Improve Home Care Research Articles

Research progress on treatment burden and intervention measures for elderly chronic disease comorbidity

Abstract. With the acceleration of global aging, chronic diseases have become a critical factor threatening the elderly population. This study analyzes the current status and intervention measures of treatment burden among elderly chronic disease comorbidity patients from economic, psychological, and social perspectives. Disparities between urban and rural areas, patient health literacy, and incomplete medical systems are key factors exacerbating this burden. Measures such as enhancing health literacy, optimizing medical insurance policies, promoting multidisciplinary diagnosis and treatment models, and improving home care can alleviate patient burdens. Future efforts should focus on the diversification and individualization of treatment burdens, equitable resource allocation, enhancement of patient self-management capabilities, and improvement of patient quality of life.

Long-term outcome of permanent tracheostomy management in two brachycephalic dogs using a commercial and a three-dimensional-printed silicone stent.

To report the long-term outcome of utilization of a silicone stent to support the management of a permanent tracheostomy. Short case series. Two client-owned brachycephalic dogs. Two brachycephalic dogs with stage III laryngeal collapse underwent permanent tracheostomy. After the tracheostomy had healed, a silicone stent was inserted to support the stoma and facilitate home care. One dog wore a commercially available silicone stent for the follow-up period of 2 years. For the dog in Case 2, a 3D-printed, medical-grade silicone stent with an increased length was designed, as the dog had developed skin sores from the commercial device. Both dogs tolerated the silicone stent well. Stent care was managed by the owners without need for assistance. They reported that the silicone stent facilitated cleaning of the stoma surroundings and that they felt an increased confidence in airway patency, as the device prevented the tracheal stoma from collapsing. In Case 1, tracheoscopy 1 year after first stent insertion revealed minimal visible changes to the tracheal stoma. In Case 2, the 3D printed silicone stent led to a remission of skin sores and the dog wore the device comfortably until succumbing to an unrelated disease 13 months later. The insertion of a silicone stent is a simple and cost-effective method to improve home care of dogs with permanent tracheostomy. Larger dogs, as in Case 2, may benefit from custom-designed 3D-printed stents.

CONSTRUÇÃO E VALIDAÇÃO DE TECNOLOGIA EDUCACIONAL SOBRE O PÓS-TRANSPLANTE HEPÁTICO PARA O FAMILIAR CUIDADOR

ABSTRACT Objective: to construct and validate an educational booklet on post-liver transplant for family caregivers. Method: a methodological study carried out in two stages from August 2021 to July 2023: 1) Construction of the educational booklet aimed at liver transplant patient's family caregivers; and 2) Content and face validation by expert judges and semantic validity with the target audience. For the experts to analyze the validity data, the Content Validity Index was used (≥0.78 per item and ≥0.80 in total), as well as the Exact Binomial Distribution test (p>0.05 and 0.80) and the Intraclass Correlation Coefficient (95%) for greater reliability. In the semantic evaluation, the IRaMuTeQ software was used to guide the analysis of the interviews, using Descending Hierarchical Classification and Word Cloud. Results: after the bibliographic survey, four axes guided the construction of the booklet. The total Content Validity Index was 0.99 (p>0.05), with excellent reliability (ICC=0.946). The total Face Validity Index was 0.93 (p>0.05), with good reliability (ICC=0.766). In terms of semantics, the analytical categories pointed to a satisfactory level of perception and understanding of the booklet by the target audience. Conclusion: the technology is innovative, including caregivers in the education process, and is relevant to post-transplant care. The validation process shows the feasibility of understanding the booklet and the need to use it to improve home care.

SUCCESSFUL METHODS FOR ELICITING VIEWS OF DIRECT CARE WORKERS REGARDING NEEDS AND PREFERENCES OF HOME CARE CLIENTS

Abstract Over the past decades, as the recruitment and retention of Direct Care Workers (DCWs) has become a critical issue, numerous studies have sought to elicit workers’ views, particularly on job satisfaction, stressors, and intent to stay. This project, which includes a review of those studies, uncovered a wide variety of methods and approaches, which we are evaluating for use in future studies that would capture direct care worker’s insights regarding the needs and preferences of the people for whom they provide support. In particular, this project, in conjunction with a larger one designed to assess dually-eligible care recipients’ experiences with formal home care, explores methodologies best suited to capturing the congruence of DCWs’ views with those of recipients’ needs and preferences. It would test the hypothesis that DCWs’ assessments may supplement recipients’ insights, and may strengthen advocacy to improve home care access, policies and practices. The presentation will offer a systematic review of methods and instruments, including use of validated tools and those with face validity that addresses culturally relevant factors, as well as the use of focused and hypothesis-generating open-ended interviews that are sensitive to the power relationships and voices of those participants in the endeavor. The presenters will offer potentially innovative practices, such as observation, documentation analysis, and the use of Delphi techniques which draw on the knowledge and expertise of DCWs. The presentation will also draw on studies that utilized technology and social media to reach and engage this study population.

Exploring factors contributing to the risk of falls in community-dwelling older adults: A review of the literature

Background: Falling is a big threat to community-dwelling older adults’ independence. The chance of falling increases as people become older, which increases morbidity and mortality. The outcomes related to falls impact families, communities, and healthcare systems. As a result, the Primary Health Care Corporation (PHCC) seeks to decrease the number of falls for community-dwelling older adults in Qatar.Aims: To explore the risk factors for falls in community-dwelling older adults. To inform the education of PHCC nurses so that they might begin to look at prevention strategies.Method: Cronin et al.’s framework guided this integrative literature review. CINAHL, Academic Search Complete, Embase, and PubMed databases were utilized to search for relevant articles. The search process returned 20 articles that met the inclusion requirements.Results: Various intrinsic and extrinsic factors lead to falls in community-dwelling older adults. The intrinsic factors include socio-demographic factors, physical health factors, physiological factors, sensory factors, psychological factors, and social factors. Environmental factors were the sole extrinsic factor.Conclusion: The findings of this literature review can be used to inform the creation of an educational program to improve home care nurses’ understanding of and attitudes toward the causes of falls in community-dwelling older adults. Through this program, nurses may begin to predict factors that lead to falls and, therefore, find strategies that help to reduce them.

Supporting First Nations Family Caregivers and Providers: Family Caregivers', Health and Community Providers', and Leaders' Recommendations.

Family caregivers and care providers are increasingly becoming more distressed and reaching a breaking point within current systems of care. First Nations family caregivers and the health and community providers employed in First Nations communities have to cope with colonial, discriminatory practices that have caused intergenerational trauma and a myriad of siloed, disconnected, and difficult-to-navigate federal-, provincial/territorial-, and community-level policies and programs. Indigenous participants in Alberta's Health Advisory Councils described Indigenous family caregivers as having more difficulty accessing support than other Alberta caregivers. In this article, we report on family caregivers', providers', and leaders' recommendations to support First Nations family caregivers and the health and community providers employed in First Nations. We used participatory action research methods in which we drew on Etuaptmumk (the understanding that being in the world is the gift of multiple perspectives) and that Indigenous and non-Indigenous views are complementary. Participants were from two First Nation communities in Alberta and included family caregivers (n = 6), health and community providers (n = 14), and healthcare and community leaders (n = 6). Participants advised that family caregivers needed four types of support: (1) recognize the family caregivers' role and work; (2) enhance navigation and timely access to services, (3) improve home care support and respite, and (4) provide culturally safe care. Participants had four recommendations to support providers: (1) support community providers' health and wellbeing; (2) recruit and retain health and community providers; (3) improve orientation for new providers; and (4) offer providers a comprehensive grounding in cultural awareness. While creating a program or department for family caregivers may be tempting to address caregivers' immediate needs, improving the health of First Nations family caregivers requires a population-based public health approach that focuses on meaningful holistic system change to support family caregivers.

Defining practice variation and exploring influencing factors on needs assessment in home care nursing: A Delphi study.

To describe a Delphi study regarding practice variation in needs assessment by Dutch home care nurses, to define practice variation in home care nursing and explore which factors may have a role in this needs assessment. A Delphi study was conducted with the participation of home care representatives. A Delphi questionnaire was developed, preceded by literature research and an expert meeting. The Delphi study took place between December 2020 and February 2021. The goal was to achieve a consensus level of at least 70%. After three rounds, 32 experts reached a consensus about definitions regarding variation in needs assessment, warranted and unwarranted variation. In total, 59 factors were determined related to (1) the client and health, (2) the clients' context, (3) nurses and (4) the nurses' context. Thirty-four factors scored warranted of influence and 18 (of 34) were client related. Most of the factors that scored unwarranted influencing needs assessment (17 of 26) were related to the home care nurses' context. Having a consensus about the definition of practice variation in needs assessment and possible influencing factors support the professionals to discuss and improve the unity and quality of their decision-making process in home care. This may contribute to more righteous care for clients in need of home care. Since 2015, home care nurses in the Netherlands are responsible for determining the amount, type and duration of care for clients in need of home care. This so-called needs assessment legitimizes the payment by health insurers. Signals of practice variation in needs assessment are heard in home care field. Although practice variation may be justified, it can lead to over or underuse of care, which may affect clients' outcomes. If we can identify influencing factors and find patterns that contribute to practice variation, we might gain a better understanding of the process and improve home care. In this study, there was no patient or public involvement. Client representatives were included in this research as experts in the home care field, and they participated in three rounds of the Delphi study. They contributed by sharing their expert opinion on the definitions presented and the factors possibly influencing needs assessment.

Challenges to the provision of home care and support for people with severe mental illness: Experiences and perspectives of patients, caregivers, and healthcare providers in Dar es Salaam, Tanzania.

A balance between hospital-based and community-based services is needed to effectively provide mental health services for people with mental illness. As an essential part of community mental health services, home-based care plays an important role in meeting patients' needs, and should, therefore, be appropriately provided. To achieve this, there is a need to understand the challenges faced and take relevant actions to address them. This study aimed to explore challenges to home care and support for people with mental illness in Temeke district, Dar es Salaam. We used a descriptive qualitative study approach to explore challenges to home care and support for people with mental illness among patients, their caregivers, and healthcare providers. The purposeful sampling method was used to recruit participants at Temeke hospital, data was collected using in-depth interviews and focus group discussions, and analysis was performed using a content analysis framework. Four main themes highlighting challenges encountered in the provision of home care and support for individuals with mental illness were revealed. They include poor understanding of mental illness, abandonment of patients' care responsibilities, disputes over preferred treatment, and lack of outreach services for mental health. Participants also provided suggestions to improve home care and support for people with mental illness. Home care for people with mental illness is affected by poor knowledge of the mental illness, social stigma, and lack of outreach visits. There is a need for the provision of health education regarding mental illness, stigma reduction programs, and funding and prioritization for outreach home visits to improve home care and support for people with mental illness. Further research is needed to determine the magnitude of these challenges and factors that can facilitate the provision of support in similar settings.

Meanings of being a change agent in implementing a new organisational culture in home care services: A phenomenological hermeneutic study

Culture change is common in healthcare organisations worldwide today, and change agents are key persons in the process of change. It is therefore of vital importance to deepen the knowledge about change agents’ experiences. The aim of the study was to illuminate meanings of being a change agent to improve home care services. Ten change agents were interviewed individually using open-ended questions. The interviews were analysed with phenomenological hermeneutics. The design of the study followed the COREQ guidelines. Three themes were revealed in the analysis: ‘Being confirmed by the opportunity to make quality improvements’; ‘Pushing oneself to transfer the message’; and ‘Being strengthened by achievements but wishing for better conditions’. In order to prepare co-workers, change agents need training before their mission begins and during the change process.

THE PHYSICAL AND MENTAL HEALTH OF HOME HEALTHCARE WORKERS: WHAT DO WE KNOW AND WHAT CAN WE DO ABOUT IT?

Abstract This presentation will use data from the 2014-2018 CDC's Behavioral Risk Factor Surveillance Survey to characterize the physical and mental health of home health care workers compared to other similar frontline, low-wage worker groups, before the COVID-19 pandemic. Next, using primary survey data collected in partnership with the 1199SEIU Training and Employment Fund, the health of the workforce during the COVID-19 pandemic will be presented, as well as the workforces' needs. The survey includes data from over 250 home health care workers employed in New York, NY who provided care during the pandemic. Finally, data from a pilot feasibility study of an intervention aimed at improving home care workers' well-being will be presented.

THE HEALTH OF THE DIRECT CARE WORKFORCE: EVIDENCE AND IMPLICATIONS ACROSS LONG-TERM CARE

Abstract Direct care workers play a key role in supporting the health and wellbeing of older adults and people with disabilities across care settings—yet their own health risks are largely overlooked. The four papers in this symposium address this critical knowledge gap. First, McCall and colleagues will present a comparative analysis of the health status, health insurance coverage, and healthcare experiences of direct care workers across long-term care using National Health Interview Survey data. Next, Lee et al. will present the trends and characteristics of occupational injuries and illnesses among California’s long-term care workers from 2019 to 2020 using California Workers’ Compensation data, assessing the impact of COVID-19 on their occupational health. Sterling will characterize the physical and mental health of the direct care workforce before and during COVID-19 using data from the CDC's Behavioral Risk Factor Surveillance Survey, as well as drawing on qualitative and survey-based studies of unionized, agency-employed home care workers in New York. Sterling will also present findings from a pilot feasibility study of an intervention aimed at improving home care workers’ well-being. Finally, Quinn et al. will synthesize findings on home care workers’ occupational hazards—including needlesticks, musculoskeletal strain, violence and infections—and examine how preventing these risks can improve safety for both workers and clients. The discussant will draw out themes and implications from across these complementary studies, highlighting the importance of safeguarding direct care workers’ health as a key step toward improving care quality and outcomes for older adults and people with disabilities.

DELIRIUM-LIKE BEHAVIORAL SYMPTOMATOLOGY IN COMMUNITY-DWELLING OLDER ADULTS WITH DEMENTIA

Abstract Delirium, a sudden and acute confusional state, is known to be more prevalent and deleterious in older adults with dementia; yet the literature on estimates of delirium in community-dwelling older adults with dementia is scarce. The aim of this study was to determine the patterns and frequency of delirium-like symptoms in community-dwelling older adults with dementia, as reported by their caregivers (n=50) in a 21-day diary study (n=1389 diaries). Caregiver reports of severity scores of care-recipient behaviors that were one standard deviation above the mean were considered outliers, representing a sudden and acute change. Caregivers that reported outlier scores for two consecutive days were considered delirium-like symptoms. Descriptive statistics were used to determine the number of caregivers who reported delirium-like symptoms and the percentage of days with symptoms present. Additionally, chi-square tests and Independent samples T-test were used to determine the associations between delirium-like symptoms and participant characteristics. Caregivers were predominately White/Caucasian (89%), female (94%), and a son/daughter (60%) of the care-recipient. Caregivers had an average age of 52.6 years and were caregiving an average of 3.9 years. The care-recipients had dementia for an average of 4.3 years. Caregivers reported delirium-like symptoms for 12(24%) care-recipients and this rate was consistent with previous research findings. Caregivers reported delirium-like symptoms, on average, for 6.9 days (33%) of the 21-day diary period. More research is needed to understand the occurrence and patterns of delirium in community-dwelling older adults with dementia to improve home care services, outpatient services, and support for caregivers.

The role of pets in the support systems of community-dwelling older adults: a qualitative systematic review

Objective Western countries face ageing populations and increasing numbers of older adults receiving long-term care at home (home care). Approximately 50% of households in Western countries own pets, and while pets impact the health and wellbeing of their owners, most healthcare organisations do not account for the role of pets in the lives of their clients. Due to the lack of research in older adults receiving home care that own pets, this study aimed to review previous qualitative research about the role and significance of pets for older adults in general. Method PubMed and PsycINFO were systematically searched with variations on (MeSH) terms for older adults (mean age 65 years and older), pets, and qualitative study designs. Iterative-inductive thematic analyses were performed in ATLAS.ti. Results We included fifteen studies and extracted twenty-eight themes within seven categories: Relational Aspects, Reflection and Meaning, Emotional Aspects, Aspects of Caregiving, Physical Health, Social Aspects, and Bidirectional Behaviour. Older adults reported not only on positive aspects of pet ownership such as the emotional support their pets provided but also on negative aspects such as postponing personal medical treatment. Conclusion Older adults perceived pets as important for their health and wellbeing. This implies that care workers may be able to improve home care by accounting for the role of pets of older adults receiving home care. Based on our findings, we suggest that community healthcare organisations develop guidelines and tools for care workers to improve care at home for clients with pets.

A social network analysis to explore collaborative practice in home care: research protocol

BackgroundThe conceptualization of the home as a care environment and maintaining a high standard of care requires different professionals to collaborate. This study will explore collaborative practice in home care, needs and expectations of the stakeholders involved, and identify their roles and tasks. Secondly, it will investigate possible strategies to improve home care management and, more particularly, optimize collaborative practice in home care.MethodsThe study will be conducted during three distinct consecutive phases, within a multiphase mixed-methods design. Phase 1 will use a quantitative approach in which a social network analysis will be conducted to have an overview of collaborative practice in home care in French-speaking Switzerland. Phases 2 and 3 will be qualitative and focus on three different situations involving different locations (rural and urban) and different home care functioning (home care provided by agencies and home care providing by independent caregivers). In each situation, semi-structured interviews will be conducted with home care recipients and their home caregivers. In phase 2, results of phase 1’s network analysis will be discussed, such as roles, needs, and expectations of all stakeholders involved in home care. In phase 3, phase 2’s findings will be discussed and strategies to improve home care and to optimize collaborative practice will be explored.DiscussionOver the past years, home care has grown considerably. Therefore, more and more different caregivers are involved in the recipients' homes. Since optimal coordination between these different caregivers is a prerequisite for quality and safe care, it is essential to investigate the existing collaborative practice and how it is functioning. This study will provide knowledge on roles, needs and expectations of different caregivers involved in home care. It will also allow for strategies to optimize collaborative practice and thus ensure comprehensive care for recipients. Finally, it will serve as a basis for future studies that can be conducted to address identified needs.

The experiences and needs of nurses providing home-based palliative care: A qualitative meta-synthesis.

Objective(s): We conducted a qualitative meta-synthesis of qualitative studies on nurses' experiences when caring for palliative patients to (1) identify the needs of nurses and (2) describe their experiences to provide more in-depth information. Methods: Qualitative articles published in English from 2000 to 2022 were identified from several databases through a searching strategy. Authors screened through the title, abstract, and full text of relevant studies. Articles were read repeatedly and discussed. The thematic analysis methodology was adopted to analyze the data. Results: Of 967 articles, 22 were included in our review. Notions reflecting community nurses providing palliative home care were clustered into four themes: (1) nature of community-based palliative nursing, (2) teamwork, (3) relationship with patient and family, and (4) resources. Findings also suggest establishing a sound support system, strengthening palliative education, and creating more decisive referral criteria and systems. Conclusions: The growing need for palliative home care has become challenging for community health care systems. Our study summarized various aspects of nurses providing home-based palliative care. The findings provide information for health care and education settings to improve home care systems and recruit more staff to meet the needs.

What constitutes \u2018good\u2019 home care for people with dementia? An investigation of the views of home care service recipients and providers

BackgroundOur objective was to explore what people receiving and providing care consider to be ‘good’ in-home care for people living with dementia.MethodsWe conducted 36 in-depth interviews and two focus groups with key stakeholders in Australia in the first quarter of 2018. Participants included those receiving care (4 people living with dementia, 15 family carers) or providing care (9 case managers, 5 service managers, 10 home care workers). Qualitative thematic analysis was guided by Braun and Clarke’s six-step approach.ResultsConsensus was reached across all groups on five themes considered as important for good in-home dementia care: 1) Home care workers’ understanding of dementia and its impact; 2) Home care workers’ demonstrating person-centred care and empathy in their care relationship with their client; 3) Good relationships and communication between care worker, person with dementia and family carers; 4) Home care workers’ knowing positive practical strategies for changed behaviours; 5) Effective workplace policies and workforce culture. The results contributed to the co-design of a dementia specific training program for home care workers.ConclusionsIt is crucial to consider the views and opinions of each stakeholder group involved in providing/receiving dementia care from home care workers, to inform workforce training, education program design and service design. Results can be used to inform and empower home care providers, policy, and related decision makers to guide the delivery of improved home care services.Trial registrationACTRN 12619000251123.

Transition Home Following New Fecal Ostomy Creation: A Qualitative Study.

Perioperative ostomy education is essential for patients to develop skills and comfort with self-care at home with a new ostomy, but shortened hospital length of stay (LOS) reduces time for postoperative education for patients. This study explored the initial experiences and care needs of patients who have undergone creation of a new ostomy during their transition from hospital to home. Qualitative interpretive description using latent content analysis. Thirteen patients who had undergone an elective colorectal surgery involving creation of an ostomy were interviewed. Participants were 33 to 78 years of age, 54% were female, and 62% were undergoing ostomy creation for colorectal cancer operations. Eleven participants underwent temporary ileostomy creation, and 2 patients had permanent end colostomies created. Interviews were conducted in person and audiotaped by study investigators within 4 to 6 weeks postoperatively. Audiotapes were transcribed verbatim by trained transcriptionists, and each transcript was reviewed in duplicate by study investigators. A latent content analysis method was used to determine the implied meaning in participants' experiences of having a new ostomy. The transition from hospital to home with a new ostomy was illustrated by 5 major themes: (1) Having an ostomy is a life-changing and bizarre experience; (2) Adjustment and adaptation occur through acceptance and self-reliance; (3) It's a hands-on thing: with the role of WOC nurse providing support in achieving independence; (4) Improved home care infrastructure is needed; and (5) Practical advice shared from experiential learning. Patients with new ostomies are motivated and able to cope with the ostomy and regain independence over a short period after surgery. Shorter LOS does not impede ostomy education so long as adequate home care and support group programs are available. Knowledge gained through this study will assist WOC nurses in managing patients' expectations and the planning and delivery of education to patients with newly created ostomies.

Can the Timed and Targeted Counseling Model Improve the Quality of Maternal and Newborn Health Care? A Process Analysis in the Rural Hoima District in Uganda.

Each year, more than half a million women die worldwide from causes related to pregnancy and childbirth, and nearly 4 million newborns die within 28 days of birth. In Uganda, 15 women die every single day from pregnancy and childbirth-related causes, 94 babies are stillborn, and 81 newborn babies die. Cost-effective solutions for the continuum of care can be achieved through Village Health Teams to improve home care practices and health care-seeking behavior. This study aims at examining the implementation of the timed and targeted counseling (ttC) model, as well as improving maternal and newborn health care practices. We conducted a quantitative longitudinal study on pregnant mothers who were recruited on suspicion of the pregnancy and followed-up until six weeks post-delivery. The household register was the primary data source, which was collected through a secondary review of the ttC registers. All outcome and process variables were analyzed using descriptive statistics. The study enrolled 616 households from 64 villages across seven sub-counties in Hoima district with a 98.5% successful follow-up rate. Over the course of the implementation period of ttC, there was an increase of 29.6% in timely 1st antenatal care, 28.7% in essential newborn care, 25.5% in exclusive breastfeeding, and 17.5% in quality of antenatal care. All these improvements were statistically significant. The findings from this study show that the application of the ttC model through Village Health Teams has great potential to improve the quality of antenatal and newborn care and the health-seeking practices of pregnant and breastfeeding mothers in rural communities.

The ANT Home Care Model in Palliative and End-of-Life Care. An Investigation on Family Caregivers' Satisfaction with the Services Provided.

The World Health Organization plan for a Decade of Healthy Ageing 2020–2030 has established some priorities in the field of palliative and end-of-life care. It states that “people require non-discriminatory access to good-quality palliative and end-of-life care” and recommends the “implementation of strategies for the provision of information, training, respite and support for informal caregivers”. The priorities described are in line with the home care services that National Tumor Assistance (ANT) Foundation has been providing in Italy. This 5-years investigation was designed to measure caregivers’ satisfaction and determine what types of support services are associated with greater satisfaction. 5.441 family caregivers filled out autonomously a 6-item questionnaire at the end of home care assistance, focusing on the level of satisfaction with the social and health services received. The overall data indicate a high satisfaction rate for the home care assistance received. In particular, participants rate positively the assistance provided by healthcare professionals (physicians, nurses and psychologists). The most appreciated aspects of assistance are those ensuring a global management of patients and their families, whereas an area of deficiency emerged was the continuity of care, suggesting the importance to implement the networks between the health care facilities and home care services. The present investigation constitutes a mean to highlight the aspects associated with greater satisfaction and the ones perceived as less satisfactory by caregivers. Moreover, this research constitutes a crucial instrument to improve home care assistance provided by ANT ensuring the best quality of life for both patients and their families.

Impact of a New Home Care Payment Mechanism on Growth of the Home Care Workforce in Taiwan.

Taiwan implemented its first National 10-Year Long-Term Care Plan in 2008 and its second in 2017. Over the first 10 years, the number of home care workers grew too slowly to meet demand. To increase the home care workforce, the government introduced 2 new payment mechanisms in 2018. This study assesses these mechanisms' impact on growth in numbers of home care workers and use of home care services in Taiwan. Data were collected from the Ministry of Health and Welfare (2014-2019) and the Division of Long-Term Care (2017-2019). Generalized estimating equations compared rates of growth in the number of home care, institutional care, and foreign care workers and the number of care recipients receiving care from each group before and after 2018. Before 2018, rates of growth in all three groups of care workers increased slowly. After 2018, the rate of growth for home care workers increased to 31.8% from 9%, while growth in the other two groups remained stable. While there was greater workforce growth among home care than institutional care workers post-implementation of the payment mechanisms (p < .05), the number of home care recipients (p < .05) and monthly home care visits (p < .05) also increased. The new payment mechanisms improved home care workers' autonomy and salaries and appear to have contributed to immediate increased recruitment and retention. Whether this increase continues over the long run will need to be determined.