scholarly journals Information management goals and process failures during home visits for middle-aged and older adults receiving skilled home healthcare services after hospital discharge: a multisite, qualitative study

2018 ◽  
Vol 28 (2) ◽  
pp. 111-120 ◽  
Author(s):  
Alicia I Arbaje ◽  
Ashley Hughes ◽  
Nicole Werner ◽  
Kimberly Carl ◽  
Dawn Hohl ◽  
...  
Keyword(s):  
Older Adults ◽  
Home Health ◽  
Home Healthcare ◽  
Health Providers ◽  
Middle Aged ◽  
Home Health Services ◽  
Hospital To Home ◽  
Health Transitions ◽  
Process Failures ◽  
Related Process

BackgroundMiddle-aged and older adults requiring skilled home healthcare (‘home health’) services following hospital discharge are at high risk of experiencing suboptimal outcomes. Information management (IM) needed to organise and communicate care plans is critical to ensure safety. Little is known about IM during this transition.Objectives(1) Describe the current IM process (activity goals, subactivities, information required, information sources/targets and modes of communication) from home health providers’ perspectives and (2) Identify IM-related process failures.MethodsMultisite qualitative study. We performed semistructured interviews and direct observations with 33 home health administrative staff, 46 home health providers, 60 middle-aged and older adults, and 40 informal caregivers during the preadmission process and initial home visit. Data were analysed to generate themes and information flow diagrams.ResultsWe identified four IM goals during the preadmission process: prepare referral document and inform agency; verify insurance; contact adult and review case to schedule visit. We identified four IM goals during the initial home visit: assess appropriateness and obtain consent; manage expectations; ensure safety and develop contingency plans. We identified IM-related process failures associated with each goal: home health providers and adults with too much information (information overload); home health providers without complete information (information underload); home health coordinators needing information from many places (information scatter); adults’ and informal caregivers’ mismatched expectations regarding home health services (information conflict) and home health providers encountering inaccurate information (erroneous information).ConclusionsIM for hospital-to-home health transitions is complex, yet key for patient safety. Organisational infrastructure is needed to support IM. Future clinical workflows and health information technology should be designed to mitigate IM-related process failures to facilitate safer hospital-to-home health transitions.

scholarly journals Discharge home health services referral and 30-day all-cause readmission in older adults with heart failure

2018 ◽  
Vol 14 (5) ◽  
pp. 995-1002 ◽  
Author(s):  
Cherinne Arundel ◽  
Helen Sheriff ◽  
Donna M. Bearden ◽  
Charity J. Morgan ◽  
Paul A. Heidenreich ◽  
...  
Keyword(s):  
Heart Failure ◽  
Older Adults ◽  
Health Services ◽  
Home Health ◽  
Home Health Services ◽  
Discharge Home

Longitudinal associations between time-varying insomnia symptoms and all-cause healthcare services utilization among middle-aged and older adults in the US

2021 ◽  
Author(s):  
Asos Mahmood ◽  
Satish Kedia ◽  
Aram Dobalian ◽  
Cyril F. Chang ◽  
SangNam Ahn
Keyword(s):  
Older Adults ◽  
Nursing Home ◽  
Healthcare Services ◽  
Early Morning ◽  
Home Healthcare ◽  
Time Varying ◽  
Middle Aged ◽  
Services Utilization ◽  
Hospital Stays ◽  
Insomnia Symptoms

Abstract This study examines longitudinal associations between time-varying insomnia symptoms (including difficulty initiating sleep, difficulty maintaining sleep, early-morning awakenings, and nonrestorative sleep) and all-cause healthcare services utilization (HSU; overnight hospital stays, nursing home stays, and home healthcare services) among middle-aged and older adults. Data were obtained from 2002 through 2018 waves of the Health and Retirement Study in the US for a population-representative sample of 13,168 adults (aged ≥50 years; mean [SD] age= 66.8±9.4; females= 57.7%; ≥2 comorbid medical conditions= 52.5%). A marginal structural modeling approach and generalized estimating equations were implemented to capture time-varying biological, psycho-cognitive, lifestyle, or behavioral health factors and to adjust for selection bias due to differential loss to follow-up. At baseline, 38.9% of respondents reported experiencing at least one insomnia symptom. During the 16-year follow-up, 72.9%, 17.9%, and 35.1% reported overnight hospital stays, nursing home stays, and home healthcare services utilization, respectively. Higher numbers of insomnia symptoms on a cumulative scale were associated with more overnight hospital stays, nursing home stays, and home healthcare services utilization. Further, experiencing each of difficulty initiating and maintaining sleep, and nonrestorative sleep, as standalone symptoms, was associated with a higher likelihood of HSU compared to those not experiencing any of these symptoms. Independent associations of early-morning awakening with nursing home stays and home healthcare utilization were not significant. The results emphasize the roles of screening and addressing symptoms of insomnia among middle-aged and older adults or those prone to sleep disorders to reduce avoidable HSU. Future investigations should focus on the underlying causes and health systems pathways linking insomnia symptoms to HSU.

scholarly journals Effect of Family Caregiver Need for Training on Medicare Home Health Care

2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 149-150
Author(s):  
Julia Burgdorf ◽  
Elizabeth Stuart ◽  
Jennifer Wolff
Keyword(s):  
Older Adults ◽  
Health Care ◽  
Home Health Care ◽  
Family Caregiver ◽  
Medication Management ◽  
Self Care ◽  
Home Health ◽  
Caregiver Training ◽  
Health Providers ◽  
Training Interventions

Abstract Medicare home health providers are required to offer family caregiver training; however, there is little information regarding the impact of family caregiver training on home health care intensity. A better understanding of this relationship is necessary to inform development and prioritization of caregiver training interventions in this setting. This research assesses whether and how family caregiver need for training affects care intensity during Medicare home health. We examine 1,217 (weighted n=5,870,905) fee-for-service Medicare beneficiaries who participated in the National Health and Aging Trends Study (NHATS) between 2011-2015 and received Medicare-funded home health care within one year of survey. Using propensity score adjusted, multivariable logistic and negative binomial regression, we model the relationship between family caregiver need for activity-specific training and the number/type of visits received during Medicare home health. We found that older adults whose family caregiver required training on self-care tasks had greater odds of receiving any therapy visits (aOR: 1.70; 95% CI: 1.01, 2.86), aide visits (aOR: 2.12; 95% CI: 1.11, 4.05), or training visits (aOR: 1.49; 95% CI:1.01, 2.21). Older adults whose family caregiver required training on medication management had greater odds of receiving any nursing visits (aOR: 3.03; 95% CI: 1.06, 8.68) and incurred 1.06 (95% CI: 0.11, 2.01) additional nursing visits. Findings support the importance of connecting family caregivers to training resources. Additionally, findings suggest that home health providers should consider prioritizing training interventions which focus on caregiving activities most closely tied to resource utilization: self-care and medication management.

scholarly journals Influences of Prejudice and Stereotyping in the Direct Care Workforce

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. 980-980
Author(s):  
Jennifer May
Keyword(s):  
Older Adults ◽  
Residential Care ◽  
Home Health ◽  
Direct Care ◽  
Future Research ◽  
Residential Care Facilities ◽  
Home Health Services ◽  
Care Facilities ◽  
Direct Care Workforce ◽  
And Gender

Abstract Direct Care Workers (DCW; nursing assistants, personal care aides, home health aides) have the most one on one care with sexual and gender minority (SGM) older adults who reside in residential care facilities or use home health services. DCWs make up a vast majority of the healthcare workforce, holding almost five million jobs in 2019, with approximately 70% of the positions held being in residential care facilities. In a qualitative design study, 11 DCWs were interviewed using an open-ended, semi-structured format to describe their perceptions of care provided to SGM older adults in residential care facilities and the home health setting. These results were part of a larger qualitative study which found there were cues of stereotyping and prejudice in DCW narratives toward SGM older adults. The category DCWs’ care and social system referred to characteristics of the DCWs’ work environment and the perspectives, attitudes, and reported care toward SGM older adults and diverse populations. It was determined that there are synergies among SGM older adults’ care and DCW along with DCW workforce issues (short staffed, low wages, lack of health benefits) that may prevent the DCW from being accepting of implicit bias training or culture change within these facilities/agencies. Implications for practice, policy, and future research are discussed.

scholarly journals Drivers of Home Healthcare Industry: Contrasting Views of Users and Providers in a Developing Country

2021 ◽  
pp. 72-80
Author(s):  
Ankit Singh ◽  
Ajeya Jha ◽  
Shankar Purbey
Keyword(s):  
Institutional Care ◽  
Cost Effective ◽  
Home Health ◽  
Home Healthcare ◽  
Health Providers ◽  
Survey Analysis ◽  
Service Usage ◽  
Home Health Agencies ◽  
The Right ◽  
The Cost

Home healthcare fills an important void in a country's healthcare system; factors promoting home healthcare growth vary. In this study, the perceptions of the users and providers are analyzed to identify the important factors. Survey analysis was done for ten identified factors on 378 nurses and 394 patients. Responses were analyzed with Garret Ranking Method. The systematic random sampling method was used after acquiring the list of nurses working in home health organizations. The preference should be given to the user's perception as the customer is the king; it is encouraging for Indian home health providers that users are feeling they are deriving benefits from home health service usage; however, this feeling can be further enhanced by focusing on the right factors such as doctors recommendation, the rise of chronic diseases and the cost advantage associated with home health over Institutional care. Results revealed a disparity between the perceptions of the providers and users. This study suggests that home health agencies highlight features, such as cost-effective care, medical professionals' recommendation, and utility in providing relief to chronic disease patients.

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