Personal Care Provider Research Articles

Preventing nosocomial bloodstream infections (NBSIs) by implementing hospitalwide, department-level, self-investigations: A NBSIs frontline ownership intervention.

Nosocomial bloodstream infections (NBSIs) are adverse complications of hospitalization. Most interventions focus on intensive care units. Data on interventions involving patients' personal care providers in hospitalwide settings are limited. To evaluate the impact of department-level NBSI investigations on infection incidence. Beginning in 2016, positive cultures, classified as suspected of being hospital acquired, were prospectively investigated by patients' unit-based personal healthcare providers using a structured electronic questionnaire. After analyzing the conclusions of the investigation, a summary was sent quarterly to the departments and to hospital management. NBSI rates and clinical data during a 5-year period (2014-2018) were calculated and compared before and after the intervention (2014-2015 versus 2016-2018), using interrupted time-series analysis. Among 4,135 bloodstream infections (BSIs), 1,237 (30%) were nosocomial. The rate of NBSI decreased from 4.58 per 1,000 admissions days in 2014 and 4.82 in 2015, to 3.81 in 2016, 2.94 in 2017 and 2.86 in 2018. Following a 4-month lag after introducing the intervention, the NBSI rate per 1000 admissions dropped significantly by 1.33 (P = .04; 95% CI, -2.58 to -0.07). The monthly NBSI rate continued to decrease significantly by 0.03 during the intervention period (P = .03; 95% CI, -0.06 to -0.002). Detailed department-level investigations of NBSI events performed by healthcare providers, increased staff awareness and frontline ownership and were associated with a decrease in NBSI rates hospitalwide.

Effects by educational attainment of a mammography screening patient decision aid for women aged 75 years and older.

To help inform screening decisions, a mammography screening decision aid (DA) for women aged 75years and older was tested in a cluster randomized clinical trial of 546 women. DA use increased women's knowledge of the benefits and harms of mammography and lowered screening rates. In the current study, the objective was to examine whether participants' views of the DA and/or its effects differed by educational attainment. A secondary analysis was conducted of 283 women who received the DA before a personal care provider (PCP) visit during the trial to examine the acceptability of the DA and its effects on knowledge of the benefits and harms of mammography, screening intentions, and receipt of screening by educational attainment. Adjusted analyses accounted for clustering by PCP. Of the 283 participants, 43% had a college education or less. Regardless of educational attainment, 87.2% found the DA helpful. Women with lower educational attainment were less likely to understand all of the DA's content (46.3% vs 67.5%; P<.001), had less knowledge of the benefits and harms of mammography (adjusted mean±standard error knowledge score, 7.1±0.3 vs 8.1±0.3; P<.001), and were less likely to lower screening intentions (adjusted percentage, 11.4% vs 19.4%; P=.01). Receipt of screening did not differ by educational attainment. A mammography DA for women aged 75years and older was helpful to women regardless of their educational attainment; however, those with a college degree or greater understood the DA and, possibly as a result, lowered their screening intentions. Future studies need to examine how to better support informed decision making around mammography screening in older women with lower educational attainment. The authors examined data from a previous study to learn the effects of a mammography decision aid (DA) for women aged 75years and older according to their level of education. Overall, women found the DA helpful, but women with lower educational attainment found it harder to understand the benefits and harms of mammography screening and were less likely to lower their screening intentions than women with a college degree. The findings suggest that women aged 75years and older who have lower educational attainment may need an even lower literacy DA and/or more support from health care professionals.

Un/Paid Labor: Medicaid Home and Community Based Services Waivers That Pay Family as Personal Care Providers.

The United States long-term services and supports system is built on largely unpaid (informal) labor. There are a number of benefits to allowing family caregivers to serve as paid personal care providers including better health and satisfaction outcomes, expanded workforces, and cost effectiveness. The purpose of this study was to examine how Medicaid HCBS Section 1915(c) waivers for people with intellectual and developmental disabilities allocate personal care services to pay family caregivers. Our analysis revealed about two thirds of waivers in fiscal year (FY) 2014 allowed for family caregivers to potentially be paid for personal care services. This amounted to up to $2.71 billion of projected spending, which is slightly more than half of all personal care service expenditures in FY 2014.

Factors Associated with Decision to Participate in Physical Activity by People with Spinal Cord Injury: An Analysis using Decision Tree

Background/Objectives: The purpose of this study is to analyze the effects of interactions between factors that determine whether or not to participate in physical activities by people with spinal cord injury. Methods/Statistical Analysis: Subjects of this analysis include people, who are over 19 years of age, with spinal cord injury (260 males and 56 female). A decision tree analysis was used for this research. Findings: The study results are as follow: Most important factors that determine one’s participation in physical activities despite previous spinal cord injury were shown to be in the sequence of personal care providers and personal assistants (e340), disability grade, design, construction and buildings product and technology of building for private use (e155), carrying out daily routine (d230), protective function of the skin (d810); the rate of participation in physical activity is the highest when classified as significant impacts in personal care providers and personal assistants (e340), and affected and no affected and mild in disability grade. Application/Improvements: In conclusion, an analysis of the interactions between factors is effective in understanding whether to participate in physical activities or not.

Implementing Oral Care Practices and Policy Into Long-Term Care: The Brushing up on Mouth Care Project

BackgroundOptimal mouth care is integral to the health and quality of life of dependent older adults.Yet, a persistent lack of adequate oral care in long-term care (LTC) facilities exacerbates the burden of disease experienced by residents. The reasons for this are complex and create enormous challenges for care providers, clinicians, and administrators dedicated to comprehensive high quality care. ObjectiveThe aim of this study was to develop, implement, and evaluate a comprehensive program for daily mouth care for LTC. DesignA case study design using a participatory and qualitative approach examined how individual, organizational (workplace practices and culture), and system factors (standards and policy) influenced the development and implementation of a comprehensive program to improve the delivery of daily oral care in LTC. Setting and ParticipantsThe research was undertaken in 3 LTC residences administered under the same health authority and included personal care providers, nurse managers, and directors of care. InterventionA comprehensive program for care providers including, education, resources, and organizational guidelines, to improve the delivery of daily mouth care to LTC residents was created, rolled out, and refined over a 12-month period. MeasurementsData was collected through diary studies, targeted interviews, field notes, oral care activities records, site team meetings, and direct feedback from members of the care team. ResultsThe oral care intervention resulted in a heightened awareness, support and greater efficiency amongst care team. The presence of a “champion” was a key feature for sustaining processes. Management had a clear role to play to ensure support and accountability for the intervention. ConclusionsOptimizing oral care in long-term care can be achieved through an integrated approach that includes education, provision of resources, an oral care champion, support from managers and administrators, and appropriate organizational policy.

Young individuals with stroke: a cross sectional study of long-term disability associated with self-rated global health

BackgroundPerceived disability after stroke may persist long-term even among young individuals with mild stroke and may be related to age-related expectations of health and recovery. Thus, in order to appreciate the magnitude of perceived disability in a younger stroke population studies are needed to explore perceived health-related differences between young individuals with stroke and a matched general population. Further, to provide long-term measures by health care, relevant to the same young individuals with stroke, their perceived long-term functioning and disability associated with health need to be explored.MethodsThe generic questionnaire EQ-5D was used to compare ratings of global health and disability between young individuals living in the community up to 6 years after stroke (n = 150) and an age and geographically matched general population (n = 2661). Stroke related medical data were retrieved from medical records and the study specific questionnaire, the MYS-questionnaire, was used to assess self-rated disability associated with global health.ResultsAmong the young individuals 79% had suffered a mild stroke, 45% rated a low global health compared to 15% of the matched general population and a higher proportion rated problems in mobility, self-care, usual activities and anxiety/depression. Among the young individuals with stroke, limitations and restrictions in leisure activities, work, reading as well as low level of physical activity, utilizing personal care provider or personal assistance and tiredness were negatively associated with self-rated global health (R square 0.60).ConclusionThe negative effects of stroke, on self-rated global health among young individuals living in the community, appear to be substantial, multi factorial and long-standing which call for interdisciplinary research collaborations and team measures by health care long-term.

Allowing Spouses to Be Paid Personal Care Providers: Spouse Availability and Effects on Medicaid-Funded Service Use and Expenditures

Medicaid service use and expenditure and quality of care outcomes in California's personal care program known as In-Home Supportive Service (IHSS) are described. Analyses investigated Medicaid expenditures, hospital use, and nursing home stays, comparing recipients who have paid spouse caregivers with those having other relatives or unrelated individuals as their caregivers. Medicaid claims and IHSS assessment data for calendar year 2005 were linked for IHSS recipients aged 18 years or older (n = 386,447) The rates of ambulatory care-sensitive hospital admissions and Medicaid-covered nursing home placements were at least comparable among IHSS recipients' with spouse, parent, other relative, or nonrelative caregivers. Statistically significant differences reflected more desirable outcomes for those with relatives as paid caregivers. In no comparisons did those with spouse providers have worse outcomes than those with nonrelative providers. Average monthly Medicaid expenditures for all services were also lower for IHSS recipients with family provider. There were no financial disadvantages and some advantages to Medicaid in terms of lower average Medicaid expenditures and fewer nursing home admissions when using spouses, parents, and other relatives as paid IHSS providers. This argues in favor of honoring the recipient's and family's preference for such providers.

Employment status among low-income Caucasian and Latina breast cancer survivors

6612 Background: Return to work (RTW) after breast cancer is associated with treatment recovery and quality of life. Prior research has found an 80% RTW rate in primarily Caucasian breast cancer survivors; however, little is known about the trajectory of RTW among Latinas. Qualitative research suggests that RTW is a major concern for Latinas. This study compares the rate of RTW between Latinas and Caucasians and investigates the role of job type in RTW. Methods: This is a prospective, longitudinal study of low-income, underserved breast cancer survivors who spoke English or Spanish, did not have metastatic disease, and were enrolled in the Medi-Cal Breast and Cervical Cancer Treatment Program. We interviewed survivors at 6 mos., 18 mos., and 3 yrs. after diagnosis to assess changes in employment status. The impact of independent variables including ethnicity, employment at diagnosis, job type, age, health status, and education was assessed using chi-square tests. Results: 666 survivors completed surveys at both 6 mos. and 3 yrs; 65% were Latina. The median age was 49 and 54 yrs. for Latinas and Caucasians, respectively (p &lt; 0.001). 45% of Latinas had less than a high-school education compared to 3% of Caucasians (p &lt; 0.001). The majority of Latinas worked in 3 job types: personal care-provider (23%), housekeeper (22%), and manufacturing (13%). Caucasians had greater job diversity, including clerical (15%), personal care-provider (13%), food preparer/server (12%), and sales (10%). At diagnosis, 51% of Latinas and 59% of Caucasians were employed (p = 0.07), and among these, Latinas were less likely to be working at 6 and 18 mos. than Caucasians (27% vs. 47% at 6 mos., p = 0.002 and 45% vs. 59% at 18 mos., p = 0.026). This difference dissipated by yr. 3 (53% of Latinas vs. 58% of Caucasians, p = 0.41). Job type at diagnosis was associated with RTW. Conclusions: Employed low-income Latinas and Caucasians appear to follow different RTW trajectories after breast cancer, with fewer Latinas working at 6 and 18 mos. Differences exist in job type between these populations; Caucasians have greater variation in job type and a trend toward greater likelihood of changing job type after breast cancer. This may reflect limitations in career choice among low-income Latinas and may be related to their protracted RTW trajectory. No significant financial relationships to disclose.

Rehabilitation of Patients with Conductive Hearing Loss and Moderate Mental Retardation by Means of a Bone-Anchored Hearing Aid

To evaluate whether the bone-anchored hearing aid (BAHA) can be applied successfully to patients with conductive hearing loss and moderate mental retardation. Retrospective clinical evaluation. Tertiary referral center. Twenty-two patients with congenital moderate mental retardation and conductive or mixed hearing loss were selected to receive a BAHA at the University Medical Centre Nijmegen, the Netherlands. Four of them were fitted despite a limited air-bone gap. Rehabilitative BAHA application. Implantation results, skin reactions, and audiological data were evaluated during a mean follow-up of 36 months. All the patients were still using the BAHA 7 days a week and for more than 8 hours a day after a follow-up period between 5 and 96 months. Two implants (9%) were lost due to insufficient integration but were reimplanted successfully. With the BAHA, mean free-field thresholds showed a clear mean improvement of 9 dB compared with the previous hearing aid. Considerable improvements in daily activities were seen in at least five patients. Moderate mental retardation should no longer be considered as a contraindication for BAHA application. Although implant loss was low, extra attention may be required from the personal care providers to maintain the percutaneous implant. The BAHA was well-accepted by the patients with moderate mental retardation and was being used for most of the day. Implementation of the BAHA as hearing aid treatment in patients with moderate mental retardation proved to be sufficiently effective and may have strongly positive effects on activities at school or at work.

Home care nursing in Japan: a challenge for providing good care at home.

Home care in Japan has developed over the past 30 years. Nurses have taken leadership in promoting home care and at the same time have expanded their roles. The roles of Japanese nurses in the field of home care are presented in the context of the historical perspective and view for the future. Home care nurses have performed care management for their community as well as for individual older clients living in their community. Currently, nurses work as high-tech and personal care providers and are developing a new role in health care enterprises. The number of nurses working as clinical nurse specialists will increase consistently with the rapid increase of master's programs. In the future, nurses should take a lead in developing health policy. The purpose of the article is to describe the current situation of home care clients and home care nursing in Japan. In addition, four issues of home care in Japan are described related to home care for older persons, high-tech home care, terminal care, and home care for psychiatric patients.

A Comparison of Health Care Experiences for Medicaid and Commercially Enrolled Children in a Large, Nonprofit Health Maintenance Organization

Proponents of Medicaid managed care have argued that this type of care offers the potential to provide mainstream health care for poor children and the elimination of the 2-tier system of care that has long existed for poor and nonpoor children. However, few studies have attempted to assess whether differences in access, utilization, and satisfaction exist between Medicaid and commercially sponsored children who are enrolled in the same managed care plan. To systematically answer the following research question: Within the same large, nonprofit, group-model health maintenance organization (HMO), how do children enrolled in Medicaid compare with children enrolled commercially across the domains of access, utilization, and satisfaction with care? We compared access, satisfaction, and utilization of services between Medicaid and commercially sponsored children enrolled in Kaiser Permanente of Northern California during 1998 through use of a telephone survey and administrative data. Kaiser Permanente is a nonprofit, integrated, group HMO that serves 2.8 million members in more than 15 counties in northern California. The sample for this survey included 510 Medicaid-enrolled children and 512 commercially enrolled children. An overall response rate of 82% was achieved. Bivariate and multivariate analyses were used to compare Medicaid and commercially enrolled children. We found few differences between commercial and Medicaid enrollees across the domains of access, utilization, and satisfaction. Where access differences were present (problems in finding a personal care provider, problems getting care overall, and experiencing 1 or more barriers to care), the differences favored Medicaid-enrolled children. That is, Medicaid enrollees were reported to experience significantly fewer access problems and barriers than commercial enrollees, even after adjustment for confounding factors. Only one difference was found between Medicaid and commercial enrollees across the 6 utilization variables examined (volume of emergency department visits), and no differences were found among the 4 satisfaction and 2 global assessments of care received. Taken together, our results suggest that Medicaid-enrolled children experience as good as or better care than their commercially enrolled counterparts. However, there are other possible explanations for our findings. It may be that families of Medicaid-enrolled children hold their care providers to a lower standard than families of commercially enrolled children, given historic inequities in care between poor and nonpoor families. In addition, some degree of selection bias may be present in our sample, although that is true for both the Medicaid and commercial populations. Our findings suggest that large commercial HMOs are capable of eliminating the access barriers and stigma traditionally associated with the Medicaid program. However, this conclusion must be tempered with the knowledge that other explanations for our findings may also be at play.

Incorporating assistive devices into community-based long-term care: an analysis of the potential for substitution and supplementation.

This article examines the use of assistive devices as a part of the long-term care arrangements of community-dwelling older Americans. It examines the potential for assistive devices to substitute for and supplement personal care assistance. Data from the Phase 2 Disability Supplements to the 1994-1995 National Health Interview Surveys are used to compare the use of personal care and equipment among persons reporting difficulty with a given activity of daily living. The capacity of equipment to substitute for or supplement personal care is highly task-specific and depends on the characteristics of the devices and the personal care providers. In general, those using simple devices are less likely to use informal care, whereas those using complex devices are more likely to use formal care services. Technology has the potential to confer quality of life enhancements for older persons and their caregivers and cost savings for payers.

The Cold Clinic: A Collaborative Nursing Effort to Benefit Students

Collaboration between a nurse educator and nurse administrator paired beginning baccalaureate nursing students and the university health center's self-care cold clinic to benefit all involved in the project. Nursing students assisted clients through the cold clinic's five stations, establishing relationships and practicing communication and assessment skills. The health center benefited from exposure to the new techniques brought to the experience by nursing students, clients benefited from having a personal care provider during their cold-clinic experience, and nursing students benefited from being able to practice nursing skills that emphasized critical thinking over high-tech skills as they worked with clients of their own age. In sum, students were educated, wellness was promoted, and self-care behavior was enhanced.

Social change and women's reproductive health care

Ihe issue of women's reproductive health care lies at the busy intersection of social and medical tradition and social and medical change. No other area of medical practice so closely impinges on emotion-laden attitudes, beliefs, and behaviors or has engendered such rage and conflict, both private and public. The modern practitioner is bombarded with medical change, governmental change, and psychosocial change. 1 Comfortable assumptions crumble; contradictions and complaints abound. Providers and consumers of obstetric and gynecologic (ob/gyn) care are having a hard time understanding and collaborating with each other. Women are bombarded daily by a barrage of advice, unsynthesized data, and highly emotional opinions about reproductive health care from sources other than personal care providers: friends, self-designated health experts, and the media. 2 They are subject to historical, psychological, and environmental influences on the conduct of their reproductive lives. There is no way for the obstetrician/gynecologist to stay on top of developments in the specialty, conduct a practice, maintain a personal life, and follow both lay and expert influences on reproductive issues. The medical practice model on which our health care training is based is one that has disappeared from many health care systems. 3 Perhaps for that reason, some observers of medical care issues tend to romanticize it. The old-fashioned doctor role had both advantages and disadvantages. Its purported limitations are what modern medicine has triumphed over, and its idealized interpersonal skills are what some critics of modern medicine mourn.