Showing papers in "Home Health Care Services Quarterly in 2007"

Care coordination for cognitively impaired older adults and their caregivers.

Abstract: SUMMARY Dementia and delirium, the most common causes of cognitive impairment (CI) among hospitalized older adults, are associated with higher mortality rates, increased morbidity and higher health care costs. A growing body of science suggests that these older adults and their caregivers are particularly vulnerable to systems of care that either do not recognize or meet their needs. The consequences can be devastating for these older adults and add to the burden of hospital staff and care-givers, especially during the transition from hospital to home. Unfortunately, little evidence exists to guide optimal care of this patient group. Available research findings suggest that hospitalized cognitively impaired elders may benefit from interventions aimed at improving care management of both CI and co-morbid conditions but the exact nature and intensity of interventions needed are not known. This article will explore the need for improved transitional care for this vulnerable population and their caregivers.

Discharge planning, transitional care, coordination of care, and continuity of care: clarifying concepts and terms from the hospital perspective.

Abstract: Hospital discharge planning is a key element of continuity of care for persons leaving the hospital. Yet many important questions regarding processes and effects of discharge planning have not been addressed, in part because the multiple terms associated with discharge planning have not been consistently defined or used. Failure to clearly name, define, and consistently use terms creates a barrier that inhibits scientific progress and best practice. This article reviews the use of terms and definitions and compares concepts associated with hospital discharge planning across key documents frequently referenced by hospitals. A conceptual model is proposed to facilitate consistent use of these concepts.

Abuse and Violence During Home Care Work as Predictor of Worker Depression

Abstract: Objectives. Home care workers provide care without the normal protections afforded in the hospital. This study describes the prevalence of abuse and violence experienced by home care workers and its relationship to workers' depression. Methods. A two-wave telephone survey (N = 1,643) was conducted to assess the prevalence of abuse and prevalence/incidence of workers' depression. Results. Abuse was significant for elevated odds for depression, with a dose effect. Violence was highly associated with depression. Conclusions. Preventive and early intervention measures should be taken to reduce mental health consequences of abuse and violence among home care workers.

The Central Role of Performance Measurement in Improving the Quality of Transitional Care

Abstract: SUMMARY The objectives of this study were: (1) to demonstrate the ability of the Care Transitions Measure (CTM) to identify care deficiencies; (2) to devise and implement a quality improvement approach designed to remedy these deficiencies; (3) to assess the impact of the quality improvement approach on CTM scores; and (4) to test whether the CTM-3 predicts return to the emergency department. The CTM was found to be a sensitive tool able to capture changes in performance. The 3-item CTM was found to significantly predict post-hospital return to the emergency department within the first 30 days (p = 0.004).

Managing Depression in Home Health Care: A Randomized Clinical Trial

Abstract: A prospective randomized trial was conducted to examine the effectiveness, feasibility, and degree of implementation of home health care quality improvement interventions when implemented under usual conditions by usual care providers. A total of 311 older adults were randomized to enhanced usual care (EUC) that included routine depression screening and staff training in depression care management for older adults or to the intervention group (INT) that included antidepressants and/or psychotherapy treatment plus EUC. Implementing a routine screening protocol using the PHQ-9 and depression care management quality improvements is feasible in diverse home health care organizations and results in consistently better (but not statistically significant) depression outcomes in the INT group.

Development and testing of an analytic model to identify home healthcare patients at risk for a hospitalization within the first 60 days of care.

Abstract: SUMMARY Preventing hospitalization is one of the major objectives of home health care. Accomplishing this goal is being able to identify patients at risk for hospitalization and intervening appropriately. The current study explored which factors place patients at risk at the start of care and are predictive over the first 60 days of care. Outcomes Assessment Information Set (OASIS), plan of care, medications and medical record information from an urban home health agency were used to build and validate a predictive hospitalization model. The model was developed and tested using a large set of patients (n = 46,366). Patients were classified into seven risk groups from very low to very high. Results revealed that a combination of demographic, financial, clinical and health status factors could accurately predict patients' likelihood for hospitalization and the model agreed with clinical judgments. Examples of how the risk model could be used in practice are provided.

Bouncing-back: rehospitalization in patients with complicated transitions in the first thirty days after hospital discharge for acute stroke.

Abstract: SUMMARY Background: “Bounce-backs” (movements from a less intensive to a more intensive care setting) soon after hospital discharge are common, but reasons for bouncing-back remain unknown. Objective: To examine how the primary diagnosis for first rehospitalization relates to thirty-day bounce-back number and initial discharge destination in acute stroke. Population: Administrative data from 5,250 Medicare beneficiaries > 65 years discharged with acute ischemic stroke in 1998–2000 to a rehabilitation center, skilled nursing facility or home with home health care and with at least one thirty day rehospitalization. Analysis: Probability of thirty-day bounce-back was calculated using multivariate models. Results: Infections and aspiration pneumonitis were the most common reasons for rehospitalization, regardless of initial discharge site. Conclusions: Efforts addressing aspirations and infections, the preventable complications of immobility, will be critical in decreasing acute stroke bounce-backs.

Employer Retention Strategies and Their Effect on Nurses' Job Satisfaction and Intent to Stay

Abstract: Faced with a nursing shortage and anticipated increase in demand, home care agencies are implementing retention strategies with little knowledge of their effectiveness. The purpose of this study is to describe the strategies implemented and their effect on nurse job satisfaction and intention to leave. Data were collected from a random sample of 123 New England agencies during in-person interviews. Most agencies reported implementing multiple recruitment and retention strategies. Regression results suggest that the effects of employer retention strategy on nurses' intent to stay are the indirect result of its effects on job satisfaction. The only retention intervention that made a statistically significant difference in job satisfaction was shared governance, and no retention strategy directly affected nurses' intention to stay in their jobs.

Aging in Place? Evidence That a State Medicaid Waiver Program Helps Frail Older Persons Avoid Institutionalization

Abstract: Long-term care will increasingly shift from institutions to home and community based services. Using data from a Medicaid home care waiver program in South Carolina, the Community Long-Term Care (CLTC) program, we evaluated differences in frailty and service use among CLTC clients between 1995 (n = 3,748) and 2005 (n = 9,157). The expectation was that CLTC clients had become more frail in that period, and had greater access to services in the community, results that might suggest the CLTC program had helped individuals to avoid institutionalization. Frailty measures included acute and chronic conditions, other health conditions, and activities of daily living (ADL). We evaluated the percentage of clients using services, and service use intensity. A large majority of clients in both years were impaired in at least four ADL. In 2005, CLTC clients were significantly more likely to have chronic conditions, including hypertension, chronic obstructive pulmonary disease, Alzheimer's disease, arthritis, ...

Gender Differences in the Community Service Use Attitudes of Older Spousal Caregiver-Care Recipient Couples

Abstract: Prior research has consistently overlooked spousal care recipients' attitudes toward service use within the caregiver-care recipient dyadic context. To address this gap in knowledge, this exploratory study collected data from both caregiver and care recipient spousal informants to compare their community service use attitudes by gender. This study employed a purposive sample of 30 older spousal caregiver-care recipient couples (N = 60). Service use attitude measures were adapted from the Community Service Attitude Inventory. For the entire sample, caregivers and care recipients had similar attitude scores at the group level of comparison. In the caregiver subsample, female spousal caregivers reported a higher level of confidence in service system compared with male spousal caregivers. Male spousal caregivers reported a higher worry and fear attitude compared with female spousal caregivers. In the care recipient subsample, female spousal care recipients reported a higher wait-and-see attitude comp...

Exploring influences on community-based case managers' advance care planning practices: facilitators or barriers?

Abstract: Community-based geriatric case managers work with an increasingly frail older population in need of advance care planning throughout the end of life. However, little is known regarding factors that influence their professional practices in this area. This qualitative study used four focus groups to explore case managers' (N = 27) perceptions of facilitators and barriers to advance care planning practices. Themes from the study suggest that case managers view five key influences that appear to either assist or impede practices, depending on case manager's perceptions and experiences. Themes include: (1) Paradox of case management and programmatic realities; (2) extent of family presence and involvement; (3) level of proficiency in advance care planning; (4) degree of client receptivity to planning; and (5) limited communication with providers. The findings suggest that case managers vary in their advance care planning practices by differing perceptions regarding clients, families, professional exp...

Can't they get anything better? Home support workers call for change.

Abstract: A descriptive exploratory study examined the demographic characteristics and working conditions of home support workers in one Canadian province. Four hundred and sixty-three workers, a response rate of 43.5%, completed the Home Support Worker Survey, an instrument designed for the purposes of the study. Workers identified a need for changes to their working conditions including better wages, improved benefits, and a modified work schedule. Since these workers are the largest segment of formal care providers and the mainstay of formal support services for chronically ill seniors, attention to their issues is critical to the sustainability of the home care industry.

Client and Responder Perceptions of a Personal Emergency Response System: Lifeline

Abstract: A mixed methodology mail survey was used to gauge level of customer satisfaction with, and identify issues that may help improve, personal emergency response system service delivery. A total of 1,2...

Older Carers in Ageing Societies: An Evaluation of a Respite Care Program for Older Carers in Western Australia

Abstract: The Australian Red Cross Older Carers Program was developed in 2003 to support the unique needs of “older carers” aged 65 and older (50 if Indigenous) who care for a person (a care recipient, usually a family member) aged 18 or older who have a permanent disability. The aim of the program was to provide intensive case planning, management, and volunteer support that would assist older carers to more readily access respite and continue their caring role in the home. To help achieve this end, ongoing individualised and holistic assistance involving older carers in decision making was an integral component of the Older Carers Program, as was the use of regular home visits by program staff. The Older Carers Program evaluation was both a process and outcome evaluation. Much of the evaluation research focused on the extent to which it had met its stated aims and objectives. However, because the program was quite new and innovative there was a significant further focus upon the processes and activities ...

Financial management services in consumer-directed programs.

Abstract: Shifting from an agency-based model of personal assistance services to consumer direction has important consequences for both recipients and workers. In consumer direction, recipients assume the responsibilities of employing their attendants–for both self-directing their supportive services and being responsible for numerous fiscal responsibilities. Many states have eased these fiscal responsibilities among recipients in publicly financed personal care programs by using Financial Management Services (also known as fiscal intermediaries). This article introduces the major types of Financial Management Services organizations used by Medicaid consumer-directed personal care programs, and examines the extent to which the varied approaches can and do serve the needs of both recipients and workers. Despite the expansion of consumer-directed programs and the accompanying emergence of Financial Management Services, these organizations have not been extensively studied or evaluated. The paper concludes wi...

Level of empowerment and health knowledge of home support workers providing care for frail elderly.

Abstract: The purpose of this study was to assess the profile of home support workers (HSWs) caring for the frail elderly and to determine the perceived empowerment levels and general health knowledge of these support workers. Background, work-profile, empowerment level and health knowledge related to seniors of 64 HSWs were assessed using questionnaires. Findings revealed the majority of workers to be middleaged women, and their health knowledge scores were low. Empowerment levels were moderate as was formal power. Findings demonstrate the need to revise the curriculum of HSWs to include health topics, as well as the need for continued education and strategies to enhance empowerment levels.

Patterns of emergency care use in residential care settings: opportunities to improve quality of transitional care in the elderly

Abstract: Emergent care is a prominent feature in the complex matrix of care transitions for vulnerable elders. This article evaluates local patterns of emergent care transport using ambulance transport data for the year 2003, analyzed by residential setting (independent senior apartments, licensed residential care and nursing homes). Significant differences were found between categories and between facilities within categories (p < .001). The more than three-fold difference in ambulance transport rate between nursing homes reinforces the need to recognize these transitions as quality indicators. Differences between senior apartments and licensed residential care settings provide initial insight suggesting opportunities for quality improvement in these community settings.

ReACH National Demonstration Collaborative: early results of implementation.

Abstract: SUMMARY The Reducing Acute Care Hospitalization (ReACH) National Demonstration Collaborative is a two-year multi-wave initiative using a “virtual” Collaborative Learning Model to reduce acute care hospitalization rates among home care patients. ReACH aims to reduce hospitalization to 23%, as recommended by the Centers for Medicare and Medicaid Services in its 8th Scope of Work for Quality Improvement Organizations. This article reports on the early implementation experience of a sample of 17 of 65 home health agencies participating in Wave I of ReACH. It examines agency challenges in implementing a structured practice improvement initiative, improving hospital to home transitions and focusing appropriate resources on high risk patients. Lessons learned will inform future home health care quality improvement initiatives.

State Medicaid Home Care Policies: Inside the Black Box

Abstract: With Medicaid now the largest budget item for many states and the biggest payer of home and community-based services (HCBS), there is increasing interest in the policies used by states on their three main Medicaid HCBS programs: 1915(c) waivers, state plan personal care, and home health. This article presents an analysis of annual national surveys (2002-2004) of Medicaid HCBS programs that investigate the four main features over which states have discretion: (1) eligibility criteria, (2) services offered (including consumer direction), (3) discretionary cost controls (financial caps, service limits, and wait lists), and (4) workforce issues including the use of independent providers. The findings advance knowledge of state policy trends within each of the three programs and variations between them.

Preferences for accepting prescribed community-based, psychosocial, and in-home services by older adults.

Abstract: The purpose of this study was to describe the preferences of minority and non-Hispanic White homebound older adults aged 60 and over for making decisions to accept and arrange community-based, psychosocial, and in-home services prescribed by Home Health clinical social workers (N = 249). Overall, prescribed community-based, psychosocial, and in-home service referrals were accepted by participants. In-home supportive services, Short- and Long-Term Case Management, and Psychiatric Nurse were the most frequently arranged services by clinical social workers. Resistance by both minority and non-Hispanic Whites to the arrangement of services was evident for several other services. Social workers, case managers, and other professionals involved in the arrangement and planning of services for similar older adults can use the results to gain an understanding of both the specialized services prescribed by clinical social workers to functionally dependent older adults and the decisions older adults make to ...

A research and policy agenda for transitions from nursing homes to home.

Abstract: More than 1 million adults make the transition from nursing homes to the community every year, often using formal health services including Medicare Part A skilled home health care. Although the need for discharge planning is well described, and the risks associated with care transitions are increasingly recognized, there is very limited information about the process and outcomes as patients move from nursing home to home. This paper reviews pertinent published data and health services research as background information and outlines a research agenda for studying these important transitions.

Fibromyalgia, cognitive problems and independence: physical activity may be useful in home health care.

Abstract: Home health care providers often deal with older clients who have cognitive deficits. Cognitive problems have a negative impact on independence. Certain chronic pain conditions present with cognitive dysfunction as a co-morbidity. Fibromyalgia syndrome is one such condition. Home health care providers need to know that mild-moderate exercise may positively affect fibromyalgia-related cognitive deficits at very low cost. All of the above is discussed in this paper along with advice concerning the provision of exercise for older, homebound people.