Home Health Care Providers Research Articles

Free-Text Documentation of Dementia Symptoms in Home Healthcare: A Natural Language Processing Study

Background:Little is known about symptom documentation related to Alzheimer’s disease and related dementias (ADRD) by home healthcare (HHC) clinicians.Objective:This study: (1) developed a natural language processing (NLP) algorithm that identifies common neuropsychiatric symptoms of ADRD in HHC free-text clinical notes; (2) described symptom clusters and hospitalization or emergency department (ED) visit rates for patients with and without these symptoms.Method:We examined a corpus of −2.6 million free-text notes for 112,237 HHC episodes among 89,459 patients admitted to a non-profit HHC agency for post-acute care with any diagnosis. We used NLP software (NimbleMiner) to construct indicators of six neuropsychiatric symptoms. Structured HHC assessment data were used to identify known ADRD diagnoses and construct measures of hospitalization/ED use during HHC.Results:Neuropsychiatric symptoms were documented for 40% of episodes. Common clusters included impaired memory, anxiety and/or depressed mood. One in three episodes without an ADRD diagnosis had documented symptoms. Hospitalization/ED rates increased with one or more symptoms present.Conclusion:HHC providers should examine episodes with neuropsychiatric symptoms but no ADRD diagnoses to determine whether ADRD diagnosis was missed or to recommend ADRD evaluation. NLP-generated symptom indicators can help to identify high-risk patients for targeted interventions.

The Development of a Risk Evaluation Scale for Elderly Patients with Home Healthcare

Home healthcare is a service model for which there is a currently growing need, especially for elderly patients. The examination of the home healthcare requirement risks under certain headings is of great importance for institutions or units providing home healthcare and for individuals applying for these services. To fill this gap, a 2-grade (yes/no) scale has been developed comprising 21 items to measure the home healthcare requirement risks of elderly patients in Turkey. In the context of the development of the scale, following a pilot study, a trial form of the scale was applied to 506 elderly individuals in the province of Burdur. Explanatory and confirmatory factor analysis was applied to the data, using R program, SPSS vn 24 (IBM Statistical Package for Social Sciences) and Lisrel 8.7 software. The scale that emerged at the end of the analysis comprised two dimensions; “The General Health Status and Physical Autonomy of the Patient” and “The Suitability of the Living Area of the Patient and the Economic Status”. The KMO value calculated for the scale was 0.603. the KR-20 internal consistency coefficient calculated was 0.895 for the first dimension, 0.680 for the second dimension and 0.840 for the whole scale.

Healthcare providers\u2019 experiences in supporting community-living older adults to manage multiple chronic conditions: a qualitative study

BackgroundLiving with multiple chronic conditions (MCC), the coexistence of two or more chronic conditions, is becoming more prevalent as the population ages. Primary care and home care providers play key roles in caring for older adults with MCC such as facilitating complex care decisions, shared decision-making, and access to community health and support services. While there is some research on the perceptions and experiences of these providers in caring for this population, much of this literature is focused specifically on family physicians. Little is known about the experiences of other primary care and home care providers from multiple disciplines who care for this vulnerable group. The purpose of this study was to explore the experiences of primary and home care healthcare providers in supporting the care of older adults with MCC living in the community, and identify ways of improving care delivery and outcomes for this group.MethodsThe study used an interpretive descriptive design. A total of 42 healthcare providers from two provinces in Canada (Ontario and Alberta) participated in individual semi-structured, face-to-face 60-min interviews. Participants represented diverse disciplines from primary care and home care settings. Inductive thematic analysis was used for data analysis.ResultsThe experiences and recommendations of healthcare providers managing care for older adults with MCC were organized into six major themes: (1) managing complexity associated with MCC, (2) implementing person-centred care, (3), supporting caregivers, (4) using a team approach for holistic care delivery, (5) encountering challenges and rewards, and (6) recommending ways to address the challenges of the healthcare system. Healthcare providers identified the need for a more comprehensive, integrated system of care to improve the delivery of care and outcomes for older adults with MCC and their family caregivers.ConclusionsStudy findings suggest that community-based healthcare providers are using many relevant and appropriate strategies to support older adults living with the complexity of MCC, such as implementing person-centred care, supporting caregivers, working collaboratively with other providers, and addressing social determinants of health. However, they also identified the need for a more comprehensive, integrated system of care.

A PROFILE OF CAREGIVING AMONG SEPSIS SURVIVORS RECEIVING POST-ACUTE HOME HEALTH CARE

Sepsis survivors transitioning from hospital-to-home are clinically complex. Family caregivers can face challenges managing patients’ care needs; however, skilled home health care (HHC) can serve as an important resource during this care transition. This study’s purpose was to describe caregiving needs among older sepsis survivors receiving post-acute HHC, and identify sources of unmet caregiving needs. We conducted a retrospective analysis of a national dataset of Medicare beneficiaries starting a new HHC episode who were after hospital discharge for sepsis between 2013 and 2014 (n=165,228). All patients received at least one HHC visit the first week after hospital discharge. Caregiving activities included seven items from the start of care Outcome and Assessment Information Set. Descriptive statistics were used to examine types of caregiving activities and needs, demographics, and clinical information. Proportions of patients with unmet caregiving needs ranged from 9%-29%, with the largest proportion of unmet needs in activities of daily living (ADL) assistance (29%), medication administration (28%), and medical procedures/treatments (25%). Unmet caregiving needs across activities were largely due to a caregiver needing training/supportive services (75%-88%), suggesting that many sepsis survivors receiving HHC have caregivers who are available to help, but who lack the knowledge and skills to manage patients’ complex care needs. Thus, HHC providers should address caregiving training and support needs, especially related to assistance with ADLs, medication administration, and medical procedures/treatments. Future research is needed to determine specific educational strategies for caregiver training and support, especially related to skills and knowledge assessment, and training delivery and monitoring.

Caregivers' Experiences Regarding Training and Support in the Post-Acute Home Health-Care Setting.

Background:Post-acute home health-care (HHC) services provide a unique opportunity to train and support family caregivers of older adults returning home after a hospitalization. To enhance family-focused training and support strategies, we must first understand caregivers’ experiences.Objective:To explore caregivers’ experiences regarding training and support for managing older adults’ physical functioning (PF) needs in the post-acute HHC setting.Method:We conducted a qualitative descriptive study using semi-structured telephone interviews of 20 family caregivers. Interviews were recorded, transcribed, and analyzed using conventional content analysis.Results:We identified the following primary categories: facilitators to learning (eg, past experience, learning methods), barriers to learning (eg, learning on their own, communication, timing/logistics, preferred information and timing of information delivery), and interactions with HHC providers (eg, positive/negative interactions, provider training and knowledge).Conclusion:Caregivers were responsive to learning strategies to manage older adults’ PF needs and, importantly, voiced ideas to improve family-focused training and support. HHC providers can use these findings to tailor training and support of family caregivers in the post-acute HHC setting.

How language barriers influence provider workload for home health care professionals: A secondary analysis of interview data

BackgroundIncreasingly, patients with limited English proficiency are accessing home health care services in the United States. Few studies have examined how language barriers influence provider role implementation or workload in the home health care setting. ObjectivesTo explore home health care professionals’ perspectives about how workload changes from managing language barriers influence quality and safety in home health care. DesignA qualitative secondary data analysis using a summative content analysis approach was used to analyze existing semi-structured interview data. SettingA large urban home health care agency located on the East Coast of the United States. ParticipantsThirty five home health care providers [31 registered nurses, 3 physical therapists, 1 occupational therapist]. ResultsA total of 142 discrete incidents emerged from the analysis. Overall, home health care providers experienced distinct shifts in how they implemented their roles that added to their workload and time spent with Limited English Proficiency patients and family members. Providers were concerned about interpretation accuracy and perceived it as potentially posing risks to patient safety. Changes in work patterns, therefore, sought to maximize patient safety. ConclusionsHome health care providers decision-making about how they adapt practice when faced with a language barrier is a sequence of actions based on awareness of the patient’s language preference and if they spoke another language. Subsequent choices showed proactive behaviors to manage increased workload shaped by their perceived risk of the threats posed by the quality of interpreter services. Future research should develop quantitative models examining differences in workload when caring for limited English proficiency versus English speaking patients as well as the relationship between visit length and patient outcomes to determine optimal quality models.

Home Health Care For Children With Medical Complexity: Workforce Gaps, Policy, And Future Directions.

With the medical and surgical advances of recent decades, a growing proportion of children rely on home-based care for daily health monitoring and care tasks. However, a dearth of available home health care providers with pediatric training to serve children and youth with medical complexity markedly limits the current capacity of home health care to meet the needs of patients and their families. In this article we analyze the workforce gaps, payment models, and policy challenges unique to home health care for children and youth with medical complexity, including legal challenges brought by families because of home nursing shortages. We propose a portfolio of solutions to address the current failures, including payment reform, improved coordination of services and pediatric home health training through partnerships with child-focused health systems, telehealth-enabled opportunities to bridge current workforce gaps, and the better alignment of pediatric care with the needs of adult-focused long-term services and supports.

Home Health Care Providers Struggle With State Laws And Medicare Rules As Demand Rises.

Home Health Care Providers Struggle With State Laws And Medicare Rules As Demand Rises.

Supporting trust in home healthcare providers: insights into the care recipients’ perspective

ABSTRACTSuccessful care in home health for older adults is heavily dependent on the relationships between care recipients and care providers. A key component of that relationship is trust. To investigate trust in this context, we explored what older care recipients perceive as supporting trust in home care providers. Participants discussed three main categories that support trust in a care provider: professional skills (e.g., safety), personal traits (e.g., honesty), and communication (e.g., content). Insights from the care recipients’ perspective are utilized to provide training recommendations for developing trust. For example, care providers should complete tasks in the care recipients’ preferred manner.

Loss of relationship: a qualitative study of families and healthcare providers after patient death and home-based palliative care ends.

Home-based palliative care is care of the patient in their home, while doctors and other healthcare providers (HCPs) make visits as required. Family involvement naturally cultivates a relationship between HCPs and the family. Once the patient dies and home-based palliative care ends, this relationship is abruptly terminated, which may be challenging to both the family and the HCPs. The objective of this study was to understand the thoughts and opinions of HCPs and families on their encountered loss of relationship at the end of home-based palliative care. Perceptions of 63 participants (32 HCPs and 31 family members) were explored using semi-structured interviews and the qualitative research methodologies of grounded theory. HCPs were interviewed at the Temmy Latner Centre for Palliative Care (TLCPC), a home-based palliative care group of physicians, and 2 hospitals in Toronto, while family members were recruited from TLCPC's records of deceased patients. Six overarching themes, relating to HCP-family relationship dynamics, the experience of loss of relationship, and potential solutions, were derived from the data: (I) home palliative care is intimate; (II) dissatisfaction is experienced with abrupt relationship ending; (III) families benefit from open communication, especially after patient death; (IV) HCPs recognize the insufficiency in bereavement resources; (V) benefits are recognized for a system to ease loss of relationship, and lastly; (VI) challenges with introducing such a system concern HCP. Overall, families and HCPs do not like the loss of relationship post-patient death, and recognize the potential benefits of an approach that would allow for communication going forward.

What is the marginal benefit of payment-induced family care? Impact on Medicaid spending and health of care recipients.

Research on home-based long-term care has centered almost solely on the costs; there has been very little, if any, attention paid to the relative benefits. This study exploits the randomization built into the Cash and Counseling Demonstration and Evaluation program that directly impacted the likelihood of having family involved in home care delivery. Randomization in the trial is used as an instrumental variable for family involvement in care, resulting in a causal estimate of the effect of changing the combination of home health-care providers on health-care utilization and health outcomes of the beneficiary. We find that some family involvement in home-based care significantly decreases health-care utilization: lower likelihood of emergency room use, Medicaid-financed inpatient days, any Medicaid hospital expenditures, and fewer months with Medicaid-paid inpatient use. We find that individuals who have some family involved in home-based care are less likely to have several adverse health outcomes within the first 9months of the trial, including lower prevalence of infections, bedsores, or shortness of breath, suggesting that the lower utilization may be due to better health outcomes.

A hybrid memetic-ant colony optimization algorithm for the home health care problem with time window, synchronization and working time balancing

Abstract This paper addresses the routing and scheduling of caregivers in a home health care problem. In order to obtain a valid planning, some skill, time window, and synchronization constraints must be met. Since the increase in demand, organizations providing home health care are eager to optimize the planning of caregivers which is often performed manually. Thus, many works have emerged on this research problem, taking into account new constraints gradually. One interesting aspect is the workload balancing between caregivers. Indeed, the workload must be roughly the same to obtain fairness. Already applied successfully to similar problems, the ant colony optimization algorithm has never been applied to the home health care problem. As a result, an original hybrid algorithm combining memetic and ant colony optimization algorithm is suggested for solving the home health care problem with working time balancing. Computational results on benchmark instances from the literature highlight the efficiency of the proposed hybrid algorithm in comparison with other metaheuristics and a commercial optimization solver.

Signs of Inequality? Variations in Providing Home Health Care Across Care Organizations and Across European Countries in the IBenC Study.

Most countries aim to allocate home health care to those in need in a fair and equal way. Equal allocation implies that the amount of home care a person receives would reflect the level of health impairment and the need for resources. It is not clear whether countries succeed in attaining this. Our objective was to explore signs of (un)equal home health care provisioning across care organizations and across European health countries. We used data of the IBenC study collected from 2718 older community care recipients from 33 organizations in 6 Western European countries (www.ibenc.eu). We benchmarked differences of provided and expected formal care time across organizations and countries. Expected formal care hours were estimated by multiplying the overall sample’s mean formal hours with recipients’ case mix weights from interRAI’s resources utilization group profiles. We found substantial variations in provided formal care time among organizations both within and across countries that could not be explained by the case mix differences of recipients. This implied presence of inequality of home care provisioning. These findings may alert professionals and policy makers striving for equal home health care provisioning for dependent older persons.

Updated Overview of the SEER-Medicare Data: Enhanced Content and Applications.

The National Cancer Institute's Surveillance, Epidemiology, and End Results (SEER)-Medicare-linked database was first created almost 30 years ago. Over time, additional data have been added to the SEER-Medicare database, allowing for expanded insights into the delivery of health care across the cancer continuum from screening to end of life. This article includes an overview of the current SEER-Medicaredatabase, presenting potential users with an introduction to how the data can facilitate innovative epidemiologic and health services research studies. With a focus on the population 65 years and older, this article presents descriptive data on beneficiary demographics, cancer characteristics, service settings, Medicare coverage (eg, Parts A, B, C, and D), and use (number of services or bills) from 2011 to 2015. From 2011 to 2015, 857 056 cancer patients and 601 470 population-based noncancer controls were added to the database. The database includes detailed tumor characteristics and clinical assessments for cancer cases, and demographics and health-care use (eg, hospitals, outpatient facilities, individual providers, hospice, home health-care providers, and pharmacies) for both cases and controls. Although characteristics varied overall between cases and controls, sufficient cancer-specific matched controls are available. Roughly 60% of cases were enrolled in fee for service at cancer diagnosis. The annual average number of claims per case was 60.7 and 92.3 during the year before and after cancer diagnosis, respectively, and 127.5 during the year before death. The large sample size and diverse array of data on cancer patients and noncancer controls in the SEER-Medicare database make it a unique resource for conducting cancer health services research.

A Column Generation-Based Gossip Algorithm for Home Healthcare Routing and Scheduling Problems

Home healthcare (HHC) is a service that dispatches caregivers to people in need of healthcare who live in the home. The task assignment and route generation for caregivers can be formulated as an extension of the well-known vehicle routing problem with time windows (VRPTW). Currently, the most successful exact algorithms for VRPTW are based on a framework combining column generation (CG) and branching. Although such methods could be successful for HHC routing and scheduling problem (HHCRSP) as well, fast approximate algorithms are appealing, especially for large problems. In an early version of this paper, we employed a heuristic distributed gossip algorithm to solve HHCRSP. In this paper, we integrate the gossip algorithm with a local solver based on CG, which makes it an effective algorithm for larger problem instances. As it will be shown with extensive numerical experiments, for large problem instances, gossip-CG performs better than the pure CG. Note to Practitioners —The task of routing and scheduling caregivers for HHC providers can be formulated as a mathematical problem that is theoretically challenging to solve to optimality for large-scale problems involving many clients and caregivers. Although extensive research and tools for tackling this problem already exist, in practice, even in developed countries, it is still common to rely on schedules generated manually by staff. What we present in this paper is the summary of our theoretical work on tackling such problems. The benefit of the framework that we propose, the CG-based gossip method, is that it can be preempted at any time if the staff requires to obtain a good schedule as soon as possible. If ample time is available, one can let our algorithm to run for a longer period of time to generate even shorter routes.

A memetic algorithm for multi-objective optimization of the home health care problem

Abstract Home health care structures provide cares for the elderly, people with disabilities or patients with chronic conditions. Since the increase in demand, organizations providing home health care are eager to optimize their activities. The planning of caregivers' activities must optimize several objectives, often conflicting, that requires an extensive time to obtain a fair and valid schedule. In this paper, we address the multi-objective home health care problem with the aim of ensuring the applicability of the planning. To that end, the objectives considered in the proposed model are the minimization of the total working time of the caregivers, while maximizing the quality of service and minimizing the maximal working time difference among nurses and auxiliary nurses. A memetic algorithm for multi-objective optimization is proposed to solve the problem. Computational results on benchmark instances from the literature highlight the efficiency of the proposed algorithm in comparison with other existing metaheuristics thanks to four comparison metrics. As well, an analysis of the results exposes the trade-off between the three objectives. As a result, requiring a minimum caregivers' travel time solution leads to scarcity of the available solutions and so, cannot be demanding on the quality of the other objectives.

Hidden in Plain Sight: A Guide to Human Trafficking for Home Healthcare Clinicians.

Human trafficking is a global problem reaping $150 billion annually, mainly from commercial sex or forced labor activities involving adult and child victims. Eighty-seven percent of human trafficking victims are known to have been seen by a healthcare provider at least once during the time held captive, but due to lack of awareness, this opportunity to identify and aid victims is often missed. Home healthcare providers have access to homes where human trafficking victims may be hidden in plain sight. It is critical that home healthcare providers know the signs of human trafficking, how to screen a potential victim, how to report any suspicious activities, and ways to remain safe while working in the community. If a human trafficking victim or perpetrator is identified or even suspected, home healthcare providers should move to a safe location and call the 24/7 National Human Trafficking Hotline (1-888-373-7888).

Medication Literacy and Somali Older Adults Receiving Home Care.

Medication literacy is the ability of individuals to access and understand medication information and then use that information to act and take their medication in a safe and appropriate way. The purpose of this study was to explore medication literacy in a group of Somali older adults and their families using qualitative secondary analysis. We conducted an analytic expansion of an existing qualitative study that explored the home healthcare perceptions of Somali older adults and their families. Qualitative data collected from 14 Somali families about home healthcare were reviewed and analyzed for material related to medication literacy. Data analysis revealed a number of important findings related to medication literacy and resulted in the discovery of four themes: Medication literacy is needed among Somali older adults and their families, Using home healthcare (HHC) to improve medication literacy, Better communication is essential to improving medication literacy, and Medication literacy is an intersecting family and social issue. The results of this study indicate that HHC has a role to play in improving the health and medication literacy of these families. They also highlight the need to further explore what techniques, tools, and/or supports HHC professionals need to care for non-English speaking populations. Future research needs to address how to meet the needs of diverse and vulnerable patients like Somali older adults, and how best to prepare HHC providers to do this.

Service provision and quality outcomes in home health for rural Medicare beneficiaries at high risk for unplanned care

ABSTRACTMultiple barriers exist to providing home health care in rural areas. This study examined relationships between service provision and quality outcomes among rural, fee-for-service Medicare beneficiaries who received home health care between 2011 and 2013 for conditions associated with high-risk for unplanned care. More skilled nursing visits, visits by more types of providers, more timely care, and shorter lengths of stay were associated with significantly higher odds of hospital readmission and emergency department use and significantly lower odds of community discharge. Results may indicate unmeasured clinical severity and care needs among this population. Additional research regarding the accuracy of current severity measures and adequacy of case-mix adjustment for quality metrics is warranted, especially given the continued focus on value-based payment policies.

ASSOCIATION BETWEEN THE ORGANIZATION AND ENVIRONMENTAL FACTORS AND WORK INJURIES AMONG HOME HEALTH CARE NURSES

Work-related injuries have an adverse impact on health and safety of the employees, patients, and health care organization. Nurses’ exposure to work injuries is one of the highest rates in home and community care institutions. Nurses working in home health care (HHC) encounter multidimensional risk factors, including the organizational and environmental hazards associated with HHC. The purpose of this cross-sectional study was to examine the relationship between the organization and environmental factors and the work injuries (WIs) as experienced by HHC nurses (HHCNs). A prediction of the significant factors related to work injuries was explored. A self-reported data was obtained from 74 nurses working in nine HHC units in the Makkah Region, KS, using the Safety Home Care Nursing (SHCN) questionnaire. The results showed that the supervisory support (SS) (β = -0.36, p = .009) and the access to a client's home (AC) (β = -0.25, p= 0.05) were negatively affecting the WIs as experience by HHCNs. This implies that the training of Front-line supervisors and HHC providers in safety management and safety communication would improve competence in effective implementation of safety practices. This study suggests to ensure a safe HHC through the execution of an integrative approach involving managers, nurses, and other practitioners, as well as the patients’ and their informal caregivers. Article DOI: https://dx.doi.org/10.20319/lijhls.2018.41.6581 This work is licensed under the Creative Commons Attribution-Non-commercial 4.0 International License. To view a copy of this license, visit http://creativecommons.org/licenses/by-nc/4.0/ or send a letter to Creative Commons, PO Box 1866, Mountain View, CA 94042, USA.