Receiving Home Health Care Services Research Articles

Investigetion of Pressure Sores Frequency and Risk Factors of Patients Registered to Home Health Unit

Aim: The study was to investigate the frequency of pressure sores, the risk factors causing their formation, and their relationship with nutrition in patients receiving home health services. Materials and Methods: After scanning all 4098 patients registered with the Home Health Unit of an Education and Research Hospital in İzmir, Turkey, it was discovered that 186 of them had pressure sores. The study concluded with 151 patients as 35 patients passed away during the data collection process. The questionnaire employed in the study comprised two parts: The first part examined patients' sociodemographic and clinical characteristics, while the second part utilized the Pressure Ulcer Scale for Healing, Braden Pressure Ulcer Risk Assessment Scale, and Malnutrition Universal Screening Tool. Results: Pressure sores were found in 3.69% of the 4098 patients. The mean age of the patients was 78.29 (78.28±14.51), and 103 (68.2%) were female patients. Upon analyzing patients based on the presence of chronic diseases, it was noted that the risk of pressure sore development was notably higher in the high and very high-risk groups, particularly among those with neurological diseases. Approximately 44.4% of the patients utilized nutritional products. A statistically significant correlation was observed between the use of high-protein dietary products and the Braden scale score.. Conclusion: This study shows that the patients receiving Home Health Care Services are in the risky group in terms of pressure sores and malnutrition, but the incidence decreases with good care and caregiver education. The most important factors that increased the risk of pressure sore formation and the severity of pressure sores were neurological disease, nutritional status, and urinary and fecal incontinence.

Care Burden and Life Satisfaction of Caregivers Who are Providing Home Health Care to Patients.

This study aims to evaluate the care burden and life satisfaction in caregivers who are providing home health care to patients and determine the relationship between life satisfaction and care burden. This cross-sectional descriptive study was performed on 133 caregivers who provided home health care to patients and 133 control groups between February and December 2020. Care burden was evaluated using the Zarit Burden Inventory (ZBI), and life satisfaction was evaluated using the Satisfaction with Life Scale (SWLS). The mean age of hundred thirty-three caregivers was 52.5±10.5 years, and that of the control group was 51.2±9.9 years. The mean ZBI score of the caregivers was 47.0±16.4. According to the ZBI score, 46.6% of the caregivers had a moderate care burden and 21.8% had a heavy caregiver burden. The caregiver burden was higher in those with a low education level, those without social insurance, those who felt insufficient in care, and those who did not receive help from other family members. The SWLS score of caregivers was significantly lower than that of control group (p<0.001). The SWLS score was lower in those with a low education level and those without an employee as a caregiver. There was a negative correlation between SWLS and ZBI score (p<0.001). Caregivers of patients receiving home health-care services are exposed to a significant care burden. The care burden was higher in those with a low education level, those without social insurance, those who felt insufficient in care, and those who did not receive help from other family members. The care burden affects the satisfaction of life.

Antipsychotic use among older patients with dementia receiving home health care services: Prevalence, predictors, and outcomes.

Antipsychotic use is a safety concern among older patients in home health care (HHC), particularly for those with Alzheimer's disease and related dementias (ADRD). The objective of this study was to examine the prevalence and predictors of antipsychotic use among older adults with and without ADRD who received HHC, and the association of antipsychotic use with outcomes among patients living with ADRD. In this secondary analysis of adults ≥65 years receiving care from an HHC agency in New York in 2019 (N = 6684), we used data from the Outcome and Assessment Information Set, Medicare HHC claims, and home medication review results in the electronic HHC records during a 60-day HHC episode. ADRD was identified by diagnostic codes. Functional outcome was the change in the composite activities of daily living (ADL) score from HHC admission to HHC discharge (measured in 5833 patients), where a positive score means improvement and a negative score means decline. Data were analyzed using logistic (predictors) and linear regression (association with outcome) analyses. The point prevalence of antipsychotic use was 17.2% and 6.6% among patients with and without ADRD, respectively. Among patients living with ADRD, predictors of antipsychotic use included having greater ADL limitations (odds ratio [OR] = 1.30, p = 0.01), taking more medications (OR = 1.04, p = 0.02), having behavioral and psychological symptoms (OR = 5.26, p = 0.002), and living alone (OR = 0.52, p = 0.06). Among patients living with ADRD, antipsychotic use was associated with having less ADL improvement at HHC discharge (β = -0.70, p < 0.001). HHC patients living with ADRD were more likely to use antipsychotics and to experience worse functional outcomes when using antipsychotics. Antipsychotics should be systematically reviewed and, if contraindicated or unnecessary, deprescribed. Efforts are needed to improve HHC patients' access to nonpharmacological interventions and to provide education for caregivers regarding behavioral approaches to manage symptoms in ADRD.

Social Risk Factors are Associated with Risk for Hospitalization in Home Health Care: A Natural Language Processing Study

ObjectiveThis study aimed to develop a natural language processing (NLP) system that identified social risk factors in home health care (HHC) clinical notes and to examine the association between social risk factors and hospitalization or an emergency department (ED) visit. DesignRetrospective cohort study. Setting and ParticipantsWe used standardized assessments and clinical notes from one HHC agency located in the northeastern United States. This included 86,866 episodes of care for 65,593 unique patients. Patients received HHC services between 2015 and 2017. MethodsGuided by HHC experts, we created a vocabulary of social risk factors that influence hospitalization or ED visit risk in the HHC setting. We then developed an NLP system to automatically identify social risk factors documented in clinical notes. We used an adjusted logistic regression model to examine the association between the NLP-based social risk factors and hospitalization or an ED visit. ResultsOn the basis of expert consensus, the following social risk factors emerged: Social Environment, Physical Environment, Education and Literacy, Food Insecurity, Access to Care, and Housing and Economic Circumstances. Our NLP system performed “very good” with an F score of 0.91. Approximately 4% of clinical notes (33% episodes of care) documented a social risk factor. The most frequently documented social risk factors were Physical Environment and Social Environment. Except for Housing and Economic Circumstances, all NLP-based social risk factors were associated with higher odds of hospitalization and ED visits. Conclusions and ImplicationsHHC clinicians assess and document social risk factors associated with hospitalizations and ED visits in their clinical notes. Future studies can explore the social risk factors documented in HHC to improve communication across the health care system and to predict patients at risk for being hospitalized or visiting the ED.

Home Healthcare Patients With Distinct Psychological, Cognitive, and Behavioral Symptom Profiles and At-Risk Subgroup for Hospitalization and Emergency Department Visits Using Latent Class Analysis.

One-third of home healthcare patients are hospitalized or visit emergency departments during a 60-day episode of care. Among all risk factors, psychological, cognitive, and behavioral symptoms often remain underdiagnosed or undertreated in older adults. Little is known on subgroups of older adults receiving home healthcare services with similar psychological, cognitive, and behavioral symptom profiles and an at-risk subgroup for future hospitalization and emergency department visits. Our cross-sectional study used data from a large, urban home healthcare organization (n = 87,943). Latent class analysis was conducted to identify meaningful subgroups of older adults based on their distinct psychological, cognitive, and behavioral symptom profiles. Adjusted multiple logistic regression was used to understand the association between the latent subgroup and future hospitalization and emergency department visits. Descriptive and inferential statistics were conducted to describe the individual characteristics and to test for significant differences. The three-class model consisted of Class 1: "Moderate psychological symptoms without behavioral issues," Class 2: "Severe psychological symptoms with behavioral issues," and Class 3: "Mild psychological symptoms without behavioral issues." Compared to Class 3, Class 1 patients had 1.14 higher odds and Class 2 patients had 1.26 higher odds of being hospitalized or visiting emergency departments. Significant differences were found in individual characteristics such as age, gender, race/ethnicity, and insurance. Home healthcare clinicians should consider the different latent subgroups of older adults based on their psychological, cognitive, and behavioral symptoms. In addition, they should provide timely assessment and intervention especially to those at-risk for hospitalization and emergency department visits.

Home Health Care Clinicians' Use of Judgment Language for Black and Hispanic Patients: Natural Language Processing Study.

A clinician's biased behavior toward patients can affect the quality of care. Recent literature reviews report on widespread implicit biases among clinicians. Although emerging studies in hospital settings show racial biases in the language used in clinical documentation within electronic health records, no studies have yet investigated the extent of judgment language in home health care. We aimed to examine racial differences in judgment language use and the relationship between judgment language use and the amount of time clinicians spent on home visits as a reflection of care quality in home health care. This study is a retrospective observational cohort study. Study data were extracted from a large urban home health care organization in the Northeastern United States. Study data set included patients (N=45,384) who received home health care services between January 1 and December 31, 2019. The study applied a natural language processing algorithm to automatically detect the language of judgment in clinical notes. The use of judgment language was observed in 38% (n=17,141) of the patients. The highest use of judgment language was found in Hispanic (7,167/66,282, 10.8% of all clinical notes), followed by Black (7,010/65,628, 10.7%), White (10,206/107,626, 9.5%), and Asian (1,756/22,548, 7.8%) patients. Black and Hispanic patients were 14% more likely to have notes with judgment language than White patients. The length of a home health care visit was reduced by 21 minutes when judgment language was used. Racial differences were identified in judgment language use. When judgment language is used, clinicians spend less time at patients' homes. Because the language clinicians use in documentation is associated with the time spent providing care, further research is needed to study the impact of using judgment language on quality of home health care. Policy, education, and clinical practice improvements are needed to address the biases behind judgment language.

Investigation of vitamin D, vitamin B12 and ferritin levels in children receiving Home Health Care Services in Southeastern Turkey

Objective: For proper nutrition of children followed by the Home Health Care (HHC) unit, a close follow-up is extremely important. Vitamin deficiencies are common in children in this group who need parental or caregiver-dependent nutrition. The purpose of this study conducted in Batman Province, was to investigate vitamin D, vitamin B12 and ferritin levels of individuals under 18 years of age who are followed by the HHC unit and continue their lives and treatments at home, except for emergencies. Materials and Methods: This study was derived from the files of 416 pediatric patients who were followed up in Batman Province HHC unit between January 1, 2022, and December 31, 2022. It was designed as a retrospective, single-center study evaluating 25-hydroxyvitamin D (OH) levels, vitamin B12 levels, ferritin levels, and demographic variables from individuals followed by HHC unit. The data were collected from the HHC unit’s files. IBM-SPSS version 24 was used for analysis. Results: The mean age of the 416 children receiving home health care services included in the study was 10.38±4.37 years. 234 (56.2%) of the participants were male and 182 (43.8%) were female. The 25(OH)D level was 18.47±5.41 ng/mL for all ages, and the ferritin level was 34.90 (33.08) ng/mL. The vitamin B12 level was 480.31±190.38 ng/L. The 25-OH-D vitamin levels of the children in the study was significantly low. Conclusion: Patients followed within the scope of home health care services are at risk for malnutrition and vitamin deficiencies, and annual follow-up of the patients in this regard and personalized diet programs should be created. Vitamin D insufficiency and deficiency are common in children in this group, who cannot leave the house except for compulsory situations and cannot benefit from sunlight sufficiently. We think that these children with chronic diseases should take vitamin D prophylaxis.

Risk of Rehospitalization or Emergency Department Visit is Significantly Higher for Patients who Receive Their First Home Health Care Nursing Visit Later than 2Days After Hospital Discharge.

This study explored the association between the timing of the first home health care nursing visits (start-of-care visit) and 30-day rehospitalization or emergency department (ED) visits among patients discharged from hospitals. Our cross-sectional study used data from 1 large, urban home health care agency in the northeastern United States. We analyzed data for 49,141 home health care episodes pertaining to 45,390 unique patients who were admitted to the agency following hospital discharge during2019. We conducted multivariate logistic regression analyses to examine the association between start-of-care delays and 30-day hospitalizations and ED visits, adjusting for patients' age, race/ethnicity, gender, insurance type, and clinical and functional status. We defined delays in start-of-care as a first nursing home health care visit that occurred more than 2 full days after the hospital discharge date. During the study period, we identified 16,251 start-of-care delays (34% of home health care episodes), with 14% of episodes resulting in 30-day rehospitalization and ED visits. Delayed episodes had 12% higher odds of rehospitalization or ED visit (OR 1.12; 95% CI: 1.06-1.18) compared with episodes with timely care. The findings suggest that timely start-of-care home health care nursing visit is associated with reduced rehospitalization and ED use among patients discharged from hospitals. With more than 6 million patients who receive home health care services across the United States, there are significant opportunities to improve timely care delivery to patients and improve clinical outcomes.

Predictors of Mortality in Home Health Care Service: Data from Saudi Arabia.

ObjectiveThis study aimed to 1) report the prevalence of chronic conditions among Saudi people receiving long-term home health care (HHC) services, 2) identify the predictors of mortality among individuals receiving long-term HHC services, and 3) study the association between frailty and poor health outcomes among HHC users.DesignRetrospective cross-sectional descriptive study.Setting and ParticipantsA total of 555 participants were recruited from HHC services at King Saud University Medical City (KSUMC), Riyadh, Saudi Arabia. We collected the data from electronic health records (EHR), patient charts, and caregiver interviews for 555 participants included in HHC program from the year 2019 to 2022.MethodsOnly individuals fulfilling the HHC program’s eligibility criteria were included to the study. A total of 555 participants were included in the analysis. We assessed the functional performance by the Katz activity of daily living and Bristol Activity of Daily Living Scale (BADLS). A trained health care provider assessed frailty using the Clinical Frailty Scale (CFS). We calculated the means and frequency to describe the prevalence of chronic conditions and variables of interest. A Chi-square test or independent-samples t-test was run to determine if there were differences between the alive and deceased individuals. A binary logistic regression model was performed to predict mortality of HHC service recipients.ResultsThe mean age for deceased individuals in HHC was 78.3 years. Over twenty percent of individuals receiving HHC services were readmitted to the hospital. We found that the strongest predictors for mortality were pressure ulcers with an odds ratio of 3.75 and p-value of <0.0001, and the Clinical Frailty Scale, which had an odds ratio of 1.69 and p-value of 0.002, using multivariate regression analysis.Conclusions and ImplicationsIn conclusion, our study found that pressure ulcers and frailty are the strongest predictors of mortality for individuals receiving home health care services.

Oral health and oral health-related quality of life among older adults receiving home health care services: A scoping review.

To map the literature on subjective and objective oral health indicators and oral health-related quality of life (OHRQoL) in older adults receiving home health care services (HHCS). The proportion of older adults in need of HHCS will increase in the coming years. Previous studies indicate that frail and dependent older adults are at increased risk for oral diseases, due to challenges with daily oral hygiene and regular access to dental services. Four databases were searched in November 2020 for relevant literature. Search terms included a comprehensive list of terms for adults 65 years or older receiving HHCS, clinical and subjective oral health indicators, and OHRQoL. The literature was reviewed based on inclusion and exclusion criteria. Of the 3114 sources identified, 18 were included. Data on oral diseases and symptoms among older adults receiving HHCS were limited and heterogeneous. Overall, older adults often lacked some of their natural teeth and often had removable dentures that needed repair. In addition, plaque, caries, xerostomia, and chewing and swallowing problems were common among the population group. Data on OHRQoL were scarce and indicated a positive association with a higher number of present teeth, while decayed teeth, root remnants, and dry mouth had substantial negative impacts on the daily activities of older adults receiving HHCS. This scoping review show that older adults above 65 years receiving HHCS generally have poor oral health status and that there is a knowledge gap regarding their OHRQoL.

Clinical notes: An untapped opportunity for improving risk prediction for hospitalization and emergency department visit during home health care.

Between 10 and 25% patients are hospitalized or visit emergency department (ED) during home healthcare (HHC). Given that up to 40% of these negative clinical outcomes are preventable, early and accurate prediction of hospitalization risk can be one strategy to prevent them. In recent years, machine learning-based predictive modeling has become widely used for building risk models. This study aimed to compare the predictive performance of four risk models built with various data sources for hospitalization and ED visits in HHC. Four risk models were built using different variables from two data sources: structured data (i.e., Outcome and Assessment Information Set (OASIS) and other assessment items from the electronic health record (EHR)) and unstructured narrative-free text clinical notes for patients who received HHC services from the largest non-profit HHC organization in New York between 2015 and 2017. Then, five machine learning algorithms (logistic regression, Random Forest, Bayesian network, support vector machine (SVM), and Naïve Bayes) were used on each risk model. Risk model performance was evaluated using the F-score and Precision-Recall Curve (PRC) area metrics. During the study period, 8373/86,823 (9.6%) HHC episodes resulted in hospitalization or ED visits. Among five machine learning algorithms on each model, the SVM showed the highest F-score (0.82), while the Random Forest showed the highest PRC area (0.864). Adding information extracted from clinical notes significantly improved the risk prediction ability by up to 16.6% in F-score and 17.8% in PRC. All models showed relatively good hospitalization or ED visit risk predictive performance in HHC. Information from clinical notes integrated with the structured data improved the ability to identify patients at risk for these emergent care events.

Relational Aspects of Parent and Home Health Care Provider Care Practices for Children With Complex Care Needs Receiving Health Care Services in the Home: A Narrative Review.

Children with medical complexity have ongoing health needs that may require dependence on medical technologies. While hospital admissions are an important focus of care delivery for these children, a majority of the time they are cared for in their own homes. Parents' report feeling overwhelmed and stressed by the scope of their responsibilities, but they become sophisticated care providers and assume greater authority when providing their children's care at home. Communication, decision-making, and dealing with conflict with members of health care teams have been central concerns in parents' reports of their home health care experiences. The objective is to review literature on relational aspects of parent and home health care provider care practices for children with medical complexity receiving home health care services. A narrative review was conducted. A search of MEDLINE, EMBASE, EBM Reviews, PsychINFO, ERIC, and CINAHL databases for English language studies published since database inception was carried out. Eligible studies focused on relational aspects of parent and home health care provider care practices for children with medical complexity receiving home health care services. Nine empirical studies were selected for this review. Literature describes parents' and providers' experiences managing a child with medical complexity in the home and the effects for the family and the parent-health care provider relationship. Parents want to be actively involved in all aspects of care that affects their child and ultimately their family. Further investigation is needed to better understand relational aspects of parent-home health care provider care practices to support child/family health and well-being in the home setting.

Consequences of the Covid-19 virus on individuals receiving homecare services in Norway. A qualitative study of nursing students\u2019 reflective notes

BackgroundReflective notes in nursing education can facilitate students’ understanding of how individuals in need of home healthcare services experience unfamiliar situations, such as a pandemic. The aim of this study is to describe the consequences of the COVID-19 virus for individuals receiving homecare services through the eyes of nursing students.MethodsThis is a qualitative descriptive study using content analysis to examine reflection notes from 17 nursing students in their last year of academic studies while undertaking home healthcare service training.ResultsOur study shows students’ reflections on the consequences of the COVID-19 virus on individuals needing home healthcare services and their families. The analysis reveals three categories that described the effect of the virus according to students’ reflections: i) how social life became restricted and only includes the closest family members and home healthcare staff (declining social circle), ii) how family members take on more responsibility to care for the individual and the pronounced impact of this on the day-to-day lives of the individual’s next of kin (expanding responsibility of care), and iii) actions and reactions related to preventing the spread of the virus (dealing with the invisible threat).ConclusionsStudents’ reflection notes show that COVID-19 had major consequences, not only on the individuals receiving home healthcare services, but also on their relatives and on home healthcare staff.

Infection Hospitalization Trends Among US Home Healthcare Patients, 2013–2018

Background: Infections are a frequent cause of hospital (re)admissions for older adults receiving home health care (HHC) in the United States. However, previous investigators have likely underestimated the prevalence of infections leading to hospitalization due to limitations of identifying infections using Outcome and Assessment Information Set (OASIS), the standardized assessment tool mandated for all Medicare-certified HHC agencies. By linking OASIS data with inpatient data from the Medicare Provider Analysis and Review (MedPAR) file, we were able to better quantify infection hospitalization trends and subsequent mortality among HHC patients. Method: After stratification (by census region, ownership, and urban or rural location) and random sampling, our data set consisted of 2,258,113 Medicare beneficiaries who received HHC services between January 1, 2013, and December 31, 2018, from 1,481 Medicare-certified HHC agencies. The 60-day HHC episodes were identified in OASIS. Hospital transfers reported in OASIS were linked with corresponding MedPAR records. Our outcomes of interest were (1) hospitalization with infection present on admission (POA); (2) hospitalization with infection as the primary cause; and (3) 30-day mortality following hospitalization with infection as the primary cause. We identified bacterial (including suspected) infections based on International Classification of Disease, Ninth Revision (ICD-9) and ICD-10 codes in MedPAR. We classified infections by site: respiratory, urinary tract, skin/soft tissue, intravenous catheter-related, and all (including other or unspecified infection site). We also identified sepsis diagnoses. Result: From 2013 through 2018, the percentage of 60-day HHC episodes with 1 or more hospital transfers ranged from 15% to 16%. Approximately half of all HHC patients hospitalized had an infection POA. Over the 6 years studied, infection (any type) was the primary cause of hospitalization in more than a quarter of all transfers (25.86%–27.57%). The percentage of hospitalizations due to sepsis increased from 7.51% in 2013 to 11.49% in 2018, whereas the percentage of hospitalizations due to respiratory, urinary tract, or skin/soft-tissue infections decreased (p &lt;0.001). Thirty-day mortality following a transfer due to infection ranged from 14.14% in 2013 to 14.98% in 2018; mortality rates were highest following transfers caused by sepsis (23.14%-26.51%) and respiratory infections (13.07%-14.27%). Conclusion: HHC is an important source of post-acute care for those aging in place. Our findings demonstrate that infections are a persistent problem in HHC and are associated with substantial 30-day mortality, particularly following hospitalizations caused by sepsis, emphasizing the importance of infection prevention in HHC. Effective policies to promote best practices for infection prevention and control in the home environment are needed to mitigate infection risk.Funding: NoDisclosures: None

Increasing Home Healthcare Referrals and Access to Community Resources in Response to High Emergency Department Utilization.

The goal of this interprofessional quality initiative project was to decrease emergency department (ED) visits for nonemergency health problems by referring superutilizers to home healthcare or connecting them with existing community resources. An interprofessional team of students from schools of nursing, public health, and occupational therapy collaborated on a community assessment, investigated and gathered community resources, and interviewed key stakeholders at a rural ED to identify the root causes of high utilization. Using these data, we designed an algorithm for ED clinicians that provided an organized community resource collection and electronic resources for ED staff. We focused on encouraging an increase in the evaluation of patients for eligibility to receive home healthcare services.

Evde Sağlık Hizmeti Alan Hastaların Profillerinin İncelenmesi: Batman İli Örneği

Evde Sağlık Hizmeti Alan Hastaların Profillerinin İncelenmesi: Batman İli Örneği

Quality of Life of Older People Receiving Home Health Care Services: An Example From Turkey

Advanced age, restrictions on daily life activities, increased disability, and chronic diseases negatively affect the quality of life of older individuals. The aim of the present study was to investigate the quality of life of older patients receiving home health care services (HHCS) in Samsun province, Turkey. The population of this cross-sectional study comprised 489 individuals aged 65 years and older. Patient selection was performed using the stratified randomized sampling method. A total of 183 patients were included in the study. Data were collected using a questionnaire and face-to-face interviews. The Mann-Whitney U and Kruskal–Wallis tests were used in the statistical evaluation of data, and significance was regarded as p &lt; .05 for all tests. Some 75.4% of the patients were women, and the average age was 82 years. Eighty-three percent of the participants were semi-dependent or completely dependent in the activities of daily living (ADL); however, in the instrumental activities of daily living (IADL), 96.0% were semi-dependent or completely dependent. The quality of life of the older people receiving HHCS was identified as low both in the physical and mental health components. However, physical quality of life was statistically higher in men, in graduates of primary school or above, and in patients with no decubitus ulcers compared with the others. We found that the older individuals receiving HHCS had a lower quality of life due to their chronic diseases and high dependency compared with the general population and their contemporaries.

Assessment of Receipt of the First Home Health Care Visit After Hospital Discharge Among Older Adults

Home health care is one of the fastest growing postacute services in the US and is increasingly important in the era of coronavirus disease 2019 and payment reform, yet it is unknown whether patients who need home health care are receiving it. To examine how often patients referred to home health care at hospital discharge receive it and whether there is evidence of disparities. This cross-sectional study used Medicare data regarding the postacute home health care setting from October 1, 2015, through September 30, 2016. The participants were Medicare fee-for-service and Medicare Advantage beneficiaries who were discharged alive from a hospital with a referral to home health care (2 379 506 discharges). Statistical analysis was performed from July 2019 to June 2020. Hospital referral to home health care. Primary outcomes included whether discharges received their first home health care visit within 14 days of hospital discharge and the number of days between hospital discharge and the first home health visit. Differences in the likelihood of receiving home health care across patient, zip code, and hospital characteristics were also examined. Among 2 379 506 discharges from the hospital with a home health care referral, 1 358 697 patients (57.1%) were female, 468 762 (19.7%) were non-White, and 466 383 (19.6%) were dually enrolled in Medicare and Medicaid; patients had a mean (SD) age of 73.9 (11.9) years and 4.1 (2.1) Elixhauser comorbidities. Only 1 284 300 patients (54.0%) discharged from the hospital with a home health referral received home health care services within 14 days of discharge. Of the remaining 1 095 206 patients (46.0%) discharged, 37.7% (896 660 discharges) never received any home health care, while 8.3% (198 546 discharges) were institutionalized or died within 14 days without a preceding home health care visit. Patients who were Black or Hispanic received home health at lower rates than did patients who were White (48.0% [95% CI, 47.8%-48.1%] of Black and 46.1% [95% CI, 45.7%-46.5%] of Hispanic discharges received home health within 14 days compared with 55.3% [95% CI, 55.2%-55.4%] of White discharges). In addition, disadvantaged patients waited longer for their first home health care visit. For example, patients living in high-unemployment zip codes waited a mean of 2.0 days (95% CI, 2.0-2.0 days), whereas those living in low-unemployment zip codes waited 1.8 days (95% CI, 1.8-1.8 days). Disparities in the use of home health care remain an issue in the US. As home health care is increasingly presented as a safer alternative to institutional postacute care during coronavirus disease 2019, and payment reforms continue to pressure hospitals to discharge patients home, ensuring the availability of safe and equitable care will be crucial to maintaining high-quality care.

The Ventilator-Dependent Child: Best Practices for Educating Home Care Nurses.

Pediatric Home Service (PHS) in Roseville, Minnesota, has provided home care for children with medical complexity for over 30 years. This article describes the PHS program for educating and training home care nurses (HCNs). Since the inception of the company, advanced training for family and professional caregivers of ventilator-dependent children has been an important focus. The current program for HCN has three components and incorporates simulation and in-home training. Standardizing educational requirements and competencies for pediatric HCNs across nursing agencies has the potential to improve outcomes for children with medical complexity receiving home healthcare services.

Evde Sağlık Hizmeti Alan Hastaların Bakım Verenlerinde Bakım Yükü

Giriş: Bu çalışma Evde Sağlık Hizmeti (ESH) alan hastalara bakım verenlerin bakım yükünü ve etkileyen faktörleri değerlendirmeyi amaçlamıştır. Yöntem: Kesitsel tipteki çalışmaya evde sağlık hizmeti alan hastaların bakım hizmeti verenleri dahil edilmiştir. Bakım verenlerin bakım yükünü değerlendirmek amacıyla Zarit Bakım Yükü Ölçeği (ZBYÖ), bakım yüküne etki eden değişkenleri belirlemek amacıyla veri toplama formu kullanılmıştır. Bulgular: Çalışmaya ESH’den faydalanan 80 hastaya primer bakım verenler dâhil edilmiştir. Bakım verenlerin ZBYÖ puan ortalaması 38,4 olarak belirlenirken, bunların %43,8’inin ZBYÖ puanının yüksek, %2,5’inin ise çok yüksek olduğu tespit edilmiştir. Bakım yükü yüksek olanların %74,3’ü, baktıkları hastalara bakacak başka kimsenin bulunmamasından dolayı bakım verdiklerini belirtmiştir. Bakım verenlerin bakım yükü düzeyleri ile tükenmişlik, güçsüzlük-çaresizlik hissetme ve hastayla iletişim kurma sıkıntısı yaşama durumları arasında anlamlı ilişki saptanmıştır (p=0,001). Bakım yükü çok yüksek olanların tamamının anti-depresan kullandığı ve kendisini tükenmiş hissettiği tespit edilmiştir. Bakım verenlerin depresyon ve uyku ilacı kullanma durumları ve uyku kaliteleriyle bakım yükü düzeyleri arasında anlamlı bir ilişkinin olduğu ortaya konmuştur (p&amp;lt;0,05). Sonuç: Bakım verenlerin çoğunun bakım yükü düzeyi yüksek olarak saptanmış olup bu kişilerin tükenmişlik ve güçsüzlük-çaresizlik hissettiği, ayrıca bakımla ilgili eğitim-danışmanlık ve yardım gereksinimi duyduğu belirlenmiştir. Bu sonuçlar ışığında, ESH kapsamının, bakım verenlerin çeşitli gereksinim ve taleplerini de göz önünde bulunduracak şekilde genişletilmesinin ve bakım verenlere özellikle psikolojik ve sosyal destek alanlarında yardımcı olunmasının, bakım yükünün hafifletilmesi açısından faydalı olabileceği düşünülmektedir.