Despite the relatively high turnover rates and increasing demand for homecare, little is known about the costs of turnover for homecare employers. To create effective policies to reduce turnover and associated costs, employers require an understanding of what factors contribute to the costs of turnover. Building upon existing models from labour economic and human resources theories, we worked with subject matter experts from a large homecare employer organization to co-design the first known homecare cost of turnover model. The resulting model accounts for sector-specific cost differences and can be used to estimate the costs of homecare worker turnover. As homecare continues to face high workforce instability, clear estimates of the cost of turnover can guide organizations and decision-makers in the evidence-based design of retention policies and programs to the benefit of homecare workers, funders, those seeking homecare, and the broader health and social care system.

Abstract Introduction Co-production approaches are increasingly used in research. However, they are not often evaluated in care home settings. The study aimed to explore how co-production occurred in a series of workshops around falls management in care homes. Methods Sixteen stakeholders (care home residents and relatives, care home staff, health and social care professionals) participating in co-production workshops in a systematic action research study were invited to take part in a qualitative evaluation. The workshops were developing a model for delivering falls training in care homes across Nottinghamshire. Non-participant observations of workshops explored stakeholder interactions. Nine stakeholders participated in reflection meetings to share their experiences of the process. Framework analysis mapped key themes to the National Institute for Health and Care Research’s (NIHR) co-production principles. Results Nine themes were identified. Sharing power was influenced by opportunities to challenge dominant voices, resulting from the influence of the research team and separate stakeholder groups, and wider integration challenges across the health and social care system. Inclusion of all perspectives was affected by variable involvement of key stakeholders in the workshops and supported by a flexible approach. Respecting and valuing knowledge was influenced by self-confidence and supported by appreciating diverse stakeholder expertise and experiences. All stakeholders reported benefits of participating in co-production workshops, for example helping others and learning about falls management. However, reputational concerns and fatigue were potential harms of participation. Team dynamics changed as relationships developed. Conclusions Co-production was largely a positive experience for stakeholders and the NIHR’s key principles were partially achieved based on our qualitative findings. Co-production in care home settings is a complex process affected by multiple factors, including the individuals involved, stakeholder relationships, organisational priorities, and integration across the system. Future research should consider organisational power dynamics at all stages and create safe spaces for inclusive participation.

Background: Virtual Health Clinics (VHCs) gained widespread adoption during the COVID-19 pandemic, providing accessible care while reducing the need for in-person visits. As home care services continue to evolve post-pandemic, understanding the experiences of both patients and healthcare providers using VHCs is essential, particularly in underserved regions such as Hail, Saudi Arabia. Aim: This qualitative study explores the experiences, challenges and enablers of healthcare providers and home care patients who use virtual health clinics in the Hail region. Methods: Semi-structured interviews were conducted with a purposive sample of five healthcare providers and fifteen home care patients receiving services through the Home Health Care Department at King Khalid Hospital between January and June 2024. Interviews were transcribed and analyzed thematically using an inductive approach supported by NVivo 12 software. Results: Three key themes emerged from the analysis: (1) the need for structured training in virtual care technology, with providers reporting limited preparation and patients expressing confusion during virtual visits; (2) the dual nature of remote communication, which offered time and cost savings but was hindered by poor connectivity in rural areas; and (3) limited access to IT support during virtual appointments, particularly outside standard working hours, which contributed to service disruptions. Limitations: The study’s findings are based on a small sample size from a single hospital, which may limit generalizability. The qualitative design also introduces potential interpretation bias. Conclusion: While virtual health clinics offer clear advantages for home care delivery, their effective implementation depends on addressing operational challenges, including training, communication infrastructure and IT support. These insights provide practical guidance for healthcare administrators and policymakers seeking to expand virtual care services in home-based settings.

Falls cause millions of injuries and deaths annually, making prevention a key priority in home health care (HHC). Traditional fall risk assessments often overlook the complex interaction of personal, environmental, and behavioral factors. This study addresses these limitations by introducing a novel approach that leverages multimodal data, specifically visual frames and structured prompts, to assess fall risk in in-home patients. Using the multimodal large language model (MLLM), LLaVA-NeXTVideo-7B-hf, we analyze simulated in-home patients' video data to enable a more comprehensive and dynamic evaluation of fall risk, paving the way for intelligent, video-based fall prevention in home health care. Preliminary validation using simulated video data demonstrates the feasibility of using MLLMs for such tasks. Simulated in-home patient video data were processed into 24 equally spaced frames. Twelve visually observable fall risk factors extracted from the literature search, categorized as intrinsic, extrinsic, or behavioral, guided the creation of prompts for the MLLM. Standardized prompts were developed by testing the model with concise prompts for simple inferences and elaborated prompts for complex ones. Each prompt was run 3 times, and consensus results were compared with expert evaluations. The model achieved 85.71% accuracy with concise prompts on 7 simple risk factors and 100% accuracy with elaborated prompts on two complex ones. However, the model consistently failed for 2 risk factors that required clinical judgment or had limited visual data. MLLMs like LLaVA-NeXTVideo 7B-hf show strong potential for augmenting fall risk assessment in HHC when guided by well-structured prompts. The approach focuses on visually inferable factors and is intended to complement, rather than replace, clinical evaluation. This proof-of-concept feasibility study shows that MLLMs can support preliminary fall risk analysis using simulated home health care video data and lays the groundwork for future video-based research in this setting, where existing work remains limited. To our knowledge, this is the first study to evaluate the feasibility of MLLM-based video analysis for fall risk assessment in home health care.

Cardiovascular disease (CVD), the leading global cause of death, highlights the critical need for effective blood pressure management. Non-invasive blood pressure (NIBP) monitoring, compared with invasive methods, enables home-based and long-term use, supporting early detection and continuous care. Despite significant progress, challenges remain, including accuracy issues, insufficient validation in real-world settings, limited application-specific sensor designs, and inadequate calibration standards and validation platforms. These gaps call for a systematic review to clarify the unmet needs and future research directions. This article reviews current advances in four key areas: (1) novel NIBP estimation principles designed to minimize user intervention; (2) flexible and wearable electronics that improve accuracy and comfort; (3) integration with theranostic applications and broader healthcare scenarios enabled by NIBP technologies; (4) calibration and validation strategies that enhance reliability and accuracy. With the rapid growth of home healthcare and AI-enabled wearable systems, addressing these challenges is essential to advance personalized, precise and stable cardiovascular medicine.

Development and Validation of a Culturally Adapted Interactive Game-Based Digital Tool for Screening Mild Cognitive Impairment in Older Adults.

Improved Benders decomposition for home healthcare vehicle and drone routing problem in two-echelon supply chains

Aim: This study aimed to evaluate the levels of job satisfaction and professional burnout among healthcare workers (HCWs) providing home health care services (HHSs). Materials and Methods: A cross-sectional, descriptive design was employed. Data were collected through an online questionnaire administered to HCWs assigned to HHS units of public hospitals in Samsun Province, Türkiye. The first six items of the questionnaire assessed participants’ sociodemographic characteristics and duration of service, followed by the Maslach Burnout Inventory and the Minnesota Satisfaction Questionnaire. Results: Eighty five participants completed the survey, with a mean age of 35.71 ± 8.74 years. Gender, age, professional category, and duration of service—both overall and within HHS—had statistically significant effects on burnout levels. Age was positively correlated with emotional exhaustion and personal accomplishment scores (p = 0.027 and p = 0.002, respectively). Internal satisfaction scores of the Minnesota Satisfaction Questionnaire also showed a positive correlation with age (p = 0.035). Emotional exhaustion and depersonalization subscales of the Maslach Burnout Inventory were negatively correlated with all Minnesota Satisfaction Questionnaire subscales (p < 0.001), whereas the personal accomplishment subscale demonstrated a positive correlation with Minnesota Satisfaction Questionnaire scores (all p < 0.001). Conclusion: Higher job satisfaction among HCWs was associated with lower levels of emotional exhaustion and depersonalization and with greater perceived personal accomplishment. Enhancing job satisfaction through organizational and psychosocial support interventions may help reduce burnout and improve overall well-being among professionals working in home health care services.

Characteristics Associated With Home Health Care Referral After Discharge From Hospital.

Vaccination has been a cornerstone of the public health response to the COVID-19 pandemic, particularly in protecting older and frail populations. A detailed characterization of antibody titer dynamics and their determinants represents a crucial step toward optimizing vaccination strategies. However, antibody titers are bounded within assay-specific limited intervals and often display skewness and intra-subject correlation, which limit the suitability of conventional modeling approaches. We analyzed longitudinal antibody titer data from 608 residents and staff members of five nursing homes in Calabria (southern Italy) using beta-generalized linear mixed models (β-GLMMs). This framework enabled simultaneous modeling of the mean humoral response (μ), precision parameter (ϕ), and probability of achieving the maximum immune response (α), thereby providing a comprehensive assessment of factors influencing immune dynamics. Two distinct patterns of antibody titer evolution were identified. Among nursing home residents, stroke was associated with higher antibody concentrations, whereas atrial fibrillation, lower body mass index, non-Alzheimer’s dementia, and chronic obstructive pulmonary disease were linked to reduced responses. The β-GLMM approach allowed for a more accurate identification of demographic and clinical determinants compared with traditional methods. These findings underscore the utility of β-GLMMs for analyzing bounded longitudinal immunological data and highlight key factors shaping vaccine-induced immunity. Such insights may lead to more tailored immunization strategies in vulnerable older populations.

Post-acute care (PAC) utilization following sepsis hospitalization remains understudied, particularly concerning racial and ethnic and urban-rural disparities. To examine trends and disparities in PAC utilization after sepsis hospitalization, focusing on race, ethnicity, and rurality. A comprehensive search of databases (PubMed, CINAHL, Embase, Web of Science, and Scopus) was conducted for eligible studies using data through March 2020. The Social Ecological Model guided the review. Eleven studies met inclusion criteria. Our synthesis found a discontinuous increase in PAC use, with a shift from home discharges toward greater use of nursing homes and home health care after 2006. White patients had higher PAC utilization than racial and ethnic minority individuals. Rural and urban non-teaching hospitals discharged more sepsis survivors to long-term care hospitals, while urban teaching hospitals had more discharges to HHC. This review establishes a pre-reform, pre-pandemic baseline for PAC utilization among sepsis survivors. Despite overall gains, disparities in PAC utilization persist by race, ethnicity, and hospital type. As payment and care delivery models have evolved since 2016, future research should leverage this historical baseline to assess the impact of new policies on equitable PAC access for sepsis survivors.

Summary:Discharge destination following hospitalization plays a critical role in surgical recovery, long-term outcomes, and healthcare resource use. Although postacute care facilities are increasingly used, there is limited literature within plastic surgery addressing their role and implications. This review outlined the continuum of discharge options available to plastic surgery patients, including long-term acute care hospitals, inpatient rehabilitation facilities, skilled nursing facilities, assisted living facilities, postoperative guest suites, and home with or without home health care. Each destination differs significantly in patient acuity, level of available services, and payer coverage. Plastic surgery patients undergoing complex procedures such as free tissue transfer, trauma reconstruction, or burn care may require specialized facilities for wound management, rehabilitation, or close monitoring. Medicare and Medicaid policies influence access, and coverage varies widely across facility types and states. Home discharge is generally associated with superior outcomes and more predictable costs, but nonhome postacute care facilities remain essential for patients with higher medical and functional needs. For plastic surgeons, knowledge of these discharge settings is essential to effective discharge planning, directly impacting readmission rates, reimbursement, and patient recovery. Plastic surgeons must engage actively in discharge planning by advocating for the most appropriate level of care, aligning patient safety, functional recovery, and financial stewardship.

Healing at Home: Receipt of Home Health Care and Patient-Centered Outcomes Among Older Adults After Acute Myocardial Infarction.

BackgroundWith increasing life expectancy and the growing burden of chronic diseases, healthcare systems are shifting from hospital-centered models to community- and home-based care. The use of home mechanical ventilators (HMVs) facilitates early discharge from hospital settings yet creates significant physical, psychological, and social burdens for caregivers. Identifying strategies to reduce ventilator dependency during palliative inpatient care may alleviate these challenges.MethodsThis retrospective, cross-sectional, descriptive study employed a quantitative approach with purposive sampling. The study included 75 bedridden patients who were transferred from intensive care units (ICUs) to palliative care services with a planned transition to home healthcare. A multidisciplinary rehabilitation program encompassing respiratory, physical, nutritional, and psychological interventions was systematically implemented in the palliative care unit. Data on the patients’ functional and nutritional status, as well as pressure ulcer risk scores, were collected and analyzed to evaluate their association with successful weaning from HMV.ResultsAmong the study population, 77.3% (n = 58) were successfully weaned off HMV. Significant predictors of ventilator weaning included higher Early Functional Ability (EFA) scores at admission, particularly in the sensorimotor and cognitive domains, as well as greater improvement in Karnofsky Performance Scores during the palliative stay. Improvements in nutritional and pressure ulcer risk scores were not significantly associated with ventilator weaning.ConclusionsMultidisciplinary palliative care with targeted rehabilitation interventions may effectively reduce HMV dependency in patients transitioning from intensive care. A higher initial functional status and improvements in physical performance are key determinants of successful weaning, potentially lowering the burden on caregivers in home settings.

Background Almost 900,000 patients in the United States living with chronic obstructive pulmonary disease (COPD) require home health care each year. Pharmacists are integral members of the home health care team, especially for older adults living with COPD, because of their expertise in identifying and resolving medication therapy problems (MTPs) during transitions of care. Objective To identify, characterize, and compare the quantities and categories of MTPs in older adults living with COPD who require home health care following hospital discharge. Methods This cross-sectional study involved adults aged 65 years and older living with COPD who were discharged from an academic medical center between June 1, 2023, and November 30, 2023. MTPs were classified using two frameworks: the American Society of Health-System Pharmacists (ASHP) and the Pharmacy Quality Alliance (PQA). Results During the study period, 535 older adults were prescribed home health care, 15 of whom had a hospitalization discharge diagnosis of COPD and were screened for inclusion. Among the 13 patients eligible for inclusion, 92.3% experienced one or more MTPs. Almost 80% of the identified MTPs involved issues related to medication indication: 50% of this cross-sectional cohort were not prescribed medications when clinically indicated, and up to 40% of patients were prescribed medications without apparent indications. The ASHP framework identified more than twice the number of MTPs compared to the PQA framework. Conclusion The ASHP framework may identify more MTPs than the PQA framework in older adults living with COPD who require home health care upon discharge. Further research evaluating pharmacist interventions related to MTPs would be beneficial across diverse settings and patient populations.

Alzheimer's disease and related dementias often remain undiagnosed in home health care, where early symptoms are rarely documented in electronic health records (EHRs). The current study aimed to develop and evaluate a speech-based screening algorithm for detecting mild cognitive impairment (MCI) using routine follow-up calls. Speech data were collected from brief, semi-structured follow-up calls between nurse assistants and patients, Clinical Dementia Rating (CDR) interviews, and structured EHR data (Outcome and Assessment Information Set [OASIS]). Machine learning models were trained on these modalities individually and in combination. Model performance was evaluated using the area under the curve (AUC) of the receiver operating characteristic and secondary metrics. Among 114 participants, the multimodal model combining follow-up call speech and OASIS variables achieved the best performance (AUC = 91.03), outperforming models based on CDR interviews (AUC = 80.67), follow-up calls alone (AUC = 81.09), and OASIS alone (AUC = 78.53). Patients with MCI showed greater comorbidity burden, higher rates of dual eligibility, and lower health literacy compared with cognitively healthy participants. Speech collected from routine follow-up calls, when combined with structured clinical data, can enhance early detection of MCI in home health care. This multimodal, low-burden approach leverages existing care coordination workflows and holds promise for scalable cognitive screening in diverse, aging populations.

Hospitalized older adults with serious illness may be discharged to a skilled nursing facility (SNF) with the hope of improving strength to live independently and receive further disease-directed treatment, or because it is one of the few insurance-covered options for care that provides room and board coverage. For those that do not improve, discharge to a SNF can begin a cycle of costly care transitions between hospital, home with home health care, SNFs, and long-term care facilities, leading to fragmented care and missed opportunities for discussions about preferences for care, illness understanding, and to address distressing symptoms. It can also lead to dying in the emergency room and other locations that are not consistent with patient wishes. In this article, we describe key policies that contribute to high-cost, low-value care near the end of life for older adults using the Medicare SNF benefit. With this foundation, we propose next steps to understand the scope of the problem better and offer solutions to improve care, including increasing palliative care delivery in SNFs and changes to the Medicare SNF benefit to improve hospice access and utilization for beneficiaries who currently experience multiple care transitions near the end of life.

Consistent home health care routing and scheduling problem under time uncertainty

A multi-time-window multi-objective hybrid fleet home health care routing optimization problem considering caregiver utilization and compatibility

Home Health Care Intervention for Patients with Bariatric Surgery regarding their Lifestyle Pattern.