Home Health Care Providers Research Articles

Culturally Competent Care for Taiwanese Temporary Residents

This article describes a problem relevant to home health care, that of treating foreign nationals. The problems of providing culturally competent care for Taiwanese nationals stimulated the authors to review the literature and to conduct unstructured interviews with Taiwanese temporary residents of the United States in an effort to generate specific suggestions for improving the negotiation of the American health care system for these people. The first author, herself a member of the population of interest, conducted interviews in Chinese with members of her acquaintance. Findings were that, while language was often problematic, of more concern was the lack of understanding about Taiwanese culture that led health care providers to make inappropriate suggestions to their patients. Suggestions are offered for how home health care providers can decrease the confusion experienced by the Taiwanese patient.

Goal Attainment Scaling: A Responsive Measure of Client Outcomes

Goal Attainment Scaling (GAS) was developed by Kiresuk and Sherman in 1968. Although highly criticized in the early years of its conception, GAS is beginning to be recognized as a reliable, valid, and responsive outcome measurement approach. This article describes the application of GAS, using elderly home health care clients as an example. Reliability and validity issues are examined. Criticism of GAS is often based on traditional psychometric assumptions associated with normative assessment and does not reflect the evaluative nature of the GAS methodology. The advantages and limitations of GAS are discussed. Goal Attainment Scaling has the potential to demonstrate the important contribution home health care programs make to clients by measuring the change that has occurred during their admission to the program. This kind of information is required by policy makers, case managers, and home health care providers to develop policy, allocate limited resources, and offer appropriate and effective services.

Managed Care: Effects on Home Health Care Providers and Stroke Survivors

The advent of managed care has changed the delivery of home health care services for stroke survivors and their families. Because clinicians are providing fewer visits, they need to focus their assessment and diagnoses, interventions, and evaluation steps to offer the most effective, efficient, and economic care possible.

Implications for Home Health and Hospice Care under the New Prospective Payment System

The purpose of this article is to discuss the impact of new federal regulations on home health care. Because the primary changes focus on payment method, aspects of the effect of the prospective payment system (PPS) on home health care patients and providers are explored. The historical background and contemporary rationale for reform are offered, and the issues of quality and ethics are addressed. The article concludes with thoughts on the importance of maintaining the integrity of Medicare/Medicaid programs and a challenge to the idea that a dichotomy exists between cost containment and high quality in health care. With full cooperation and commitment by all involved parties, a balance can be struck in which higher-quality care is provided in a cost-effective manner.

Problems with herbal remedies in anticoagulated home care patients

The increasing popularity of alternative therapies, including herbal remedies, poses new challenges for home health care providers. The cost of herbal remedy use now exceeds $1 billion annually in the United States and is expected to increase. The use of traditional medicine in combination with alternative therapy may lead to complications for patients and their caregivers as evidenced by the adverse effects of certain herbal products in patients who receive traditional anticoagulant or antiplatelet medication.

Estimating an hedonic translog cost function for the home health care industry

Medicare home health care plays an important role in providing cost effective care for the chronically ill and elderly. Long seen as a cost effective substitute for nursing home care, home care has become even more important with expenditures increasing by 31.4% from 1990 to 1996. The purpose of this paper is to provide a short run cost analysis of a sample of home health care providers to gain insight into the efficient provision of home health care services. This paper is a significant improvement over previous studies in that it uses a nationwide database to more accurately represent the multiproduct nature of the industry and uses an hedonic translog cost estimation with desirable economic properties.

Integrating Home Health Care into Managed Care: Getting the Physician Involved

The importance of developing a partnership to establish a health system that will improve the health of individuals in the home, and in the community, is presented from three perspectives: payer, home health care provider, and physician. From all perspectives, physician involvement is necessary for the success of home health care. Strategies to increase physicians' involvement include physician education and enhanced reimbursement, key components to improving their use of home health care services. These two factors were not adequately addressed in the past and must be the focus for the future. However, bringing the partnership of payer, provider, and physician to a reality is not the sole responsibility of just one group. Rather, all participants working together within the system are responsible for the evolution of a new and better health system. Technology will also impact the future practice of medicine and home health care, and will allow providers and patients to have better access to each other. Improved access will ultimately result in increased satisfaction and better outcomes for patients.

The Agency for Health Care Policy and Research guidelines: implications for home health care providers.

The Agency for Health Care Policy and Research (AHCPR) was established in 1989 under the U.S. Department of Health and Human Services as a means to facilitate the development and implementation of clinical practice guidelines that are based on current research and the consensus opinion of experts within a specific area of clinical practice. This article provides a summary of the recommendations in each guideline with implications for home health care nursing practice.

Management of Tuberculosis in Home Health Care

Tuberculosis (TB) continues to be a major public health concern within the United States. In 1993, the World Health Organization (WHO) declared TB a global emergency. An increase in the number of cases, coupled with fewer admissions to hospitals, and shorter lengths of stay have resulted in the majority of people with TB being managed in the home setting. The challenge for health care workers is to promptly identify and treat all cases of TB, identify and screen close contacts, and develop screening programs for high-risk individuals. Home health care providers are often the critical link in the successful management of this clientele.

Monitoring the medications of clients with noninsulin-dependent diabetes mellitus

Noninsulin-dependent diabetes mellitus (NIDDM) (type 2) affects 16 million people in the United States. To effectively monitor such clients in the home, a thorough knowledge of the medications used to control hyperglycemia is needed. Primary failure with monotherapy has been studied and found to occur within 6 years. Combinations of two drug classes now are used to control blood glucose levels. The home health care provider must be aware of the mechanism of action of the different classes of hypoglycemic agents to monitor treatment. This article will discuss the different agents, their mechanism of action, and the use of combination therapies.

Outcome-Based Quality Improvement in the Information Age

The outcomes movement in home health care is expanding rapidly, with strong support from both the industry and Medicare. The Federal government has proposed requiring all Medicare-certified agencies to collect data items from the Outcome and Assessment Information Set (OASIS) to form the basis for standardized riskadjusted outcome reporting as part of a systematic outcome-based quality improvement (OBQI) approach. In addition to contributing to improving patient outcomes, OASIS data items, when combined with other assessment information, utilization data, and cost information, can provide home health care agencies with a powerful integrated information set for internal management and strategic planning.

Enhancing Patient Compliance in the Elderly

Inadequate compliance with medications is a significant contributor to the costs of medical care in every therapeutic area. No matter how severe the consequence, there is no assurance that all patients will take their medications as prescribed. Elderly patients are a particular concern because of their common deficits in physical dexterity, cognitive skills and memory, and the number of medications that they are typically prescribed. To overcome problems of compliance in the elderly, healthcare providers are advised to prescribe a simple dosage regimen for all medications to be taken (preferably 1 or 2 doses daily), to help the patient select cues that assist them in remembering to take doses (time of day, meal-time, or other daily rituals), to provide devices to simplify remembering doses (medication boxes), and to regularly monitor compliance. A variety of compliance aids are available to help patients organise their medications (e.g. plastic boxes) or remember dose times (alarms). Medication packaged in standard pharmacy bottles should be identified with special labels, or dose charts can be provided to check the daily schedule. Single-unit doses, widely used in hospitals, may be cumbersome for elderly patients who have difficulty opening the foil-backed wrappers. Medication boxes with compartments that are filled weekly by the patient, family member or a home healthcare provider are useful organisers that simplify the patient's responsibilities for self-administration. Microelectronic devices can provide feedback that shows patients whether they have been taking doses as scheduled. Some systems are also designed to notify patients within a day if doses were omitted. No system is optimal for all patients, but elderly patients deserve a comprehensive assessment of their needs to enhance medication compliance.

Outcome-based quality improvement in home health care: the OASIS indicators.

The outcomes movement in home health care is expanding rapidly, with strong support from both the industry and Medicare. The Federal government has proposed requiring all Medicare-certified agencies to collect data items from the Outcome and Assessment Information Set (OASIS) to form the basis for standardized risk-adjusted outcome reporting as part of a systematic outcome-based quality improvement (OBQI) approach. In addition to contributing to improving patient outcomes, OASIS data items, when combined with other assessment information, utilization data, and cost information, can provide home health care agencies with a powerful integrated information set for internal management and strategic planning.

The Safe Medical Devices Act and Home Health Care: Risk Management Issues and Solutions

On July 31, 1996, new regulations took effect that were promulgated under the Safe Medical Devices Act (SMDA). These regulations squarely address the home health care provider, creating new reporting and communication challenges for home health care agencies (HHAs). As the months have elapsed, questions have begun to emerge regarding the SMDA regulations that reflect the unique nature of home health care in the distribution and use of durable medical equipment. Reasonable minds might differ on the best way to tackle these issues and the practical aspects of addressing SMDA in home care. This article addresses some of these issues, emphasizing the importance of cogent policy, procedures, inservice education, documentation, and lines of communication.

Innovations in the Management of Heart Failure in the Home Health Care Environment

As home health care providers are confronted with a capitated care environment, the challenge for survival is to provide patients chronically ill with heart failure, the least costliest care in a time constrained and cost contained environment without compromise to quality while ensuring decreased use of emergency department visits and rehospitalizations. Specific to home care, innovation to meet this challenge can be operationalized by network communication incorporating an integrated pathway of service delivery; an interactive patient education manual that can be computer generated; utilization of cardiac mentors in the delivery of care as service office resources; incorporation of a telemanagement and telemonitoring system to enhance patient compliance; and a systematic approach to outcome measurement. Since incorporation of these new frontiers, Advocate Home Health Services has realized a hospital readmission rate of only 4.8% in 30 days or less from last rehospitalization when compared to the national average of 23%.

What can be done about home health fieldwork?

The literature indicates that health care is moving away from institutional care and specialization to the community and home where providers need generalist competencies. As educators strive to prepare students for this environment, fieldwork experiences in the community and home are opportunities for students to develop generalist competencies. Because of the current scarcity of fieldwork sites, in general, scheduling placements is difficult. As educators seek new sites, home health settings and therapists who provide home health care as a component of their service need to be considered. Home health occupational therapy requires a practitioner to adopt a holistic perspective in order to assist clients to function optimally in their home environment. Because a large number of students work in addition to taking classes, they can be encouraged to find jobs as home health aides or chore providers as part-time employment before and during their didactic education. This work experience can help them to acculturate to the home setting. By encouraging students' participation in home health experiences, educators are helping to facilitate generalist competencies.

Liability Risks for Home Health Care Providers under Managed Care Arrangements

Capitation and managed care have created new liability risks for home care providers. The change from fee- for-service to capitated home care delivery reverses economic incentives for providers and gives rise to worrisome conflicts of interest. Unlike fee for-service delivery, capitation has an inherent incentive to underserve the home care patient. Increased contractual linkages, characteristic of managed care, will result in expanded liability. Market trends include acute facilities discharging sicker patients earlier and providers attempting riskier procedures at home. Overall, managed care and capitation offer seductive advantages for home care providers, but bring with them new and serious exposures to liability.

Partnerships between home care providers and client families

We should assume nothing about who “belongs” in a patient's family and how that family defines its functions. Implicit and explicit outsider descriptions of who contitutes a family can bias perceptions and prevent meaningful communication between the family and the home health care providers. Once the key players have been identified, we need to understand, accept, and encourage the client's insider description of family membership in an effort to form beneficial partnerships with them. By identifying family members and functions, we can build on their strengths to create care plans that will use resources effectively and support our clients' mental and physical health.

Assessing the strategy‐performance paradigm: Implications for organizational adaptation in discontinuous environments for home health care providers

Home health care agencies are on the brink of experiencing prospective payment systems which will prove to be a major environmental shift. What will be the best strategy to offset the effects of prospective payment systems? Longitudinal studies of hospitals facing similar pressures may offer the best solution. This paper offers an attempt to address whether proactive or low cost strategies will provide home health agencies with higher firm performance after prospective payment systems.

Health care delivery in a sleep center

This report presents and describes measures developed for the tracking of care provided to patients referred for evaluation to a sleep clinic and center in a U.S. federal health facility. We provide qualitative and quantitative indicators, tracked for a two-year period of time, for system management, information flow, measures of consultation and subsequent identification of apneic activity (Respiratory Disturbance Index > 10) and treatment for sleep apnea, and the satisfaction with diagnostic testing and treatment. Measures of laboratory efficiency were generally stable, except for the time from the clinic visit to PSG and the time from PSG interpretation to the final written report. We have some evidence that patient satisfaction with CPAP/BiLevel care may vary with a change in a home health care provider. Also, there was a surprisingly high rate of replacement of masks during nasal CPAP therapy. Results indicate the feasibility of such an approach and identify certain areas for improvement in process and communication relevant to the management of sleep disordered breathing.