Home Care Services Research Articles

Transitional Care Support for Medicaid-Insured Patients With Serious Mental Illness: Protocol for a Type I Hybrid Effectiveness-Implementation Stepped-Wedge Cluster Randomized Controlled Trial

Background People diagnosed with a co-occurring serious mental illness (SMI; ie, major depressive disorder, bipolar disorder, or schizophrenia) but hospitalized for a nonpsychiatric condition experience higher rates of readmissions and other adverse outcomes, in part due to poorly coordinated care transitions. Current hospital-to-home transitional care programs lack a focus on the integrated social, medical, and mental health needs of these patients. The Thrive clinical pathway provides transitional care support for patients insured by Medicaid with multiple chronic conditions by focusing on posthospitalization medical concerns and the social determinants of health. This study seeks to evaluate an adapted version of Thrive that also meets the needs of patients with co-occurring SMI discharged from a nonpsychiatric hospitalization. Objective This study aimed to (1) engage staff and community advisors in participatory implementation processes to adapt the Thrive clinical pathway for all Medicaid-insured patients, including those with SMI; (2) examine utilization outcomes (ie, Thrive referral, readmission, emergency department [ED], primary, and specialty care visits) for Medicaid-insured individuals with and without SMI who receive Thrive compared with usual care; and (3) evaluate the acceptability, appropriateness, feasibility, and cost-benefit of an adapted Thrive clinical pathway that is tailored for Medicaid-insured patients with co-occurring SMI. Methods This study will use a prospective, type I hybrid effectiveness-implementation, stepped-wedge, cluster randomized controlled trial design. We will randomize the initiation of Thrive referrals at the unit level. Data collection will occur over 24 months. Inclusion criteria for Thrive referral include individuals who (1) are Medicaid insured, dually enrolled in Medicaid and Medicare, or Medicaid eligible; (2) reside in Philadelphia; (3) are admitted for a medical diagnosis for over 24 hours at the study hospital; (4) are planned for discharge to home; (5) agree to receive home care services; and (6) are aged ≥18 years. Primary analyses will use a mixed-effects negative binomial regression model to evaluate readmission and ED utilization, comparing those with and without SMI who receive Thrive to those with and without SMI who receive usual care. Using a convergent parallel mixed methods design, analyses will be conducted simultaneously for the survey and interview data of patients, clinicians, and health care system leaders. The cost of Thrive will be calculated from budget monitoring data for the research budget, the cost of staff time, and average Medicaid facility fee payments. Results This research project was funded in October 2023. Data collection will occur from April 2024 through December 2025. Results are anticipated to be published in 2025-2027. Conclusions We anticipate that patients with and without co-occurring SMI will benefit from the adapted Thrive clinical pathway. We also anticipate the adapted version of Thrive to be deemed feasible, acceptable, and appropriate by patients, clinicians, and health system leaders. Trial Registration ClinicalTrials.gov NCT06203509; https://clinicaltrials.gov/ct2/show/NCT06203509 International Registered Report Identifier (IRRID) DERR1-10.2196/64575

Aging in place or aging out of place? Family caregivers’ perspectives on care for older Pakistani migrants in Norway

AbstractThe aging population in Europe is increasing, with growing ethnic diversity among older individuals due to migration. Public policies emphasize ‘aging in place’ to address financial challenges and reduce the burden on the healthcare system. However, research often overlooks the heterogeneity among older people, especially non-European migrants. Also, research on family caregivers’ role in enabling ‘aging in place’ for older relatives with migrant backgrounds is limited, despite many older non-European migrants’ preference for family care in comparison to long-term institutional care. This study aims to explore the experiences and perspectives of family caregivers in the context of formal and informal care and their preferences regarding the place of care for older family members with migrant backgrounds, particularly the Pakistani Ahmadiyya community in Norway. Eighteen semi-structured individual interviews and two group interviews were conducted in Urdu and English with nineteen female family caregivers of older relatives, ages 25–62, residing in Norway. The analysis yielded three main themes: (1) “Nursing homes are not for the ones who love their parents”, (2) Preferences for home with the possibility of sharing care, and (3) Mismatch between family care needs and formal care. Family caregivers’ perception of health services has a decisive impact on their older relatives’ demand and use of formal health services, emphasizing the need for trust. Even though home care services were seen as a viable option, they should be adapted so that the family caregivers can use them and feel supported in enabling ‘aging in place’ for older migrants.

HOME CARE POST FEMUR FRACTURE SURGERY ON MR. A IN THE WATUBELAH AREA, CIREBON REGENCY IN 2024

Home Care is a health service carried out at home and aims to improve, maintain, and increase the independence of patients and families. The home care activities at Mr. A aim to be a form of community service with the hope that the family can be independent in caring for Mr. A. The implementation of community service in the form of home care services uses a family nursing care approach, starting from conducting assessments, determining diagnoses, and providing interventions, documentation, and evaluations. The implementation of home care services is carried out for three days by providing education and wound care. After the wound was treated, Mr. A's wound no longer had fluid coming out of the wound, and when given education, Mr. A and his family understood what was conveyed.

A Intervenção do Serviço de Atenção Domiciliar junto ao usuário e cuidador na rede de atenção à saúde

**Introduction**: Population aging drives the development of home care practices, expanding the role of healthcare teams. The Home Care Service (SAD) is characterized by comprehensive actions in health promotion, prevention, treatment, and rehabilitation performed at home, ensuring continuity of care and effective integration with healthcare networks and the user. **Objective**: To highlight the relationship between the Home Care Service (SAD) and healthcare networks. **Methodology**: This is a descriptive study in the form of a narrative literature review, which sought to highlight the relationship between the Home Care Service (SAD) and healthcare networks. The research was conducted through online access to the PubMed, Medline, and Scielo databases, using the descriptors "home care services," "SUS," and "healthcare networks." Inclusion criteria were: articles available in full text, in Portuguese and English, addressing the topic, and published between 2019 and 2023. **Results**: The results highlight the importance of home care services in assessing, identifying, and training caregivers, promoting self-care and user autonomy. The lack of professional guidance for caregivers presents an opportunity for improvement in care practices. Furthermore, SAD stands out as an innovative strategy in healthcare, surpassing primary care and emergency services, adopting a humanized approach aligned with SUS. By replacing or complementing hospital stays, it seeks equity in resource distribution for efficient access to home care, with active intervention in caregiver training, playing a crucial role in preventing complications, and consolidating itself as a key agent for a patient-centered approach within the SUS framework. **Conclusion**: The intervention of SAD with the user and caregiver is of utmost importance in training caregivers to assist users, avoiding unnecessary complications and ensuring continuity of care within SUS. Thus, the service complements the care provided in primary care and emergency services and substitutes or complements hospital stays.

Is Home Care Use Associated With Secondary Health Conditions in Persons With Spinal Cord Injury? Findings From a Longitudinal Cohort Study.

The aims of the study are to describe the use of professional home care in persons with spinal cord injury over a 10-yr period from 2012 to 2022 and to examine how the use of home care is associated with the future occurrence of secondary health conditions and hospitalizations. This is a longitudinal questionnaire survey as part of the Swiss Spinal Cord Injury Cohort Study, conducted in 2012, 2017, and 2022. There were 1549, 1294, and 1158 participants in the three surveys in 2012, 2017, and 2022. The percentage of home care users decreased from 23% in 2012 to 22% in 2017 and 19% in 2022. Fewer home care recipients reported pain (odds ratio 0.52, 95% confidence interval 0.29-0.94), with no reductions in other secondary health conditions, 5 yrs later. Study participants who received home care were more likely to be hospitalized (odds ratio 1.89, 95% confidence interval 1.05-3.42), 5 yrs later. There is a declining trend in the use of home care services among persons with SCI. While home care is associated with lesser development of pain, it does not generally reduce secondary health conditions. Individuals who receive home care are significantly more likely to report hospitalization 5 yrs later.

Organisational and Ethical Challenges While Caring for Older People During the COVID-19 Pandemic in Sweden: AFocus Group Study.

During the COVID-19 pandemic, older people in Sweden's residential care facilities and home care services experienced high mortality rates. Prior to the pandemic, the care of older people in Sweden was challenged by organisational and regulatory changes, an ageing population and insufficient increases in staff numbers. These issues led to high staff turnover, increased workloads, stress, burnout and a perceived inability to provide satisfactory care. The pandemic brought about increased job strain, stress, anxiety, depression and post-traumatic stress disorder among the staff who cared for older people. The aim of this study was therefore to focus on assistant nurses and care aides' experiences of their work environments when caring for older people during the pandemic in Sweden. The data were collected through four focus groups interviews and analysed using qualitative content analysis. The results showed that the care staff had to navigate organisational and ethical challenges in poor and unsafe work environments. They lacked supportive leadership in their respective organisations, were neither valued, seen nor heard and were treated as 'plain doers'. During the pandemic, they were unable to protect or communicate easily with the older people in their care, which had harsh consequences. According to the participants, the pandemic left them, their working conditions and this part of the care system in a worse situation than before the pandemic. The pandemic thus revealed more unsustainable and unethical working conditions for the staff than before it, including the vulnerability of the older people in their care. The findings highlights the need of policies that ensure adequate training and instruction on medical issues, for managers responsible for overseeing the care of older people. There are also a need of provision of sufficient support for care staff and health care professionals during crises. The findings also underscore the need of feasible and efficient strategies do disseminate care information and address the psychosocial needs of older people.

Promoting the Development of Home Care Services in the Greater Bay Area.

Promoting the Development of Home Care Services in the Greater Bay Area.

Patterns of referral to interprofessional services among frail older adults presenting to emergency departments in Canada.

Geriatric Emergency Department (ED) Guidelines recommend optimizing transitions of care for older patients with complex needs. In this study, we investigated referral patterns to interprofessional services, including occupational therapy, physiotherapy, dietician, social work, home care, and specialized geriatric services, among older adults presenting to the ED with high-risk characteristics. We recruited community-dwelling older adults presenting to 10 EDs across Ontario, Quebec, and Newfoundland, Canada, from April 2017 to July 2018. To observe processes of care in the ED, we deployed a two-stage high-risk case-finding and focused comprehensive assessment process based on the interRAI ED-Screener and ED Contact Assessment to identify and characterize older adults at high risk. We analyzed the secondary data using descriptive statistics and logistic regression. We screened 5265 individuals with the ED Screener, further assessed 1479 with the ED Contact Assessment, and analyzed data from a subset of 1055 community-dwelling older adults assessed with the ED Contact Assessment. Participants in our study sample had a mean age of 83 years, 58% were female, and many had a complex burden of cognitive and functional impairment and social needs. Over half of this high-needs sample were referred to general home care services (62.7%), occupational therapy (59.3%), and physiotherapy services (55.2%), while 16% were referred to specialized geriatric services. We also found a significant positive association between interprofessional referrals and the Assessment Urgency Algorithm and Institutional Risk Scale. The most important determinants of referral to interprofessional services were hospital province, functional, clinical, and social burden and support measures. The referral patterns identified suggest that patient needs and risk intensity did not always guide referral patterns in the Canadian EDs investigated. We suggest that EDs critically examine the appropriateness of their documentation and referral systems for supporting person-centered care provision.

Evaluation of the Interdisciplinary Care Home-bAsed Reablement Program (I-CHARP) for People Living With Cognitive Impairment and Dementia in Care Homes.

Major knowledge and practice gaps exist in aged care home services to support independence of older people with dementia. This research evaluates an adaptation of a community-based rehabilitation model for care homes, namely Interdisciplinary Care Home-bAsed Reablement Program (I-CHARP), by examining whether (and, if so, how) I-CHARP produces its intended effects and how this programme can be practicably implemented, sustained and scaled up across care homes in Australia. I-CHARP is a 4-month bio-behavioural-environmental rehabilitation model of care, integrated in care home services, supported through the deployment of an implementation strategy, the Research Enabled Aged Care Homes (REACH) network. It consists of (1) 8-12 full individual sessions and additional eight brief follow-ups per resident, tailored to the resident's needs, delivered primarily by a team of an occupational therapist, registered nurse and other allied health staff; (2) environmental modifications/assistive devices up to the value of $400 per resident; and (3) engagement of intervention care home staff, managers and regular visitors. An overarching evaluation approach is participatory action research using a cluster quasi-experimental design and mixed methods. It involves testing of the implementation strategy (REACH network and other approaches) while observing/gathering information on the intervention (I-CHARP) and related outcomes in three cycles. Participants include residents (aged ≥ 60 years with early stages of dementia) and care staff from 16 care homes. Care quality indicators, health care costs, field notes and semi-structured interviews/focus groups with intervention site staff, regular visitors and managers will provide further insights into I-CHARP processes and implementation issues. In the final phase of the project, an Agile Implementation Playbook will be developed for the delivery of reablement care that can be used in routine practice across care homes in Australia. The study findings will also inform future policy development and strategic directions for dementia care in care homes. Australian New Zealand Clinical Trial Registry, ACTRN12623000885695 Registered 16 August 2023, https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=386088. 1.0 dated 20 July 2023.

Community Paramedicine Program in Social Housing and Health Service Utilization

Community Paramedicine at Clinic (CP@clinic) is a chronic disease prevention program that decreases 911 calls for emergency medical services, but its wider system effects are unknown. To evaluate the effects of CP@clinic vs usual care on individual-level health service utilization outcomes. This open-label, pragmatic cluster randomized clinical trial evaluated all residents 55 years or older in 30 social housing buildings in Ontario, Canada, that had (1) a unique postal code, (2) at least 50 apartments, (3) 60% or more residents 55 years or older, and (4) a similar building for pairing (15 intervention and 15 control buildings, pair-matched randomization). The 12-month intervention had a staggered start date from January 1, 2015, to December 1, 2015, and ended between December 31, 2015, and November 30, 2016. Administrative health data analysis was conducted in May 2022. CP@clinic was a health promotion and disease prevention program led by specially trained community paramedics who held weekly drop-in sessions in social housing buildings. These paramedics conducted 1-on-1 risk assessments, provided health education and referrals to relevant community resources, and, with consent, sent assessments to family physicians. Control buildings received usual care (universal health care, including free primary and specialty medical care). Individual-level health service utilization was measured from administrative health data, with ED visits via ambulance as the primary outcome; secondary outcomes included ED visits for any reason, primary care visits, hospitalizations, length of hospital stay, laboratory tests, receipt of home care, transfer to long-term care, and medication initiation. Generalized estimating equations were used to estimate intervention effects on individual-level health service utilization, accounting for trial design and individual-level baselines. The 30 social housing buildings had 3695 residents (1846 control and 1849 intervention participants; mean [SD] age, 72.8 [9.1] years; 2400 [65.0%] female). Intention-to-treat analysis found no significant difference in ED visits by ambulance (445 of 1849 [24.1%] vs 463 of 1846 [25.1%]; adjusted odds ratio [AOR], 0.97; 95% CI, 0.89-1.05) but found higher antihypertensive medication initiation (74 of 500 [14.8%] vs 47 of 552 [8.5%]; AOR, 1.74; 95% CI, 1.19-2.53) and lower anticoagulant initiation (48 of 1481 [3.2%] vs 69 of 1442 [4.8%]; AOR, 0.68; 95% CI, 0.53-0.86) in the intervention arm vs the control arm. CP@clinic attendance was associated with higher incidence of primary care visits (adjusted incidence rate ratio, 1.10; 95% CI, 1.03-1.17), higher odds of receiving home care (AOR, 1.07; 95% CI, 1.01-1.13), and lower odds of long-term care transfers (AOR, 0.32; 95% CI, 0.13-0.81). In this cluster randomized clinical trial of CP@clinic, the intervention did not affect the rate of ED visits by ambulance; however, there were increased primary care visits and connections to home care services, which may have increased antihypertensive medication initiation and reduced long-term care transfers from social housing. Health policymakers should consider CP@clinic's impact as an upstream approach to improve care for older adults with low income. ClinicalTrials.gov Identifier: NCT02152891.

Telemonitoring activities of daily living in home healthcare services to support aging in place

Abstract Context Assessing older adults’ abilities to carry out their activities of daily living (ADLs) is a key determinant in the provision of homecare services for aging in place. Amidst a growing aging population and lack of human resources, continuous remote monitoring technology appears promising to support health and social care professionals (HSCPs) in identifying service needs. However, implementation studies conducted in real-life settings are lacking. This study is part of an on-going action design research project aimed at developing an ambient telemonitoring system monitoring ADLs to support clinical decision making. It focused on the initial step of implementation and aimed to understand 1) which HSCPs would want to use the system, 2) for which care recipient they requested it, and 3) for which reasons. Methods A multiple embedded case study utilizing mixed methods was conducted across 3 healthcare establishments in Quebec, Canada. Descriptive statistics from surveys and medical records was conducted to describe the profile of HSCPs and their care recipients. An inductive qualitative analysis was carried out through interviews with 23 HSCPs, in charge of 31 care recipients, to deepen our understanding of the reasons why they requested the system. Results HSCPs were primarily women (89%) occupational therapists (43%). Home care recipients were also primarily women (74%), with documented refusal of homecare services (65%), diagnosed with cognitive decline (94%), and living in a single-family home or apartment (68%). Overall, interviews revealed HSCPs challenges in getting the necessary information to assess their care recipients needs, despite the presence of in-home services and other strategies in place (e.g. informal carer support). Moreover, the telemonitoring system was perceived as promising for risk management. Conclusions There is an interest for the use of ADL telemonitoring technology in the delivery of home healthcare services for aging in place. Key messages • To facilitate its integration in practice, we explored the need for, and value of, ADLs telemonitoring technology by health and social care professionals (HSCPs) in real-life contexts. • By studying the integration of innovative technologies in home healthcare practices, such as ADLs telemonitoring, we aim to support HSCPs practice in fulfilling older adults desire to age in place.

Research Status of Self-care Ability, Quality of Life, and Community Home Healthcare Needs of the Elderly with Type 2 Diabetes Mellitus

This paper reviews the self-care ability, quality of life, and needs of elderly patients with type 2 diabetes in community-based home care. The study shows that the elderly's self-care ability is closely related to their quality of life, and good self-care ability can significantly reduce the incidence of complications and improve quality of life. Although community-based home care services are crucial for meeting the medical needs of the elderly, there are problems such as insufficient supply, poor information communication, and lack of economic support. By analyzing domestic and foreign studies, this paper proposes suggestions for optimizing community-based home medical services to better support the improvement of elderly diabetes patients' self-care ability and quality of life.

Home-based care services for elderly dependent adults. A comparative analysis of Madrid and Stockholm

This article analyses the situation of the Home Care Service in the two European cities of Madrid and Stockholm. There are significant differences in the development of this service in these cities which can explained by their diverse welfare models. At the same time, they also show similar trends, such as an ageing population and new demands by the elderly. The text focuses on the evolution of the service in three different dimensions: governance, working conditions and the tendering/monitoring system. The analysis is based on qualitative research, showing the predominant discourses among the key actors involved in the design and provision of the service. The results reveal the urgent need to redefine this service to respond to the new demands of the elderly as well as the changing regulatory frameworks.

Predictors, Diagnoses, and Costs of Emergency Department Visits among Home Care Clients

ObjectivesTo examine factors, diagnoses, and costs associated with emergency department (ED) visits among home care clients. DesignA prospective 1-year follow-up study. Settings and ParticipantsMore information is needed regarding the reasons and costs associated with ED visits by home care clients. Participants were persons aged ≥65 years living in Eastern Finland and receiving regular home care services (n = 293). MethodsData collection included clients’ demographics, health status (Charlson Comorbidity Index), medication use, assessments of physical (Timed Up and Go) and cognitive functioning (Mini-Mental State Examination), Basic and Instrumental Activities of Daily Living, mood (Geriatric Depression Scale, GDS-15) and health-related quality of life [HRQoL, EuroQol (EQ-5D-3 L)]. Logistic regression and univariate analyses of variance were conducted. The costs (total and per person-year) of ED visits were calculated. ResultsThe number of ED visits was 775 during the follow-up (mean 350 days). The likelihood of ED visits was reduced by better HRQoL and increased by a higher GDS-15 score, longer TUG times, and a history of heart failure and decreased glomerular infiltration. The most common primary diagnoses for ED visits were heart failure (8.4%), atrial fibrillation (4.0%), respiratory infection (4.0%), and cystitis (3.5%). The total costs of all ED visits during the follow-up were 251,247 € and internal medicine and surgery accounted for 142,726 € and 89,212 € of the cost, respectively. The costs per person-year were 981 €. Conclusions and ImplicationsHRQoL, depressive symptoms, mobility, and heart and renal failure were associated with the number of ED visits. The most common reasons for ED visits were chronic heart conditions and infectious diseases and the highest costs were incurred by internal medicine treatment. With advanced care planning and active symptom screening and cooperation of home care nurses and physicians, some of the ED visits, for example due to heart failure, might be preventable.

The Measurement of Patients’ Satisfaction as a Key Indicator of Quality of Life for the Elderly: Two Services Compared

AbstractThe ageing population and increasing life expectancy in Italy, and in other developed countries, leads to an increasing number of elderly people suffering from loss of autonomy and dangers due to frailty. As a consequence, elderly patients usually suffer from chronic diseases which require long term care, with increasing healthcare needs and costs. Therefore, services provided by home care, day centers and residential services are necessary; their primary objective being to maximize patient well-being and satisfaction. Patient satisfaction is a key indicator of the quality of care and is an important outcome of care in its own right. This study aimed to develop two generic instruments to elicit patients’ satisfaction in residential care and in home care with a rigorous and systematic methodology. The two instruments were tested for psychometric performance with face-to-face interviews and applied to a Local Health District of the Marche Region. Furthermore, due to physical and mentally frailty, many elderly patients in residential homes or receiving home care, are unable to participate in studies on satisfaction with care services, while their carers/partners can often provide relevant information. Therefore, another aim of this study was to measure patients’ and carers’/partners’ agreement on patient satisfaction in the two services investigated. Finally, the principal factors influencing patient satisfaction in the two services investigated were investigated using logistic regression analysis.

Informed consent in the age of smart technologies

Technology is increasingly being brought into the home care of older people. Digitalization is seen as an enabler for efficient and resource-saving operations. In the use of technology, informed consent is considered an ethical practice and part of a responsible home care service system. The aim of this article is to describe the problem of informed consent in situations where emerging technologies, such as artificial intelligence (AI) and mass data, are used as part of welfare services and home care for older people. The article discusses principles and ways to better integrate informed consent as an ethical practice into a responsible home care service system. A qualitative study was carried out to gather the views of experts in the field of elderly care and ethics. A content analysis of a semi-structured focus group was used to explore perceptions of the changing nature of informed consent. According to our findings, the informed consent model requires updating. The key is to embrace the idea that consent is a living process designed to respect people's autonomous choices and protect them from risk. If the nature of the use of the data collected from individuals changes significantly in the future, the consent should also be updated to reflect this change. This aspect is important because new technologies will change the nature of the collection and use of the data. Mass data collection combines multiple databases so that the resulting data can be used even far from the original purpose or context in which it was collected. Therefore, consent should always be tailored to the context, allowing sufficient time for the person seeking and giving consent to clarify the content of the consent. This process highlights the importance of understanding the agency of the consent giver.

Prevalence and Predictors of Potentially Inappropriate Prescribing in Older People Receiving Home Health Care in Saudi Arabia According to the American Geriatrics Society Beers Criteria 2019.

Potentially inappropriate prescribing (PIP) is a common health problem in older adults and is associated with negative health outcomes such as the occurrence of adverse drug events. Several studies have been conducted in different countries and settings to assess the prevalence of PIP, including in Home Care Services. However, data on the prevalence of PIP in home-care services in Saudi Arabia are limited. This study aimed to evaluate PIP use among older patients receiving home healthcare services in Saudi Arabia and to identify the predictors and commonly implicated medications.; Methods: A cross-sectional study was conducted over an 8-month period between January and August 2023. Data were collected from the medical records of patients older than 65 years who were currently receiving home health care services at King Faisal Hospital in Taif City, Saudi Arabia. PIPs were identified using the 2019 updated Beers Criteria.; Results: A total of 375 patients were included. Out of these, 285 PIPs were identified, of which 219 patients (58.4%) received at least one PIP. The most common therapeutic class associated with the PIPs was gastrointestinal medications (66.3%). Patient age and number of medications were significant predictors of PIP.; Conclusions: Our study found a high prevalence of PIP among elderly patients receiving home health care in Taif, Saudi Arabia. This study highlights the need for improved patient data automation and implementation of the Beers criteria to prevent PIPs in the future.

Associations between diabetes and risk of short-term and long-term nursing home stays among older people receiving home care services: A nationwide registry study

BackgroundOlder people with diabetes who live at home and receive home care services (HCS) are vulnerable, which may result in a need for more care than the HCS can provide. In this study we aimed to explore associations between pharmacologically treated diabetes and the risk of short-term and long-term nursing home stays (NHS) among older people receiving HCS.MethodsThis nationwide registry study included older people ≥ 65 years receiving HCS, as registered in the Norwegian Information System for the Nursing and Care Sector (IPLOS) (2010–2014). Data from IPLOS were merged with data from the Norwegian Prescription Database and the Norwegian Patient Registry. Pharmacologically treated diabetes (hereafter referred to as diabetes) was defined based on prescriptions of glucose-lowering drugs (GLD) (≥ 1 prescription in the current or previous year). Persons not prescribed GLD were defined as not having diabetes. Based on Anatomical Therapeutic Chemical (ATC) codes we identified the following subgroups: persons without diabetes, persons using “non-insulin GLD only”, “insulin and non-insulin GLD” and “insulin only”. An NHS was defined as at least one stay during a given calendar year, where a short-term NHS is temporary, and a long-term NHS is permanent. Log-binomial regression was used to test for differences in NHS and results are reported as risk ratios (RR) with 95% CIs.ResultsBoth insulin-treated subgroups had a higher risk of a short-term NHS (“insulin only” users RR 1.06 (CI 1.03–1.09) and “insulin and non-insulin GLD” users RR 1.04 (CI 1.02–1.06)) compared to those without diabetes. In general, persons with diabetes had a lower risk of a long-term NHS than those without diabetes (RR 0.92 (CI 0.89–0.94)). The subgroup using “insulin and non-insulin GLD” had the lowest risk of a long-term NHS (RR 0.86 (CI 0.81–0.91)).ConclusionDespite a lower risk of a long-term NHS among older people with diabetes, we found an increased risk of a short-term NHS among persons with insulin-treated diabetes who live at home and receive HCS. This calls for attention when planning health care, in order to provide coordinated and individualized care to prevent short-term NHS’s.

Factors related to the use of physical restraints and hand restraints among older adults receiving home care services.

Physical restraints and hand restraints are used in medical settings to provide protection and control. However, few studies have investigated their use among community-dwelling older adults. The study explored variables associated with the use of physical restraints and hand restraints among older adults receiving home care services and the reasons behind their use. This cross-sectional study recruited 128 older adults receiving home care services and with catheters. Data were collected regarding demographic characteristics; activities of daily living (ADLs); muscle strength; family function; the use of nasogastric tubes, urinary catheters, and tracheal tubes; and the type and duration of restraint use and the reasons behind such use. Among the participants, 76% experienced the use of physical restraints, and 34% experienced the use of hand restraints. The variables related to physical restraints were ADLs (adjusted odds ratio [AOR] = 0.95, p = .02) and the presence of a paid caregiver (AOR = 3.33, p = .02). The variables related to hand restraints were ADLs (AOR = 0.93, p = .03), use of a nasogastric tube (AOR = 13.46, p = .03) and the presence of a paid caregiver (AOR = 6.38, p = .02). The primary reasons behind restraint use were to prevent fall and extubation events. The use of physical restraints among older adults with catheters may be affected by their functioning in ADLs and the presence of paid caregivers to ensure their safety. Thus, implementing interventions that target functional capabilities and caregiving skills may help reduce the use of restraints.

Enhancing older care services: a comprehensive internet + community home indicator system

ObjectiveConstructing a demand-oriented Internet + community home care service indicator system, starting from the actual needs of the elderly, and quantifying the demand into specific service contents that can be provided, so as to realize the effective supply of services. It aims to provide a theoretical basis for the government to formulate relevant aging policies and provide a reference basis for promoting the innovation and development of the Internet + elderly care model.MethodsBased on existence needs, relationship needs and growth needs abbreviated as “Existence, Relatedness, Growth (ERG)” demand theory, through the discussion in the group meeting, form the expert consultation questionnaire of the demand-oriented Internet + community home care service indicator system, select experts in related fields to conduct two rounds of Delphi expert consultation, summarize the experts’ opinions to determine the indicator system items, and use the Analytic Hierarchy Process (AHP) method to construct the judgment matrix to derive the weighting coefficients of the indicators, and establish the ultimate demand-oriented Internet + community home care service indicator system.ResultsThe effective recovery rates for the two rounds of expert consoulation questionnaires were 100%, with expert authority coefficients of 0.852 and 0.868, respectively. The Kendall coefficients for the second round of expert views varied from 0.226 to 0.431, with coefficients of variation for all indexes less than 0.25.The finalized demand-oriented Internet + community home care service indicator system includes 3 first-level indicators, 10 s-level indicators, and 46 third-level indicators. The consistency ratios of indicator judgment matrices at all levels are less than 0.10, suggesting that the hierarchical analysis findings are consistent, implying that the weight coefficient distribution is appropriate.ConclusionThe demand-oriented Internet + community home care service Indicator System, which was created through expert consultation and AHP method, has reasonable content and is more dependable as an evaluation tool for reliably assessing demand for elderly servic.