Home Health Workers Research Articles

Visualizing veterans’ care: Understanding the breadth of older veterans’ paid and family support network and implications for cancer care in the older adult population.

e13777 Background: Many older adults rely on a complex network of paid and unpaid caregivers to age safely at home. Strong social networks have been long associated with improved cancer treatment outcomes in older adults. Yet medical records often only capture a primary family caregiver, and assessing support networks has not been a routine part of the equation in cancer treatment planning. We tested a novel visual tool, care mapping, with older veterans to better understand the scope of their caregiving networks. Methods: We created collaborative care maps with 10 dyads/triads of veterans and their primary paid and family caregivers receiving care at a large, urban, Veterans Health Administration medical center. Veterans were age 65+ and eligible for VA-paid home care. 50% of the veteran cohort had a cancer diagnosis. We compared the maps to veterans’ electronic medical records (EMRs) and assessed care network structure, function and adequacy. Results: For most veterans, care maps identified a larger number of care partners than EMRs alone. Functional, medical, socioemotional and spiritual supports included family, paid aides, neighbors, veteran service organizations and community groups. Unmet needs included inadequate home health workers to assist with functional decline associated with malignancy diagnosis. Veterans and caregivers largely described their networks as adequate, but mapping conversations surfaced a need for contingency care plans to relieve caregiver strain or if a caregiver could no longer provide support. Conclusions: Cancer care in older adults requires a broad, comprehensive approach and innovative ways to identify caregiver support. Such collaborative care maps can impact clinical outcomes by ensuring treatment adherence and symptom surveillance.

1947 Process evaluation of a home-based intervention to promote independence among older people living with mild frailty

Abstract Introduction Frailty is a condition that makes it increasingly difficult for individuals to recover from adverse health events and gradually erodes independence. NHS interventions in England have focused on those with more severe frailty. We tested HomeHealth, a home-based, tailored, multi-domain (six-session) behaviour change intervention to promote independence in the over-65s living with mild frailty, in a RCT recruiting 388 people (intervention 195; control 193). HomeHealth was delivered by the voluntary sector in three diverse areas and addressed mobility, nutrition, socialising, and psychological goals, among other domains. We aimed to explore acceptability, participant engagement, and experiences of delivering and receiving the service. Methods Following a mixed-methods approach, we extracted quantitative data on types of goals and progress towards goals from Health and Wellbeing plans and appointment checklists. Between July 2022 and May 2023, we interviewed 49 older participants, 7 HomeHealth workers and 8 stakeholders. Older people were purposively sampled for diversity in socio-demographic characteristics, cognitive and physical functioning, intervention adherence and allocated HomeHealth worker. Interviews explored their motivations to engage; experience of participation, delivery and study support followed by their suggestions for improvement. We analysed qualitative data thematically and quantitative data descriptively. Results Most participants set mobility goals (49%), followed by a combination of goals (31%), and made moderate progress towards these. The intervention (completed by 93.3% participants) was positively received, boosted participants’ confidence, and provided emotional support. Participants reported that sometimes behaviour was maintained post-intervention, but further appointments would have been welcomed to fill the gap in other services. However, some people found it difficult to identify goals to work on, particularly when they already felt independent and well supported. Conclusions Services to support older people with mild frailty are acceptable, have good engagement, and can lead to behaviour change, particularly among those who self-identify a need for change.

Immigration enforcement and the institutionalization of elderly Americans

This paper examines the relationship between immigration enforcement and institutionalization rates of the elderly. Exploiting the staggered implementation of the Secure Communities (SC) immigration enforcement program across U.S. counties from 2008 through 2014, we show that SC led to a 0.26 percentage points (6.8 percent) increase in the likelihood that Americans aged 65 and above live in an institution. Supportive of supply shocks in the household services market as a central mechanism, we find that the elderly who are most likely to purchase domestic worker services are also the most likely to move into nursing homes following the implementation of SC. Additionally, we find suggestive evidence of significant reductions in the work hours of housekeepers, personal care aides, and home health workers hinting at the critical role of negative supply shocks in occupations that facilitate aging in community.

PERSPECTIVES OF THE HOME HEALTH WORKFORCE ON TRAINING

Abstract As more older adults desire to age in place, home health workers are becoming a vital component of the healthcare workforce. The last large scale nationwide survey among home health workers was conducted in 2007. There has been a variety of research in this area since then; however, the majority of studies are small and qualitative in nature which may limit their generalizability. Understanding the opinions and perspectives of home health workers is vital to retaining this important part of the healthcare workforce. For the current study a broad sample of home health workers (n=1446) including home health aides, hospice health aides, personal care aides, CNAs, LVN/LPNs, and RNs completed an online self-report survey on how well their training prepared them for practice. Results indicated that most hospice health aides felt their training well prepared them for practice (80.3%), while only 56.6% of RNs reported that they felt well prepared. We also explored how prepared respondents felt on a variety of topics from patient care skills to dementia care to end of life skills. Again, hospice health aides reported the highest average scores for receiving excellent training across all topics (61.5%) and RNs reported the lowest average scores (42.6%). Feeling unprepared for a job, may lead to lower job satisfaction and higher turnover. Therefore, understanding how well-prepared home health workers feel is key to retaining this segment of the workforce. Future research should explore how to improve this training and preparation across all home health workers but particularly among RNs.

Assessing COVID-19 Vaccine Hesitancy and Trust in Home Health Workers in New York City: A Pilot Study.

This study aimed to identify characteristics surrounding COVID-19 vaccine hesitancy and trust in home health workers (HHWs) in New York City. Data were collected from HHWs through focus group sessions conducted via Zoom. We developed a facilitator guide using the 5C Scale, a validated psychometric tool for assessing vaccine hesitancy. We performed qualitative thematic analysis using a combined inductive and deductive approach. Major themes that emerged included the following: conflicting information decreased vaccine confidence; individualized outreach is valued when information gathering; mandates and financial incentives may increase skepticism; low health literacy and conflict in personal relationships are barriers to acceptance; and experiencing a severe infection and fear of exposure at work increase acceptance. Based on our study, personalized yet consistent messaging may be key to reaching hesitant HHWs.

Goal setting as part of a holistic intervention to promote independence in older people with mild frailty: a process evaluation alongside a randomised controlled trial

BackgroundFrailty is a condition resulting from a decline in physiological reserves caused by an accumulation of several deficits, which progressively impairs the ability to recover from health adverse events. Following a promising feasibility study, the HomeHealth trial assessed a holistic tailored intervention for older adults with mild frailty to promote independence in their own homes, compared with usual care. We aimed to understand how goal setting worked among older people with mild frailty. MethodsThis study was a process evaluation alongside the HomeHealth randomised trial in older adults with mild frailty. The intervention was delivered at participants’ homes, either in person or by telephone or videoconferencing. We carried out semi-structured interviews with older participants who had received the intervention (between three and six appointments), on average 233 days (range 68–465) after their last appointment, purposively sampled according to age, gender, number of sessions attended, adverse events, ethnicity, Index of Multiple Deprivation, Montreal Cognitive Assessment (MoCA) and Barthel scores, research site, and HomeHealth worker. We also conducted interviews with HomeHealth workers who delivered the intervention (n=7). Interviews explored the experience and process of goal setting, benefits and challenges, perceived progress, and behaviour change maintenance after the service had finished. Ethics approval was obtained, and all participants gave informed consent. Interviews were thematically analysed. HomeHealth workers kept formal records of goals set and assessed progress towards goals (0–2 rating scale) during six monthly-sessions, which were descriptively summarised. Findings56 interviews were completed between July 15, 2022, and May 18, 2023. Study participants (n=49) had a mean age of 80 years (range 66–94), including 32 (65%) women and 17 (35%) men. Participants self-identified as White (n=42), Asian (n=3), Black (n=2), Mixed (n=1), and other ethnic (n=1) backgrounds. Findings suggested goal setting could be both a challenge and a motivator for older participants with mild frailty. Goal setting worked well when the older person could identify a clear need and set realistic goals linked to functioning, which led to a positive sense of achievement. Challenges occurred when older people were already accessing multiple resources and health services, or where the terminology of “goals” was off-putting due to work or school connotations. Average progress towards goals was 1·15/2. Most participants set goals around improving mobility (or a combination of mobility and another goal type such as socialising), and there was evidence of participants sustaining these behaviour changes after the intervention. InterpretationOlder people with mild frailty can engage well with goal setting to promote independence. The lapse between receiving the intervention and being interviewed limited recall for some participants. However, the acceptability and adherence to the intervention for older people with mild frailty, and their moderate progress towards goals, should encourage further tailored and person-centred practices to promote their independence. FundingNational Institute for Health Research (NIHR) Health Technology Assessment.

Community Health Worker Home Visiting, Birth Outcomes, Maternal Care, and Disparities Among Birthing Individuals With Medicaid Insurance

Home visiting is recommended to address maternal and infant health disparities but is underused with mixed impacts on birth outcomes. Community health workers, working with nurses and social workers in a combined model, may be a strategy to reach high-risk individuals, improve care and outcomes, and address inequities. To assess the association of participation in a home visiting program provided by community health workers working with nurses and social workers (Strong Beginnings) with adverse birth outcomes and maternal care vs usual care among birthing individuals with Medicaid. This retrospective, population-based, propensity score matching cohort study used an administrative linked database, including birth records and Medicaid claims, linked to program participation. The Strong Beginnings program exposure took place in 1 county that includes the second largest metropolitan area in Michigan. Study participants included primarily non-Hispanic Black and Hispanic Strong Beginnings participants and all mother-infant dyads with a Medicaid-insured birth in the other Michigan counties (2016 through 2019) as potential matching nonparticipants. The data were analyzed between 2021 and 2023. Participation in Strong Beginnings or usual care. Preterm birth (less than 37 weeks' gestation at birth), very preterm birth (less than 32 weeks' gestation), low birth weight (less than 2500 g at birth), very low birth weight (less than 1500 g), adequate prenatal care, and postnatal care (3 weeks and 60 days). A total of 125 252 linked Medicaid-eligible mother-infant dyads (mean age [SD], 26.6 [5.6] years; 27.1% non-Hispanic Black) were included in the analytical sample (1086 in Strong Beginnings [mean age (SD), 25.5 (5.8) years]; 124 166 in usual prenatal care [mean age (SD), 26.6 (5.5) years]). Of the participants, 144 of 1086 (13.3%) in the SB group and 14 984 of 124 166 (12.1%) in the usual care group had a preterm birth. Compared with usual prenatal care, participation in the Strong Beginnings program was significantly associated with reduced risk of preterm birth (-2.2%; 95% CI, -4.1 to -0.3), very preterm birth (-1.2%; 95% CI, -2.0 to -0.4), very low birth weight (-0.8%; 95% CI, -1.3 to -0.3), and more prevalent adequate prenatal care (3.1%; 95% CI, 0.6-5.6), postpartum care in the first 3 weeks after birth (21%; 95% CI, 8.5-33.5]), and the first 60 days after birth (23.8%; 95% CI, 9.7-37.9]). Participation in a home visiting program provided by community health workers working with nurses and social workers, compared with usual care, was associated with reduced risk for adverse birth outcomes, improved prenatal and postnatal care, and reductions in disparities, among birthing individuals with Medicaid. The risk reductions in adverse birth outcomes were greater among Black individuals.

Effect of community health worker home visits on antenatal care and institutional delivery: an analysis of secondary outcomes from a cluster randomised trial in Mali

IntroductionThough community health workers (CHWs) have improved access to antenatal care (ANC) and institutional delivery in different settings, it is unclear what package and delivery strategy maximises impact.MethodsThis study reports...

Spouses as Home Health Workers and Cooks: Insights for Applied Research

Spouses as Home Health Workers and Cooks: Insights for Applied Research

Home health staff knowledge and experience of delirium and delirium superimposed on dementia in older adults

AbstractBackgroundPrevious studies have shown delirium is common in the home setting and can indicate a medical emergency. Many older adults come into the hospital or ER with delirium. However, little is known about the recognition of delirium by home health workers and community nurses. The purpose of this study is to explore the experience of home health staff caring for an older adult with delirium and delirium superimposed on dementia (DSD), with a focus on capturing rich details of these experiences and their knowledge of recognition and management of delirium.MethodStory circle methodology was employed. Data were collected from 20 staff members (age x̄ = 50, SD = 12.33) of a home health agency that serves 18 counties across rural Pennsylvania via Zoom video conference. Qualitative content analysis was utilized (Sandelowski, 2010). The reporting of this study followed the criteria for reporting qualitative studies in the (COREQ) 32‐item checklist.ResultNine themes emerged: (i) Negative emotions; (ii) A sudden change; (iii) Knowing the person with dementia; (iv) Potential causes of delirium; (v) Fear of delirium and staff fear; (vi) Lack of protocol; (vii) Distancing and redirecting for management; (viii) Role of family and care partners; and (ix) Barriers to identification.ConclusionThis is one of only a few studies that have explored delirium and DSD in the home health setting. This study had several innovations, including the use of story methodology and exploring the views of interdisciplinary team members. Importantly, delirium was a common occurrence in the stories they shared. Delirium often resulted in an ER visit or hospitalization. One of the most important findings was that home health staff had training for dementia and depression, but no training, agency protocol, or standardized assessment tool for delirium. A second important finding was the contribution of family and care partners in the assessment and management of delirium in persons with dementia. Implications for practice, research, and policy will be discussed.

Seeing Inside: How Stigma and Recognition Shape Community Health Worker Home Visits in São Paulo, Brazil.

Community Health Worker (CHW) home visits are central to primary care provision in São Paulo, Brazil. Yet CHWs receive little training prior to conducting these visits. In the neighborhood where I conducted ethnographic fieldwork, nearly half of patients were immigrants to Brazil, adding a layer of sociocultural and linguistic difference. I thus investigated how interactions between CHWs and patients unfolded and were shaped by cultural processes. Analyzing fieldnotes and interview data, I found that CHWs cherished relationships with older adult Portuguese-speaking patients, while expressing exasperation and even disgust with more recent immigrants and patients living with stigmatized health conditions. The cultural processes of recognition and stigma shaped CHWs' perceptions of and interactions with patients. I ground these analyses in the history of state-sponsored discourse linking immigrants with poor hygiene, concluding that home visits deserve greater scrutiny as a public health tool that may increase access to care at the expense of health equity.

A Case for Federal Labor Legislation to Protect Underpaid Home Care Workers.

The National Domestic Worker's Bill of Rights Act aimed to remedy nearly a century of labor and health inequities facing a majority of the home health workforce-including home health workers, personal care aides, and professional caregivers-who are women of color and immigrants. Although the bill did not pass, the National Domestic Workers Alliance and its affiliates continue to organize a new labor movement inclusive of home care workers that supports federal legislation and adequate labor protections for their members, particularly in right-to-work states like Texas and in municipalities where hazardous working conditions and low wages contribute to the perceived disposability and devaluation of care labor. Home care workers require federal labor protections that will hold states accountable for the health and well-being of this essential workforce.

What Do Organizations and Clinicians of Status Owe Their Patients’ Home Health Aides?

This commentary on a case offers a historical perspective on how home health work became separate from other sites and means of professional caregiving, exacerbating poor continuity of care in the US health care system. Categorizing home health work as domestic work continues to racialize and marginalize workers. Poor public policy responding to market pressures to keep home health work cheap also perpetuates home health workers' classification as independent contractors, their lack of training, and low wages. This commentary suggests an alternative model for the future of home health work in the United States.

Admitting what is needed: How the health system and society can reduce hospitalizations for children with medical complexity.

Admitting what is needed: How the health system and society can reduce hospitalizations for children with medical complexity.

Estimating the Impact of COVID-19 Pandemic Related Lockdown on Utilization of Maternal and Perinatal Health Services in an Urban Neighborhood in Delhi, India.

ObjectiveTo estimate utilization of maternal, perinatal healthcare services after the lockdown was implemented in response to the COVID-19 pandemic compared to the period before.MethodsThis study conducted in Dakshinpuri, an urban neighborhood in Delhi, reports data over a 13-month period which includes the period “before lockdown” i.e., October 1, 2019 to March 21, 2020 and “after lockdown” i.e., March 22 to November 5, 2020. The period “after lockdown” included the lockdown phase (March 22 to May 31, 2020) and unlock phase (June 1 to November 5, 2020). Mothers delivered during this period in the study area were interviewed using semi-structured questionnaires. In-depth interviews (IDIs) were conducted in a subsample to understand the experiences, challenges, and factors for underutilization of healthcare services.FindingsThe survey covered a total population of 21,025 in 4,762 households; 199 eligible mothers (mean age 27.4 years) were interviewed. In women who delivered after lockdown against before lockdown, adjusted odds of having >2 antenatal care visits in the third trimester was 80% lower (aOR 0.2, 95% CI 0.1–0.5); proportion of institutional deliveries was lower (93 vs. 97%); exclusive breastfeeding during first 6 months of birth (64.5 vs. 75.7%) and health worker home visitation within 6 weeks of birth (median, 1 vs. 3 visits) were substantially lower. Fear of contracting COVID-19, poor quality of services, lack of transportation and financial constraints were key issues faced by mothers in accessing health care. More than three-fourth (81%) of the mothers reported feeling down, depressed or hopeless after lockdown. The major factors for stress during lockdown was financial reasons (70%), followed by health-related concerns.ConclusionCOVID-19 pandemic-related lockdown substantially affected maternal and perinatal healthcare utilization and service delivery.

Integrating an early child development intervention into an existing primary healthcare platform in rural Lesotho: a prospective case–control study

ObjectivesThis study evaluated a novel early childhood development (ECD) programme integrated it into the primary healthcare system.SettingThe intervention was implemented in a rural district of Lesotho from 2017 to 2018.ParticipantsIt...

SAFE - Home Opioid Management Education (SAFE-HOME) in older adults: a naloxone awareness program for home health workers.

BackgroundOlder adults (≥65 years) have seen significant increases in opioid overdose deaths. Diversion of older adults’ opioid medication is also a contributor to opioid misuse. Naloxone, an opioid antagonist, saves lives when used for an opioid overdose, yet education on opioid overdose and naloxone access and training for older adults is limited.MethodsA prospective, interventional training program was created to educate home health workers and their older adult clients on opioid overdose and naloxone utility. The SAFE – Home Opioid Management Education (SAFE-HOME) naloxone awareness program was created to include in-person training with educational handouts around opioid risks and on the importance of naloxone. Home health workers, who provide in-home care and care coordination to older adults in rural Illinois, were trained to educate their clients with the SAFE-HOME program. Older adults were included if they were prescribed an opioid for any indication. Outcomes included change in knowledge of opioids and naloxone, home health worker perception of client knowledge level and naloxone obtainment rates following the educational intervention.ResultsThirty-five clients completed the SAFE-HOME program. The average knowledge assessment score increased from a baseline of 39.4% (SD 26.8) to 90.6% (SD 12.6, p<0.01). Most home health workers agreed their older adult clients had poor baseline knowledge of naloxone. No clients obtained naloxone due to lack of perceived need and cost barriers.ConclusionAn educational approach utilizing home health workers as client educators resulted in increased knowledge of opioid risks and naloxone utility amongst older adults.

Urban Expansion of the SAFE-Home Opioid Management Education (SAFE-HOME) Naloxone Awareness Initiative for Home Health Workers and Older Adults.

The SAFE-Home Opioid Management Education (SAFE-HOME) Naloxone Awareness pilot program utilized home health workers (HHWs) in rural settings to educate older adults prescribed opioids on naloxone access and use. This work expands the SAFE-HOME program to urban settings to prepare HHWs to educate community-dwelling older adults on opioid risks and life-saving naloxone. This prospective, interventional cohort study evaluated 60-min synchronous, virtual HHW educational training sessions describing opioid risks in older adults, opioid overdose signs and symptoms, and naloxone access and use. Knowledge assessments were conducted pre- and post-intervention via a pre-developed assessment tool in a repeated measure model. Outcomes included change in total opioid and naloxone knowledge, and baseline total and individual opioid and naloxone knowledge. Six educational sessions were held (n = 154). The average pre- and post-education scores were 62.7% (n = 108) and 83.5% (n = 82), respectively (p < 0.001). Of the 69 participants who completed both pre- and post-education assessments, the average change in total score was +19.6% (p < 0.001), opioid knowledge score −0.4% (p = 0.901), and naloxone knowledge score +32.9% (p < 0.001). At baseline, HHWs were knowledgeable on opioid risks, but lacked familiarity with naloxone access and use. Targeting HHWs with opioid and naloxone training positions them to effectively educate at-risk community-dwelling older adults.

Health Satisfaction in Health Care between Patients of 3rd Tertiary Allergy Center in Kirkuk with Salam Primary Health Care Center Patients in Kirkuk

Background: Healthcare capacity in Iraq has deteriorated due to the effects of wars and political instability. The IraqiMinistry of Health expanded the provision of health services, by directing the public sector towards primary health care.This study aimed to assess patients satisfaction with the primary health care services provided in 3rd tertiary allergy centerand Salam primary health care center patients in Kirkuk, and to determine the relationship between patient satisfaction andtheir demographic data.Method: A descriptive study was carried out at the 3rd tertiary allergy center and Salam primary health care center in Kirkukcity, Iraq. Data were collected through the use of the constructed questionnaire from 100 patients who visit those centersfor routine care, through the period of the 1st December 2020 to 31st January 2021. Data were analyzed through (Measuresof central tendency and inferential statistics) using SPSS (V.22). Chi-square test for independence of two variables hasbeen utilized to test the hypothesis, through the use of cross-classification table to examine the nature of the relationshipbetween the variables. Ethical approval and permission to access the samples was obtained from Kirkuk Health Directoratein Iraq.Results: Overall, out of 100 clients responded to our questionnaire, age showed neutral score (Mean = 2.93, SD= 1.47).and the age group (21 -30 years) were the highest represented (n=27; 27%). Mean of score was used for reference aboutthe client satisfaction, if the mean of score up to more than 3 that means positive satisfaction with the available servicesotherwise it means dissatisfaction. Chi-square test for independence of two variables was applied, and the probailityof high level of satisfaction were reported as there were a significat relationship (P &lt;0.005) in items related to (nursingcare services, availability of medical services, quality of prescribed medication, cooperation of pharmacist, availabilityof laboratory services and. laboratory staff cooperation about diagnosis than other items.Also, there were a statisticalsignificant difference (P &lt;0.005) between respondents age more than other demographic characteristics.Conclusion: The study highlighted the sources of patient satisfaction related to primary health care services. The medicaland nursing staff have a crucial role in providing health services, so their job satisfaction can improve the quality of care forpatients, and reduce health care costs. Additionally, these results can provide priorities for developing healthcare services that can improve patient satisfaction. The utilization of telemedicine services, patient-centered medical visits and eHealth applications can be adopted to increase patient satisfaction with primary health care services. The use of remote patient monitoring programs are also effective ways to treat the signs and symptoms of COVID-19 at home and protect health workers.

Evaluating the effectiveness of Community Health Worker home visits on infant health: A quasi-experimental evaluation of Home Based Newborn Care Plus in India

BackgroundHome visits by community health workers are promoted to improve the coverage and uptake of evidence-based newborn services and behaviours. However, evidence on the effectiveness of these home visits delivered through government systems at scale is limited, as is evidence from the post-neonatal period. From 2013 to 2017, the Government of India piloted an intervention called Home Based Newborn Care Plus with the goal of reducing pneumonia- and diarrhoea-related morbidity and malnutrition. Village-based Accredited Social Health Activists were incentivised to make quarterly home visits to infants between three and 12 months of age. After the pilot, the intervention was adapted and scaled up nationally (with an additional visit at 15 months of age) as a new programme called Home Based Care for Young Child.MethodsThe study used a quasi-experimental, difference-in-differences method to assess the quantitative impact on key outcome indicators by comparing changes over time in treatment districts with matched control districts. This was supplemented by a quantitative health worker survey and qualitative data collected at worker and community level.ResultsThe intervention led to a significant increase in the number of home visits, and their content became more aligned with Home Based Newborn Care Plus protocols. However, absolute levels of coverage remained low. The intervention had no detectable effect on the key outcomes of feeding practices, handwashing, iron and folic acid and oral rehydration solution supplementation, growth monitoring, and immunisation.ConclusionsGiven the scale up of Home-Based Care for Young Child, there is a need to identify appropriate and comprehensive support for Accredited Social Health Activists to attain high coverage and quality and deliver impact. This will require reconsidering current design elements (such as incentives) and solving the underlying demand side and system level challenges (such as workload and supply chains) constraining Accredited Social Health Activists.