Homebound Adults Research Articles

Understanding benefits of a college student-homebound adult partnership program to support aging in place: An exploratory study

The need for effective approaches to support aging and homebound adults is recognized internationally and domestically. This exploratory study sought to understand the proximal benefits of an intergenerational program in Delaware, USA that connected homebound individuals with college students. The primary goal was to describe program impacts on home-bound community residents to inform future research, program planning, and implementation. Outcomes of interest included quality of life, well-being, and independence. Semi-structured interviews were conducted with 19 participants recruited from a nonprofit partner. Findings yielded seven unique themes: emotional fulfillment, special feelings of support from a rare “unconditional” relationship, assistance with tasks, close connection with someone not ordinarily met, intergenerational understanding, someone to talk to, and appreciation. Additionally, the research team applied the RE-AIM (Reach, Effectiveness, Adoption, Implementation, Maintenance) framework, to contextualize the approach and findings. Results inform future evaluation efforts of homebound visiting programs, which may seek to incorporate outcome indicators aligned with these themes and serve as a foundation for future quantitative measures of impact.

The outcomes of treatment for homebound adults with complex medical conditions in a hospital-at-home unit in the southern district of Israel

BackgroundA model of hospital-at-home services called the Home Care Unit (“the unit”) has been implemented in the southern region of the Clalit Healthcare Services in Israel. The aim of the present study was to characterize this service model.MethodsA retrospective cross-over study. included homebound patients 65 years of age and above who were treated for at least one month in the framework of the unit, between 2013 and 2020. We compared the hospitalization rate, the number of hospital days, the number of emergency room visits, and the cost of hospitalization for the six-month period prior to admission to the unit, the period of treatment in the unit, and the six-month period following discharge from the unit.ResultsThe study included 623 patients with a mean age of 83.7 ± 9.2 years with a mean Mini-mental State Examination (MMSE) score of 12.0 ± 10.2, a mean Charlson Comorbidity Index (CCI) of 3.7 ± 2.2 and a Barthel Index score of 23.9 ± 25.1. The main indications for admission to the unit were various geriatric syndromes (56.7%), acute functional decline (21.2%), and heart failure (12%). 22.8% died during the treatment period and 63.4% were discharged to ongoing treatment by their family doctor after their condition stabilized. Compared to the six months prior to admission to the unit there was a significant decrease (per patient per month) in the treatment period in the number of days of hospitalization (2.84 ± 4.35 vs. 1.7 ± 3.8 days, p < 0.001) and in the cost of hospitalization (1606 ± 2170 vs. 1066 ± 2082 USD, p < 0.001).ConclusionsTreatment of homebound adults with a high disease burden in the setting of a hospital-at-home unit can significantly reduce the number of hospital days and the cost of hospitalization. This model of service for homebound patients with multiple medical problems maintained a high level of care while reducing costs. The results support the widespread adoption of this service in the community to enable the healthcare system to respond to the growing population of elderly patients with medical complexity.

Like a Social Breath: Homecare’s Contributions to Social Inclusion and Connectedness of Older Adults

The detrimental effects of social isolation on health and well-being bring forward the need for increasing social inclusion and connectedness for older, homebound adults. Homecare services may be a source of social inclusion, but the inclusive dimensions and mechanisms of care have been less explored. This study aimed to develop more knowledge on how homecare can contribute to social inclusion by exploring older adults’ experiences with care visits as social encounters. The study utilised interviews with older adults from four municipalities in Norway and Denmark from 2018 to 2019 and drew on a combination of social inclusion theories and Goffmanian microinteractionism. Positive accounts of care encounters comprised three overlapping thematic dimensions: 1) bringing social life into the house, 2) creating connections to the outside world and 3) providing opportunities to participate in a broader array of social roles and identities. Despite variations, care visits could encompass social inclusive and connective aspects that enhanced thriving and wellbeing. Care visits increased opportunities for social participation and support of a valued self and comprised bonding, bridging and linking social capital. Care workers could be important interpersonal network resources at home, providing support and social stimulation, engagement and fun. Moreover, they could bridge to the outside society through conversations or by linking to services (e.g. day centres) that increased social participation and bonding with peers outside the house. The inclusive resources embedded in homecare need to be supported and utilised in policy and practice to increase older people’s inclusion.

CARING FOR HOMEBOUND VETERANS DURING COVID-19 IN THE US DEPARTMENT OF VETERANS AFFAIRS MEDICAL FOSTER HOME PROGRAM

Abstract The COVID-19 pandemic made older, homebound adults with multiple chronic conditions increasingly vulnerable to contracting the virus. The United States (US) Department of Veterans Affairs (VA) Medical Foster Home (MFH) program cares for such Veterans residing in private homes of non-VA caregivers. In this qualitative study, we assessed adaptations to delivering safe and effective healthcare during the early stages of the pandemic for Veterans living in rural MFHs, interviewing (n=37) VA MFH care providers at 19 MFH programs across the US. We identified themes reflecting adaptations to care provision, including care providers increasing communication and education to caregivers who prioritized Veteran safety. Caregivers coordinated increasing telehealth visits, applied creative strategies to mitigate social isolation of Veterans and themselves, and Veterans were prioritized for in-home COVID-19 vaccinations. Study findings illustrate the importance of clear, regular communication and intentional care coordination to ensure high quality care for vulnerable, homebound populations during crises.

HOME-BASED EXERCISE PROGRAM WITH MEAL DELIVERY INCREASES DAILY STEP COUNT IN HOMEBOUND OLDER ADULTS

Abstract The United Nations projects adults aged 60 and older will reach 2.1 billion by 2050. With this trend, there will be an increase in older adults who are homebound, leading to more frailty with increased healthcare utilization and institutionalization. Improvements in frailty and homebound status may occur through increased physical activity, which has been shown in multiple randomized controlled trials to improve frailty. Our study aims to evaluate the effects of a home-based exercise program, administered through Meals on Wheels, on gait speed and frailty status in sixty-four homebound adults age 60 and older. All participants receive meal delivery for 12 weeks and half are randomized to receive an exercise kit with weekly exercise handouts. All participants are asked to wear an activity tracker with an additional longitudinal measure at 6 months. We now have 6 participants who have completed the study. Preliminary analysis was conducted on step count between the exercise and non-exercise group using two-sample t-tests. Average daily step count in the exercise group (n=3) was 2656 compared to 813 in the non-exercise group (n=3), p&amp;lt; 0.00001 during the first 12 weeks. The step count in the exercise group did decrease during the weeks after the intervention stopped, however they remained more active than the non-exercise group, 1112 vs 548, p&amp;lt; 0.0001. No adverse events were noted. As we continue to enroll participants, we are encouraged that the home-based exercise program with meal delivery appears to be a safe and effective way to increase physical activity in homebound older adults.

"I Depend on Her for Everything": A Retrospective Chart Review of Home Care Worker Service Disruptions for Homebound Older Adults During the COVID-19 Pandemic.

Home care workers played critical roles in meeting the complex medical and social needs of homebound adults during COVID-19, yet their contributions remain underappreciated. This study characterizes home care workers’ roles during COVID-19 and examines how home care disruptions impacted homebound individuals and caregivers. Using a qualitative analysis of electronic medical records among a randomly sampled subset of homebound patients in a home-based primary care practice, we found that home care workers were essential in meeting existing and new needs of homebound individuals. Insufficient home care worker services, including unstable schedules and inadequate hours of paid care, became particularly disruptive, leading to risks for patients and their caregivers. Given their integral role on care teams, home care workers must be a policy focus to prepare for emergent situations and ensure that homebound individuals have access to high quality, stable home care.

Caring for Homebound Veterans during COVID-19 in the U.S. Department of Veterans Affairs Medical Foster Home Program.

The onset of the COVID-19 pandemic made older, homebound adults with multiple chronic conditions increasingly vulnerable to contracting the virus. The United States (US) Department of Veterans Affairs (VA) Medical Foster Home (MFH) program cares for such medically complex veterans residing in the private homes of non-VA caregivers rather than institutional care settings like nursing homes. In this qualitative descriptive study, we assessed adaptations to delivering safe and effective health care during the early stages of the pandemic for veterans living in rural MFHs. From December 2020 to February 2021, we interviewed 37 VA MFH care providers by phone at 16 rural MFH programs across the US, including caregivers, program coordinators, and VA health care providers. Using both inductive and deductive approaches to thematic analysis, we identified themes reflecting adaptations to caring for rural MFH veterans, including care providers rapidly increased communication and education to MFH caregivers while prioritizing veteran safety. Telehealth visits also increased, MFH veterans were prioritized for in-home COVID-19 vaccinations, and strategies were applied to mitigate the social isolation of veterans and caregivers. The study findings illustrate the importance of clear, regular communication and intentional care coordination to ensure high-quality care for vulnerable, homebound populations during crises like the COVID-19 pandemic.

Impact of Social Isolation Due to COVID-19 on VA Home-Based Primary Care Veterans and Caregivers

In December 2020 we began conducting phone interviews with Veterans, and their caregivers, receiving care through the United Sates (US) Department of Veterans Affairs (VA) Home Based Primary Care (HBPC) program. Our goal was to describe experiences of Veterans and caregivers managing changes in care delivery related to the COVID-19 pandemic and navigating increased social isolation due to social distancing. We interviewed 38 Veterans (average age 78) and caregivers (average age 62) across seven VA HBPC programs. Findings showed those living in their own homes found increased isolation more manageable than those living in assisted living facilities, which restricted visitors. Caregivers had a harder time managing isolation than Veterans, as Veterans were used to being primarily homebound. Veterans and caregivers relied on increased phone communication with their HBPC teams, with some began participating in virtual visits. Implications include insights into better supporting older, homebound adults and their caregivers during disasters.

Disruptions and Adaptations in End-of-Life Care Delivery for Homebound Patients During COVID-19

The initial COVID-19 pandemic surge in New York City caused widespread delays and disruption in end-of-life services. This study examined the impact of disruptions among homebound adults in an HBPC practice who died between March-June 2020. Through an in-depth mixed-methods chart review, we identified 113 patient deaths (mean age: 87, 73% female, 67% with dementia). Forty-nine (43%) of deaths occurred in April 2020. Through a content analysis of clinician notes, we identified key COVID-related themes, including a shift to intensive phone-based care and to a lesser degree, telehealth; delays in hospice referrals and admissions; and an increase in treatment for behavioral symptoms. Our analysis also demonstrated the central role of family and paid caregivers in coordinating care, and efforts by patients, caregivers and providers to avoid hospital admissions. These findings demonstrate the importance of care coordination across medical, home and community partners to support end-of-life care in emergencies and beyond.

Providers’ Perceptions of Telehealth Barriers Among Homebound Adults in in a Home-Based Primary Care Practice

The COVID-19 pandemic resulted in a dramatic shift to video-based telehealth use in home-based primary care. We conducted an online 11-item survey exploring provider perceptions of patients’ experience with and barriers to telehealth in a large HBPC program in New York City. More than one-third (35%) of patients (mean age of 82.7; 46.6% with dementia; mean of 4 comorbidities/patient) engaged in first-time video-based telehealth encounters between April and June 2020. The majority (82%) required assistance from a family member and/or paid caregiver. Among patients who had not used telehealth, providers deemed 27% (n=153) “unable to interact over video” for reasons including cognitive or sensory ability. Fourteen percent lacked caregivers. Physicians were not knowledgeable about patients’ internet connectivity, ability to pay for cellular plans, and video-capable device access. These findings highlight the need for novel approaches to facilitating telehealth and systematic data collection before targeted interventions to increase video-based telehealth use.

Provider Perceptions of Video Telehealth in Home-Based Primary Care During COVID-19

Home health care is the most commonly used home- and community-based service to older adults “Aging in Place”. Patient experience of healthcare services is a critical aspect of patient-centered care. Indeed, policymakers have linked patient-rated quality of care to payment to healthcare providers. This study aimed to examine the association between patient-rated care performance of home health agencies and risk for hospitalization among Medicare beneficiaries. This study used several national datasets from 2016 and included 491,718 individuals from 8,459 home health agencies. Home health agencies’ performance was measured using patient experience star rating from the Home Health Consumer Assessment of Healthcare Providers and Systems (HHCAHPS). Propensity score matching was used to balance the differences in patient characteristics at baseline between those receiving care from high-performing home health agencies and those in lower-performing agencies. On average, patients were 80.5 years old, 65% female, 81% White, 10% Black, and 6% Hispanic, with 90% taking 5 or more medications. Patients had a mean score of 1.73 (SD=1.69) on the Charlson Index. Respectively, 10% and 16% of patients were hospitalized within 30 and 60 days of home health care initiation. Estimates of logistic regression after propensity score matching found that patients receiving care from lower-performing agencies were at similar risk for both 30-day (OR=0.99, p=0.817) and 60-day (OR=1.02, p=0.616) hospitalization following the start of home health care, compared to those in high-performing agencies. Our findings suggest discrepancies (or no relationship) between patient experience and objective outcomes of home health care.

Adaptations to In-Home Health Care Due to COVID-19: The VA’s Home-Based Primary Care Program

The COVID-19 pandemic disrupted traditional Home Based Primary Care (HBPC) care processes, including changes to provision of face-to-face care in-home for older adults. Our study describes and explains care delivery changes Department of Veterans Affairs (VA) HBPC programs made in response to the pandemic. We fielded a national survey to all 140 VA HBPC programs, targeting interdisciplinary care teams and HBPC leadership. We structured survey questions using a mixed method approach with both closed and open-ended questions, applying a qualitative content analysis approach to open-ended responses complemented by analysis of descriptive quantitative data. Preliminary findings highlight the value and consideration of different telehealth modalities when caring for an older, homebound population, as well as creative adaptations HBPC teams made to deliver care during the pandemic. Implications include nascent development of decision-making paradigms beyond the pandemic particularly for appropriate use of telehealth modalities for older homebound adults.

An Interdisciplinary Home-Based Medical Care Program to Reach Homebound Adults Living With Dementia

The COVID pandemic has impacted access to care, particularly for older, homebound persons living with dementia (PwD). At the beginning of the pandemic, our interdisciplinary team introduced a home-based medical care program (HBMC) to address chronically ill and homebound PwD and caregivers’ needs to promote aging in place. The purpose of this presentation is to describe PwD and caregiver service use and experiences with Virginia at Home (VaH) HBMC during the pandemic. All PwD participating in VaH program are offered home telehealth access with necessary devices. We will discuss telehealth access and use and dyad-care provider communication across up to 20 dyads to facilitate continuity of care. These data are supplemented by qualitative interviews with dyads presenting needs, preferences, and experiences accessing and using services across the first six months of program launch. We will conclude with a discussion of participant-informed program alterations to facilitate optimal overall care and outcomes.

Provider Perceptions of Video Telehealth in Home-Based Primary Care During COVID-19

The COVID-19 pandemic accelerated the adoption of virtual care. In this qualitative study, we sought to determine provider perceptions of video telehealth during the first wave of COVID-19 in NYC to inform practice for home-based primary care providers nationwide. We conducted semi-structured interviews with clinical directors, program managers, nurse practitioners, nurse managers, and social workers at 6 NYC practices (N=13) in spring 2020. We used combined open and focused coding to identify themes. Participants employed both hospital-supported and commercial technological platforms to maintain care during COVID-19. Benefits of video telehealth included improved efficiency, capacity and collaboration between providers. Barriers included patients’ physical, cognitive or technological abilities, dependence on caregivers and aides to facilitate video visits, challenges establishing trust with new patients and addressing sensitive topics over video, and concerns over missing important patient information. Considering patient, clinical, and technological conditions can help optimize telehealth implementation among older homebound adults.

POP Care: An interprofessional team-based healthcare model for providing well care to homebound older adults and their pets

A novel interprofessional clinical experience, entitled POP (Pet Owner and Pet) Care, was offered to students from the Colleges of Nursing, Veterinary Medicine, and Social Work at a large Midwest university. The objectives of the clinical experience were to (1) provide students with an opportunity to improve their readiness for interprofessional learning and beliefs about EBP; (2) deliver integrated physical and mental health care to homebound older adults and assess their outcomes; and (3) concurrently provide wellness care to the pets living with homebound older adults and assess their outcomes. Nurse practitioner (NP) faculty led the POP Care clinical rotation teams of NP, veterinary, and social work students in providing home healthcare to homebound adults and their pets. Students were provided with four learning modules prior to starting patient visits. The success of the clinical experience was evaluated via a pre- and post-survey that assessed EBP beliefs and readiness for interprofessional learning. The post-survey also included program satisfaction questions. Health outcomes were measured for the patient and their pets. Patients also answered open-ended program satisfaction questions over the phone. Results indicated that POP Care improved beliefs in EBP and readiness for interprofessional learning, enhanced interprofessional team-based care, and had a positive impact on patient and pet health and well-being.

Loneliness and Activity Engagement Among Rural Homebound Older Adults With and Without Self-Reported Depression.

Rural homebound older adults are a vulnerable population at risk for depression, loneliness, and limited participation, but studies that examine these factors in this population are scarce. To describe the degree of depression, loneliness, and activity engagement among rural homebound older adults and determine differences in loneliness and activity engagement between those with and those without self-reported depression. Cross-sectional survey. Two rural counties in south central Indiana. Homebound adults ages 60 yr and older who received nutritional or companionship services from a local Area Agency on Aging. Outcomes and Measures: Depression was measured with an item on the self-report questionnaire and the Geriatric Depression Scale-15. Loneliness was measured with an item on the self-report questionnaire and the UCLA Loneliness Scale. Activity engagement was measured with the Engagement in Meaningful Activities Survey and the Meaningful Activity Participation Assessment. Ninety-one participants returned surveys, of which 78 were analyzed. Regarding depression, 40% of participants reported having it, but results for the Geriatric Depression Scale-15 showed that 63% were in the indicative or suggestive range for depression. Participants in general reported moderate loneliness and low to moderate engagement in meaningful activities. Those with self-reported depression had significantly higher loneliness and lower activity engagement, particularly in self-care, leisure, and socializing activities. A high proportion of this sample of rural homebound older adults had depression. Those who did tended to have a higher degree of loneliness and lower engagement in meaningful activities. What This Article Adds: Depression was associated with greater loneliness and lower activity engagement in rural homebound older adults. Occupational therapy practitioners serving rural homebound older adults with depression should consider providing interventions to address loneliness and facilitate activity engagement.

Disruptions in Care and Support for Homebound Adults in Home-Based Primary Care in New York City During the COVID-19 Pandemic.

Homebound older adults are a highly vulnerable population, yet little is known about their experiences with healthcare during the COVID-19 pandemic. We interviewed patients in home-based primary care (HBPC) in New York City by telephone in May and June of 2020. Interviews covered social supports, household activities, self-care, and medical care, and asked participants to compare current with prepandemic experiences. Among 70 participants, 37% were Black and 32% were Hispanic. Disruptions in the home included greater difficulty accessing paid caregivers (13.9%) and food (35.3%) than before the pandemic, and unaddressed household chores (laundry, 81.4%; food preparation, 11.4%). Black study participants were more likely than White and Hispanic participants to report disruptions in accessing medical care (13 [50.0%] vs. 3 [14.3%] vs. 6 [27.3%], respectively, p = 0.02), as well as food preparation and medication taking. Black patients in HBPC are at risk of disparities in healthcare and social support during the COVID-19 pandemic.

A qualitative study of home health care experiences among Chinese homebound adults

BackgroundHome health care services (HHC) are emerging in China to meet increased healthcare needs among the homebound population, but there is a lack of research examining the efficiency and effectiveness of this new care model. This study aimed to investigate care recipients’ experiences with HHC and areas for improvement in China.MethodsThis research was a qualitative study based on semi-structured interviews. Qualitative data were collected from homebound adults living in Jinan, Zhangqiu, and Shanghai, China. A sample of 17 homebound participants aged 45 or older (mean age = 76) who have received home-based health care were recruited. Conceptual content analysis and Colaizzi’s method was used to generate qualitative codes and identify themes.ResultsThe evaluations of participants’ experiences with HHC yielded both positive and negative aspects. Positive experiences included: 1) the healthcare delivery method was convenient for homebound older adults; 2) health problems could be detected in a timely manner because clinicians visited regularly; 3) home care providers had better bedside manners and technical skills than did hospital-based providers; 4) medical insurance typically covered the cost of home care services. Areas that could potentially be improved included: 1) the scope of HHC services was too limited to meet all the needs of homebound older adults; 2) the visit time was too short; 3) healthcare providers’ technical skills varied greatly.ConclusionsFindings from this study suggested that the HHC model benefited Chinese older adults—primarily homebound adults—in terms of convenience and affordability. There are opportunities to expand the scope of home health care services and improve the quality of care. Policymakers should consider providing more resources and incentives to enhance HHC in China. Educational programs may be created to train more HHC providers and improve their technical skills.

Editorial: Virtual Groups to Address the Health of Homebound Adults During COVID-19: A Biopsychosocial Framework.

Editorial: Virtual Groups to Address the Health of Homebound Adults During COVID-19: A Biopsychosocial Framework.

Exploring Application of Smart Companion Robots to Facilitate Faith-Based Ministries for Older Homebound Adults

This study examined perceptions regarding application of smart robot companions to facilitate homebound religious ministry programming to older adults. A total of N= 7 participants consisting of ministers, pastoral volunteers, and older adult members from Methodist, Presbyterian, and Roman Catholic traditions engaged in a 60-minute focus group. One key goal was to address the question: If you could design a robot for ministry to homebound older adults what would you want it to do? All responses were recorded, transcribed and coded for thematic content. Three core themes emerged relative to spiritual privacy, prospective intervention, and inclusive monitoring. Relative to spiritual privacy, participants expressed concern regarding robotic ability to maintain the spiritual privacy of the older homebound adult, especially when engaged in faith-based behaviors such as private prayer, confession, and pastoral counseling. Second, participants suggested that a robot companion serve as a memory aide for older homebound members. In particular, participants acknowledged a need for robot intervention relative to sending alerts concerning prayer requests, reminders of upcoming church-related events, and notices concerning future homebound ministry visitations. Finally, participants indicated an interest for the robot to actively monitor community inclusion, noting that many older homebound adults are left out of weekly church-related services or events and experience seclusion, yet most “retain a desire be included and remain an integral part of their faith community.” Results will be used to present a conceptual model for a smart robotic faith assistant designed for delivery of homebound ministries to older adults.