients were observed in median length of stay (19, 22, and 25 days, P < .001), and institutionalization rates at discharge (4.2%, 7.6%, and 28.8%, P < .001). Among patients discharged home, similar gradients were observed in utilization of home care (68.2%, 79.7%, and 83.3%, P < .001) and day care (3.1%, 7.1%, and 14.3%, P < .001). After adjustment, compared with cognitively intact patients, only those with dementia still had longer stays (+2.7 days) and increased odds of institutionalization (adjOR 6.1, 95% CI 4.0-9.3, P < .001). Among patients discharged home, use of home and day care remained higher in those with dementia (adjOR 1.8, 95% CI 1.2-2.7, P = .005, and adjOR 1.8, 95% CI 1.2-2.7, P = .005, respectively), while CIND patients had higher odds of using home care (adjOR 1.6, 95% CI 1.1-2.4, P = .028). Among patients undergoing post-acute rehabilitation, those with dementia had increased use of both institutional and community care, whereas those with CIND had increased use of home care services only. Future studies should investigate specific strategies susceptible to reduce the related burden on health care systems.

The influence of municipal characteristics on the use of informal home care and home care services by the elderly Flemish

When explaining the use of care, the context of the care gains importance. This article focuses on the influence of the municipality on the lives of the elderly regarding the usage of different forms of care, whereas controlling for the effect of individual characteristics. Two databases on the individual characteristics of elderly Flemish people living at home were combined with a database on municipal characteristics. The effect of municipal characteristics was measured through multi-level logistic regression. A higher mean income per inhabitant and a lower number of inhabitants/100 km(2) have a positive effect on the use of informal home care. The use of home care services is positively influenced by a higher family care index and an increasing relative number of hours of domestic care provided in the municipality. Receiving care from a general practitioner, medical specialist, dentist, emergency department, community nurse, physiotherapist, home aid, day-care centre or hospital with overnight stay is not influenced by the municipality's characteristics. The use of public welfare services, meals-on-wheels programs or hospital outpatients' services, however, are affected by the municipality, but cannot be fully explained by the model. The municipality that an elderly person lives in has an impact on the amount and the types of care an elderly person receives. Persons with similar care needs and similar individual characteristics can receive very different care when they live in different municipalities. This is quite a challenging finding for researchers, as well as for care providers and policy makers.

Assessing patterns of home and community care service use and client profiles in Australia: a cluster analysis approach using linked data

The planning and delivery of care systems require knowledge on the ways in which individuals access available services that are funded by a range of health and community services. The aims of this study were to identify distinct groups of Home and Community Care (HACC) clients in New South Wales, Australia, based on patterns of actual service use, and to understand the health and social needs and resources of client groups that access different mixes of services. Multiple data sets linked at the individual level - including the 45 and Up Study community survey, the HACC Minimum Data Set and the Admitted Patient Data Collection for hospitals - provide an innovative basis to investigate the complexity of access to service use. Data were collected between 2006 and 2008. A cluster analysis based on clients' type and volume of community service use was conducted on the 4890 HACC clients in the linked dataset and nine distinct clusters of clients were identified. Three of these clusters were considered 'complex', in terms of the range of community and hospital assistance received, while the others comprised mainly of one or two dominant service types. The analytical approach and findings developed here provide a client-centred approach to monitor and evaluate access to local service systems that are being reformed to better integrate the delivery of health and community services currently funded and managed separately by national and state governments.

Day‐care service use is a risk factor for long‐term care placement in community‐dwelling dependent elderly

To identify predictors of long-term care placement and to examine the effect of day-care service use on long-term care placement over a 36-month follow-up period among community-dwelling dependent elderly. This study was a prospective cohort analysis of 1739 community-dwelling elderly and 1442 caregivers registered in the Nagoya Longitudinal Study for Frail Elderly. Data included the clients' demographic characteristics, basic activities of daily living, comorbidities, and use of home care services, including the day-care, visiting nurse, and home-help services, as well as caregivers' demographic characteristics and care burden. Analysis of long-term care placement over 36 month was conducted using Kaplan-Meier curves and multivariate Cox proportional hazards models. Among the 1739 participants, 217 were institutionalized at long-term care facilities during the 36-month follow-up. Multivariate Cox regression models, adjusted for potential confounders, showed that day-care service use was significantly associated with an elevated risk for long-term care placement within the 36-month follow-up period. Participants using a day-care service two or more times/week had significantly higher relative hazard ratios than participants not using such a service. The results highlight the need for effective measures to reduce the long-term care placement of day-care service users. Policy makers and practitioners must consider implementing multidimensional support programs to reduce the caregivers' willingness to consider long-term care placement.

Measuring the outcomes of long-term care

How should we measure the value of long-term (social) care? This paper describes a care-related quality of life instrument (ASCOT) and considers aspects of its validity. In particular the aim is to assess whether ASCOT is better suited to measuring the impact of long-term care services than the EQ5D health-related quality of life measure. Long-term care services tend to be more concerned with addressing the day-to-day consequences of long-term conditions. As such, a quality of life measure should not be overly focused on the potential impact of services on personal ability and should instead consider how services directly help people to function in everyday life. Construct validity was judged by assessing the degree to which measured quality of life improvement was consistent with the theorised positive correlation between quality of life and the use of home care services. In a 2008/9 sample of people using care services in England, we found that the impact of service use was significant when measured by ASCOT, but not significant when using EQ5D. The results support our hypothesis that ASCOT has greater construct validity in this case.

Preference for dentist’s home visits among older people

To investigate factors associated with older people's preference for a dentist's home visit. This is a report on 321 home-dwelling participants (mean age 81.6) in the population-based Geriatric Multidisciplinary Strategy for Good Care of the Elderly (GeMS) study, conducted in 2004-2005 in the city of Kuopio in eastern Finland. The information about sociodemographic and general health-related factors and the use of social and health services was collected by two study nurses using a structured interview. Each study subject was given a clinical oral examination and an interview about oral health and the use of dental health care services by one of two dentists. Logistic regression models were used to estimate odds ratios (OR) and 95% confidence intervals (CI). Of the study subjects, 25.9% preferred a dentist's home visit. The preference for choosing a dentist's home visit was associated with a low score (≤24) in the Mini-Mental State Examination, OR 6.1 (CI: 2.9-13.6), and a low score (<8) on the scale of Instrumental Activities of Daily Living, OR 8.0 (CI: 3.6-18.6). It was also associated with living alone, OR 5.9 (CI: 2.7-13.0), and high use of home care services, OR 9.3 (CI: 4.6-19.0). The findings of this study emphasize the need to organize dentists' home visits in order to increase equality in the use of dental health care services among the older people with disabilities.

Keeping It in the Family

Mexican American elders are more functionally impaired and chronically ill than Anglo elders, yet use home care services less. The purpose of this study was to describe the cultural norms that influence Mexican American elders and their caregivers not to use home care services. A secondary analysis using descriptive ethnography was conducted. Thematic analysis was used to analyze Mexican American elders' (N = 4) and family caregivers' (N = 3) individual interviews. The overall finding was the category, "We Take Care of our Own!" This finding represented how Mexican American families faced increasing needs of elders at home in the context of their cultural norm of familism. The cultural findings, "Taking Care of Our Own!" were similar to those by elders who had chosen to use home care services in a previous study. Recognizing the importance of this norm, which is central to the culture, may shape interdisciplinary interventions that support traditional Mexican American family values, yet bring skilled or supportive help into the home. Interventions to increase the use of home care services by Latino families can contribute solutions to the national agenda to reduce healthcare disparities.

Predictors of Home Care Expenditures and Death at Home for Cancer Patients in an Integrated Comprehensive Palliative Home Care Pilot Program

Empirical understanding of predictors for home care service use and death at home is important for healthcare planning. Few studies have examined these predictors in the context of the publicly funded Canadian home care system. This study examined predictors for home care use and home death in the context of a "gold standard" comprehensive palliative home care program pilot in Ontario where patients had equal access to home care services. Secondary clinical and administrative data sources were linked using a unique identifier to examine multivariate factors (predisposing, enabling, need) on total home care expenditures and home death for a cohort of cancer patients enrolled in the HPCNet pilot. SUBJECTS WITH GASTROINTESTINAL SYMPTOMS (OR: 1.64; p=0.03) and those with higher income had increased odds of dying at home (OR: 1.14; p<0.001), whereas age, number of GP visits, gastrointestinal symptoms (i.e., nausea, vomiting, bowel obstruction) and eating problems (i.e., anorexia/cachexia) predicted home care expenditures. Predictors of home death found in earlier studies appeared less important in this comprehensive palliative home care pilot. An income effect for home death observed in this study requires examination in future controlled studies. Access to palliative home care that is adequately resourced and organized to address the multiple domains of issues that patients/families experience at the end of life has the potential to enable home death and shift care appropriately from limited acute care resources.

How End-Of-Life Home Care Services Are Used from Admission to Death: A Population-Based Cohort Study

Our goal was to describe the trajectories of end-of-life nursing and personal support worker (PSW) use from home care admission until death. We studied a historical prospective cohort of end-of-life home care patients in Ontario, Canada, linking administrative databases. We calculated the odds of using any nursing or PSW hours and the incidence rate ratio of services used for each week approaching death, controlling for confounders. Among all patients (n = 11,867), the odds of using any nursing and PSW hours increased by 4 percent and 10 percent, respectively, each week closer to death. Among patients using services, the ratio of nursing and PSW hours increased 20 percent and 11 percent, respectively, in the last 4 weeks of life compared to use at 24 weeks before death. Use of nursing and PSW hours increases slightly each week before death and sharply in the last month of life. Understanding the trajectory of home care services use can help decision makers design better end-of-life care.

Home care utilization and outcomes among Asian and other Canadian patients with heart failure

BackgroundHeart failure (HF) is a major cause of hospitalization and death in the aging population around the world. Home care utilization is associated with improved survival for the patients with HF, and varies by ethno-culture. The purpose of this study was to investigate the difference in hospital readmission rate and mortality between Asian and other Canadian HF patients.MethodsHF patients were identified using hospital discharge abstracts from March 31, 2000 to April 1, 2006 in Calgary Health Region. Readmission and one-year mortality for HF were determined by linking hospital discharge and vital statistics data. Stratified by home care services use, readmission and mortality rates were compared between the Asians and other Canadians while controlling for age, sex, comorbidities, and household income.ResultsOf 26,171 HF patients discharged from hospital, 56.6% of Asians and 58.0% of other Canadians used home care services [adjusted odds ratio (OR) for Asian: 0.84, 95% confidence interval (CI): 0.74-0.89]. The hospital readmission rate was similar between Asians and other Canadians regardless of home care services use. Mortality was similar between those who used home care services (adjusted OR for Asian: 0.96, 95% CI: 0.81-1.13). For patients who did not use home care services, Asians had significantly lower mortality than other Canadians (adjusted OR for Asian: 0.76, 95% CI: 0.60-0.86).ConclusionMortality was similar between Asian and other Canadian patients when home care services were utilized. However, among those without home care, Asian patients had a significantly lower mortality than other Canadian patients.

Did Ontario's End-of-Life Care Strategy Reduce Acute Care Service Use?: The need to use quality indicators for improvement

The objective of this study was to evaluate whether Ontario's End-of-Life Care Strategy, which aimed to shift care from acute settings to the home, improved performance on quality indicators for end-of-life home care patients in use of more home care services and fewer acute care services. The study cohort included patients at the end of life admitted into home care between April 1, 2005, and September 30, 2006, and who died before April 1, 2007. Based on their admission date, patients were divided into three six-month periods corresponding to the six months prior to the strategy's implementation compared with the 12 months after. Patients were excluded if they were admitted to home care more than six months prior to death. Average hours per week of nursing and personal support worker (PSW) services were measured for the last 12 weeks of life. The use of acute care services in the last month of life was measured by the proportion of patients who had an in-hospital death, had hospitalizations, visited the emergency department (ED) and spent more than 14 days in hospital. Among home care patients (n = 9,368), per-patient use of home care and acute care did not change significantly over the time periods. The pattern of average nursing and PSW hours per week used in the last 12 weeks of life did not change a year after the strategy implementation, averaging 3.8 nursing hours per week and 3.8 PSW hours per week over the study period. The proportion of in-hospital deaths remained stable at approximately 38% over the study period. Approximately 16% of patients had an ED visit and 32% had a hospitalization in the last two weeks of life across time periods. Similarly the proportion of patients who had zero, one or greater than one ED visit or hospitalization remained constant across time periods. In conclusion, one year after the strategy's implementation, individual patients' use of end-of-life home care and acute care services remained unchanged. The strategy may require more time for its impact to be fully achieved. Measuring these quality indicators across regions may help to monitor and evaluate interventions.

Factors Associated with Home Care Service Use among Severely Disabled Elderly : A Comparison between Long-term Community Dwellers and Nursing Home Residents

Factors Associated with Home Care Service Use among Severely Disabled Elderly : A Comparison between Long-term Community Dwellers and Nursing Home Residents

Predictors of Home Health Care Service Use by Anglo American, Mexican American and South Korean Elders

Problem statement: This study was designed to identify predictors of the use of home health care services by elders in different ethnic groups. Approach: A cross-sectional study was conducted with convenient sample of Anglo elders (N = 57), Mexican American elders (N = 56) and elders in South Korea (N = 83). Hierarchical multiple regression analysis was conducted. Results: The need for home health care services was the significant predictor of home care service use for Anglo (Adjusted R2 = 0.164; R2 change = 0.176; F-change (1,56) = 11.93; p = 0.001); service awareness and low education were significant predictors for Mexican American (Adjusted R2 = 0.332; R2 change = 0.068; F-change (1,48) = 5.22; p = 0.027). Service awareness and elders living alone were significant predictors for South Korean elders (Adjusted R2 = 0.112; R2 change = 0.050; F-change (1,80) = 4.58; p = 0.035). Conclusion: The results of the study suggested that effective interventions for home health care services should focus on elders' service awareness, low income and education and elders living alone to maximize the use of home health care services.

Relationship between home care service use and changes in the care needs level of Japanese elderly

BackgroundWith the introduction of long-term care insurance (LTCI) in Japan, more home care services are available for the community-dwelling elderly. To deliver effective home care services, it is important to know the effects of service use. In this study, as the first step to determine this, we sought to describe different home service use in the sustained/improved group and deteriorated group in their care needs levels, and to report the relationship between the use of home care services and changes in care needs levels.MethodsThe participants included 624 of a total of 1,474 users of LTCI services in one city in Japan. Home care service users were stratified into a 'lower care needs level subgroup' and a 'higher care needs level subgroup' based on the baseline care needs level. Simple statistical comparison and multiple logistic regression analyses in which the change in care needs level was set as a dependent variable were performed. Gender, age, and baseline care needs level were designated as control variables. Home based services were treated as independent variables. In this study, home care services consisted of home help, home bathing services, a visiting nurse, home rehabilitation, nursing home daycare, health daycare, loan of medical devices, respite stay in a nursing home, respite stay in a health care facility, respite stay in a sanatorium-type medical care facility, and medical management by a physician.ResultsIn the lower care needs level subgroup, age (OR = 1.04, CI, 1.01-1.08), use of respite stay in a nursing home (OR = 2.55; CI, 1.43-4.56), and the number of types of long-term care services (OR = 1.33; CI, 1.02-1.74) used during an 11 month period were significantly related to a deterioration of the user's care needs level. In the higher care needs level subgroup, use of medical management by a physician (OR = 6.99; CI, 1.42-41.25) was significantly related to a deterioration of the user's care needs level. There were no home based services significantly related to sustaining or improving the user's care needs level.ConclusionThere were different home service use in two groups (the sustained/improved group and the deteriorated group). Respite stay in a nursing home service use and more types of service use were related to experiencing a deterioration of care needs level in lower care needs level community-dwelling elderly persons in Japan. Further, medical management by a physician service was related to experiencing a deterioration of care needs level in higher care needs level community-dwelling elderly persons.

Caregiving Burden, Acculturation, Familism, and Mexican American Elders’ Use of Home Care Services

Caregiving burden has been shown to predict use of home care services among Anglo Americans. In a previous study, only one of two dimensions of caregiving burden predicted such use among Mexican American caregivers. Because acculturation and familism may affect burden, we conducted analyses to test three hypotheses: increased acculturation decreases familism; decreased familism increases burden; and increased burden increases use of home care services. Among 140 Mexican American family caregivers, acculturation was positively correlated with familism; familism was not significantly correlated with burden; objective burden was positively correlated with use of home care services, and objective and subjective burden significantly interacted in their effect on the use of home care services. Targeted interventions may be needed to increase use of home care services and preserve the well-being of Mexican American elders and caregivers.

Hard Times: The Effects of Financial Strain on Home Care Services Use and Participant Outcomes in Michigan

When government funding for long-term care is reduced, participant outcomes may be adversely affected. We investigated the effect of program resources on individuals enrolled in the Michigan Home- and Community-Based Services (HCBS) waiver program for elderly and disabled adults. Using dates of major policy and budget changes, we defined 4 distinct time periods between October 2001 and December 2005. Minimum Data Set for Home Care assessment records for HCBS participants (n = 112,182) were used to examine temporal trends in formal care hours and 6 outcomes: emergency room (ER) use, hospitalization, caregiver burden, death, nursing facility (NF) use, and permanent NF placement. Controlling for demographics, functional status, and cognitive status, adjusted odds of outcomes were obtained using discrete-time survival analysis. As resources diminished, mean formal care hours decreased, declining most for persons with moderate functional or cognitive impairment, for up to an approximately 30% decrease. In the most financially restricted period, 3 adverse outcomes increased relative to baseline: hospitalization (odds ratio [OR] = 1.10; 95% confidence interval [CI] = 1.03-1.18), ER use (OR = 1.13; 95% CI = 1.03-1.24), and permanent NF placement (OR = 1.20; 95% CI = 1.00-1.42). Reductions in resources for home care were associated with increased probability of adverse outcomes. Cutting funds to home care programs can increase utilization of other more costly services, thus offsetting potential health care savings. Policymakers must consider all ways in which budget reductions and policy changes can affect participants.