Home Services Research Articles

I-DINO: High-Quality Object Detection for Indoor Scenes

Object Detection in Complex Indoor Scenes is designed to identify and categorize objects in indoor settings, with applications in areas such as smart homes, security surveillance, and home service robots. It forms the basis for advanced visual tasks including visual question answering, video description generation, and instance segmentation. Nonetheless, the task faces substantial hurdles due to background clutter, overlapping objects, and significant size differences. To tackle these challenges, this study introduces an indoor object detection approach utilizing an enhanced DINO framework. To cater to the needs of indoor object detection, an Indoor-COCO dataset was developed from the COCO object detection dataset. The model incorporates an advanced Res2net as the backbone feature extraction network, complemented by a deformable attention mechanism to better capture detailed object features. An upgraded Bi-FPN module is employed to replace the conventional feature fusion module, and SIoU loss is utilized to expedite convergence. The experimental outcomes indicate that the refined model attains an mAP of 62.3%, marking a 5.2% improvement over the baseline model. These findings illustrate that the DINO-based indoor object detection model exhibits robust generalization abilities and practical utility for multi-scale object detection in complex environments.

Home Services Recommendation System using Machine Learning for Urban Areas

The Kotlin-based on-demand home service system streamlines household tasks by offering services such as repairs, cleaning, gardening, and plumbing. In today's fast-paced world, it provides quick solutions for maintaining a clean and hygienic living environment. The Housekeeper Finder app is a prominent player in this space, utilizing advanced machine learning algorithms to deliver personalized service recommendations based on user preferences. It includes essential services like cooking, laundry, and elder care, along with a robust feedback system to improve service quality. Users can easily book services from anywhere, leveraging GPS technology to connect them with nearby providers. The "Domestic Android Application for Home Services" further enhances accessibility through location-based service requests and mapping capabilities for a seamless user experience across platforms.A s cities transition into Smart Cities, integrated information systems open new avenues for urban service recommendations, fostering liveability and sustainability. Recommendation systems analyse user behaviour to provide tailored suggestions using techniques like collaborative filtering and hybrid methods. In response to the challenges of modern work culture, the e-commerce landscape now offers easy access to essential services via mobile applications, ultimately transforming how households address their needs and promoting safer, cleaner living space.

Application and optimisation of intelligent control system for home robots

Abstract. As a significant part of the smart home, intelligent home robots can provide a variety of convenient home services such as automatic cleaning, elderly care, entertainment interaction, etc., which are highly valued and favoured by the majority of home users, and the market scale is expanding. However, the design and optimization of the control system represents a crucial technical challenge to truly realize the intelligence and autonomy of home robots. This paper presents a comprehensive analysis of the design and optimization of automatic control systems for intelligent home robots, which aims to improve the performance and user experience of intelligent home robots and better meet the needs of families. Through collection and analysis of the research on domestic robots and their control technology ,the core technical elements of the control system are summarized and refined, and the hardware structure and software framework of the control system are analyzed. The research results provide valuable insights for improving the performance and capabilities of home robot control systems to better meet the diverse needs and expectations of home users. These innovations provide a solid foundation for advancing the development of intelligent robots in the home. Future trends in control systems may include enhanced perceptual capabilities and decision-making intelligence to enable robots to better understand and meet the needs of home users.

In the Context of Integrated Healthcare and Nursing Services, the Study Explores the Production Dilemmas and Optimization of End-of-life Care Services in the Context of Aging Population in Guangxi - based on a Survey of an End-of-life Care Pilot Project i

With the continuous deepening of China's aging population, the number of the elderly has been increasing, and the mortality rate has been rising year by year. At the end of life, people often face psychological fear and physical pain. End-of-life care plays an important role in improving the quality of life of the elderly at the end of life. End-of-life care is an extremely important link in integrated healthcare and nursing services, and it is also an effective measure promoted by the state to cope with aging population. It aims to provide end-of-life care for the elderly in China and ensure the last leg of their life journey. This study takes an end-of-life care pilot project in Guangxi as an example and conducts a field survey on the implementation of end-of-life care services in relevant nursing homes. It also conducts semi-structured interviews with 13 end-of-life care workers and analyzes the data using Nvivo software. The study aims to explore the production dilemmas of end-of-life care services in the context of integrated healthcare and nursing services and propose relevant optimization measures.

Evaluation of the Interdisciplinary Care Home-bAsed Reablement Program (I-CHARP) for People Living With Cognitive Impairment and Dementia in Care Homes.

Major knowledge and practice gaps exist in aged care home services to support independence of older people with dementia. This research evaluates an adaptation of a community-based rehabilitation model for care homes, namely Interdisciplinary Care Home-bAsed Reablement Program (I-CHARP), by examining whether (and, if so, how) I-CHARP produces its intended effects and how this programme can be practicably implemented, sustained and scaled up across care homes in Australia. I-CHARP is a 4-month bio-behavioural-environmental rehabilitation model of care, integrated in care home services, supported through the deployment of an implementation strategy, the Research Enabled Aged Care Homes (REACH) network. It consists of (1) 8-12 full individual sessions and additional eight brief follow-ups per resident, tailored to the resident's needs, delivered primarily by a team of an occupational therapist, registered nurse and other allied health staff; (2) environmental modifications/assistive devices up to the value of $400 per resident; and (3) engagement of intervention care home staff, managers and regular visitors. An overarching evaluation approach is participatory action research using a cluster quasi-experimental design and mixed methods. It involves testing of the implementation strategy (REACH network and other approaches) while observing/gathering information on the intervention (I-CHARP) and related outcomes in three cycles. Participants include residents (aged ≥ 60 years with early stages of dementia) and care staff from 16 care homes. Care quality indicators, health care costs, field notes and semi-structured interviews/focus groups with intervention site staff, regular visitors and managers will provide further insights into I-CHARP processes and implementation issues. In the final phase of the project, an Agile Implementation Playbook will be developed for the delivery of reablement care that can be used in routine practice across care homes in Australia. The study findings will also inform future policy development and strategic directions for dementia care in care homes. Australian New Zealand Clinical Trial Registry, ACTRN12623000885695 Registered 16 August 2023, https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=386088. 1.0 dated 20 July 2023.

Ghaslah: Car wash application

It is known in Oman and many countries that technological devices and artificial intelligence have become a part of daily life. People use them to complete daily tasks and communicate among themselves, as well as facilitating some tasks that require time and effort. Therefore, there are many phone applications that have been developed to serve people, and they were created and developed by Omanis. These applications facilitate the promotion of the tourism, economic, and commercial sectors. Some of them support tourism by showing tourist places and introducing them to tourists, and some show important events in the Sultanate. Which tourists love to go to and supports the economy through the financial returns that result from this trade through these applications. In this project, we proposed creating a mobile application titled Ghaslah. It is an application concerned with car washes. It supports the customer and the owners of car wash companies. It enables the customer to choose the appropriate car wash company and choose the best services that the customer needs. It also supports segments of society, including women, the elderly, and people with special needs in particular. It supports car wash companies by displaying the services provided by the companies at the lowest costs in terms of advertising and other things, enabling companies to provide their services such as reservations and home services. This application will enhance the economic aspect in Oman and the owners of car wash companies and satisfy the customers with services that suit their needs.

Validity of the Johns Hopkins Adjusted Clinical Groups system on the utilisation of healthcare services in Norway: a retrospective cross-sectional study

BackgroundThe Adjusted Clinical Groups (ACG) System is a validated electronic risk stratification system. However, there is a lack of studies on the association between different ACG risk scores and the utilisation of different healthcare services using different sources of input data. The aim of this study was therefore to assess the validity of the association between five different ACG risk scores and the utilisation of a range of different healthcare services using input data from either general practitioners (GPs) or hospitals.MethodsRegistry-based study of all adult inhabitants in four Norwegian municipalities that received somatic healthcare in one year (N = 168 285). The ACG risk scores resource utilisation band, unscaled ACG concurrent risk, unscaled concurrent risk, frailty flag and chronic condition count were calculated using age, sex and diagnosis codes from GPs and a hospital, respectively. Healthcare utilisation covered GP, municipal and hospital services. Areas under the receiver operating curve (AUC) were calculated and compared to the AUC of a model using only age and sex.ResultsUtilisation of all healthcare services increased with increasing scores in the “resource utilisation band” (RUB) and all other investigated ACG risk scores. The risk scores overall distinguished well between levels of utilisation of GP visits (AUC up to 0.84), hospitalisation (AUC up to 0.8) and specialist outpatient visits (AUC up to 0.72), but not out-of-hours GP visits (AUC up to 0.62). The score “unscaled ACG concurrent risk” overall performed best. Risk scores based on data from either GPs or hospitals performed better for the classification of healthcare services in their respective domains. The model based on age and sex performed better for distinguishing between levels of utilisation of municipal services (AUC 0.83–0.90 compared to 0.46–0.79).ConclusionsRisk scores from the ACG system is valid for classifying GP visits, hospitalisation and specialist outpatient visits. It does not outperform simpler models in the classification of utilisation of municipal services such as nursing homes and home services and outpatient emergency care in primary healthcare. The ACG system can be applied in Norway using administrative data from either GPs or hospitals.

Replacing hospital nurse consultations with home-based nurse consultations for severe spasticity patients on intrathecal baclofen: a qualitative study

Aim This qualitative study explored the experiences of patients, caregivers and healthcare professionals after replacing hospital consultations with a home service solution for patients treated for severe spasticity with intrathecal baclofen. Method Semi-structured interviews were conducted with six patients, six caregivers and six healthcare professionals. The data were analysed using interpretative phenomenological analysis. Results Four themes were identified: 1) Caregivers’ new role and contribution to treatment, 2) Hospital consultations in home settings changed the balance of power, 3) A compassionate relationship, and 4) Contextual care for patients. Conclusion The home-based consultations improved caregivers’ understanding of the treatment and helped them to become active spokespersons for the patient by contributing important information about the patient’s perspectives and the effects of the treatment. The balance of power shifted towards a more equitable dynamic between patients and nurses during home consultations, facilitated by greater involvement of the patient perspective. The nurses’ working conditions changed, but patients and caregivers appreciated the shift in treatment setting.

Development of Dual-Arm Human Companion Robots That Can Dance.

As gestures play an important role in human communication, there have been a number of service robots equipped with a pair of human-like arms for gesture-based human-robot interactions. However, the arms of most human companion robots are limited to slow and simple gestures due to the low maximum velocity of the arm actuators. In this work, we present the JF-2 robot, a mobile home service robot equipped with a pair of torque-controlled anthropomorphic arms. Thanks to the low inertia design of the arm, responsive Quasi-Direct Drive (QDD) actuators, and active compliant control of the joints, the robot can replicate fast human dance motions while being safe in the environment. In addition to the JF-2 robot, we also present the JF-mini robot, a scaled-down, low-cost version of the JF-2 robot mainly targeted for commercial use at kindergarten and childcare facilities. The suggested system is validated by performing three experiments, a safety test, teaching children how to dance along to the music, and bringing a requested item to a human subject.

Veterans in Northern Ireland: Evaluation of chronic pain experience, service type, and physical and mental health functioning

Background Chronic pain is common and associated with disruptions in quality of life (QoL) and psychosocial functioning. These issues are particularly pronounced in veterans, although data in this regard primarily come from the United States Veterans Affairs System, meaning less is known regarding veterans of other countries and regions. The present study evaluated veterans living in Northern Ireland (NI), a region with historic high rates of both chronic pain and psychosocial difficulties associated with the decades-long period of civil and military conflict preceding the 1999 armistice (the Good Friday Agreement). Unique to the Northern Ireland military operation was the initiation of Home Service battalions comprised of local recruits, a role with increased risk due to the conflict’s nature and the fact that they were serving as a military and security presence in their home region. Methods A cross-sectional assessment of veterans living in Northern Ireland ( N = 722) provided details of service type (Home Service vs other service), current health conditions (including chronic pain), and current psychosocial functioning (including physical and mental health QoL, anxiety, depression, and post-traumatic stress disorder [PTSD] symptoms). Results Findings indicated that those with chronic pain had worse QoL, anxiety, depression, and PTSD. Those with chronic pain were also more likely to have served in the Home Services, be unemployed, and be receiving disability payment. Contrary to hypotheses, there was no interaction between chronic pain and service type. Conclusions These results extend previous work with veterans to the unique circumstances of a post-conflict military that engaged in operations within its own country and underscore the need for coordinated, efficacious interventions for co-morbid chronic pain and anxiety, depression, and PTSD.

교육바우처 정책 사상의 원류와 그 원리에 대한 소고

This study explores the ideological foundation of education vouchers, focusing on educational support programs for commoners during the French Revolution and the educational philosophies of Thomas Paine and John Stuart Mill. Thomas Paine emphasized the expansion of educational choice through government support and assistance for the poor, while John Stuart Mill advocated for educational improvement through free choice and competition. Their philosophies have become core ideas in the modern school choice movement and were institutionalized in the education voucher policy by Milton Friedman. This study analyzes the outcomes of education vouchers from the perspective of public choice theory and examines models such as the Tiebout hypothesis, Demand Side Financing, and Home and Community-Based Services (HCBS). Additionally, it explores the relationship between Hirschman's Exit-Voice-Loyalty model and the principle of voucher choice. In conclusion, this paper emphasizes how these concepts are related to choice and competition in public services. Furthermore, it highlights that the principles inherent in education vouchers serve as an important ideological foundation for democracy and economic development.

The Planning Process of “HOMERESC” Home Service System

This paper presents the planning process of the HOMERESC mobile application, the home service system. In contemporary times, locating companies or individuals providing home repair services has become increasingly challenging. Home repairing services in Malaysia encompass a range of maintenance and renovation tasks to enhance the condition and functionality of residential properties. Some examples include the Taman Seri Berembang flat building, which was formerly in critical condition. A 22-year-old complex of flats with 30 homes was discovered to be damaged and unsafe to live in. Therefore, a mobile application named "HOMERESC" Home Service System was developed to address all the issues and ensure the welfare of users. The name ‘HOMERESC’ was chosen to represent this application's ability to "rescue" all damaged homes. An Agile methodology has been used to build this system, ensuring the project’s goals are met and the development process goes smoothly. The implication of the research suggests that the mobile application offers a secure and viable solution for home repair services. In conclusion, the research demonstrates that the HOMERESC mobile application could enhance the safety and welfare of residential property owners.

Provision of Home & Community Based Services to Veterans by Race, Rurality, and Neighborhood Deprivation Index.

Home and community-based services (HCBS) enable frail patients to remain at home. We examined whether there were neighborhood-deprivation, racial, or rural disparities in HCBS utilization provided to Veterans by the Department of Veterans Affairs (VA) or Medicare by comparing the adjusted utilization rate of a historically disadvantaged group with the predicted utilization rate had it been treated as the historically dominant group. Among the 2.7 million VA patients over 66 years old in 2019, 11.0% were Black, 39.2% lived in rural settings, 15.3%/29.2%/30.9%/24.7% lived in least/mild/moderate/most-deprived neighborhoods. On average, 11.2% received VA or Medicare HCBS. Veterans residing in more deprived neighborhoods had 0.11-0.95% higher adjusted probability of receiving HCBS than expected had they resided in the least deprived neighborhoods. Veterans residing in rural areas had 0-0.7% lower HCBS rates than expected had they been treated like urban Veterans. Black Veterans were 0.8-1.2% more likely to receive HCBS than expected had they been treated like White Veterans. Findings indicate that VA resources were equitably employed, aligning with probable HCBS needs, suggesting that VA's substantial and long-standing investment in HCBS for care of frail Veterans could serve as a model for other payers and providers in the U.S.

The modified 5-factor frailty index predicts postoperative outcomes in patients with ovarian cancer undergoing hyperthermic intraperitoneal chemotherapy

ObjectiveThe objective of this research is to compare the ability of mFI5 to the mFI11 to predict frailty, postoperative complications, discharge location for patients with ovarian cancer undergoing hyperthermic intraperitoneal chemotherapy (HIPEC) at time of cytoreductive surgery. MethodsThis is a single-institution retrospective study in patients with advanced (Stage III, IV) or recurrent ovarian cancer treated with surgical cytoreduction with HIPEC. Logistic regression was used to evaluate frailty as well as factors associated with moderate to severe Accordion postoperative complications and discharge to home. Correlation was calculated between mFI5 and mFI11. ResultsOf 141 patients who received HIPEC between 2010 and 2020, 23 patients were classified as frail (mFI5 score ≥2), while 118 were not frail. Frail patients were significantly older with mean age 65.9 compared to non-frail patients who had mean age of 59.1 (p = 0.005), as well as a higher Charlston Comorbidity Index (p < 0.001), and more renal disease (p = 0.025), hypothyroidism (p = 0.005), and hyperlipidemia (p = 0.004). mFI5 and mFI11 scores for frailty were highly correlated (spearman rho 0.98, p < 0.001). Frail patients were more likely to be discharged to a skilled nursing facility (22.7 %) vs. 6.8 % of non-frail patients, or require home services (18.2 % vs 8.5 %, p = 0.025). On multivariable logistic regression, frail patients were more likely to experience moderate or higher Accordion postoperative complications (OR 3.08, p = 0.024). ConclusionsThe mFI5, a simpler tool than the mFI11, is also highly associated with postoperative complications and need for postoperative services in patients with ovarian cancer undergoing HIPEC at time of cytoreductive surgery.

Awareness on obstetric fistula and associated factors among women health development army, in the South Gondar zone, Amhara region, Ethiopia: A cross sectional study.

Obstetric fistula is a severe birth injury that profoundly impacts women's health, social well-being, economic stability, and psychological state. While it can be prevented with timely emergency obstetric care, a significant barrier in many developing regions, including the study area, is the lack of awareness among women. This study aimed to evaluate the level of awareness about obstetric fistula and the factors influencing it among the Women Health Development Army in the South Gondar zone of the Amhara region, Ethiopia, in 2020. A community-based cross-sectional study was done from July to December 2020, involving 633 women. Participants were selected using a multistage stratified sampling method. Data were collected using a pretested, interviewer-administered structured questionnaire. Data entry was performed using EpiData version 3.1, and analysis was conducted with SPSS version 23.0. Multivariable logistic regression models were employed to identify influencing factors, with a p < 0.05 considered statistically significant. This study found that 55.3% (95% CI, 51.6%-57.2%) of study participants had a good awareness of obstetrics fistula. Significantly associated factors include; no history of ANC (AOR = 0.52: 95% CI, 0.31, 0.86), living >30 min away from a health facility (AOR = 0.43: 95% CI, 0.23, 0.81), no history of abortion (AOR = 0.37: 95% CI, 0.19, 0.72), Injectable and implant users (AOR = 3.60: 95% CI, 1.98, 6.53), having four to six pregnancy (AOR = 1.87: 95% CI, 1.22, 2.87) and lack of communication material in the house (AOR = 0.19: 95% CI, 0.10, 0.37). This study found that 55.3% of women have a good awareness of obstetrics fistula. ANC follow-up history, abortion history, type of family planning, type of communication, number of pregnancies, availability of health facility, and distance of health facility were significantly associated with awareness of obstetric fistula. Hence, local and national efforts should be made to enhance access to information at home and basic maternal health services including antenatal care.

Retracted: Implementation Of A Specialist Geriatric Ward; Outcomes One Year After Inception

Abstract Background Older adults being admitted to an acute hospital setting have care needs that would benefit from coordinated care on a Specialist Geriatric Ward (SGW). Prior to May 2023, older patients admitted to our institution received input from geriatric medicine through a variety of avenues. There was a clear need for dedicated and formal access to specialist geriatric services. It was hypothesised that care delivered on a SGW would improve patient access to the Right Care, in the Right Place at the Right Time. It has long been recognised in the literature that a dedicated SGW with appropriate access to Health and Social Care Professionals is the gold standard of care for older adults admitted to the acute setting. Methods An evidence based SGW was designed and implemented in May 2023. This consisted of a 32-bed dementia and delirium friendly ward, staffed with a consultant geriatrician, medical team, frailty and dementia Clinical Nurse Specialists, a multidisciplinary team and a dedicated patient flow lead for older persons. Ingress pathways to the ward included emergency department medical admissions, Frailty at the Front door referrals and patients selected from geriatric medicine consults. Egress pathways availed of included offsite rehabilitation, rehabilitation at home services and integrated care team input. All patients received early discharge planning and a comprehensive geriatric assessment was initiated on admission to the ward. Key performance indicators included length of stay (LoS), reduction in “Safari Rounds” which improves Clinician/Patient contact, daily whiteboard rounds, improved predicted discharge date (PDD) compliance. Data and outcomes were reviewed weekly. Results After one year, the SGW demonstrated improvements across all metrics with percentage cohorted patients improving by 24% and both average and median LoS reduce by 19 days. Total number of bed days saved was 1,513. Conclusion Multidisciplinary care delivered on a SGW improves patient and service outcomes.

Optimising Emergency Care for Older Adults: A Case Study of the EDITH Service Following a Proximal Humerus Fracture

Abstract Background The Emergency Department in the Home (EDITH) service offers emergency Occupational Therapy and medical assessments to older adults at home, thus negating the need for hospital attendances. Mr X, an 86-year-old with vascular dementia and hypertension, sustained a left proximal humerus fracture from a fall. Following assessment in the ED, Mr X was deemed fit for discharge and was referred to EDITH for an acute functional assessment and clinical review. Methods Within 72 hours of discharge, Mr X was visited at home by an Occupational Therapist (OT) and an Advanced Nurse Practitioner (ANP). The OT conducted a home environment assessment, falls-risk screening, delirium screening, reviewed social supports, and performed a functional assessment. Education on one-handed dressing techniques and falls prevention was provided. The ANP conducted a clinical review, and reviewed Mr X’s medication and analgesia. Mr X had the support of his wife to assist with Activities of Daily Living (ADLs), functional mobility and medication management. Mr X’s son purchased assistive equipment recommended by the OT, to enhance home safety. Referrals were made to the local memory support service, a Physiotherapist, and his Public Health Nurse to organise formal care supports. Results Mr X remained at home with support from his wife, primary care services, and virtual EDITH follow-up. Mr X had a scheduled review at the fracture clinic following his ED attendance. Conclusion Emergency care practitioners play a crucial role in addressing acute functional and clinical changes in older adults attending the ED. Supported ED discharges and service integration during the acute phase can prevent hospital admissions. Collaboration between emergency medicine and primary care is essential for addressing acute medical needs and long-term functional outcomes. With adequate social support and timely services, older adults can recover successfully at home.

Rationing Rights: Administrative Burden in Medicaid Long-term Care Programs.

States use Medicaid waivers to provide supports for disabled people in communities, rather than in institutions. Because waivers are not entitlements, those deemed eligible are not guaranteed these supports. How do states, in practice, use bureaucratic procedures to ration this 'conditional' right? Drawing on primary and secondary data, we analyze waiver programs, and document state administrative procedures to indirectly and directly ration access. Burdens indirectly limit disabled peoples' access to Medicaid home and community-based services, via a complex array of waiver programs that exacerbate costs associated with gaining eligibility, and directly limit access, via waitlists and prioritization among the eligible. There is also evidence that states strategically deploy opaqueness to provide political cover for unpopular waitlists. The overall process is opaque, confusing, and time intensive, with burdens falling hardest on marginalized groups. Administrative burdens impede the right to live in the community afforded to people with disabilities under the American with Disabilities Act. The opaqueness and associated burdens with waiver programs are a way to conceal these costs, thereby demonstrating how burdens "neatly carry out the 'how' in the production of inequality, while concealing ... the why."

“I would have to walk around to find the best Wi-Fi connection…”: qualitatively exploring challenges associated with rapid rollout of telehealth in Canadian long-term care homes

BackgroundEarly in the COVID-19 pandemic, long-term care (LTC) homes in British Columbia, Canada, restricted visitation to ensure the safety of their residents against transmission of the novel coronavirus. As such, these LTC homes had to quickly implement a rapid rollout of telehealth services to maintain physician care for residents while avoiding the infection risk of in-person visits amidst lockdown measures. The abrupt transition from traditional in-person physician care to telehealth presented significant challenges. Investigating these challenges is pivotal to the development of strategies for sustained telehealth use for physician services in LTC homes. This analysis is part of a broader qualitative, utilization-focused evaluation study of telehealth services rapidly implemented for physician care in LTC homes within the Fraser Health Authority region of British Columbia. The evaluation has aimed to consider integral factors such as telehealth challenges, facilitators, preferences, and continued use. Semi-structured interviews and focus groups were conducted with 70 physicians, staff, residents, and family caregivers across 27 different LTC homes in the region. All interviews and focus groups were transcribed verbatim and were analyzed using a thematic approach to identify common barriers surrounding the rapid rollout of telehealth in LTC across relevant groups.ResultsFrom the data, four challenges were identified: connectivity challenges (e.g., inconsistent or no Wi-Fi or cellular connectivity), device challenges (e.g., lack of accessible devices and software issues), privacy challenges (e.g., lack of private space to support telehealth use), and informational challenges (e.g., lack of electronic medical record access). All challenges posed barriers to telehealth access for both care provider and recipient groups in LTC settings.ConclusionsThe challenges identified in this analysis are supported by existing literature, which is significant given the different contexts within which such research has been undertaken. Collectively, this knowledge base can support evidence-informed improvements to telehealth for physician care in LTC settings. Future research should capture the perspectives of diverse cultural groups, LTC residents with cognitive impairments, and those who provide and receive care in rural settings.

Barriers to accessing home and community-based services among family caregivers of Veterans.

The Department of Veterans Affairs (VA) has long recognized the importance of having a rich complement of home and community-based resources for the Veteran population. For Veterans experiencing disability-related impairments, home- and community-based services (HCBS) facilitate aging in place and alleviate family caregivers' burden. However, even in the enriched VA context, HCBS are underutilized. Our objective was to understand unmet needs and barriers to accessing HCBS from the perspectives of Veterans' family caregivers. This multi-method study recruited family caregivers of Veterans seen within a major VA Health Care System. Eligible caregivers provided care for at least 8 h/week in the prior 6 months, to a Veteran with 1+ impairments in instrumental activities of daily living. Recruitment was conducted via flyers, physician referrals, registries, and chart reviews. Participants completed 1-h semi-structured interviews to assess unmet psychosocial needs and barriers to accessing VA and non-VA HCBS. Interviews were analyzed using a thematic analysis approach. A total of 23 caregivers (62.9 + 13.5 years; 74% women; 52.2% White; 26.1% Black; 95.2% pre-9/11) provided 8.4 ± 6.3 h of daily care. Most had provided care for more than 1 year; nine had cared for their Veteran for 5+ years. The following themes were identified: (1) need for clear, accurate, timely information about HCBS; (2) lack of time, amplified by COVID-19 restrictions; (3) need for respite to manage their own health and other caregiving responsibilities; and (4) perceived difference in care needs that can strain caregivers' relationship with the care recipient. In addition to known barriers including lack of timely knowledge, service delays, and caregiver stress, Veteran-caregiver disagreements emerged as a novel barrier to using HCBS. A multi-pronged approach that addresses these barriers may increase timely access to HCBS.