Home Health Care Providers Research Articles

Characteristics of workplace violence prevention training and violent events among home health and hospice care providers.

In the rapidly growing home health and hospice industry, little is known about workplace violence prevention (WVP) training and violent events. We examined the characteristics of WVP training and estimated violent event rates among 191 home health and hospice care providers from six agencies in California. Training characteristics were identified from the Occupational Safety and Health Administration guidelines. Rates were estimated as the number of violent events divided by the total number of home visit hours. Between 2008 and 2009, 66.5% (n = 127) of providers reported receiving WVP training when newly hired or as recurrent training. On average, providers rated the quality of their training as 5.7 (1 = poor to 10 = excellent). Among all providers, there was an overall rate of 17.1 violent events per 1,000 visit-hours. Efforts to increase the number of home health care workers who receive WVP training and to improve training quality are needed.

Environmental Health and Safety Hazards Experienced by Home Health Care Providers

Environmental Health and Safety Hazards Experienced by Home Health Care Providers

Participation Rates and Perceptions of Caregiving Youth Providing Home Health Care.

Little is known about the population of caregiving youth in the United States. We sought to describe the participation rates, demographics, and caregiving tasks among sixth graders served by the American Association of Caregiving Youth (AACY) in its Caregiving Youth Project (CYP) in Palm Beach County, FL and evaluate the perceived benefit of AACY services. Sixth grade enrollment data from eight middle schools between 2007 and 2013 were obtained from The School District of Palm Beach County and the AACY. Data were obtained using a retrospective review of AACY program participant files. These files contained responses to evaluative questions from both students and family members. Overall, 2.2 % of sixth graders enrolled and participated in the program. Among the 396 caregiving sixth graders studied, care recipients were predominantly a grandparent (40.6 %) or parent (30.5 %). Common activities included providing company for the care recipient (85.6 %), emotional support (74.5 %), and assistance with mobility (46.7 %). Youth reported a median of 2.5 h caregiving on weekdays and 4 h on weekend days, while families reported fewer hours (1.6 and 2.3, respectively). At the end of the school year, the sixth graders reported improvement in school (85.5 %), caregiving knowledge (88.5 %), and self-esteem (89.5 %). Slightly over 2 % of sixth graders participated in the CYP. While support services may mitigate the negative effects of the time spent by caregiving youth, more prospective research is needed to better define the true prevalence, tasks, and time spent caregiving among this subpopulation.

Physicians’ attitudes toward home healthcare services in Turkey: A qualitative study

ABSTRACTBackground: Because of the growth of the older population and the prevalence of chronic diseases, home care services (HCS) have become an important aspect of healthcare worldwide. However, various difficulties and deficiencies are present in the provision of these recently implemented services in Turkey. Modifications to home healthcare services are in progress.Objective: Physicians have an active role in home healthcare services. The present study was performed to examine physicians’ attitudes toward this service in detail.Methods: Twenty-six physicians who provide home healthcare services in the city of Ankara were included in the study. We conducted in-depth, semi-structured, face-to-face interviews. The interviews were audio-recorded, transcribed, and qualitatively analysed.Results: Most physicians thought that home care could be provided to patients who are bedridden, are very old, have a chronic disease, have problems leaving the house, or do not have family support. They also expressed displeasure about the abuse of services and discordance of organization between hospitals and primary care centres. They noted that real circumstances in practice were not compatible with regulations and that cooperation and coordination between departments are necessary and important.Conclusion: The current study underlines physicians’ interest in and support of the home care system, which has various drawbacks and limitations. Legislation needs to be further changed to improve the quality of service and eliminate deficiencies in home healthcare.

Environmental Health and Safety Hazards Experienced by Home Health Care Providers: A Room-by-Room Analysis.

The number of personnel providing in-home health care services is increasing substantially. The unique configuration of environmental hazards in individual client homes has a significant impact on the safety and health of home health care providers (HHPs). This mixed-methods study used data from a standardized questionnaire, focus groups, and individual interviews to explore environmental health and safety hazards encountered by HHPs in client homes. The participant sample (N = 68) included nurses, aides, therapists, and owners/managers from a variety of geographic locations. The most often-reported hazards were trip/slip/lift hazards, biohazards, and hazards from poor air quality, allergens, pests and rodents, and fire and burns. Frequency of identified key hazards varied by room, that is, kitchen (e.g., throw rugs, water on floor), bathroom (e.g., tight spaces for client handling), bedroom (e.g., bed too low), living room (e.g., animal waste), and hallway (e.g., clutter). Findings indicate the need for broader training to enable HHPs to identify and address hazards they encounter in client homes.

Home Care Workers' Skills in the Context of Task Shifting: Complexities in Care Work.

Task shifting, which involves the transfer of care work from regulated health-care professionals to home care workers (HCWs), is a strategy to ensure the efficient delivery of home care services in Canada and internationally. Using a feminist political economy approach, this paper explores the effects of task shifting on HCWs' skills. Task shifting may be understood as a form of downward substitution-and an effort to increase control over workers while minimizing costs-as some of health-care professionals' responsibilities are divided into simpler tasks and transferred to HCWs. Our interviews with 46 home health-care providers in Ontario, which focused explicitly on HCWs' role in care provision, problematize the belief that "low skilled" care workers have little control over their work. HCWs' skills become more complex when they do transferred tasks, and HCWs sometimes gain greater control over their work. This results in increased autonomy and mastery for many HCWs. In turn, this serves to reinforce the intrinsic rewards of care work, despite the fact that it is low paid and undervalued work.

The Challenges of Providing Home Health Care for Vascular Patient

The Challenges of Providing Home Health Care for Vascular Patient

Use of the international classification of functioning, disability and health to develop a home health care system

Background: In Thailand, home health care is an essential service for persons with disabilities. TheMedical Service Center, Faculty of Medicine, Mahasarakham University, Thailand had responsibility for providing home health care to people in 6 communities; however, the outcome was not reached the optimum goal of the service. To improve effectiveness of the service, therefore, an action research was conducted to develop a home health care system of the center. The International classification of Functioning, Disability and Health (ICF) was applied in this development as it conformed to the holistic approach and could implement in community setting for several purposes. The research consisted of 2 parts, designing and implementing the system. This report revealed the findings of the first part of the research. Purpose: To explore the perception of the ICF among health personnel who were having roles in home health care service of the center, and to develop ahomehealth care system of the center. Methods: The research was conducted during January to September 2014. Eight health personnel in home health care team of the center participated in the study. They were a pharmacist, 3 nurses and 4 Thai traditional medicine personnel. To obtain the first purpose of the study, each participant was interviewed by the main investigator (PA) using a semistructured interview guide. Examples of interviewed issues were what the ICF was, how to use the ICF and how to apply it to the home health care service. For the second purpose, several group meetings were arranged for all of the participants. The 8 health personnel were encouraged to discuss and express their opinions about problems, supporting factors and barriers of the current home health care service of the center. Body of knowledge about the ICF and its application to health care service was presented to the participants. Then, an ICF-based home health care system of the center was collaboratively developed. Results: All of the participants were not familiar with the ICF and had no idea how to apply it to their works. However, after learning about the ICF and its application from the group meetings, the participants appeared to recognize the ICF as a useful framework for health care service such as goal setting, treatment planning and outcome measurement. In the home health care system developed by the participants, an ICF-based assessment tool with 12 ICF codes and their qualifiers selected from various Comprehensive ICF Core Sets was designed. How to manage and process all data were also established. Conclusion(s): The ICF was possibly used for guiding an effective service of home health care in which health care providers could design goals and appropriate implementation aswell as evaluation for clients in community setting. Further study to explore impacts of the developed home health care system after implementing it for the length of time is needed. Implications: Physical therapists and other health personnel may apply the findings of this study as a guideline for developing home health care services in their contexts.

Understanding sharps injuries in home healthcare: The Safe Home Care qualitative methods study to identify pathways for injury prevention.

BackgroundHome healthcare is one of the fastest growing sectors in the United States. Percutaneous injuries from sharp medical devices (sharps) are a source of bloodborne pathogen infections among home healthcare workers and community members. Sharps use and disposal practices in the home are highly variable and there is no comprehensive analysis of the system of sharps procurement, use and disposal in home healthcare. This gap is a barrier to effective public health interventions. The objectives of this study were to i) identify the full range of pathways by which sharps enter and exit the home, stakeholders involved, and barriers for using sharps with injury prevention features; and ii) assess the leverage points for preventive interventions.MethodsThis study employed qualitative research methods to develop two systems maps of the use of sharps and prevention of sharps injuries in home healthcare. Twenty-six in-depth interview sessions were conducted including home healthcare agency clinicians, public health practitioners, sharps device manufacturers, injury prevention advocates, pharmacists and others. Interview transcripts were audio-recorded and analyzed thematically using NVIVO qualitative research analysis software. Analysis of supporting archival material also was conducted. All findings guided development of the two maps.ResultsSharps enter the home via multiple complex pathways involving home healthcare providers and home users. The providers reported using sharps with injury prevention features. However, home users’ sharps seldom had injury prevention features and sharps were commonly re-used for convenience and cost-savings. Improperly discarded sharps present hazards to caregivers, waste handlers, and community members. The most effective intervention potential exists at the beginning of the sharps systems maps where interventions can eliminate or minimize sharps injuries, in particular with needleless treatment methods and sharps with injury prevention features. Manufacturers and insurance providers can improve safety with more affordable and accessible sharps with injury prevention features for home users. Sharps disposal campaigns, free-of-charge disposal containers, and convenient disposal options remain essential.ConclusionsSharps injuries are preventable through public health actions that promote needleless treatment methods, sharps with injury prevention features, and safe disposal practices. Communication about hazards regarding sharps is needed for all home healthcare stakeholders.

Identifying participation needs of people with acquired brain injury in the development of a collective community smart home

Purpose: This study explored the personalized and collective participation needs of people with acquired brain injury (ABI) living in a future shared community smart home. Methods: An action research study was conducted with 16 persons, seven with ABI, four caregivers and five rehabilitation or smart home healthcare providers. Twelve interviews and two focus groups were conducted, audiotaped, transcribed and analyzed for content. Results: Seventy personalized and 18 collective participation needs were reported related to daily and social activities. Personalized needs concerned interpersonal relationships, general organization of activities, leisure, housing, fitness and nutrition. Collective needs related mainly to housing, general organization of activities and nutrition. Conclusions: Personalized and collective participation needs of people with ABI planning to live in a community smart home are diverse and concern daily as well as social activities.Implications for RehabilitationTo meet participation needs of people with ABI, the design of smart homes must consider all categories of daily and social activities.Considering personalized and collective needs allowed identifying exclusive examples of each.As some persons with ABI had difficulty identifying their needs as well as accepting their limitations and the assistance required, rehabilitation professionals must be involved in needs identification.

Predictors for assessing electronic messaging between nurses and general practitioners as a useful tool for communication in home health care services: a cross-sectional study.

BackgroundNurses providing home health care services are dependent on access to patient information and communicating with general practitioners (GPs) to deliver safe and effective health care to patients. Information and communication technology (ICT) systems are viewed as powerful tools for this purpose. In Norway, a standardized electronic messaging (e-messaging) system is currently being established in health care.ObjectiveThe aim of this study was to explore home health care nurses’ assessments of the utility of the e-messaging system for communicating with GPs and identify elements that influence the assessment of e-messaging as a useful communication tool.MethodsThe data were collected using a self-developed questionnaire based on variables identified by focus group interviews with home health care nurses (n=425) who used e-messaging and existing research. Data were analyzed using logistic regression analyses.ResultsOver two-thirds (425/632, 67.2%) of the home health care nurses returned the questionnaire. A high proportion (388/399, 97.2%) of the home health care nurses who returned the questionnaire found the e-messaging system to be a useful tool for communication with GPs. The odds of reporting that e-messaging was a useful tool were over five times higher (OR 5.1, CI 2.489-10.631, P<.001) if the nurses agreed or strongly agreed that e-messaging was easy to use. The odds of finding e-messaging easy to use were nearly seven times higher (OR 6.9, CI 1.713-27.899, P=.007) if the nurses did not consider the system functionality poor. If the nurses had received training in the use of e-messaging, the odds were over six times higher (OR 6.6, CI 2.515-17.437, P<.001) that they would consider e-messaging easy to use. The odds that a home health care nurse would experience e-messaging as easy to use increased as the full-time equivalent percentage of the nurses increased (OR 1.032, CI 1.001-1.064, P=.045).ConclusionsThis study has shown that technical (ease of use and system functionality), organizational (training), and individual (full-time equivalent percentage) elements had an impact on home health care nurses’ assessments of using e-messaging to communicate with GPs. By identifying these elements, it is easier to determine which interventions are the most important for the development and implementation of ICT systems in home health care services.

Evaluation of demographic characteristics, and general disease state of patients affliated with home health care unit of Malatya State Hospital.

OBJECTIVE:Home Health Care Unit a unit provides health services for elderly, bedridden and individuals with chronic diseases at home along within the frame of the diagnosis, and treatments of the relevant experts. Therefore, it is intended to reduce the probable physical and emotional burden related to the patient that arise by commuting to the hospital, to increase the number of empty beds for other patients and to improve the living standard by reducing the risk of hospital infection. In this study, the demographic characteristics of housebound patients, their general disease and its relationship with age and gender was investigated.METHODS:The following study was performed on 626 active patients of Malatya State Hospital Home Health Care Unit from January to November 2014. Data were analyzed using Microsoft Excel Program.RESULTS:The study included 60.5% (n=379) female and 39.5% (n=247) male patients. The highest group consisted of patients with 80 years or above 37.7% (n=236). Cerebrovascular disease (CVD) (n=95; 25.0%), senility (n=56; 14.8%) and Alzheimer’s disease (n=50; 13.2%) were commonly observed in women. Male patients had CVD (n=54; 21.8%), femur fracture or gonarthrosis which required surgery (n=28; 11.3%), and fracture due to trauma or traffc accidents (n=28; 11.3%), senility and Alzheimer’s disease (n=218.5%).CONCLUSION:In recent years home health care units became even more important after the gradual increase in the elderly population and injuries due to accidents. This study can help to provide home health care units in a more effcient manner by educating the staff and relatives who take care of the patients.

Gestión logística en la prestación de servicios de hospitalización domiciliaria en el Valle del Cauca: caracterización y diagnóstico

This paper presents the first logistics management diagnosis for the health care institutions certified by the Ministry of Health to provide Home Health Care (HHC) services in the state of Valle del Cauca, Colombia. The objective is to characterize how HHC providers make logistics decisions associated with the service delivery process, and to identify improvement and research opportunities in the field. The diagnosis was conducted through the application of a semi-structured questionnaire that evaluated six work axes and the maturity level of service processes. The results show the need for a more integral logistics management supported by the knowledge of the epidemiological and demographic profile of the population in the state.

A matheuristic for routing real-world home service transport systems facilitating walking

This paper provides a solution procedure for a state-dependent real-world routing and scheduling problem motivated by challenges faced in the urban home service industry. A transport service delivers staff members of different qualification levels to clients and picks them up after completion of their services. The possibility to walk to clients, interdependencies, time windows, assignment constraints as well as mandatory working time and break regulations are considered. The introduced matheuristic consists of two stages, identifying potential walking-routes and optimising the transport system. The presented numerical studies are performed with real-world based instances from the Austrian Red Cross, a major home health care provider in Austria. The results show that implementing walking and pooling of trips in solution procedures decreases the number of required vehicles substantially.

Facing diversity under institutional constraints: challenging situations for community nurses when providing care to ethnic minority patients

To explore the challenges faced by community nurses when providing home health care to ethnic minority patients. Norway has a growing number of immigrants, including older immigrant patients. Community nurses who provide home care encounter considerable challenges when delivering services to an increasingly diverse patient population. A qualitative study based on a hermeneutics approach. A qualitative study was conducted involving 19 nurses in Norwegian home health care districts, which had high proportions of minority patients. Data were collected in 2008. We identified three critical aspects of the encounters between community nurses and minority patients. The first was intimate care. Nurses perceived the fear of mistakes and crossing boundaries related to the cultural and religious practices of minority patients as particularly stressful. The second was rehabilitation after stroke. The beliefs of nurses in the benefits of rapid rehabilitation conflicted with those of the minority patients and their relatives who favoured extended rest during recovery. Third, the commitment of community nurses to transparency in the care of dying patients was tested severely when they met relatives who believed in religious explanations for the destinies of patients and who wanted to conceal the true diagnosis from terminally ill patients. Community nurses encountered various challenges due to a lack of experience with highly diverse patient populations. This situation will continue to create difficulties for nurses and minority patients if management support and appropriate training measures are not provided.

A Community College's Perspective on the RIBN Initiative

The Regionally Increasing Baccalaureate Nurses (RIBN) initiative pairs community colleges and private colleges with universities to help nursing students complete a bachelor of science in nursing (BSN) degree early in their career. In the Eastern North Carolina Collaborative of the RIBN initiative, East Carolina University is partnered with 5 community colleges: Beaufort County Community College, Pitt Community College, Lenoir Community College, Roanoke-Chowan Community College, and Craven Community College. All of the partners in this collaborative have rigorous nursing programs and know how valuable the RIBN program can be to our region. In this sidebar, I will specifically describe Beaufort County Community College’s perspective on the RIBN initiative. Beaufort County Community College serves not just the county of Beaufort but also Hyde, Tyrrell, and Washington counties—essentially, the landmass between the Pamlico and Albemarle sounds. In total, our service area is slightly more than 2,000 square miles [1]. In addition, students from neighboring Martin County who wish to pursue nursing may also attend Beaufort County Community College, because Martin Community College does not offer a nursing program. The North Carolina Department of Commerce currently designates all of these counties as tier 1 counties (a designation given to counties that are most economically distressed); residents of these rural counties face barriers such as limited infrastructure, a higher unemployment rate, limited access to health care, and limited access to higher education [2]. When the leaders of the nursing program at Beaufort County Community College were approached about the RIBN concept, we immediately realized that participation in this initiative would allow our program to become part of an affordable solution for students who wanted to earn a BSN degree. Our program’s nursing graduates overwhelmingly choose to stay in the rural communities in which they live. They are employed by long-term care facilities, small community hospitals, physician offices, and agencies that provide home health care or hospice care. These employers have not had access to an applicant pool of nurses with baccalaureate degrees, but we believed that the RIBN initiative could change that. Thus the RIBN program will have a significant positive impact on rural students who wish to pursue a BSN degree and on health care establishments in the region. The RIBN initiative has also prompted a frank discussion of how we can better prepare students in the traditional associate degree in nursing (ADN) program so that they are better positioned to pursue further education once they graduate from Beaufort County Community College. This conversation led to a paradigm shift in the way we advise students. Historically, we gave our prenursing students a curriculum plan that could be completed in 2 years. If they wanted to continue their education and earn a BSN degree after completing the ADN program, they faced the challenge of having to take college algebra, statistics, microbiology, additional courses in the humanities, and other transfer courses; this meant having to study for an additional year and a half—while working a full-time job—before they could apply to a RN-BSN program. However, we now encourage prenursing students to take the more advanced courses needed to satisfy transfer credit requirements, instead of taking lower-level courses that fulfill only the minimum requirements for the ADN. Currently, approximately 20% of our students take courses that would fulfill BSN requirements, but we hope to increase this percentage. Our lofty goal is that 75% of ADN graduates will need only the university-level nursing courses to obtain their BSN degree. As part of this shift, we are currently in the process of reviewing articulation agreements for the RN-BSN programs; these agreements provide a simplified, guaranteed transfer process. We are also increasing enrollment in transfer courses, providing information to students regarding the RN-BSN admission requirements of nearby universities, and realigning our ranking procedure to give “points” to students who take more advanced courses that provide transfer credits. Over the next few years, we hope to significantly increase the percentage of nursing students at Beaufort County Community College who enroll in the RIBN program. The RIBN program and other initiatives are better preparing our students to function in and lead the health care establishments in our communities. With the changes that are now taking place in national health care policy, we are going to need many new leaders to help our rural communities navigate through the storm.

Preventing Burns in the Elderly

Burn injury to individuals older than 60 years occurs with a frequency that is disproportionate to that of all other victims except the very young. Burns continue to remain a major healthcare problem in the United States and globally. Seniors 65 years and older make up 13.7% of the total population of the United States, and these numbers are expected to increase during the next 30 years (). Further, older adults who live alone are 30% more likely to suffer an unintentional injury than the rest of the population. As seniors age, their potential for suffering a fire or burn-related injury increases because of the aging process, comorbidities, and limited financial means. These factors describe a vulnerable population in need of protection and safety. This article assists the home healthcare provider to recognize the characteristics and vulnerability of the older adult as related to a burn injury. Guidelines that will assist the home healthcare provider in promoting a safe and comfortable environment are discussed.

Is OASIS Effective in Predicting Rehospitalization for Home Health Care Elderly Patients?

Using the Outcome and Assessment Information Set (OASIS), this study examined the feasibility of using OASIS items to identify direct and indirect factors contributing to rehospitalization among elderly patients receiving home health care. The outcomes revealed that being male, having a median level of cognitive impairment, a lower level of functional ability, and the absence of support, such as environmental support, psychosocial support, or facilitated medical care directly contributed to rehospitalization. While being older, obese, having a poorer clinical status, receiving ADL and/or IADL and less frequent informal care contributed to rehospitalization indirectly through decreased functional ability. Home health care providers may take full advantage of OASIS data, assessing both the direct and indirect factors leading to rehospitalization to identify patients at risk and intervene when needed.

Transition of Care in Patients With Heart Failure

Heart failure (HF) affects 6 million Americans, has an expected increasing prevalence in the next 20 years, and has a 5-year mortality rate of 50%. It represents the number one reason for hospitalization in patients older than 65 years. Recent legislation has increased the accountability of care of patients with HF, specifically readmission rates for HF in less than 30 days. This increased focus on HF readmission rates has led many health care organizations to reassess transition-of-care issues (i.e., from home to hospital, from hospital to home) and possible interventions to positively impact these readmission rates. During this process, home health care providers play an integral role and should be aware of possible issues to ensure optimum care for patients.

Can the Care Transitions Measure Predict Rehospitalization Risk or Home Health Nursing Use of Home Healthcare Patients?

The Care Transitions Measure (CTM) was designed to assess the quality of patient transitions from the hospital. Many hospitals are using the measure to inform their efforts to improve transitional care. We sought to determine if the measure would have utility for home healthcare providers by predicting newly admitted patients at heightened risk for emergency department use, rehospitalization, or increased home health nursing visits. The CTM was administered to 495 home healthcare patients shortly after hospital discharge and home healthcare admission. Follow-up interviews were completed 30 and 60 days post hospital discharge. Interview data were supplemented with agency assessment and service use data. We did not find evidence that the CTM could predict home healthcare patients having an elevated risk for emergent care, rehospitalization, or higher home health nursing use. Because Medicare/Medicaid-certified home healthcare providers already use a comprehensive, mandated start of care assessment, the CTM may not provide them additional crucial information. Process and outcome measurement is increasingly becoming part of usual care. Selection of measures appropriate for each service setting requires thorough site-specific evaluation. In light of our findings, we cannot recommend the CTM as an additional measure in the home healthcare setting.