Quality Of Care In Homes Research Articles

Interprofessional Collaborations: Delivering Quality Home Care Services to Patients who are Elderly

This article underscores the importance of inter-professional collaborations when providing home care services to patients who are elderly. The extant research literature illuminates the advantages of inter-professional collaborations in healthcare settings. Benefits such as patient satisfaction, seamless care coordination, and improved health outcomes have long been acknowledged. However, when these care collaborations occur within the home milieu, other patient benefits are evident to include: (a) decreased hospital readmissions; (b) improved daily functioning; (c) reductions in health costs; (d) better informed decision making by providers; and (d) more accurate patient assessments. This review article accentuates inter-professionalism and best practices when caring for persons who are elderly in their home environment. Keywords: Inter-professional, Home Care, Home Care for the Elderly Objective: To educate the readership on the benefits of using an inter-professional approach when providing home care to patients who are elderly. Method: A systematic review of the literature is presented which examines inter-professional home care practices with patients who are elderly. The author conducted an electronic literature search for peer-reviewed articles published between 2001and 2021 using the following data bases: EBSCO Host, E-Journal, Academic Search Premier, ERIC, Academic Search Complete, and ScienceDirect. Eighty percent of the articles reviewed were published within the last seven years. The delimitation of extending the review to the past 20 years ensures relevance to the population being studied and health system contexts. The search strategy included select key words (inter-professional approach, home care, home care for the elderly), either separately or in combination. The literature selection process resulted in the inclusion of 49 journal articles in this review. Results: The extant literature provides a clear rationale for using inter-professional collaboration when serving patients who are elderly in the home setting. More inclusive research is needed in order to better delineate the notions and needs of diverse disciplines (e.g., pharmacy, nutrition, speech pathology, physical therapy, occupational therapy, counselors, psychologists, etc.) and to guide more meaningful collaborations. Lastly, a more inclusive theoretical model capturing the key workings of inter-professional collaboration processes is needed. Conclusion: This review article accentuates quality components and best practices for serving elderly persons (inter-professionally) in the home environment. A number of key recommendations are made to more systematically improve team-based care. This article will serve as the foundation for a professional book on inter-professional collaboration. At least 8 disciplines will be invited to contribute a chapter to the book. These contributions will provide a medium for formal inter-professional education.

Selecting home care quality indicators based on the Resident Assessment Instrument-Home Care (RAI-HC) for Switzerland: A public health and healthcare providers' perspective.

Despite an increasing importance of home care, quality assurance in this healthcare sector in Switzerland is hardly established. In 2010, Swiss home care quality indicators (QIs) based on the Resident Assessment Instrument-Home Care (RAI-HC) were developed. However, these QIs have not been revised since, although internationally new RAI-HC QIs have emerged. The objective of this study was to assess the appropriateness of RAI-HC QIs to measure quality of home care in Switzerland from a public health and healthcare providers' perspective. First, the appropriateness of RAI-HC QIs, identified in a recent systematic review, was assessed by a multidisciplinary expert panel based on the RAND/UCLA Appropriateness Method taking into account indicators' public health relevance, potential of influence, and comprehensibility. Second, the QIs selected by the experts were afterwards rated regarding their relevance, potential of influence, and practicability from a healthcare providers' perspective in focus groups with home care nurses based on the Nominal-Group-Technique. Data were analyzed using median scores and the Disagreement Index. 18 of 43 RAI-HC QIs were rated appropriate by the experts from a public health perspective. The 18 QIs cover clinical, psychosocial, functional and service use aspects. Seven of the 18 QIs were subsequently rated appropriate by home care nurses from a healthcare providers' perspective. The focus of these QIs is narrow, because three of seven QIs are pain-related. From both perspectives, the majority of RAI-HC QIs were rated inappropriate because of insufficient potential of influence, with healthcare providers rating them more critically. The study shows that the appropriateness of RAI-HC QIs differs according to the stakeholder perspective and the intended use of QIs. The findings of this study can guide policy-makers and home care organizations on selecting QIs and to critically reflect on their appropriate use.

Is It What You Have or What You Do With It? Staffing, Human Resource Management, and Knowledge Management Practices

Research in the nursing home industry shows more robust knowledge management activities are associated with the adoption of patient-centered, culture change initiatives among high Medicaid nursing homes. These findings are notable because they highlight the important role that knowledge management activities may play for improving quality of care in under-resourced nursing homes. They also raise important questions about the conditions that may support or hinder the use of these activities. Using survey responses from 393 nursing home administrators, we empirically examined whether two components of human resources – staffing levels and HRM practices – are associated with the level of knowledge management activities in high Medicaid census nursing homes. More robust HRM practices were associated with greater levels of knowledge management activities, as well as three separate domains of knowledge management (acquisition, dissemination, and responsiveness). Staffing levels, in contrast, were not significantly associated with the level of knowledge management activities.

Age Matters: Building Blocks Needed to Inform Nurse Staffing Hours Requirements in Residential Care for Older Adults

This study addresses the need for more complete information about the impact of nurse staffing hours (NSH) on nursing home quality of care. We used national data to examine the relationship between three types (Registered Nurse, Licensed Practical Nurse, and Nurse Aide) of hours, and long-stay quality of care measures over time, taking into account the possible confounding influence of regional differences. Data analyzed were from U.S. Nursing Home Compare datasets which reflect quarterly reports, July 1, 2018 - June 30, 2019 (14,768 facilities). The hours for each staff type in each facility were compared with the facility’s four-quarter quality average scores for each of the 12 measures. Results showed only one strong and statistically significant relationship (Beta= .548; p< .001) between Nurse Aide hours and the quality measure used in data sets to exemplify facilities that serve “lower-risk” residents. Analyzes using multiple R (.517) indicate that the linear combination of the three NSH types strongly and significantly (p< .001) predicted the four-quarter average scores and explained 27% of the variance in the scores. Holding the other two NSH types constant, the scores for that measure increased by 63 for each additional increase in the Nurse Aide nurse staffing hours per resident per day. There was no multicollinearity among the three types of staffing hours. This research adds information to the foundation needed for future research about process indicators to assess their efficacy as measures of actual quality of care, and will be submitted as a Technical Note to journals.

Cognitive job crafting as mediator between behavioral job crafting and quality of care in residential homes for the elderly.

Extending previous studies on job crafting, the aim of the present study is to analyze the effect of job crafting on quality of care in residential homes for elderly people in two European countries (Spain and Sweden). We hypothesize that cognitive crafting could be a consequence of behavioral crafting and that it will mediate the relationship between behavioral crafting and the perception of quality of care. A correlational design was used, with two-waves approximately 12 months apart (n = 226). Our results indicate that behavioral job crafting at T1 had an effect on cognitive job crafting at T2, relational job crafting at T1 increases quality of care at T2, and the mediation effect of cognitive job crafting. These results indicate that we must differentiate between the two forms of crafting (behavioral and cognitive), not as indicators of the same latent construct, but as aggregates. Additionally, we point out two main implications for managerial practice. First, as relational job crafting has a direct effect on quality of care, it is important to assure an organizational culture oriented towards employees. Secondly, due to the mediation effect of cognitive job crafting, managers should facilitate meaningful work environments. To do so, jobs should be re-designed, increasing skills variety, identity and significance.

The needs of key-stakeholders for evaluating client\u2019s experienced quality of home care: a qualitative approach

BackgroundTo optimize home care, it is essential to determine how care recipients experience quality of care. Traditionally, quality of care is measured with normative quality indicators such as safety, efficiency, or prevalence rates such as falls. The growing interest for qualitative patient-reported experience measures in home care requires insight into the needs of care receivers, providers, and organizations as key-stakeholders. Each stakeholder has their own needs that are important to communicate and use to conduct thorough comparisons before implementing new experience measures. This study aims to understand the needs of clients, formal/informal caregivers, and managers/policy officers in measuring client’s experienced quality of care in home care.MethodsFour focus group interviews and 25 semi-structured interviews with key-stakeholders were conducted and analyzed by means of content analysis. The value-proposition canvas was used as a thematic framework to explore the purpose of experience quality of care measures and related pains and gains.ResultsThere were two main purposes for measuring experienced quality of care: first improving the primary care process of individual clients and second for learning and improving in home care team. Using experienced quality of care measures for external accountability and transparency on an organizational or national level were considered less relevant. Among others, participants described not having time and no clear procedure for conducting an evaluation as a pain of the current methods used to evaluate perceived quality of home care. As gains they put forward the ability to informally evaluate experiences during care delivery and to openly discuss complaints with a familiar caregiver.ConclusionsThis study advocates that home care organizations should be aware of the goal of quality of care measures. They should consider selecting experienced quality of care measures mainly for improving primary care processes of individual clients. The results also underline the relevance of adopting next to quantitative evaluations, more narrative evaluation methods which support communicating openly on care experiences, leading to concrete point-of-improvement. The findings of this study can serve as a guide for both the development or selection of adequate methods, from the perspectives of key-stakeholders, in assessing experienced quality in home care.

Older ill persons’ and their adult children’s experiences with primary healthcare: A reflective lifeworld research approach

Aging in place puts ill and frail older persons in a vulnerable situation, and relatives, especially adult children, are expected to assume caring responsibilities. Healthcare professionals, like homecare nurses, play a key role in providing care to older persons needing support to live at home. However, the quality of primary home care has been questioned. The aim of this study was to describe older persons living at home and their adult children’s lived experiences with caring responsibility assumed by healthcare professionals. We used a reflective lifeworld research approach and analyzed 23 interviews and eight diaries. The COREQ checklist was followed. The findings revealed that caring responsibility is tantamount to being professionally competent and balancing immanent power to either promote or inhibit important areas of the older persons’ and their adult children’s lifeworld. Blurred lines of caring responsibility between the participants, the healthcare professionals, and the healthcare systems occurred and indicated that there were errors of commission and omission regarding the safety of older persons in their own homes.

The Seniors Quality Leap Initiative (SQLI): An International Collaborative to Improve Quality in Long-Term Care

ObjectivesTo describe an innovative Canadian and US community of practice that employs empirical evidence based on risk-adjusted indicators to guide collaborative initiatives to improve the quality of care in nursing homes. DesignOngoing study of quality of care related to pain management in nursing home residents using clinical assessment records. Settingand Participants: Nursing home residents in 14 organizations in Canada and the United States between 2014 and 2017. The most recent analytic samples for quality indicator calculation involve 11,123 unique residents in 68 homes associated with 12 different long-term care organizations. MeasuresAssessment data on pain and associated risk adjusters were obtained from the RAI/MDS 2.0 and MDS 3.0 assessments in Canadian and US nursing homes, respectively. ResultsThe Seniors Quality Leap Initiative has been functioning as an active community of practice for almost a decade with the aim of demonstrating leadership in the use of collaborative approaches to drive evidence-informed improvements in the quality of long-term care. Initiatives with a specific emphasis on improving care related to pain resulted in notable improvements in quality of clinical care in specific homes as well as within the network as a whole. Conclusions and ImplicationsThe Seniors Quality Leap Initiative demonstrates that a partnership between organizations in 2 countries can foment quality transitions through a shared commitment to identifying needs; employing flexible, but practical initiatives; and evaluating the impact of those initiatives through a transparent reporting mechanism.

The Effects of Medicare Payment Changes on Nursing Home Staffing

In light of persistent shortcomings in nursing home care quality and evidence that lower nurse staffing levels could be harmful to residents, we examine whether staffing levels are affected by changes in Medicare reimbursement rates. We exploit a 2006 change in Medicare’s methodology for adjusting provider payments for geographic differences in costs, a change that generated plausibly exogenous variation in nursing facility reimbursement rates. Our method compares facilities with higher and lower shares of Medicare resident days, which were differentially exposed to the payment changes we examine. Using panel data on US nursing homes from 2003 through 2009, we find that higher Medicare payments increased nurse staffing hours per resident day. Additional results suggest that changes in Medicare payments did not affect other measures of quality.

Evaluating the Quality of Home Care in China Using the Home Care Quality Assessment Tool.

This study aimed to evaluate the quality of home care in China using the Home Care Quality Assessment Tool (HCQuAT). We recruited 38 home health agencies in Shanghai, China, which included 18 in urban areas, 11 in suburban areas, and nine in rural areas. Data on quality of home care from each agency were collected by trained staff using the HCQuAT. On average, these home health agencies scored 74.28/100.00 (SD = 6.80) on the HCQuAT, with an excellence rate of 39.5% and a failing rate of 23.7%. The mean scores on the structure quality module, process quality module, and outcome quality module were 71.2 ± 21.8, 86.6 ± 9.2, and 44.1 ± 37.5, respectively. Significant differences existed across geographic locations (p = .018). Significant variations were identified in the quality of home care across quality modules and geographic locations. Outcome quality and quality in rural areas were lower than those for their counterparts.

Exploring the Association Between the Quality of HIV Care in Nursing Homes and Hospitalization.

Persons living with HIV/AIDS (PLWH) are living long enough to need age-related and HIV-related nursing home (NH) care. Nursing home quality of care has been associated with risk for hospitalization, but it is unknown if quality of HIV care in NHs affects hospitalization in this population. We assessed HIV care quality with four national measures adapted for the NH setting. We applied the measures to 2011-2013 Medicare claims linked to Minimum Data Set assessments of resident health, prescription dispensing data, and national reports of NH characteristics. Cox proportional hazards models calculated the risk of all-cause and HIV/AIDS-related hospitalization by HIV care compliance. We identified 1,246 PLWH in 201 NHs with 382 all-cause and 63 HIV/AIDS-related hospitalizations. Nursing home HIV care compliance varied from 24.9% to 64.7%. After regression adjustment, we could detect no difference in all-cause or HIV/AIDS-related hospitalizations by NH HIV care compliance. We postulate that the lack of association may be due to inappropriate HIV care quality measures that do not accurately represent NHs ability to care for PLWH. There is urgent need to create valid NH HIV care quality measures.

Promising Directions of Innovative Technologies for Home Care of Citizens

The article considers home social care as the most popular type of social service for citizens. It is noted that it is necessary to improve the quality and targeting of home care, its adaptation to modern realities, the introduction of information methods and technologies for providing social services to needy categories of the population.

Assessment of Activities of Daily Living (ADL) in elderly population

Introduction: Most of the developing country facing growing number of elderly population because of decrease in fertility and increase in longevity. Elderly age (≥ 60 years) is a period in which people are prone to chronic diseases and their functional independency is probably restricted by physical and mental disabilities. Aim &amp; Objectives: To find out the prevalence of physical dependency among elderly in Uttarakhand, India. Material &amp; Methods: Activities of daily living (ADL) comprise the basic actions that involve caring for self and body, including personal care, eating and mobility. Results: In the present study population of 400, 112 (28%) study population were found to be physically dependent for their daily activities and out of them 63.39 % had moderate to severe dependency. Conclusion: High level of physical dependency in this study population need urgent attention towards good quality home care and geriatric health care services in India at primary, secondary and tertiary level.

Towards personalized care: Factors associated with the quality of life of residents with dementia in Australian rural aged care homes.

Quality of dementia care improves with a personalized approach to aged care, and knowledge of the disease process and unique care needs of residents with dementia. A personalized model of care can have a significant impact on the overall organizational culture in aged care homes. However, the dimensions of personalized aged care relating to dementia often remain under-managed. We aim to explore the factors that shape the dimensions of personalized dementia care in rural nursing homes using qualitative data of a mixed-method 'Harmony in the Bush' dementia study. The study participants included clinical managers, registered nurses, enrolled nurses and care workers from five rural aged care homes in Queensland and South Australia. One hundred and four staff participated in 65 semi-structured interviews and 20 focus groups at three phases: post-intervention, one-month follow-up and three-months follow-up. A multidimensional model of nursing home care quality developed by Rantz et al. (1998) was used in data coding and analysis of the factors. Three key themes including seven dimensions emerged from the findings: resident and family [resident and family centeredness, and assessment and care planning]; staff [staff education and training, staff-resident interaction and work-life balance]; and organization [leadership and organizational culture, and physical environment and safety]. A lack of consideration of family members views by management and staff, together with poorly integrated, holistic care plan, limited resources and absence of ongoing education for staff, resulted in an ineffective implementation of personalized dementia care. Understanding the dimensions and associated factors may assist in interpreting the multidimensional aspects of personalized approach in dementia care. Staff training on person-centered approach, assessment and plan, and building relationships among and between staff and residents are essential to improve the quality of care residents receive.

Hospice use at end of life in children with cancer: The effect of insurance.

10558 Background: The National Quality Forum has endorsed hospice care as a metric of high quality end-of-life (EOL) care for adults with cancer. Specific hospice-related quality metrics include hospice enrollment, hospice enrollment for ≥3d, and death outside of the acute care setting. These metrics have been examined extensively in adults and disparities related to a number of clinical and sociodemographic factors, including insurance, have been identified. However, for children with cancer, hospice utilization data is lacking. We addressed this gap by examining location of death and hospice utilization at EOL for children with cancer and determining whether these metrics varied with insurance status. Methods: We used national insurance claims data (Truven) to conduct a population-based analysis of patients with cancer who died between 2011 and 2017 at age 0-21y. The dataset was queried for hospice claims, inpatient claims, and location of death. The association between insurance (private vs. Medicaid) and 1) location of death, 2) hospice enrollment, and 3) days between first hospice claim and death was examined using multivariable regression analysis, adjusting for age at death, gender, and cancer diagnosis (hematologic malignancies vs. solid tumor). Results: A total of 1,492 children died at a mean age of 11y (SD: 6y); 56% were privately-insured, 56% were male, and 30% had hematologic malignancies. Overall, 58% died in the hospital (privately-insured: 54% vs. Medicaid: 63%). Forty-five percent enrolled in hospice (privately-insured: 46% vs. Medicaid: 43%) with 2% returning to the hospital to die after enrolling in hospice. The average time between first hospice claim and death was 3d (privately-insured: 10d vs. Medicaid: 2d, p = &lt; 0.001). When compared to privately-insured children, children on Medicaid had similar likelihood of hospice enrollment (RR = 1.0, 95%Cl = 0.6-1.8). However, children on Medicaid were more likely to die in the hospital (RR = 1.3, 95%CI = 1.1-1.4) and have fewer days between hospice enrollment and death if enrolled in hospice (IRR: 0.5, 95%CI = 0.3-0.8). Conclusions: In this first study to examine national hospice utilization in children with cancer, care varies significantly with insurance status. Children on Medicaid are more likely to die in the hospital and have shorter hospice enrollment duration than children with private insurance. Whether this variation represents EOL care preferences, provider biases, differences in quality and availability of hospice or home care to different insurers, or other barriers needs to be examined.

Home care quality indicators based on the Resident Assessment Instrument-Home Care (RAI-HC): a systematic review

BackgroundOne way of measuring the quality of home care are quality indicators (QIs) derived from data collected with the Resident Assessment Instrument-Home Care (RAI-HC). In order to produce meaningful results for quality improvement and quality comparisons across home care organizations (HCOs) and over time, RAI-HC QIs must be valid and reliable. The aim of this systematic review was to identify currently existing RAI-HC QIs and to summarize the scientific knowledge on the validity and reliability of these QIs.MethodsA systematic review was performed using the electronic databases PubMed, CINAHL, Embase, PsycINFO and Cochrane Library. Studies describing the development process or the psychometric characteristics of RAI-HC QIs were eligible. The data extraction involved a general description of the included studies as well as the identified RAI-HC QIs and information on validity and reliability. The methodological quality of the identified RAI-HC QI sets was assessed using the Appraisal of Indicators through Research and Evaluation (AIRE) instrument.ResultsFour studies out of 659 initial hits met the inclusion criteria. The included studies described the development and validation process of three RAI-HC QI sets comprising 48 unique RAI-HC QIs, which predominantly refer to outcome of care. Overall, the validity and reliability of the identified RAI-HC QIs were not sufficiently tested. The methodological quality of the three identified RAI-HC QI sets varied across the four AIRE instrument domains. None of the QI sets reached high methodological quality, defined as scores of 50% and higher in all four AIRE instrument domains.ConclusionsThis is the first review that systematically summarized and appraised the available scientific evidence on the validity and reliability of RAI-HC QIs. It identified insufficient reporting of RAI-HC QIs validation processes and reliability as well as missing state-of-the-art methodologies. The review provides guidance as to what additional validity and reliability testing are needed to strengthen the scientific soundness of RAI-HC QIs. Considering that RAI-HC QIs are already implemented and used to measure and compare quality of home care, further investigations on RAI-HC QIs reliability and validity is recommended.

Where Are We and What Shall We Do Next? A Qualitative Study of the Quality of Home Care in Shanghai, China.

Introduction: With the increasing need for home care in Shanghai, China, it is crucial to ensure its quality. This study aimed to explore quality-related issues of home care in Shanghai, China, and identify strategies for improvement. Method: This is a descriptive qualitative study. Semistructured interviews were conducted among 27 individuals, including home care managers (n = 8), nurses (n = 10), and patients and/or their caregivers (n = 9). Colaizzi's seven-step analysis method was used to guide data analysis. Results: Three themes emerged regarding the quality of home care in China: unsatisfactory structure quality, unsatisfactory process quality, and imperfect outcome quality evaluation system. Recommended strategies for quality improvement included issuing standards for home care evaluation, refining structure quality and process quality, and establishing an outcome quality evaluation system. Conclusions: Concerns about the quality of home care in China were identified by providers and patients. More research especially studies quantifying the care quality and its influencing factors are needed.

Defining, monitoring and improving quality in Welsh care homes.

Despite the focus on quality in care homes, and the body of evidence that drives policy and practice, care home residents in Wales experience variations in quality of care. Quality is not easily defined, and care providers may have differing views on quality and how it is monitored. Health and social care professionals - including nurses - should understand the factors that affect quality in care homes. Quality improvement projects can support the development of a workplace culture that can sustain quality in care homes. This article defines quality, details methods that may be used to monitor quality, and outlines how quality in care homes can be improved.

Exploring the association between quality of homecare services and older adults’ well-being

ABSTRACTHomecare services play an important role in enabling older adults with chronic illness or functional impairment to continue living in their homes and communities. Previous research on homecare services has not fully explored the potential psychological benefits of homecare services. This study investigates the association between quality of homecare services and psychological well-being by analyzing two surveys. The results showed that the association between well-being and the quality of homecare services was mediated by satisfaction with health (z = 4.36, p = .000), satisfaction with family life (z = 4.96, p = .000) and satisfaction with friendship (z = 3.56, p = .000). The top three most important life domains, health, family life, and friendships, combined fully mediated the association between well-being and the quality of homecare services. These findings suggest that quality homecare services could enhance clients’ well-being in the areas of family life and friendships beyond health.

QUALITY INDICATORS FOR STROKE PATIENTS AT HOME-BASED CARE SETTING: A REVIEW

Background: One method to identify the level of performance is using quality of care indicators. Even though many quality indicators of health care have been announced, those which specify in home care services are limited in that none of them describe the stroke patients’ condition. The purposes of this study are to determine through systematic literature review what methods can be used to assess the quality of home care that patients received and to identify what components can be used as a determinant of the quality of home care services.&#x0D; Method: Google Scholar, EBSCO, ProQuest and PubMed database websites were searched for articles and information.&#x0D; Results: The method that was used is a qualitative study using a literature review with quantitative analysis of a previously accepted research instrument with a questionnaire that has been widely available and considered reliable. The researchers identified thematic differentiation in grouping the quality indicators used by those articles, however most of them are classified as outcome indicators, one as process indicator, and none as structure or input indicator. Overall quality indicators in home care that are used by the three articles are based on the Home Care Quality Indicators Instrument (HCQIs).&#x0D; Conclusions: Several studies discussed home care quality indicators but no articles specifically analyze home care provision for stroke patients. Further research is needed to clarify the components indicators for stroke patients and more importantly, these indicators should be valid, and reliable.