Home Health Care Field Research Articles

“Walking Along a Difficult Path Towards Reward”: Home Healthcare Nurses’ Work Experiences and Satisfaction

The growing demand for skilled personnel and the challenges faced by home healthcare (HHC) underscore the significance of these issues for nurses’ job satisfaction and daily experience of working in this field. The aim of the study was to explore the lived experience and job satisfaction of HHC nurses working in Greece. A qualitative study with semi-structured interviews was conducted. The data were collected from November to December 2021. The analysis was based on thematic analysis by Braun and Clarke. Data were organized with Atlas.ti v8. The sample consisted of 9 nurses (8 female and 1 male), with mean value of 10.22 years of working experience in the field of HHC. Four main themes emerged during the thematic analysis: “Nurse as a guest” “Understanding the world of home healthcare,” “Walking along a difficult path towards reward,” and “Looking forward to a better tomorrow.” Nurses’ descriptions gave the framework of working conditions in HHC and the uniqueness of this working environment, highlighting at the same time the factors that positively or negatively affect their job satisfaction. This valuable knowledge could act as a basis for the development of new targeted strategies, with the goal of creating a healthy, productive environment that would strengthen the desire of nurses to work in HHC.

Survey in Hyogo Prefecture on the Current Status of Pharmacists in Home Health Care and Exploration of Factors Causing Psychological Burden

There is a need for pharmacists to be actively involved in home healthcare through a wide range of collaboration in healthcare and welfare. However, insufficient evidence is available to search for factors that prevent pharmacists from being proactive in home healthcare. In this study, we conducted an extensive questionnaire survey among pharmacists engaged in home pharmacy work who belong to the Hyogo Pharmaceutical Society regarding the current status of pharmacists' work in home medical care and their psychological burden; we also explored the factors that may hinder the future development of home medical care. As a result, 925 (44%) valid responses were obtained, and seven factors- "current multidisciplinary cooperation", "relationships with patients and their families", "emotional burden for home healthcare", "attitude toward patients", "ideal of multidisciplinary cooperation", "anxiety about aggressive intervention", and "anxiety about talking to and dealing with patients"- were extracted. Furthermore, it was suggested that pharmacists' mental burden and anxiety are closely related to their successful experiences in building relationships with patients and patients' families as well as with multidisciplinary cooperation in home healthcare. Therefore, to train pharmacists to be actively involved in home healthcare, it is important not only to impart knowledge and skills but also for them to gain experience practicing their contributions as pharmacists in the field of home healthcare with multiple professions, patients, and patients' families.

Home health care routing and scheduling problem with different groups of patients and health workers

PurposeIn this study, the authors investigate a different routing and scheduling problem in the field of home health care (HHC) management system. The purpose of this paper is to route and schedule the workday of health workers, assign the patients to suitable health workers, make accurate decisions to minimize costs, provide timely services and, in general, enhance the efficiency of HHC centers.Design/methodology/approachA mixed-integer linear programming model is developed to assign health workers to patients. The model considers health professionals with different skills, namely nurses and physicians. Additionally, three groups of patients are considered: patients who need a nurse, patients who need a physician and patients who need both. In the third group, the nurse must be present at the patient’s home following the physician’s visit in order to perform the required tasks.FindingsThe results of this study show a reduction in costs which results from the fewer health workers employed and dispatched in comparison with traditional approaches. With the help of our solution approach and model, HHC centers may not only successfully reduce their costs but also manage to meet their patients’ demands by assigning suitable nurses and physicians.Originality/valuePrevious studies have often focused on problems involving only one group of health professionals and rarely address problems involving multiple groups. The authors consider this a shortcoming, because in many cases, patients should be visited several times and by various health professionals.

Green VRP applied to Home Health Care problem

Many real-world problems related to the route such as its fees, ecological footprint, duration, and/or distance. We propose a bi-objective formulation for this problem named Green Vehicle Routing Problem with Time Windows Temporal Dependency Multiple Structure and Multiple Specialties “GVRPTW-TD-2MS” in home health care field. It aims in the first degree to optimize the economic and environmental aspects. It determines the shortest path caregivers’ tours made by alternative fuel vehicles with the minimum carbon emission produced and alternative fuel stations shared. The social aspect is considered as the second concern in our research paper which, maximize the patients’ satisfaction levels.

Hybrid metaheuristics for solving a home health care routing and scheduling problem with time windows, synchronized visits and lunch breaks

The home health care routing and scheduling problem (HHCRSP), a challenging operational problem in the field of home health care (HHC), consists of assigning suitable caregivers to serve patients at their homes and optimizing a set of caregiver’s visits according to certain criteria. Besides the time windows and qualifications of caregivers that are generally considered in HHCRSP, this study further concerns three practical constraints, which are (1): some patients require the services that should be performed by at least two caregivers simultaneously (synchronized visits); (2) caregivers should take lunch breaks when they working during the lunch period (lunch breaks); (3) caregivers can depart from either their homes or the HHC company (flexible departure modes of caregivers). In this study, the concerned problem is firstly modeled as a mixed-integer programming model, and four hybrid metaheuristics are developed. Numerical results obtained with the instances, adapted from a set of benchmark instances, as well as the statistical information, computed by Friedman test present that the hybrid genetic general variable neighborhood search (HGGVNS) shows the best performance among four algorithms. Furthermore, sensitivity analyses are conducted to evaluate the impact of synchronization scales, time window widths, break regulations, and departure strategies on the final solutions. The results of this study can offer HHC management a valuable scheme to construct a high-quality planning of HHC visits by taking into account various important real-life constraints, some of which were not yet been tackled in the literature.

Re-planning In Home Healthcare: A Decomposition Approach To Minimize Idle Time For Workers While Ensuring Continuity Of Care

Abstract Scheduling and routing careworkers is a perpetual challenge in the home health care (HHC) industry: it is essential to ensure a good quality of care under reasonable expenses. HHC consists in providing care to fragile people, therefore the pool of patients often changes: the schedule must be computed again, but continuity of care must be preserved to keep the patients satisfied. The working environment in the HHC field is remarkably stressful therefore it causes a high turnover rate in the staff, and has a strong impact on service quality. It is crucial to provide schedules that satisty both patients and careworkers. In this paper, we address a weekly home health care re-planning problem with continuity constraints. A decomposition approach is proposed to offer a careworker-friendly solution: first a path-generation algorithm creates admissible tours, and then a set partitioning model selects the tours.

Applications Based on Service-Oriented Architecture (SOA) in the Field of Home Healthcare.

This article makes a literature review of applications developed in the health industry which are focused on patient care from home and implement a service-oriented (SOA) design in architecture. Throughout this work, the applicability of the concept of Internet of Things (IoT) in the field of telemedicine and health care in general is evaluated. It also performs an introduction to the concept of SOA and its main features, making a small emphasis on safety aspects. As a central theme, the description of different solutions that can be found in the health industry is developed, especially those whose goal is health care at home; the main component of these solutions are body sensor networks. Finally, an analysis of the literature from the perspectives of functionalities, security implementation and semantic interoperability is made to have a better understanding of what has been done and which are probable research paths to be studied in the future.

NSGAII enhanced with a local search for the vehicle routing problem with time windows and synchronization constraints

In the field of Home Health Care (HHC), the vehicle routing problem with time windows, synchronization, and precedence constraints (VRPTW-SP) involves finding the lowest-cost set of routes to visit patients requesting one or more services in a specific time window and during a fixed time service. Each patient has preference weights associated to the vehicles who are available to provide the requested service. To solve the problem, different variations for multi-objective met a-heuristic based on the Non-dominated Sorting Genetic Algorithm (NSGAII) are proposed. The considered objectives are the minimization of travel costs and the maximization of patients preferences. This problem was solved in a previous work as a single-objective variant, despite the conflicting nature of these two criteria. Numerical results are presented for instances with up to 73 patients. Metrics such as spacing, hyper-volume and the number of non dominated solutions are used to measure the quality of solutions.

Community Home Healthcare in 6-Year Pharmacy Education

As we enter more and more into a super-aging society, the requirement for home healthcare will increase. Pharmacists must work along with doctors and nurses in the field of home healthcare. Within the 6-year pharmacy curriculum, we must educate students as medicinal professionals who will join a medical team to serve the community. The Good Practice (GP) program, which has been supported by the Ministry of Education, Culture, Sports, Science & Technology, continues to be offered in our university. As a part of this program, students learn home healthcare in the community in cooperation with Yubari Medical Center. In addition, our students (pharmacy) can study community medicine together with students from Tenshi College (nursing and nutrition) in an optional class made available in Yubari during their summer vacation. According to the results of our survey after these programs, students have achieved a deep recognition of the importance of community medicine and cooperation with other medical staff in contributing to community home healthcare. We carry out these programs under agreements of collaboration with Yubari Medical Center and Tenshi College. We will talk today about training for pharmaceutical care in the community and the effect of training through this class on pharmacy education.

Trends and risks in home health care

PurposeThe number of care‐dependent people will rise in future. Therefore, it is important to support home health care (HHC) providers with suitable methods and information, especially in times of disasters. The purpose of this paper is to reveal potential threats that influence HHC and propose an option to incorporate these threats into the planning and scheduling of HHC services.Design/methodology/approachThis paper reveals the different conditions and potential threats for HHC in rural and urban areas. Additionally, the authors made a disaster vulnerability analysis, based on literature research and the experience of the Austrian Red Cross (ARC), one of the leading HHC providers in Austria. An optimization approach is applied for rural HHC that also improves the satisfaction levels of clients and nurses. A numerical study with real life data shows the impacts of different flood scenarios.FindingsIt can be concluded that HHC service providers will be faced with two challenges in the future: an increased organizational effort and the need for an anticipatory risk management. Hence, the development and use of powerful decision support systems are necessary.Research limitations/implicationsFor an application in urban regions new methods have to be developed due to the use of different modes of transport by the nurses. Additionally, an extension of the planning horizon and triage rules will be part of future research.Practical implicationsThe presented information on developments and potential threats for HHC are very useful for service providers. The introduced software prototype has proven to be a good choice to optimize and secure HHC; it is going to be tested in the daily business of the ARC.Social implicationsEven in the case of disasters, HHC services must be sustained to avoid health implications. This paper makes a contribution to securing HHC, also with respect to future demographic trends.Originality/valueTo the best of the authors’ knowledge there are no comprehensive studies that focus on disaster management in the field of HHC. Additionally, the combination with optimization techniques provides useful insights for decision makers in that area.

Medical devices in the home: A unique challenge for the FDA

With the rising numbers of elderly populations and those with chronic diseases, the Home Healthcare field has inevitable expanded within the United States. Patients, more specifically home-bound patients, are becoming increasingly dependent on medical technology to help sustain and improve their quality if life. Often times, home care patients, or care recipients, depend on a properly functioning medical device for recovery. As efficient as this method may be, home healthcare also comes along with many challenges involving use and management of medical devices. Difficulties regarding device function, use, the environment, and human factors can all serve as factors to jeopardize patient safety. FDA recognizes that devices need to be safe and capable of meeting needs in an uncontrolled home environment. Major stakeholders such as manufacturers, distributors, human factor specialists, professional health organizations, healthcare professionals, patient/caregivers, and other government agencies. FDA would assure that manufacturers are designing and testing devices for the home, that proper training and education to use the device are available and completed, and the public knows how to report problems with their devices. FDA launched the Medical Device Home Use Initiative in April 2010 which proposed different methods that can support safety and safe use of medical devices in the home environment. FDA faces many challenges in assuring safe usage of medical devices in the home. FDA hopes that stakeholders can also become actively involved in working with us to address a total life cycle approach on device safety.

Preparing Newly Licensed Associate Degree Nurses to Work in Home Health Care

This article describes an innovative learning program, designed for associate degree nurse (ADN) graduates, developed at the visiting Nurse Service of New York (VNSNY) to expand its hiring pool of potential applicants to home health care nursing positions. The program, “Transitions to Home Health Care,” provides a strong emphasis on independent judgment, assessment skills, and collaboration with other professions and resources outside the home health care agency. In view of the expanding number of ADN graduates and the increasing competition for a limited number of new bachelor of science in nursing (BSN), VNSNY developed and is testing a model that combines a specially designed one-year didactic educational course and a clinical practice internship program to prepare new ADN graduates to work in the home health care field at a level more comparable to that of BSN graduates. To date, VNSNY has had preliminary success with this new approach.

Down to the Fundamentals of Telehealth and Home Healthcare Nursing

Many changes have taken place in the field of home healthcare. Because of these changes, home health agencies must be creative and implement various tools that help improve quality of care for their patients. Starting with the most basic intervention definitely can lend a hand in improving patient outcomes. Phone monitoring, the most basic form of telehealth, can be an important aspect in a patient's plan of care.

Social Work in Home Care and Adult Day Settings: A Comparative Study

This article explores the job characteristics of social work practice in the home health care field versus the adult day care arena. In many ways, the two positions are very similar; the types of clients or patients serviced, the multidisciplinary nature of the work, and the issues faced when working with this population are examples of similarities. This comparison helps readers understand how the transition from fieldwork to the center setting can be achieved. This exploration represents the personal experiences of the author, who, after almost 25 years in the home health care field, now works in adult day care.

Problems controlling fraud and abuse in the home health care field

PurposeThe purpose of the current study is to assess the efforts to control fraud in the home health care industry in the USA by examining the problems that criminal justice officials confronted in their attempts to control home health care fraud and abuse.Design/methodology/approachAttention is given to the history of the home health care industry in the USA, the types of fraud found in the health care field in general, and the officials who are given the duty of controlling health care fraud.FindingsThe results of this study suggest that the problems fraud control officials face in their response to home health care offenders are similar to those confronted in the response to white‐collar offending, but also similar to those confronted in the response to many conventional offenses.Originality/valueHighlights the problems in controlling fraud and abuse in the US home care health field.

Fraud by Home Health Care Workers and the Criminal Justice Response

Research in the medical literature suggests that the investigation of fraud in the home health care field grew significantly throughout the 1990s. Although criminologists have examined health care fraud by physicians, virtually no criminological research has assessed crime within the home hath care industry. This article attempts to fill that void by considering the kinds of home health care offenses that are investigated by fraud control units throughout the United States. Content analysis is performed on 247 reported incidents of home health cue abuses. Finding indicate that home health care professionals commit offenses that are similar to, yet different from, those that are committed by doctors. The importance of community service as a sanction for these offenders, and the need for background checks, are considered. Support for conflict theory and general systems theory emerges as well.

Project Management: A Powerful Approach for Home Health Care Management

This article stresses the potential application of a formal project management approach to home health care management. Following a brief description of project management, implementation factors are discussed to facilitate the successful implementation of this approach and to reap the expected benefits. A sample of project management techniques and tools are described, especially for the planning and controlling of projects typically used in the home health care field. Managers can readily see that adopting project management can be done with minimal organizational disruption and training. Clearly, the costs of adopting project management are relatively small compared with the potential benefits in terms of improved efficiency and productivity, work quality, reduced work stress, and reduced conflict at the interpersonal and organizational levels.

The Complexity of Everyday Ethics in Home Health Care

ABSTRACT Little attention has been given to the ethical dimensions of social work practice in the growing field of home health care. This descriptive, exploratory study examined the influence of frail elders' cognitive status, safety, and caregiver burden on social workers' support for autonomy. The major findings of this study were that all three factors were significantly related to support for autonomy. Especially important was the emergence of a ranking of the relative importance of these three factors in social workers' decision making: the first factor considered was cognitive status, the second was safety, and the third was caregiver burden.

Developing a Workplace Violence Program in the Home Health Care Setting

Workplace violence is escalating at an alarming rate. The home health care field is a particularly vulnerable area because services are provided to a cross-section of the community, and the care is provided within the community rather than within a contained structure. Home health care employers are encouraged to develop effective workplace violence prevention programs that include control measure strategies within the office and in the field, coupled with diversified education programs. Educating staff and maintaining open communication with all employees will serve to contain the costs of the agency as well as to allay staff anxieties, thereby maintaining productivity.

Implementing a Practice Council in Home Health Care and Hospice

The field of home health care is entering a challenging period. Reduced visit allocations will increase the accountability of caregivers to provide competent and outcome- oriented service. Creative solutions will be necessary to prevent staff disillusionment. The shared governance movement is a potential avenue for empowering direct caregivers to make decisions that can shape their practice and enhance professional satisfaction. This article will describe one model of shared governance and present a step-by-step guide to implementing a practice council in the home care and hospice setting.