Home Health Care Providers Research Articles

Daily scheduling of caregivers with stochastic times

This paper addresses a daily caregiver scheduling and routing problem arising in home health care or home care service providers. The problem is quite challenging due to its uncertainties in terms of travel and service times derived from changes in road traffic conditions and customer health status in practice. We first model the problem as a stochastic programme with recourse, where the recourse action is to skip customers without services if the caregiver arrives later than their latest starting service time (i.e. hard time window requirements). Then, we formulate the problem as a set partitioning model and solve it with a branch-and-price (B&P) algorithm. Specifically, we devise an effective discrete approximation method to calculate the arrival time distribution of caregivers, incorporate it into a problem-specific label algorithm, and use a removal-and-insertion-based heuristic and the decremental state-space relaxation technique to accelerate the pricing process. Finally, we conduct numerical experiments on randomly generated instances to validate the effectiveness of the discrete approximation method and the proposed B&P algorithm.

A memetic algorithm for a home health care routing and scheduling problem

This work addresses a home health care routing and scheduling problem with time window and synchronization constraints. Each patient is associated with a period of availability according to their preferences while some visits may require the presence of two staff members simultaneously, which requires the synchronization of two visits. In this paper, the problem is studied with hard and soft patients time window and synchronization constraints. We developed a mixed integer programming model and a memetic algorithm featuring two original crossover operators. Experiments are conducted on benchmark instances from the literature as well as new instances based on real life data from a home health care provider in France. The results highlight the efficiency of the memetic algorithm since it provides great results while being flexible to the instance type. Indeed, the memetic algorithm is efficient whether the problem is studied with hard or soft time window and synchronization constraints, various caregivers qualification or several home health care offices.

Elderly Home Health Care Challenges among Health Care Provider in Riyadh at Nursing College Princess Nourah Bint Abdelrhman University

Home health care is a kind of health care provided in the home which is provided by licensed caregiver’s professionals who provide medical treatment needs. So the current study aimed to identify the challenges faced by health care provider for home health care among elderly in Riyadh City, Kingdom of Saudi Arabia. Descriptive design was used for this study among 100 home health care provider. A self-administered questionnaire was used after testing reliability and validity. The result revealed that 77% of the study sample was nurses and 68% was female. Majority of the respondents agree that Saudi community needs home health care. Support from Government agencies and insurance companies for home health care provider considered to be the most challenging. The study found that there was a high statistical significant difference in attitudes between the two groups of health care providers (Gender and Marital status) (with P value 0.10, 0.00 respectively). Home health care in Saudi Arabia is a significant need that merits support and attention.

Impact of the workload definition on the multi-objective home health care problem

Home health care services provide nursing and general hygiene cares in patient homes. Recently, structures providing home health care tend to optimize their activities leading to an increased interest in this problem. An important aspect of the problem is the balancing of the workload between the caregivers. The workload can be defined as the aggregation of several times: the travel time, the time spent on providing cures and the idle time. Because of its multi-objective nature, it is important to find a good compromise between the minimization of working time, the non-satisfaction of patients’ soft time window and synchronization constraints, and the workload balancing. In order to analyze the trade-off between the various objectives, we propose to model the home health care routing and scheduling problem as a multi-objective problem. Different definitions of the workload are studied in order to analyze their impacts on the trade-off between the objectives. A metaheuristic from the literature is used for the experiments. The results highlight the importance of workload definition on the trade-off between the different objectives and the ease of optimizing one objective over the others.

A matheuristic for a multi-depot home health care problem

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. In addition, the growing number of patients is expanding their geographic reach. As a result, home health care structures tend to be located in different offices to get closer to their patients. As a result, caregivers employed by the structures must be assigned to one of the offices so they start and end their workday at their associated office. Unlike the existing literature where an upstream assignment of caregivers is performed to become a parameter of the model, we suggest a mixed-integer programming model of the multi-depot home health care problem without pre-assignment of caregivers to offices. As a result, the assignment of caregivers to the offices is resolved during the resolution of the problem in order to obtain the best possible combinations. In addition, we propose an original matheuristic to solve the multi-depot home health care problem without pre-assignment of caregivers to offices. The experiments are conducted on a set of 56 heterogeneous instances. The results highlight the efficiency of the matheuristic since it provides a low deviation ratio compared to an optimization solver with a faster resolution.

Home Healthcare and the Medicare Fraud Strike Force.

Modern federal healthcare fraud investigations use big data to find outliers among providers who are then targeted for enforcement actions. This approach is being used to pursue an outsized number of criminal cases against home healthcare agencies, resulting in decades-long prison sentences and tens of millions in fines. But it is remarkably transparent, giving home healthcare providers ample opportunity to stay out of harm's way. The government has provided the statistical characteristics by which it searches for fraud among home healthcare agencies, along with the benchmarks it uses to determine who is an outlier. And enforcement actions against home healthcare agencies have consistently targeted the same conduct: payments to payment recruiters and physicians in return for referring patients who often do not need the services billed. This article provides practical advice on how home healthcare agencies can gauge and limit their own legal exposure by monitoring their statistics against the government's benchmarks and by instituting basic controls to prevent targeted conduct.

Trust in Physicians, Continuity and Coordination of Care, and Quality of Death in Patients with Advanced Cancer.

Provider-centered factors contribute to unexplained variation in the quality of death (QOD). The relationship between healthcare providers (HCPs) and patients, bidirectional communication, and consistency of longitudinal care planning are important provider-centered factors. To explore whether the level of trust in HCPs, the quality of continuity of care, and the level of coordination of care among home HCPs are associated with the QOD for cancer patients dying at home. This study was a part of a nationwide multicenter questionnaire survey of bereaved family members of cancer patients evaluating the quality of end-of-life care in Japan. We investigated 702 family members of cancer patients who died at home. The QOD was evaluated from nine core domains of the short version of the Good Death Inventory (GDI). We measured five factors on a Likert scale, including patient and family trust in HCPs, continuity of care by home hospice and hospital physicians, and coordination of care among home hospice staff. A total of 538 responses (77%) were obtained and 486 responses were analyzed. Trust in HCPs was correlated with the GDI score (r = 0.300-0.387, p < 0.001). The quality of care coordination was associated with the GDI score (r = 0.242, p < 0.001). Trust of the patient and family in home hospice staff, as well as coordination of care among hospice staff, are associated with the QOD for cancer patients dying at home.

Safety Risks Among Home Infusion Nurses and Other Home Health Care Providers.

In the United States, home health care (HHC) is a rapidly growing industry and home infusion therapy is a rapidly growing market. HHC can present substantial occupational safety and health (OSH) risks. This article summarizes major OSH risks relevant to home infusion therapy by illustrating them through real-life scenarios collected systematically using qualitative research methods by the National Institute for Occupational Safety and Health-funded research projects at the University of Massachusetts Lowell. The need for home infusion therapy will continue to grow in the future, and safety interventions to prevent or minimize OSH risks are essential.

The home health care problem with working regulations

Due to the geographically dispersed locations of their clients, home health care providers have to perform a complex routing and scheduling task. Besides the well-researched routing problem, the adherence to legal and organizational working regulations is a basis for application in practice. These requirements are already widely incorporated in the nurse rostering problem for stationary institutions, but also have to be considered while generating routes for home care providers. We introduce new and adapted working regulations to the home health care problem. The mixed-integer formulation is adaptable to the requirements of different providers. Our numerical results show that an exact solution approach is noncompetitive with respect to computing time in most cases. We therefore propose a heuristic approach based on an adaptive large neighborhood search to cope with the complexity of the problem. The numerical results are computed on generated but realistic instances as well as on data sets provided in previous publications. The results show that the heuristic achieves good results in comparison to the mixed-integer program in only a portion of the computation time. Additional to a numerical analysis, we investigate the influence of the working regulations on the solutions which indicates the importance of modeling working regulations. If the regulations are neglected, a high number of violations are caused.

A multi-agent system based on reactive decision rules for solving the caregiver routing problem in home health care

Home Health Care (HHC) services are growing worldwide. HHC providers that employ their caregivers have to manage operational decisions such as assigning patients to caregivers and planning the caregivers’ routes. Centralized “off-line” approaches are generally used to deal with both these problems. In this paper, we solved the caregiver routing problem in a dynamic and distributed way using a Multi-agent system (MAS) to simulate caregiver behavior. Four decision rules were developed for the caregivers: NPR (Nearest Patient Rule), NRR (No-wait Route Rule), SRR (Shortest Route Rule), and BRR (Balanced Route Rule). These decision rules were implemented and tested on a multi-agent platform to assess their performances. We designed an experimental plan based on case studies that represent different sizes of HHC provider inspired from real-world examples. The results obtained show the relevance of using local decision rules to plan the caregiver's route.

Post-acute care reform: Implications and opportunities for hospitalists.

Nearly all practicing hospitalists have firsthand experience discharging patients to post-acute care (PAC), which is provided by inpatient rehabilitation facilities, skilled nursing facilities, or home healthcare providers. Many may not know that PAC is poised to undergo transformative change, spurred by recent legislation resulting in a range of reforms. These reforms have the potential to fundamentally reshape the relationship between hospitals and PAC providers. They have important implications for hospitalists and will open up opportunities for hospitalists to improve healthcare value. In this article, the authors explore the reasons for PAC reform and the scope of the reforms. Then they describe the implications for hospitalists and hospitalists' opportunities to Choose Wisely and improve healthcare value for the rapidly growing number of vulnerable older adults transitioning to PAC after hospital discharge.

Athomecare, Inc.: Health Care Services Rollup

The AtHome Care case is currently taught in Susan Chaplinsky's Finance and Private Equity course elective. It is supported by a teaching note for instructors and an Excel spreadsheet for student analysis. This introductory case explores the venture capital (VC) and discounted cash flow (DCF) methods of valuing early-stage companies. OutReach Networks is an unusual start-up company in that it was profitable early in its development and did not have to seek VC funding to support its growth. The company has grown quickly and may soon be a candidate for an IPO. In November 2011, an experienced venture capitalist approaches the founder with an offer to invest $30 million in exchange for 30% of the company. While the founder sees some benefit from the VC's experience in preparing the firm for an IPO and the funding enabling it to scale more quickly, he cannot understand how the VC has arrived at this offer. The founder believes the funding should be worth no more than 15% of his firm. Potential reasons for the disagreement over the valuation are (1) differences in the founder's and investor's view of the company's risk, (2) disagreement over the appropriate set of comparable companies, and (3) differences in the methods used to calculate the percentage equity stake. The case is appropriate for use in courses covering entrepreneurial finance or venture capital. Excerpt UVA-F-1679 Rev. Nov. 26, 2012 ATHOMECARE, INC.: HEALTH CARE SERVICES ROLLUP In mid-April 2010, Clark McCullough, a partner at Ardent Capital, reviewed the final investment memorandum concerning a possible $ 110 million investment in AtHomeCare, Inc., a private company providing home health care services. Over the course of the previous year, Ardent Capital had completed preliminary due diligence, and in the fall of 2009, it had signed a letter of intent (LOI) and had been granted an exclusivity agreement to consider a potential purchase of the company. Although the company fit well within Ardent's current areas of investment focus, the deal had been conceived as a rollup strategy, in which AtHomeCare would serve as an investment platform, and other health care services companies would be acquired to build a larger entity. A large portion of the due diligence had focused on finding a suitable acquisition target, but to date no target had been locked in. . . .

Impact of Community Health Workers on Elderly Patients’ Advance Care Planning and Health Care Utilization

Advance care planning (ACP) is recommended for all persons to ensure that the care they receive aligns with their values and preferences. To evaluate an ACP intervention developed to better meet the needs and priorities of persons with chronic diseases, including mild cognitive impairment. A year-long, pre-post intervention using lay community health workers [care coordinator assistants (CCAs)] trained to conduct and document ACP conversations with patients during home health visits with pre-post evaluation. The 818 patients were 74.2 years old (mean); 78% women; 51% African American; 43% white. Documentation of ACP conversation in electronic health record fields and health care utilization outcomes. In this target population ACP documentation rose from 3.4% (pre-CCA training) to 47.9% (post) of patients who had at least 1 discussion about ACP in the electronic health record. In the 1-year preintervention period, there were no differences in admissions, emergency department (ED) visits, and outpatient visits between patients who did and did not have ACP discussion. After adjusting for prior hospitalization and ED use histories, ACP discussions were associated with a 34% less probability of hospitalization (hazard ratios, 0.66; 95% confidence interval, 0.45-0.97), and similar effects are apparent on ED use independent of age and prior ED use effects. Patients with chronic diseases including mild cognitive impairment can engage in ACP conversations with trusted home health care providers. Having ACP conversation is associated with significant reduction in seeking urgent health care and in hospitalizations.

Effect of the Goals of Care Intervention for Advanced Dementia

ImportanceIn advanced dementia, goals of care decisions are challenging and medical care is often more intensive than desired.ObjectiveTo test a goals of care (GOC) decision aid intervention to improve quality of communication and palliative care for nursing home residents with advanced dementia.Design, Setting, and ParticipantsA single-blind cluster randomized clinical trial, including 302 residents with advanced dementia and their family decision makers in 22 nursing homes. InterventionsA GOC video decision aid plus a structured discussion with nursing home health care providers; attention control with an informational video and usual care planning.Main Outcomes and MeasuresPrimary outcomes at 3 months were quality of communication (QOC, questionnaire scored 0-10 with higher ratings indicating better quality), family report of concordance with clinicians on the primary goal of care (endorsing same goal as the “best goal to guide care and medical treatment,” and clinicians’ “top priority for care and medical treatment”), and treatment consistent with preferences (Advance Care Planning Problem score). Secondary outcomes at 9 months were family ratings of symptom management and care, palliative care domains in care plans, Medical Orders for Scope of Treatment (MOST) completion, and hospital transfers. Resident-family dyads were the primary unit of analysis, and all analyses used intention-to-treat assignment.ResultsResidents’ mean age was 86.5 years, 39 (12.9%) were African American, and 246 (81.5%) were women. With the GOC intervention, family decision makers reported better quality of communication (QOC, 6.0 vs 5.6; P = .05) and better end-of-life communication (QOC end-of-life subscale, 3.7 vs 3.0; P = .02). Goal concordance did not differ at 3 months, but family decision makers with the intervention reported greater concordance by 9 months or death (133 [88.4%] vs 108 [71.2%], P = .001). Family ratings of treatment consistent with preferences, symptom management, and quality of care did not differ. Residents in the intervention group had more palliative care content in treatment plans (5.6 vs 4.7, P = .02), MOST order sets (35% vs 16%, P = .05), and half as many hospital transfers (0.078 vs 0.163 per 90 person-days; RR, 0.47; 95% CI, 0.26-0.88). Survival at 9 months was unaffected (adjusted hazard ratio [aHR], 0.76; 95% CI, 0.54-1.08; P = .13).Conclusions and RelevanceThe GOC decision aid intervention is effective to improve end-of-life communication for nursing home residents with advanced dementia and enhance palliative care plans while reducing hospital transfers.Trial Registrationclinicaltrials.gov Identifier: NCT01565642

Home health nursing care services in Greece during an economic crisis.

The purpose of this review was to describe public home healthcare nursing services in Greece. The effectiveness and the efficiency of home healthcare nursing are well documented in the international literature. In Greece, during the current financial crisis, the development of home healthcare nursing services is the focus and interest of policymakers and academics because of its contribution to the viability of the healthcare system. A review was conducted of the existing legislation, the printed and electronic bibliography related to the legal framework, the structures that provide home health care, the funding of the services, the human resources and the services provided. The review of the literature revealed the strengths and weaknesses of the existing system of home health care and its opportunities and threats, which are summarized in a SWOT analysis. There is no Greek nursing literature on this topic. The development of home health nursing care requires multidimensional concurrent and combined changes and adjustments that would support and strengthen healthcare professionals in their practices. Academic and nursing professionals should provide guidelines and regulations and develop special competencies for the best nursing practice in home health care. At present, in Greece, which is in an economic crisis and undergoing reforms in public administration, there is an undeniable effort being made to give primary health care the position it deserves within the health system. There is an urgent need at central and academic levels to develop home healthcare services to improve the quality and efficiency of the services provided.

Straight Talk About Birth Control: A Contraceptive Education Protocol for Home Care.

Home healthcare providers play a critical role in the prevention of unintended pregnancies by providing evidence-based contraception education during home visits. This article describes an innovative and comprehensive contraception protocol that was developed for Nurse-Family Partnership to improve contraception education for home healthcare patients. The protocol focused on increasing uptake of long-acting reversible contraception (LARC) for high-risk prenatal and postpartum home healthcare patients. The protocol was designed to reduce early subsequent pregnancies and thereby improve outcomes for mothers and their infants. An evidence-based translation project was designed and piloted in three California counties. The protocol consisted of a contraception education module for nurses and a patient education toolkit. The toolkit included an interactive patient education workbook emphasizing LARC methods for nurses to complete with their patients along with other teaching tools. The project was evaluated using pre- and posttest surveys that measured changes in nurses' knowledge, attitudes, and practice before, after, and 2 months after implementation. Outcomes revealed the following statistically significant results: (a) nurses' knowledge doubled at the first posttest and persisted at 2 months, (b) nurses' attitudes improved on two of the three measures, and (c) there was a 17.7% increase in the frequency of LARC birth control education 2 months after implementation. An evidence-based contraception protocol can promote acceptance of LARC methods and improve home healthcare clinician comfort with and frequency of birth control education.

Snowbirds.

Scott Scherpenberg, BSN, RN, is the director of nursing and administration for VNA Healthtrends, Phoenix, Arizona, a leading home healthcare provider. Scott combines his clinical abilities with strong management and leadership background to direct the practice, developing strong clinical staff with top-rated outcomes. The author declares no conflicts of interest. Address for correspondence: Scott Scherpenberg, BSN, RN, VNA Healthtrends, Phoenix, AZ ([email protected]).

Podiatric Issues in Older Adults

A common debilitating condition in older adults which impact their level of independence involve conditions interfering with the ability to walk freely. Podiatric conditions develop over decades of wearing ill-fitted shoes, heels or as a result of chronic systemic conditions which impact the feet. This article will discuss the most common podiatric conditions frequently observed in older adults and steps that home health care providers should take to eliminate the threat of impaired mobility

Abdominal Assessment.

Abdominal pain is one of the most common complaints by patients, and assessment of abdominal pain and associated symptoms can be challenging for home healthcare providers. Reasons for abdominal pain are related to inflammation, organ distention, and ischemia. The history and physical examination are important to narrow the source of acute or chronic problems, identify immediate interventions, and when necessary, facilitate emergency department care.

Aneroid Blood Pressure Manometer Calibration Rates of Devices Used in Home Health.

Hypertension is associated with cardiovascular disease, stroke, and a range of other medical sequelae. Accurate blood pressure (BP) readings, which depend on the integrity and calibration of the measuring device, are essential to identifying suboptimal BP. This study describes calibration rates of aneroid BP devices (a) utilized in home healthcare (HHC) and (b) having the needle resting within the zero accuracy indicator. BP devices from one branch of a home care agency were inspected and checked for calibration according to the protocol set forth by the European Society of Hypertension. Of the 125 devices measured, 78.4% were in calibration. Of the 94 devices with the gauge needle resting in the zero accuracy indicator, 11.7% were not in calibration; whereas, 51.6% of the 31 devices with the gauge needle resting outside the zero accuracy indicator were found not in calibration. Twenty-one devices were not checked for calibration due to inflation bulb malfunction, tubing tears, or excessive wear. Furthermore, visual inspection of the needle placement did not confirm a device as being in or out of calibration. Proper maintenance and routine calibration of BP equipment is foundational to assuring accuracy of BP readings obtained by HHC providers.