Improve Home Care Research Articles

Sex Differences in Home Care Performance: A Population-Based Study

BackgroundHome care services play an integral role in promoting independence, reducing hospital admission and readmission rates, and preventing or delaying nursing home admission among older adults. Despite important sex differences in functional status and use of services by recipients of home care, differences in home care performance measures by sex have not been examined. ObjectiveTo assess sex differences in the quality of publicly funded home care services in Ontario, Canada. MethodsValidated, publicly reported home care quality indicators derived from the Resident Assessment Instrument for Home Care using the 2009 and 2010 Home Care Reporting System database were assessed for 119,795 Ontario home care clients aged 65 years and older. Unadjusted and risk-adjusted sex differences in performance were examined provincially and by health region. ResultsIn unadjusted analyses, there were sex differences in health outcomes on all indicators examined (decline or failure to improve in activities of daily living, cognitive decline, depressive symptoms, and pain control). After risk adjustment, differences were minimal. For example, in unadjusted analyses, 23.1% of women and 18.7% of men reported poorly controlled pain. After risk adjustment, 21.2% of women and 21.6% of men reported poorly controlled pain, with a difference of −0.4% (95% CI, −0.4% to −0.3%). Across health regions risk adjustment eliminated sex differences. There was 1.3-fold to 2.6-fold variation in performance on indicators across health regions. ConclusionsAfter risk adjustment, no important sex differences in home care quality indicators were identified. Sizable regional variations observed indicate potential to improve home care outcomes for both women and men. Sex differences in unadjusted analyses demonstrate the value of examining both unadjusted and adjusted outcomes and suggest sex-specific strategies will likely be needed to improve home care quality.

Associations between workers' health, and non-standard hours and insecurity: the case of home care workers in Ontario, Canada

This article examines associations between home care workers' health, and non-standard hours and insecurity. Health refers to symptoms of stress and musculoskeletal disorders (MSDs), non-standard hours refer to part-time and casual hours, and insecurity refers to job and employability insecurity. Data come from our 2002 survey of 532 home care workers (nurses, therapists and personal support workers) in a medium-sized city in Ontario, Canada. Path analysis regression results for the conceptual model show that (1) part-time and casual hours and job insecurity are positively and significantly associated with symptoms of stress, (2) the associations between part-time and casual hours and MSDs are mediated by symptoms of stress, and (3) job and employability insecurity are directly associated with MSDs. Results provide evidence that non-standard hours and insecurity must be addressed in order to improve home care workers' health. We show the detrimental effects of non-standard hours and insecurity on workers' health, and the results have implications for employers, human resource managers, trade unionists and government policy-makers.

Theory of Constraints as Design Science: The Case of Improving Home Care

In this paper, we apply design science methodology to tackle the resource allocation problem faced by a home care initiative of a Northern European city. Combining problem-solving methods with Theo...

Investigation on the psychological healthy conditions of the elderly in the community and study of social endowment problems

Objective To investigate the psychological healthy conditons of the elderly in the Bayi community of Liaocheng city,study the related factors and social pension problems.Methods In the Bayi community of Liaocheng city,780 elderly people (over 60 years old) were investigated face to face by the different questionnaires including self-designed questionnaire,mini-mental state examination (MMSE),the Geriatric Depression Scale (GDS),self-esteem index (SEI).Results Chronic disease,intellectual function,depressive state and family social support were the main factors influencing the daily life of the elderly.Conclusions Some measures are considered effective in improving the life quality of the elderly,which are including developing and improving home care,supplementary set of senile apartments and aged nursing hospital,carrying out psychological consulting and expanding the service scope by making full use of community health service stations. Key words: Community; Elderly; Psychological healthy; Social endowment

Interventions to delay institutionalization of frail older persons: design of a longitudinal study in the home care setting

BackgroundOlder people usually prefer staying at home rather than going into residential care. The Belgian National Institute for Health and Disability Insurance wishes to invest in home care by financing innovative projects that effectively help older people to stay at home longer. In this study protocol we describe the evaluation of 34 home care projects. These projects are clustered according to the type of their main intervention such as case management, night care, occupational therapy at home and psychological/psychosocial support. The main goal of this study is to identify which types of projects have the most effect in delaying institutionalization of frail older persons.Methods/designThis is a longitudinal intervention study based on a quasi-experimental design. Researchers use three comparison strategies to evaluate intervention - comparison among different types of projects, comparisons between older persons in the projects and older persons not benefiting from a project but who are still at home and between older persons in the projects and older persons who are already institutionalized. Projects are asked to include clients who are frail and at risk of institutionalization. In the study we use internationally validated instruments such as the interRAI Home Care instrument, the WHO-QOL-8 and the Zarit Burden Interview-12. These instruments are filled out at baseline, at exit from the project and 6 months after baseline. Additionally, caregivers have to do a follow-up every 6 months until exit from the project. Criteria to exit the cohort will be institutionalization longer than 3 months and death. The main analysis in the study consists of the calculation of incidence rates, cumulative incidence rates and hazard rates of definitive institutionalization through survival analyses for each type of project.DiscussionThis research will provide knowledge on the functional status of frail older persons who are still living at home. This is important information to identify determinants of risk for institutionalization. The identification of effective home care projects in delaying institutionalization will be useful to inform and empower home care providers, policy and related decision makers to manage and improve home care services.

Complications of Central Venous Catheters in Children Undergoing Hematopoietic Stem Cell Transplantation in Turkey

Although central venous catheters (CVCs) have become an integral element of the care of patients undergoing hematopoietic stem cell transplantation (HSCT), the associated complications can lead to treatment delays and negatively affect the child and family's quality of life. The aim of this study was to identify the types, rate of, and risk factors for the complications relating to CVCs used in children undergoing HSCT in Turkey. One hundred children were followed prospectively to track catheter-related complications in the transplantation unit. Overall, 186 complications were documented. The most frequent complications were catheter-related infections and malfunctions. Children who had nonhematological disease had a higher rate of complications than those with hematological disease. HSCT nurses should follow and apply evidence-based clinical practice guidelines to support the management of catheters. Nurse staffing ratios and workload may be an issue in developing countries. The authors believe that proper maintenance of CVCs contributes to the reduction of catheter-related complications despite these issues and that problems can be overcome by hiring experienced staff, appropriate nursing education, and by organizing and improving home care programs for HSCT patients.

New nursing roles for the integrated management of complex chronic and palliative care patients in the region of Valencia/Nuevos perfiles enfermería para el manejo integral de pacientes crónicos complejos y paliativos en la Comunidad Valenciana

The autonomous region of Valencia has a population of 5.1 million divided into 24 health districts and the governing body of the Valencia Health Service is the Valencia health agency (AVS, Agencia Valenciana de Salut). In the framework of the plan for improving home care in the region of Valencia [1] a study was carried out between 2005 and 2006, across three of these health districts. The study assessed the quality of home care provided by the two largest agents (by volume of activity): the primary care teams (PCTs—a total of 241, at present) through a home care programme (HCP) and the hospital-at-home (HaH) units, well developed in the AVS region (with a total of 24, at present). Able to attend 1428 patients per day, these HaH units supported 35,802 discharges in 2010. The main objective of the study was to establish a basis for designing improvement interventions in the sphere of home care. Notably, the results demonstrated a fragmentation and lack of continuity of care between HaH units and the HCP for palliative care patients and those with advanced chronic diseases, a very complex group of patients associated with a high use of resources that may jeopardise the sustainability of the system.

Home care workers: interstate differences in training requirements and their implications for quality.

Home care workers, the fastest growing segment of the U.S. direct care workforce, provide nonmedical services that are not reimbursed by Medicare; consequently, requirements for training and supervision are left to the states. The purposes of this study are to compare these state requirements and to identify core competencies for home care workers. Our content analysis of relevant state laws determined that 29 states require a license for home care providers. Of these 29 states, 26 require orientation and 15 require in-service training for home care workers; the duration and content of these programs vary widely across the states. Fifteen states require on-site supervision of home care workers. We believe that in addition to current state training requirements (e.g., activities of daily living (ADLs) and instrumental activities of daily living (IADL) assistance; infection control), other core competencies (e.g., basic medication information; behavioral management) should also be mandatory. More frequent on-site supervision is also necessary to improve home care quality.

Evidence-based Standardized Care Plans for Use Internationally to Improve Home Care Practice and Population Health

Evidence-based Standardized Care Plans for Use Internationally to Improve Home Care Practice and Population Health

Assessing the impact of a restorative home care service in New Zealand: a cluster randomised controlled trial

Due to the ageing population, there is an increased demand for home care services. Restorative care is one approach to improving home care services, although there is little evidence to support its use in the community setting. The objective of this trial was to evaluate the impact of a restorative home care service for community-dwelling older people. The study was a cluster randomised controlled trial undertaken at a home care agency in New Zealand. The study period was from December 2005 to May 2007. Older people were interviewed face-to-face at baseline, four and 7 months. A total of 186 older people who received assistance from a home care agency participated in the study, 93 received restorative home care and 93 older people received usual home care. The primary outcome measure was change in health-related quality of life (measured by the Short Form 36 [SF36] Health Survey). Secondary outcomes were the physical, mental, and social well-being of older people (Nottingham Extended Activities of Daily Living, Timed Up and Go, Mastery scale, Duke Social Support Index). Findings revealed that compared with usual care, the intervention demonstrated a statistically significant benefit in health-related quality of life (SF36) at 7 months for older people (mean difference 3.8, 95% CI -0.0 to 7.7, P = 0.05). There were no changes in other scale measurements for older people in either group over time. There was a statistically significant difference in the number of older people in the intervention group identified for reduced hours or discharge (29%) compared with the control group (0%) (P < 0.001). In conclusion, a restorative home care service may be of benefit to older people, and improves home care service efficacy.

Bringing Children Home

Pediatric home care is an emerging need. Eleven years ago, six community-based, not-for-profit home care agencies in New Hampshire and Vermont took action by progressively forming the Visiting Nurse Association Health System of Northern New England, Inc. (VNAHSNNE) workgroup to improve pediatric home care. The focus of a pediatric home care initiative called Bringing Children Home was created to provide enhanced training for pediatric nurses and bridge the gap between inpatient pediatric care and home care, thus improving home care for children with complex medical needs. The goal of the workgroup is to enhance the transition from hospital to home, ultimately providing improved quality care to the patient and the family.

Evidence-based Standardized Care Plans for Use Internationally to Improve Home Care Practice and Population Health.

To develop evidence-based standardized care plans (EB-SCP) for use internationally to improve home care practice and population health. A clinical-expert and scholarly method consisting of clinical experts recruitment, identification of health concerns, literature reviews, development of EB-SCPs using the Omaha System, a public comment period, revisions and consensus. Clinical experts from Canada, the Netherlands, New Zealand, and the United States participated in the project, together with University of Minnesota School of Nursing graduate students and faculty researchers. Twelve Omaha System problems were selected by the participating agencies as a basic home care assessment that should be used for all elderly and disabled patients. Interventions based on the literature and clinical expertise were compiled into EB-SCPs, and reviewed by the group. The EB-SCPs were revised and posted on-line for public comment; revised again, then approved in a public meeting by the participants. The EB-SCPs are posted on-line for international dissemination. Home care EB-SCPs were successfully developed and published on-line. They provide a shared standard for use in practice and future home care research. This process is an exemplar for development of evidence-based practice standards to be used for assessment and documentation to support global population health and research.

An Intervention to Improve Nurse-Physician Communication in Depression Care

Depression in older adult home care recipients is frequently undetected and inadequately treated. Failed communication between home healthcare personnel and the patient's physician has been identified as a barrier for depression care. The purpose of this pilot intervention study was to improve nurse competency for communicating depression-related information to the physician. A single group pre-post experimental design. Two Medicare-certified home healthcare agencies serving an urban and suburban area in New York. Twenty-eight home care nurses, all female Registered Nurses. Two-hour skills training workshop. To evaluate the intervention, pre-post changes in effective nurse communication using Objective Structured Clinical Examinations and nurse survey reports. The intervention significantly improved the ability of the home care nurse to perform a case presentation in a complete and standard organized format pre versus postintervention. The intervention also increased nurse-reported certainty to communicate depression-related information to the physician. Our findings provide support for the ability of a brief, depression-focused communication skills training intervention to improve home care nurse competency for effectively communicating depression-related information to the physician.

Knowledge-based provision of home care e-services for the elderly and disabled

Introduction: Elderly chronic patients are an increasing population using more and more national health services all around Europe. One way to better manage this social and economic challenge is to improve home care through the introduction of information and communication technologies (ICTs). Description: The K4Care European research project has developed a web-based multi-agent platform providing the medical and manage- ment e-services required in a home care system. Due to the comorbidity of the typical patients of this application, the tool allows medical practitioners to define fully personalised care treatments (Individual Intervention Plans). Each of them involves the execution of diverse actions from different actors of the system. Every actor deals with an intelligent agent of the K4Care platform. Agents coordinate their activities autonomously in order to efficiently execute these personalised plans under the supervision of practitioners. Moreover, all the behaviour of the system is guided dynamically by the organisational and medical knowledge represented in the form of ontologies and formal intervention plans. Conclusion: The prototype developed in the K4Care project can be taken as a proof-of-concept of the viability of improving home care assistance in the near future by using a combination of artificial intelligence methodologies, medical knowledge and ICTs.

What is the role of the general practitioner towards the family caregiver of a community-dwelling demented relative?

Objective. To identify the attitudes and perspectives of the family physician towards the caregivers of demented relatives and to describe the caregivers’ satisfaction. Design. Systematic review. Subjects. The studied population consisted of dementia family and their general practitioners. Main outcome measures. Outcome measures were the generic tasks and skills of the general practitioner to improve home care from the perspective of the family caregiver. Caregivers were assessed on satisfaction regarding the care provided by their general practitioner. Results. The general practitioner is aware of his/her skills and limits in all aspects of dementia care and his/her role towards the family caregiver. They also acknowledged the importance of an adequate diagnostic process, but they felt uncomfortable disclosing the diagnosis to both the patient and the caregiver. They reported having more confidence in treatment matters than in diagnostic stages. Caregivers’ reports on the attitude of their general practitioner in the diagnostic process were rated from helpful to poorly empathized. General practitioners found themselves to be highly involved in dementia home care, but caregivers rated their involvement to be insufficient. The lack of appropriate communication skills of general practitioners was also not appreciated by the caregivers. A lack of time and reward was considered by the general practitioner to be a major obstacle in dementia care. Conclusion. The key role of general practitioners as care providers and care planners is consolidated by the family caregivers’ confidence in their skills. Clear guidelines from early diagnosis to adequate referrals should improve the ability of the general practitioner to support these time and energy-consuming home-care situations. Intervention studies addressing the gaps in the skills of the general practitioners in dementia home care management could be helpful in supporting the family caregiver.

Implementing community-based perinatal care: results from a pilot study in rural Pakistan

This pilot study investigated the feasibility of delivering a package of community-based interventions for improving perinatal care using lady health workers (LHWs) and traditional birth attendants (Dais) in rural Pakistan. The intervention was implemented in four of eight village clusters (315 villages, total population 138,600), while four served as a comparison group. The LHWs in intervention clusters received additional training focused on essential maternal and newborn care, conducted community education group sessions, and were encouraged to link up with local Dais. The intervention was delivered within the regular government LHW programme and was supported by the creation of voluntary community health committees. In intervention villages, there were significant reductions from baseline in stillbirth (from 65.9 to 43.1 per 1000 births, P < 0.001) and neonatal mortality rates (from 57.3 to 41.3 per 1000 live births, P < 0.001). The proportion of deliveries conducted by skilled attendants at public sector facilities also increased, from 18% at baseline to 30%, while the proportion of home births decreased from 79% to 65%. A household survey indicated a higher frequency of key behaviours (e.g. early and exclusive breastfeeding, delayed bathing and cord care) in intervention villages. The improved stillbirth and neonatal mortality rates observed indicate that community health workers (i.e. LHWs and Dais) can be effective in implementing a community and outreach package that leads to improved home care practices by families, increased care-seeking behaviour and greater utilization of skilled care providers. These preliminary observations require confirmation in an adequately powered trial.

Homecare issues in rotavirus gastroenteritis

This article will describe the burden of rotavirus gastroenteritis (RGE) and its management, highlighting educational issues that nurse practitioners can assist caregivers to enhance at-home management. A Medline search of the medical literature was used to identify articles that describe the burden, clinical presentation, and management of RGE. RGE is a serious medical condition characterized by diarrhea and vomiting and is a major cause of morbidity and hospitalization among children aged 5 years or younger. Proper at-home treatment can be challenging; however, improved home care may limit emergency department visits and hospitalizations. Mild to moderate RGE may be successfully managed at home if caregivers are adequately educated in deciding when a child needs to be evaluated in a physician's office and in managing dehydration at home.

Personal Assistance for Patients Living with a Severe Neurological Disorder

Patients with neurological diseases increasingly are being cared for at home. The purpose of this study was to describe stressful everyday experiences in connection with neurological disorders, to learn how people cope with such experiences, and gain knowledge about coping resources. Twenty-seven persons receiving personal assistance were interviewed twice at home. The 54 interviews were subjected to inductive content analysis. The persons encountered many problems in everyday life and usually handled them by means of acceptance, avoidance, practical problem solving, and reappraisal. Dependence on personal assistance gave rise to a sense of helplessness, but it was also the major coping resource. Nurses can improve home care by giving instruction and guidance to persons working as personal assistants.

Vivencias, expectativas y demandas de cuidadoras informales de pacientes en procesos de enfermedad de larga duración

Objectives To determine informal caregivers’ opinions and experiences of providing care and their expectations and needs concerning professional nurses who make home visits. Method A qualitative study was carried out in 1999 in the Autonomous Community of Andalusia. Participants: Female homecarers of terminally-ill patients with cancer or AIDS and elderly persons with dementia. Strategies for obtaining information: indepth interviews and discussion groups. The content analysis used Virginia Henderson's model as a framework. Results In the caregivers’ statements, six types of care that they carried out related to hygiene, food, excretion, mobility, wound care, and medicine administration were identified. The caregivers were satisfied with professional nurses’ technical and communication skills. However, their satisfaction with the number of visits and their own training was low. They requested training courses in specific skills (wound care, diet) and in prevention and health (postural changes, mobility exercises). Conclusions The tasks carried out by the caregivers are physically and emotionally demanding, and caregivers frequently lack the required technical skills. To improve home care services, visits should be more frequent and caregivers’ training should be up-graded.

How to improve home care pain management processes.

This article describes the process and tools one agency used when their ORYX indicator, "managing a patient's pain," was consistently below the national benchmark. The process can be used for addressing Adverse Events through the OBQI Process as well.