Home Health Providers Research Articles

Home User Survey: Medical Device Labeling Instruction Information

<i>Home User Survey:</i> Medical Device Labeling Instruction Information

Multiple sclerosis and disease-modifying therapies

Over the past 18 years, treatments for multiple sclerosis (MS) called disease-modifying therapies (DMTs) have been developed. These therapies are designed to decrease the number of MS attacks, and to slow the progression of the disease. They have become a standard part of the current treatment for MS. There are different classes of the currently available DMTs: interferons, glatiramer acetate, natalizumab, and mitoxantrone. Although they are effective, these medications have significant side effects, and many are very expensive. The study by Noyes et al.1 was designed to create a new model to examine the cost-effectiveness of DMTs for relapsing-remitting MS in the United States. Researchers used data from an ongoing survey that was sent to over 2,000 people in the United States with MS. Twice a year, participants were asked questions about health care utilization. In other words, they were asked about things like how often they saw a doctor, went to the hospital, or visited the emergency department. Once a year, the same group was asked questions about income, insurance, and their work situation. The researchers examined over 800 of the surveys. Based on this, they estimated the cost of the person's health care. This included the number of hospital stays, outpatient treatments, emergency room visits, office visits, mental health visits, home health provider and home health aide visits, and laboratory and MRI studies. Since each hospital might have different charges for each procedure of tests, the authors used average Medicare reimbursements and published rates for home care to make an estimate of the overall cost of health care for MS. Lost productivity costs were also measured. The authors estimated how …

Analysis and proposed model of family caregivers' relationships with home health providers and perceptions of the quality of formal services.

Relationships between families and home health nurses promote effective care and service access for those at end of life, positive caregiver experiences, and satisfaction with care. This study explores family caregivers' accounts of relationships with home care nurses; findings inform a model of relationships and satisfaction with home health services. Ethnographic, qualitative interviews were conducted with 26 bereaved caregivers in one Western Canadian regional health agency. Data analysis was informed by symbolic interactionism. Participants described their relationships with home care nurses and spoke about their assessments of the care provided. Findings highlighted the importance of the length, frequency, and continuity of contact, conversation, socializing, and sharing information. Participants were cognizant of their own and care recipients' roles in building relationship. Nurse behaviors demonstrating affection, acknowledgment, commitment, and understanding were appreciated. A model links relationship preconditions, relational demonstrations, and perceived care quality and may be used to identify points of intervention.

The Patient Protection and Affordable Care Act: Health Care Fraud Enforcement Disguised as Reform and What It Means for Home Health and Hospice Providers

The Patient Protection and Affordable Care Act presents new challenges to home health and hospice providers. This article discusses those challenges, along with the impacts that may result from this Act’s implementation. Compliance programs and disclosure are among the implications presented.

Challenges for Home Health Care Providers: A Needs Assessment

ABSTRACTHome health care is the delivery of predominantly medically related services to patients in a home setting rather than in a medical facility. It provides substantial benefits over traditional, hospital-based health care, such as supporting older adults’ independence and quality of life, as well as being more cost-effective. This aspect of the health care industry could be enhanced through increased technological supports. When providing health care in a home setting, formal caregivers, such as certified nursing assistants (CNAs), registered nurses (RNs), physical therapists (PTs), and occupational therapists (OTs), are faced with many challenges that impede their ability to perform their jobs. Technological interventions have the potential to alleviate many of these challenges. However, to achieve this potential, new technologies must be created to meet the needs of home health care providers. To date, these providers’ specific and most critical needs are not thoroughly understood. This understanding can be gained by conducting a detailed needs assessment that captures the common challenges and difficulties that home health care providers encounter. We conducted a needs assessment comprising three phases: (a) an extensive literature review of research regarding the needs of home health providers, both hospital and home-based (CNAs, RNs, PTs, and OTs); (b) subject matter expert interviews with experienced individuals from home health care; and (c) structured interviews with CNAs. We identified several significant sources of frustration and difficulty faced by CNAs including medical device usage, patient education, family involvement, provider isolation, and barriers to communication. This analysis provides an understanding of the challenges confronting home health care providers that can provide guidance for interventions. Future home health care technology can be developed to specifically target these workers’ most urgent needs and allow them to perform their jobs with greater ease. Moreover, RNs, PTs, and OTs can benefit from understanding some of the challenges faced by their teammates in the home health care process.

E Health Records and Information Exchange

E Health Records and Information Exchange

Cross border reproductive care in six European countries

The quantity and the reasons for seeking cross border reproductive care are unknown. The present article provides a picture of this activity in six selected European countries receiving patients. Data were collected from 46 ART centres, participating voluntarily in six European countries receiving cross border patients. All treated patients treated in these centres during one calendar month filled out an individual questionnaire containing their major socio-demographic characteristics, the treatment sought and their reasons for seeking treatment outside their country of residence. In total, 1230 forms were obtained from the six countries: 29.7% from Belgium, 20.5% from Czech Republic, 12.5% from Denmark, 5.3% from Slovenia, 15.7% from Spain and 16.3% from Switzerland. Patients originated from 49 different countries. Among the cross border patients participating, almost two-thirds came from four countries: Italy (31.8%), Germany (14.4%), The Netherlands (12.1%) and France (8.7%). The mean age of the participants was 37.3 years for all countries (range 21-51 years), 69.9% were married and 90% were heterosexual. Their reasons for crossing international borders for treatment varied by countries of origin: legal reasons were predominant for patients travelling from Italy (70.6%), Germany (80.2%), France (64.5%), Norway (71.6%) and Sweden (56.6%). Better access to treatment than in country of origin was more often noted for UK patients (34.0%) than for other nationalities. Quality was an important factor for patients from most countries. The cross border phenomenon is now well entrenched. The data show that many patients travel to evade restrictive legislation in their own country, and that support from their home health providers is variable. There may be a need for professional societies to establish standards for cross border reproductive care.

Dying Badly at Home: Preventing and Managing Symptomatic Crises (506)

Objectives 1. Discuss common lapses in communication and information transfer, and gaps in transitions of care from a regional referral hospital to the home that result in symptom crises for hospice patients. 2. Identify strategies and specific steps in planning for discharge and transitions of care, including a useful checklist that can prevent most crises from occurring. 3. Discuss the Hospice Symptom Security Order Set (Hospice Symptom SOS), a packet of three parenteral medications prescribed and dispensed to hospice patients and families at the time of discharge from the referral hospital, for use by hospice nurses only at the time of a symptomatic urgency. Symptomatic crises can subvert a patient’s and family’s goal of a peaceful death at home. Seriously ill patients and their families highly value freedom from pain, anxiety, and shortness of breath in the last days of life. Palliative care and hospice programs should be able to anticipate most symptom problems and assure patients and their families that adequate crisis prevention and early crisis management plans will be in place. Rural settings impose challenges of potential delays in treating uncontrolled symptoms if medications are not immediately available in the home. Hospice nurses may have to travel long distances in adverse weather. Rural pharmacies often have limited hours and limited familiarity with or stocks of palliative medications; therefore, key medications may not be readily available. A survey of New Hampshire hospice programs revealed significant variability content and use symptom management medication kits. We present data on problems of care for seriously ill patients derived from a Transitions of Care Survey conducted among regional hospital, home health, and hospice providers in northern New England. We also discuss specific programmatic and regional quality improvement initiatives that respond to these problems. Components include a Hospice Discharge Checklist, Palliative Care Formulary Guidelines, and the Hospice Symptom Security Order Set. The Hospice Symptom SOS is an individualized packet of three parenteral medications that are prescribed for hospice patients at time of discharge from our regional tertiary care hospital. These medications are intended to be used only by a hospice RN in a symptom crisis. This protocol allows for effective response to seizures, accelerating pain, and agitation. The medications are provided to the patients free of charge, along with appropriate tools for administration. Information regarding the use and acceptance of the Hospice Symptom SOS will be discussed.

Health Reform Is Toying With LTC Change

Health Reform Is Toying With LTC Change

Fall Risk Assessment &amp; Prevention in Home Care

Falls happen. Fortunately, there are usually no serious consequences in the general population. However, when looking at the microcosm of the older person, falls frequently occur and are often life changing. In the home care world, where the majority of patients are either older and/or infirmed, falls are even more frequent and result in serious consequences to patients and their families. Although the impact of falls on patients is well documented, the impact of falls on home health providers is more indirect and deserves discussion.

Elders at Risk During Disasters

Recent natural and manmade disasters such as the September 11, 2001 terrorist attacks, the hurricanes of 2005, and Chicago heat waves demonstrate the vulnerability of older adults to such events. In this article, the specific physical, psychosocial, and cultural characteristics of older adults that place them at greater risk during disasters and emergencies are discussed. Unique concerns of older adults and their families in disasters and emergencies are addressed. In addition, the impact that these characteristics have on the ability of older adults to respond to such events and recover from them is discussed. Finally, strategies that home health providers can use in working with vulnerable older adults are explored.

The Global Emergence of Advanced Practice Nurses in Providing Home and Community Health Care Services

Organizations, health systems, and interested individuals globally are assessing and investigating issues related to community health care services, home health management, and advanced nursing practice. Scarcity of financial and human resources has motivated health care policy makers to rise to the challenge to explore skill mix in the health care workforce in the hope of improving multidisciplinary collaboration in the provision of care for the world's populations. Nurses with advanced knowledge and skills are at the forefront of providing health care in home-based and community settings. This article describes the extent of this global phenomenon as it relates to advanced nursing practice and identifies a variety of international strategies utilized to introduce advanced practice nurses into health care systems.

Respite: Cultural Values in North American and Caribbean Caregiving

Providing home health care to family members presents many physical and psychological stressors. Health care professionals frequently counsel family caregivers to seek respite by temporarily delegating caregiving responsibilities to others. However, when viewed from the perspective of rhetoric, definitions of respite as private time away from the care recipient are culturally bound ideographs and may not be appropriate outside North America. This qualitative study explored North American–trained social workers practising on the Caribbean island of St. Kitts as they promoted a concept of respite care defined by North American norms. Family caregivers interviewed rejected this model of respite care, situating their caregiving within the context of established family relationships.

Hurricane Emergency Planning by Home Health Providers Serving the Poor

Five agencies providing home health care to indigent populations in New Orleans, Louisiana were evaluated in terms of emergency planning and implementation. This was to help improve response to community disasters for indigent populations. Preparation for Hurricane Katrina was examined looking at interaction with local and state departments of health. It was found that the state dept of health provided leadership in making the emergency plans, but not in implementation. Local departments of health appeared to have very little responsibility in emergency planning. Although every agency had a plan, when it came to implementation there was lack of coordination and breakdown in communication at all government levels. Recommendations for future policy include: 1) early evacuation of special needs patients; 2) improved training of staff to include practice drills; 3) improve communication systems; and, 4) increased funding of state and local departments of health to provide training.

Health Coaching

Health coaching is quickly emerging as a new approach of partnering with patients to enhance self-management strategies for the purpose of preventing exacerbations of chronic illness and supporting lifestyle change. Medicare is now pilot testing this approach for patients with congestive heart failure and diabetes. With acute care hospitalization an outcome of great interest to us all, health coaching is an exciting technique worthy of consideration by home health providers.

CPT Code Changes for 2007

<i>CPT</i> Code Changes for 2007

Validation of the Burden Index of Caregivers (BIC), a multidimensional short care burden scale from Japan

BackgroundWe constructed a concise multidimensional care burden scale that reflects circumstances unique to Japan, with a focus on intractable neurological diseases. We surveyed 646 family caregivers of patients with intractable neurological diseases or stroke using 28 preliminary care burden scale items obtained from qualitative research. The results were used to finalize the feeling of care burden scale (BIC: burden index of caregivers), and verify its reliability and validity.MethodsThe survey was conducted among caregivers providing home health care to patients with intractable neurological diseases (PD [Parkinson's disease], SCD [spinocerebellar degeneration], MSA [multiple system atrophy], and ALS [amyotrophic lateral sclerosis]) or CVA (cerebrovascular accident) using a mailed, self-administered questionnaire between November, 2003 and May, 2004.ResultsResponse rates for neurological and CVA caregivers were 50% and 67%, respectively, or 646 in total (PD, 279; SCD, 78; MSA, 39; ALS, 30; and CVA, 220). Item and exploratory factor analyses led to a reduction to 11 items, comprising 10 items from the 5 domains of time-dependent burden, emotional burden, existential burden, physical burden, and service-related burden; and 1 item on total burden. Examination of validity showed a moderate correlation between each domain of the BIC and the SF-8 (Health related quality of life scale, Short Form-8), while the correlation coefficient of the overall BIC and CES-D was 0.62. Correlation between the BIC and ZBI, a preexisting care burden scale, was high (r = 0.84), while that with the time spent on providing care was 0.47. The ICC (Intraclass correlation coefficient) by test-retest reliability was 0.83, and 0.68 to 0.80 by individual domain.ConclusionThese results show that the BIC, a new care burden scale comprising 11 items, is highly reliable and valid.

Health care utilization among Medicare-Medicaid dual eligibles: a count data analysis

BackgroundMedicare-Medicaid dual eligibles are the beneficiaries of both Medicare and Medicaid. Dual eligibles satisfy the eligibility conditions for Medicare benefit. Dual eligibles also qualify for Medicaid because they are aged, blind, or disabled and meet the income and asset requirements for receiving Supplement Security Income (SSI) assistance. The objective of this study is to explore the relationship between dual eligibility and health care utilization among Medicare beneficiaries.MethodsThe household component of the nationally representative Medical Expenditure Panel Survey (MEPS) 1996–2000 is used for the analysis. Total 8,262 Medicare beneficiaries are selected from the MEPS data. The Medicare beneficiary sample includes individuals who are covered by Medicare and do not have private health insurance during a given year. Zero-inflated negative binomial (ZINB) regression model is used to analyse the count data regarding health care utilization: office-based physician visits, hospital inpatient nights, agency-sponsored home health provider days, and total dental visits.ResultsDual eligibility is positively correlated with the likelihood of using hospital inpatient care and agency-sponsored home health services and the frequency of agency-sponsored home health days. Frequency of dental visits is inversely associated with dual eligibility. With respect to racial differences, dually eligible Afro-Americans use more office-based physician and dental services than white duals. Asian duals use more home health services than white duals at the 5% statistical significance level. The dual eligibility programs seem particularly beneficial to Afro-American duals.ConclusionDual eligibility has varied impact on health care utilization across service types. More utilization of home healthcare among dual eligibles appears to be the result of delayed realization of their unmet healthcare needs under the traditional Medicare-only program rather than the result of overutilization in response to the expanded benefits of the dual eligibility program. The dual eligibility program is particularly beneficial to Asian and Afro-American duals in association with the provision of home healthcare and dental benefits.

Analysis of the Relationships between Visiting Nurses and Home Helpers Providing Home Health Care to the Frail Elderly

Analysis of the Relationships between Visiting Nurses and Home Helpers Providing Home Health Care to the Frail Elderly

Unmet Need and Problems Accessing Specialty Medical and Related Services Among Children with Special Health Care Needs

To extend what is known about parent reports of their child's need for specialty medical and related services, unmet need, and specific types of access problems among children with special health care needs (CSHCN). Using data from a 1998-1999 20-state survey of families of CSHCN, we examined differences in parent report of need for services by child characteristics, investigated parent report of unmet need and access problems by service area and number of services needed, and estimated the likelihood of four access problems and unmet need by child, family, and health insurance characteristics. Overall, the sample children had numerous service needs, although the prevalence of need varied by service type and child characteristics. Reports of unmet need were greater for older children and for children with multiple service needs, unstable health care needs or a behavioral health condition, parents who were in poor health or had more than a high school education, and families whose insurance coverage was inconsistent or lacked a secondary plan. Reports of access problems were greatest for mental health and home health services. The two most prevalent access problems were finding a skilled provider and getting enough visits. The results underscore the importance of finding new ways to link children with behavioral health problems to mental health services, implementing coordinated care and the other core dimensions of the medical home concept, increasing the number of specialty pediatricians and home health providers, and expanding coverage for a wider range of mental health services.