Hospital Home Care: Strategic Management for Integrated Care Delivery

Background: Specialised palliative home-care supports patients with life-limiting diseases in their familiar surroundings. The number of palliative care teams and patients being cared for is increasing worldwide. To assess and improve quality, it is needed to understand, how specialised palliative home-care can be provided successfully. For this purpose we examined the views of all involved stakeholders. Aim: To identify the issues that patients, their relatives and involved health professionals view as important in ensuring the success of specialised palliative home-care. Design: We used a qualitative design based on participant observations, interviews and focus groups following the principles of a Grounded Theory approach. Setting/participants: All specialised palliative home-care teams ( n = 22) caring for adults in Hesse, Germany, participated. We conducted participant observations ( n = 5), and interviewed patients ( n = 14), relatives ( n = 14) and health professionals working in or collaborating with specialised palliative home-care ( n = 30). We also conducted focus groups ( n = 4) with health professionals including a member check. Results: Successful specialised palliative home-care needs to treat complex symptoms, and provide comprehensive care including organisation of care, involving relatives and addressing issues of death and dying. Sense of security for patients and relatives is key to enable care at home. Care delivery preferences include a focus on the quality of relationships, respect for individuality and the facilitation of self-determination. Conclusions: Consideration of the identified key issues can help to ensure successful specialised palliative home-care. Knowledge of these should also be considered when researching and assessing quality of care. Trial registration: German Clinical Trials Register DRKS-ID: DRKS00012421; http://www.germanctr.de .

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HEALTHCARE PROVIDERS’ EXPERIENCES IN CARING FOR OLDER ADULTS WITH MULTIPLE CHRONIC CONDITIONS

Innovation in Aging ◽

10.1093/geroni/igz038.1160 ◽

2019 ◽

Vol 3 (Supplement_1) ◽

pp. S317-S318

Author(s):

Jenny Ploeg ◽

Marie-Lee Yous ◽

Kimberly Fraser ◽

Sinéad Dufour ◽

Sharon Kaasalainen ◽

...

Keyword(s):

Older Adults ◽

Primary Care ◽

Home Care ◽

Family Caregivers ◽

Chronic Conditions ◽

Care Delivery ◽

Healthcare Providers ◽

Multiple Chronic Conditions ◽

Team Approach ◽

Personal Support

Abstract The management of multiple chronic conditions (MCC) in older adults living in the community is complex. Little is known about the experiences of interdisciplinary primary care and home providers who care for this vulnerable group. The aim of this study was to explore the experiences of healthcare providers in managing the care of community-living older adults with MCC and to highlight their recommendations for improving care delivery for this group. A qualitative interpretive description design was used. A total of 42 healthcare providers from two provinces in Canada participated in semi-structured interviews. Participants represented diverse disciplines (e.g., physicians, nurses, social workers, personal support workers) and settings (e.g., primary care and home care). Thematic analysis was used to analyze interview data. The experiences of healthcare providers managing care for older adults with MCC were organized into six major themes: (1) managing complexity associated with MCC, (2) implementing person-centred care, (3), involving and supporting family caregivers, (4) using a team approach for holistic care delivery, (5) encountering rewards and challenges in caring for older adults with MCC, and (6) recommending ways to address the challenges of the healthcare system. Healthcare providers highlighted the need for a more comprehensive integrated system of care to improve care management for older adults with MCC and their family caregivers. Specifically, they suggested increased care coordination, more comprehensive primary care visits with an interprofessional team, and increased home care support.

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Models of home care services for persons with dementia: a narrative review

International Psychogeriatrics ◽

10.1017/s1041610215000137 ◽

2015 ◽

Vol 27 (10) ◽

pp. 1593-1600 ◽

Cited By ~ 14

Author(s):

Lee-Fay Low ◽

Jennifer Fletcher

Keyword(s):

Case Management ◽

Home Care ◽

Integrated Care ◽

Community Dwelling ◽

Narrative Review ◽

Nursing Home Admission ◽

Community Based ◽

People With Dementia ◽

The Impact ◽

Community Based Services

ABSTRACTBackground:Worldwide trends of increasing dementia prevalence, have put economic and workforce pressures to shifting care for persons with dementia from residential care to home care.Methods:We reviewed the effects of the four dominant models of home care delivery on outcomes for community-dwelling persons with dementia. These models are: case management, integrated care, consumer directed care, and restorative care. This narrative review describes benefits and possible drawbacks for persons with dementia outcomes and elements that comprise successful programs.Results:Case management for persons with dementia may increase use of community-based services and delay nursing home admission. Integrated care is associated with greater client satisfaction, increased use of community based services, and reduced hospital days however the clinical impacts on persons with dementia and their carers are not known. Consumer directed care increases satisfaction with care and service usage, but had little effect on clinical outcomes. Restorative models of home care have been shown to improve function and quality of life however these trials have excluded persons with dementia, with the exception of a pilot study.Conclusions:There has been a little research into models of home care for people with dementia, and no head-to-head comparison of the different models. Research to inform evidence-based policy and service delivery for people with dementia needs to evaluate both the impact of different models on outcomes, and investigate how to best deliver these models to maximize outcomes.

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Toward a Scalable Home-Care Delivery for Frail Elders and People with Special Needs

2007 IEEE 10th International Conference on Rehabilitation Robotics ◽

10.1109/icorr.2007.4428544 ◽

2007 ◽

Cited By ~ 2

Author(s):

Abdelsalam Helal ◽

Bessam Abdulrazak

Keyword(s):

Home Care ◽

Special Needs ◽

Care Delivery ◽

Frail Elders

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Integrated care delivery

British Journal of Community Nursing ◽

10.12968/bjcn.2018.23.9.414 ◽

2018 ◽

Vol 23 (9) ◽

pp. 414-414

Author(s):

Alison While

Keyword(s):

Integrated Care ◽

Care Delivery

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Observing the Work Practices of an Inter-professional Home Care Team: Supporting a Dynamic Approach for Quality Home Care Delivery

COOP 2014 - Proceedings of the 11th International Conference on the Design of Cooperative Systems, 27-30 May 2014, Nice (France) ◽

10.1007/978-3-319-06498-7_15 ◽

2014 ◽

pp. 243-258 ◽

Cited By ~ 1

Author(s):

Khuloud Abou Amsha ◽

Myriam Lewkowicz

Keyword(s):

Home Care ◽

Care Delivery ◽

Care Team ◽

Work Practices ◽

Dynamic Approach ◽

Professional Home ◽

Professional Home Care

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Can a Home Care Package deliver a meaningful life? Challenges for rural home care delivery

Journal of Hospital Administration ◽

10.5430/jha.v10n2p12 ◽

2021 ◽

Vol 10 (2) ◽

pp. 12

Author(s):

Pauline Marsh ◽

Amelie Fuller ◽

Judith Anderson

Keyword(s):

Home Care ◽

Care Delivery ◽

Individual Autonomy ◽

Negative Consequences ◽

Meaningful Life ◽

Current Form ◽

Life Challenges ◽

Care Package ◽

And Control ◽

Depth Interviews

Objective: To explore the capacity and responsiveness of the Home Care Package (HCP) Program to deliver the promise of a meaningful life for rural residents.Methods: In-depth interviews utilising appreciative enquiry in two local government areas in rural/outer regional Tasmania (MM2-6). Participants: Rural staff and residents who were either receiving, seeking or delivering support through the HCP Program.Results: Interviews revealed that positive impacts of being assisted to stay at home resulted when staff were able to provide support that was appropriate to need, and enabled the continuation of rural community engagement, individual autonomy and control. When the HCP did not provide these, or even hindered them, there were negative consequences, and feelings of confusion, mistrust, and disappointment for staff and residents. The rural context creates specific challenges for the HCP Program in its current form, related to service availability and choice, staff recruitment, training and availability, and client/provider needs mismatch.Conclusions: Older rural people are variously impacted upon by the HCP Program. Factors of rurality, including workforce issues, hamper the Program’s potential to positively contribute to a meaningful life. As demand grows, changes are needed. There is a need to examine the Program design for urban-centrisms, and gain a greater awareness of older rural people’s needs and rural service challenges.

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Transpersonal caring model in home-Care nursing for children with special care needs

Journal of Nursing Education and Practice ◽

10.5430/jnep.v9n1p105 ◽

2018 ◽

Vol 9 (1) ◽

pp. 105

Author(s):

Luana Tonin ◽

Maria R. Lacerda ◽

Luciane Favero ◽

Jaqueline D. Nascimento ◽

Patricia K. Rocha ◽

...

Keyword(s):

Home Care ◽

Care Delivery ◽

Theory And Practice ◽

Initial Contact ◽

Care Needs ◽

Analytical Strategy ◽

Analytical Technique ◽

Home Care Nursing ◽

Healthcare Needs ◽

Care Nursing

The study was theoretically and philosophically guided by the Theory of Human Care, entailing the use of the Elements of the Clinical Caritas Process, having humanistic assumptions based on Home Care, and being operationalized by the following action steps: Initial Contact, Approaching, Transpersonal Encounter and Separation. It aimed to apply the Transpersonal Care Model in Home Care Nursing to children with special healthcare needs. Qualitative care-research (intervention), developed by means of five components: approaching the studied object; encounter with the cared-researched being; connections between theory and practice; separation from the researcher-caregiver being to the cared-researched being, and analysis of what has been learned by means of the General Analytical Strategy – Relying on theoretical propositions – and Specific Analytical Technique – Pattern Combination. The key results from the development of each one of the steps are, as follows: assumptions were applied 537 times, 322 usages of the Clinical Caritas Process, and 467 care needs were met by means of the model. The model potentialities were identified, understanding that it was built for the population at home care, thus enabling relation development, meeting their needs, and supporting nurses to foster care delivery.

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Impact of Pressure Injury Prevention Protocol in Home Care Services on the Prevalence of Pressure Injuries in the Dubai Community

Dubai Medical Journal ◽

10.1159/000511226 ◽

2020 ◽

Vol 3 (3) ◽

pp. 99-104

Author(s):

Sajitha Prasad ◽

Nazneen Hussain ◽

Sangeeta Sharma ◽

Somy Chandy ◽

Jessy Kurien

Keyword(s):

Health Care ◽

Home Care ◽

Care Delivery ◽

Assessment Tools ◽

Care Plan ◽

Significant Drop ◽

Braden Scale ◽

Increased Risk ◽

Prevention Protocol ◽

The Impact

Background: Pressure injuries (PIs) in the community have emerged as a health care burden in the past few years, leading to high rates of morbidity and mortality among the elderly population. There is evidence that simple risk assessment tools and protocols have reduced the prevalence of PIs considerably by shifting the focus to timely prevention and adequate management. The prevalence of PIs is high in home care setting and utilizes a major share of the organizational resources for its treatment and prevention. Aim: This study aims to assess the impact of the newly developed PI prevention protocol for home care patients in Dubai. The objectives are to evaluate effective implementation of the proposed protocol and its impact on the prevalence of PIs in the community to identify the gaps for improvement in the future. Methods: This retrospective observational was conducted in 13 primary health care centers in Dubai, UAE. Data were collected from 249 patients’ records at an average age of 75.5 ± 14.5 years old with compromised mobility (bedbound/chairbound) from January to July 2019. The PI prevalence was assessed before and after 6 months of implementing the PI prevention protocol and comparison was done using a standardized skin assessment scale (Braden Scale). Internationally validated tools from the Agency for Healthcare Research and Quality and National Institute for Health and Care Excellence were used to ensure the reliable use of the Braden Scale and PI protocol compliance. The prevalence was calculated from the existing key performance indicators in the home care office and considering the significant improvement at p value of <0.05. Results: The findings in the first quarter revealed a significant drop in both prevalence (9.0%) and incidence rate (6.0%) to approximately 2.0%. Overall PIs prevalence declined significantly after implementing the protocol (p < 0.0001) among both genders. Also, a significant improvement was detected in the use of Braden Scale and multidisciplinary care plan (p < 0.0001). Conclusion: This study indicates that standardization of care delivery reduces the increased risk and incidence of PIs with a potentially positive outcome on PI prevalence.

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