Home Health Care Providers Research Articles

Smart Phone App eMediCall™ Usability and its Impact on the Clinical Communication among Nursing Home Healthcare Providers and Nurses

Smart Phone App eMediCall™ Usability and its Impact on the Clinical Communication among Nursing Home Healthcare Providers and Nurses

Home Health Care Problem with Synchronization Visits and Considering Samples Transferring Time: A Case Study in Tehran, Iran.

Health care facilities have not increased in response to the growing population. Therefore, government and health agencies are constantly seeking cost-effective alternatives so they can provide effective health care to their constituents. Around the world, health care organizations provide home health care (HHC) services to patients, especially the elderly, as an efficient alternative to hospital care. In addition, recent pandemics have demonstrated the importance of home health care as a means of preventing infection. This study is the first to simultaneously take into account nurses' working preferences and skill levels. Since transferring samples from the patient's home to the laboratory may affect the test results, this study takes into account the time it takes to transfer samples. In order to solve large instances, two metaheuristic algorithms are proposed: Genetic Algorithms and Particle Swarm Optimization. Nurses are assigned tasks according to their time windows and the tasks' time windows in a three-stage scheduling procedure. Using a case study set in Tehran, Iran, the proposed model is demonstrated. Even in emergencies, models can generate effective strategies. There are significant implications for health service management and health policymakers in countries where home health care services are receiving more attention. Furthermore, they contribute to the growing body of knowledge regarding health system strategies by providing new theoretical and practical insights.

Prevalence, causes, and consequences of moral distress in healthcare providers caring for people living with dementia in long-term care during a pandemic.

Healthcare providers caring for people living with dementia may experience moral distress when faced with ethically challenging situations, such as the inability to provide care that is consistent with their values. The COVID-19 pandemic produced conditions in long-term care homes (hereafter referred to as ‘care homes’) that could potentially contribute to moral distress. We conducted an online survey to examine changes in moral distress during the pandemic, its contributing factors and correlates, and its impact on the well-being of care home staff. Survey participants (n = 227) working in care homes across Ontario, Canada were recruited through provincial care home organizations. Using a Bayesian approach, we examined the association between moral distress and staff demographics and roles, and characteristics of the long-term care home. We performed a qualitative analysis of the survey’s free-text responses. More than 80% of care home healthcare providers working with people with dementia reported an increase in moral distress since the start of the pandemic. There was no difference in the severity of distress by age, sex, role, or years of experience. The most common factors associated with moral distress were lack of activities and family visits, insufficient staffing and high turnover, and having to follow policies and procedures that were perceived to harm residents with dementia. At least two-thirds of respondents reported feelings of physical exhaustion, sadness/anxiety, frustration, powerlessness, and guilt due to the moral distress experienced during the pandemic. Respondents working in not-for-profit or municipal homes reported less sadness/anxiety and feelings of not wanting to go to work than those in for-profit homes. Front-line staff were more likely to report not wanting to work than those in management or administrative positions. Overall, we found that increases in moral distress during the pandemic negatively affected the well-being of healthcare providers in care homes, with preliminary evidence suggesting that individual and systemic factors may intensify the negative effect.

Attitudes of nurses towards home healthcare in a developing economy

Background/Aims Various factors, including the ageing population, have led to an increasing demand for healthcare delivered in the patient's own home. This study explored perceptions of home care among nurses, including the potential benefits to patients and nursing careers. Methods A cross-sectional exploratory study was performed. A questionnaire was designed and distributed to 200 home healthcare nurses from one agency in India, of which 152 responded. The questionnaire asked respondents to rate their agreement to 12 items regarding their perceptions of home healthcare on a 5-point Likert scale. Factor analysis was carried out to identify themes. Mean scores were calculated for each questionnaire item to determine levels of agreement. Results Respondents generally had a positive view of home healthcare, with most agreeing that it allowed the nurse to carry out a holistic assessment of the patient (4.40/5) and provide preventative care (4.33/5). Many also agreed that home healthcare could prevent hospitalisation (4.15/5). However, respondents were less sure about the appropriateness of home healthcare for patients with terminal illnesses (3.96/5) and stated that home healthcare providers and hospitals needed to work together to ensure continuity of care (4.47/5). Conclusions Home healthcare is a promising field and nurses within this profession are generally aware of the potential benefits to patients. It is important to raise the profile of home healthcare in India to make it more accessible and ensure that other healthcare professionals are able to refer patients when appropriate.

Attitudes of nurses towards home healthcare in a developing economy

Background/Aims Various factors, including the ageing population, have led to an increasing demand for healthcare delivered in the patient's own home. This study explored perceptions of home care among nurses, including the potential benefits to patients and nursing careers. Methods A cross-sectional exploratory study was performed. A questionnaire was designed and distributed to 200 home healthcare nurses from one agency in India, of which 152 responded. The questionnaire asked respondents to rate their agreement to 12 items regarding their perceptions of home healthcare on a 5-point Likert scale. Factor analysis was carried out to identify themes. Mean scores were calculated for each questionnaire item to determine levels of agreement. Results Respondents generally had a positive view of home healthcare, with most agreeing that it allowed the nurse to carry out a holistic assessment of the patient (4.40/5) and provide preventative care (4.33/5). Many also agreed that home healthcare could prevent hospitalisation (4.15/5). However, respondents were less sure about the appropriateness of home healthcare for patients with terminal illnesses (3.96/5) and stated that home healthcare providers and hospitals needed to work together to ensure continuity of care (4.47/5). Conclusions Home healthcare is a promising field and nurses within this profession are generally aware of the potential benefits to patients. It is important to raise the profile of home healthcare in India to make it more accessible and ensure that other healthcare professionals are able to refer patients when appropriate.

An intelligent algorithm to evaluate and improve the performance of a home healthcare center considering trust indicators

Home healthcare (HHC) is a beneficial choice for many people and especially an essential alternative to clinics and hospitals for infection prevention during the COVID-19 pandemic. Moreover, patient trust in HHC providers is critical to care success and highly affects patient satisfaction. In this paper, an intelligent algorithm is proposed to assess the performance of an HHC center considering trust indicators. For this purpose, the effect of these indicators on patient satisfaction was examined. First, the required data is collected from patients who received care from the HHC service under study through two validated questionnaires containing items related to trust and patient satisfaction. Efficiency scores for each decision-making unit were computed using an artificial neural network and statistical methods. Based on each trust indicator, sensitivity analysis and statistical tests were conducted to evaluate the (in) appropriateness of HHC center performance. In addition, a strengths-weaknesses-opportunities-threats analysis is conducted to suggest strategies for improving the HHC center performance. The algorithm was validated using the data envelopment analysis method. As far as we know, this is the first study to evaluate the performance of HHC centers based on trust indicators, and the model presented in this study can be implemented in other healthcare units to enhance patient satisfaction.

Firearms, Physicians, Families, and Kids: Finding Words that Work

Firearms, Physicians, Families, and Kids: Finding Words that Work

Employing Family Caregivers: An Innovative Health Care Model.

Employing Family Caregivers: An Innovative Health Care Model.

\u2018Living in a shrinking world\u2019\u2014The experience of loneliness among community-dwelling older people with reduced mobility: a qualitative grounded theory approach

BackgroundLoneliness is associated with severe consequences for both the physical and mental health of older people. Research has shown that mobility limitations are an important risk factor for the emergence and maintenance of feelings of loneliness. The aim of this study was to explore the experiences of loneliness among community-dwelling older people with reduced mobility and its underlying dynamics.MethodsThis study employed a qualitative, descriptive design, inspired by a grounded theory approach. Participants were purposively recruited in collaboration with home health care providers. The main inclusion criteria were as follows: aged 75 years or older, being mobile impaired, experiencing feelings of loneliness, and living at home and being cognitively able to be interviewed. Data analysis of 15 semi-structured, in-depth interviews was conducted based on the Qualitative Analysis Guide of Leuven (QUAGOL).ResultsLoneliness was expressed through all the stories, but it appeared as an elusive, intangible phenomenon. Both indicating the presence of loneliness and describing what this phenomenon means were difficult to express for most participants. Loneliness was experienced as an inherent part of the ageing process characterised by losses, limitations and meaninglessness. Participants described how they have experienced losing grip on the world in which they live and feel isolated in a literally and figuratively shrinking world. Loneliness is described as the feeling that one is unable to address the situation that results in deep sadness and the feeling of no longer being of value to their environment.ConclusionsThis study shows that loneliness among community-dwelling older persons with reduced mobility is embedded in experiences of loss related to ageing, among which reduced mobility plays a significant role. The results suggest the existence of a more profound experience of loneliness than might appear at first glance. How to recognise experiences of loneliness and how to support a meaningful existence for community-dwelling older persons should be given priority in health care. The findings of this study can increase professional caregivers’ sensitivity to implicit signals of loneliness. Further research is necessary to refine the outcomes and to further explore the role of reduced mobility in the experience of loneliness.

Use of standard, contact, and droplet precautions with eye protection for the prevention of severe acute respiratory coronavirus virus 2 (SARS-CoV-2) transmission among home healthcare personnel in hospice and home healthcare settings-King and Snohomish counties, Washington, February-October 2020.

Among EvergreenHealth Home Care Service professionals, no coronavirus disease 2019 (COVID-19) cases were reported when they were instructed to use standard, contact, and droplet precautions with eye protection while providing home health care to patients diagnosed with laboratory-confirmed severe acute respiratory coronavirus virus 2 (SARS-CoV-2). These precautions might provide some level of protection against coronavirus disease 2019 (COVID-19) among home healthcare personnel.

Relational Aspects of Parent and Home Health Care Provider Care Practices for Children With Complex Care Needs Receiving Health Care Services in the Home: A Narrative Review.

Children with medical complexity have ongoing health needs that may require dependence on medical technologies. While hospital admissions are an important focus of care delivery for these children, a majority of the time they are cared for in their own homes. Parents' report feeling overwhelmed and stressed by the scope of their responsibilities, but they become sophisticated care providers and assume greater authority when providing their children's care at home. Communication, decision-making, and dealing with conflict with members of health care teams have been central concerns in parents' reports of their home health care experiences. The objective is to review literature on relational aspects of parent and home health care provider care practices for children with medical complexity receiving home health care services. A narrative review was conducted. A search of MEDLINE, EMBASE, EBM Reviews, PsychINFO, ERIC, and CINAHL databases for English language studies published since database inception was carried out. Eligible studies focused on relational aspects of parent and home health care provider care practices for children with medical complexity receiving home health care services. Nine empirical studies were selected for this review. Literature describes parents' and providers' experiences managing a child with medical complexity in the home and the effects for the family and the parent-health care provider relationship. Parents want to be actively involved in all aspects of care that affects their child and ultimately their family. Further investigation is needed to better understand relational aspects of parent-home health care provider care practices to support child/family health and well-being in the home setting.

Home Health Care Utilization in Children With Medicaid.

Although many children with medical complexity (CMC) use home health care (HHC), little is known about all pediatric HHC utilizers. Our objective was to assess characteristics of pediatric HHC recipients, providers, and payments. We conducted a retrospective analysis of 5 209 525 children age 0-to-17 years enrolled Medicaid in the 2016 IBM Watson MarketScan Medicaid Database. HHC utilizers had ≥ 1 HHC claim. Healthcare Common Procedure Coding System (HCPCS) and Current Procedural Terminology (CPT) codes were reviewed to codify provider types when possible: registered nurse (RN), licensed practical nurse (LPN), home health aide (HHA), certified nursing assistant (CNA), or companion/personal attendant. Enrollee clinical characteristics, HHC provider type, and payments were assessed. Chronic conditions were evaluated with Agency for Healthcare Research and Quality's Chronic Condition Indicators and Feudtner's Complex Chronic Conditions. Of the 0.8% of children who used HHC, 43.8% were age <1 year, 25% had no chronic condition, 38.6% had a noncomplex chronic condition, 21.5% had a complex chronic condition without technology assistance, and 15.5% had technology assistance (eg, tracheostomy). HHC for children with technology assistance accounted for 72.6% of all HHC spending. Forty-five percent of HHC utilizers received RN/LPN-level care, 7.9% companion/personal attendant care, 5.9% HHA/CNA-level care, and 36% received care from an unspecified provider. For children with technology assistance, the majority (77.2%) received RN/LPN care, 17.5% companion/personal assistant care, and 13.8% HHA/CNA care. Children using HHC are a heterogeneous population who receive it from a variety of providers. Future investigations should explore the role of nonnurse caregivers, particularly with CMC.

A First Route Second Assign decomposition to enforce continuity of care in home health care

Home health care (HHC) is a very popular service that plays an important role in reducing hospitalization costs and improving the quality of life for patients. Human resource planning is one of the most important processes in HHC facilities, and service providers must deal with several operational problems, e.g., the assignment of nurses to patients and the nurse routing. These two problems in HHC are intrinsically related. In the literature, they are solved simultaneously or sequentially, by exploiting First Assign Second Route (FASR) decomposition approaches in which the assignment problem is solved first and the routing problem is solved second. However, on the one hand, the simultaneous approach focuses primarily on the routing component of the problem but fails to offer continuity of care to the patients. On the other hand, FASR is more adequate to enforce the continuity of care constraint but is less effective toward the routing part. In this paper, we propose a novel decomposition approach that combines the advantages of each these approaches, which is based on the First Route Second Assign (FRSA) paradigm. To validate our FRSA approach and compare with a benchmark FASR decomposition, we also develop an instance generator that is inspired by real HHC settings with different sizes and travel time ratios. Experiments show the effectiveness of the FRSA decomposition and improvements with respect to the classical FASR, especially when travel times constitute a relevant part of the workload and the routing component of the problem is predominant; moreover, continuity of care is fully respected. Thus, FRSA can be effectively implemented by HHC providers for an efficient planning of resources and visits, especially where patients are spread in a vast territory.

CPAP telemonitoring can track Cheyne-Stokes respiration and detect serious cardiac events: The AlertApnée Study.

Case reports have suggested that continuous positive airway pressure (CPAP) telemonitoring can detect the onset of acute cardiac events such as decompensated heart failure (HF) or atrial fibrillation through an increase in the apnoea-hypopnoea index (AHI) and onset of Cheyne-Stokes Respiration (CSR). This study addressed whether long-term remote CPAP treatment telemonitoring revealing CSR can help detect serious cardiac events (SCEs) in obstructive sleep apnoea (OSA) patients. This monocentric prospective cohort study included adults receiving CPAP therapy for OSA with daily telemonitoring. Any sudden increase in AHI generated an alert for the home healthcare provider to download CPAP data to identify CSR. A medical consultation was scheduled if CSR was detected. We included 555 adults (412 men; 57% with known cardiovascular comorbidities). During the 1-year follow-up, 78 CSR episodes were detected in 74 patients (CSR+). The main conditions associated with incident CSR were HF (24 patients [30.8%]), ventilatory instability (21, 26.9%), leaks (13, 16.7%), medications inducing central apnoeas (baclofen, ticagrelor, opioids) (7, 9.0%), arrhythmias (6, 7.7%) and renal failure (2, 2.6%). Fifteen (20.3%) CSR+ patients had a confirmed SCE. In univariable analysis, a CSR episode increased the risk of an SCE by 13.8-fold (5.7-35.6) (p < 0.0001), with an adjusted OR of 5.7 (2.0-16.8) in multivariable analysis. Long-term telemonitoring of patients on CPAP treatment can alert CSR episodes and allows early detection of SCEs in patients with or without known cardiac comorbidities.

POP Care: An interprofessional team-based healthcare model for providing well care to homebound older adults and their pets

A novel interprofessional clinical experience, entitled POP (Pet Owner and Pet) Care, was offered to students from the Colleges of Nursing, Veterinary Medicine, and Social Work at a large Midwest university. The objectives of the clinical experience were to (1) provide students with an opportunity to improve their readiness for interprofessional learning and beliefs about EBP; (2) deliver integrated physical and mental health care to homebound older adults and assess their outcomes; and (3) concurrently provide wellness care to the pets living with homebound older adults and assess their outcomes. Nurse practitioner (NP) faculty led the POP Care clinical rotation teams of NP, veterinary, and social work students in providing home healthcare to homebound adults and their pets. Students were provided with four learning modules prior to starting patient visits. The success of the clinical experience was evaluated via a pre- and post-survey that assessed EBP beliefs and readiness for interprofessional learning. The post-survey also included program satisfaction questions. Health outcomes were measured for the patient and their pets. Patients also answered open-ended program satisfaction questions over the phone. Results indicated that POP Care improved beliefs in EBP and readiness for interprofessional learning, enhanced interprofessional team-based care, and had a positive impact on patient and pet health and well-being.

Home pulse oximetry after discharge from a quaternary-care children's hospital: Prescriber patterns and perspectives.

Pulse oximetry monitoring is prescribed to children receiving home oxygen for chronic medical conditions associated with hypoxemia. Although home pediatric pulse oximetry is supported by national organizations, there is a lack of guidelines outlining indications and prescribing parameters. A mixed-methods analysis of pediatric home pulse oximetry orders prescribed through the institutional home healthcare provider at a large US children's hospital 6/2018-7/2019 was retrospectively reviewed to determine prescribed alarm parameter limits and recommended interventions. Semi-structured qualitative interviews with pediatric providers managing patients receiving home oxygen and pulse oximetry were conducted to identify opportunities to improve home pulse oximetry prescribing practices. Interviews were analyzed using a modified content analysis approach to identify recurring themes. A total of 368 children received home pulse oximetry orders. Orders were most frequently prescribed on noncardiac medical floors (32%). Attending physicians were the most frequent ordering providers (52%). Frequency of use was prescribed in 96% of orders, however, just 70% were provided with specific instructions for interventions when alarms occurred. Provider role and clinical setting were significantly associated with the presence of a care plan. Provider interviews identified opportunities for improvement with the device, management of alarm parameter limits, and access to home monitor data. This study demonstrated significant variability in home pulse oximetry prescribing practices. Provider interviews highlighted the importance of the provider-patient relationship and areas for improvement. There is an opportunity to create standardized guidelines that optimize the use of home monitoring devices for patients, families, and pulmonary providers.

Discharge Communications for Older Patients Between Hospital Healthcare Providers and Home Healthcare Providers: An Integrative Review

The increasing volume of our aging population is dramatically affecting the need for home care services. The discharge process from hospital to home can be fraught with communication challenges if critical information is not provided. The transition process can threaten patient safety and incur adverse patient health outcomes. However, little is known about how the communication occurs between hospital and home health providers. Therefore, this integrative literature review was conducted to (1) describe the discharge communication that is occurring for older patients between hospital and home healthcare providers and (2) summarize the limitations of current discharge communication. A systematic search was conducted using CINAHL, PubMed, Web of Science, and PsycINFO databases. Findings were categorized to address each aim. Seven studies were included for full reviews. Healthcare providers used a variety of communication methods, including: written information, phone calls, or in-person meetings to exchange the discharge information of older patients. Limitations in communications included excessive and incomplete discharge documents, lack of provider’s contact information, lack of trust in each other, and lack of bidirectional communications. The quality of discharge communications can improve by utilizing mediators and implementing standardized discharge documentation requirements. Overall, there was a lack of literature that described the methods and limitations of discharge communication for older patients between hospital and home care services. Further studies can be conducted to generate more evidence. Healthcare providers may improve the quality of discharge communication by addressing the suggested areas.

When Technology Enters at Home: The Challenges of Home Health Care Providers in a Developing Country.

The number of patients with chronic diseases requiring invasive mechanical ventilation at home is increasing. Thus, identifying the challenges of this valuable type of care can be an elective step for achieving health-related goals. This study was conducted to determine the challenges faced by home health care providers. Three themes emerged from the data analysis: (1) hospital-based challenges with 2 subthemes: the family unpreparedness for home care and the lack of continuous education; (2) home health care agency challenges with 2 subthemes: home health care workers and the deficiency in organizational policies; and (3) economic challenges. Three themes of hospital-related challenges, home health care agency challenges, and economic challenges that emerged in the study showed that support from the insurance system, improvement of home care agency policies, and holistic care for patients through a multidisciplinary team approach are essential for addressing the current challenges of care for patients under invasive mechanical ventilation at home.

Exploring the home healthcare workforce in Alzheimer's disease and related dementias: Utilization and cost outcomes in US community dwelling older adults

ObjectiveThis study assessed home health care use associated with Alzheimer's Disease and related dementias (ADRD) in US community dwelling older adults, including workforce, intensity, and cost outcomes. Materials and methodsMedical Expenditure Panel Survey (2010–2018) household and home care event files were used to identify adults ≥ 65 years with ADRD. Outcomes included home health care provider type, intensity of care use, and annual direct home care cost. All analyses applied person weights for national estimates. ResultsAmong the 20,443 eligible older adults, 4.2% (n = 843) reported ADRD. Among all professional and non-professional health care workers, nurse practitioners (NPs, 38.5%) and home health care aids (35.6%) were most used. Comparing ADRD vs non-ADRD: the annual per-person average number of days in home care was 110 vs. 64 (p<0.001) and home care costs accounted for 30.8% vs. 7.5% of total health care costs. After adjusting for participants' characteristics, those with ADRD were more likely to use home health care (OR = 4.32, 95% CI=3.29 – 5.68) and showed 229% (95% CI = 175% - 297%) higher associated costs than controls (p<0.001). ConclusionThe study provides insight into the home care workforce. Of the professional workforce NPs were most often used and home care aides dominated the non-professional workforce. As expected, ADRD increased the likelihood and intensity of home health care utilization and associated direct home care costs significantly.

A qualitative study of effective collaboration among nurse home visitors, healthcare providers and community support services in the United States.

Collaboration across sectors is needed to improve community health, but little is known about collaborative activities among public health prevention programs. Using the Nurse-Family Partnership® (NFP) home visiting program as context, this qualitative study aimed to describe effective collaboration among nurse home visitors, healthcare providers and community support services to serve families experiencing social and economic adversities. We used grounded theory to characterise collaboration with six purposively sampled NFP sites in the United States through in-depth interviews. We interviewed 73 participants between 2017 and 2019: 50 NFP staff, 18 healthcare providers and 5 other service providers. Interviews were recorded, transcribed, validated and analysed in NVivo 11. Validation steps included inter-coder consistency checks and expert review. Thematic memos were synthesised across sites. Most participants perceived collaboration to be important when serving families with complex needs, but substantial variation existed in the degree to which NFP nurses collaborate with providers dependent on provider type and community context. Factors that contributed to effective collaboration were relational in nature, including leadership commitment and provider champions, shared perceptions of trust, respect and value, and referral partnerships and outreach; organisational in terms of mission congruence between providers; and structural such as policy and system integration that facilitated data sharing and communication channels. These findings provide greater insights into effective cross-sector collaboration and care coordination for families experiencing adversities. Collaboration across sectors to promote health among families experiencing adversities requires intentional efforts by all inter-professional providers and continued commitment among all levels of leadership to coordinate services.