Older Adult Factors Associated With Identified Need for Family Caregiver Assistance During Home Health Care

2019 ◽  
Vol 32 (2) ◽  
pp. 67-75 ◽  
Author(s):  
Julia Burgdorf ◽  
Alicia Arbaje ◽  
Jennifer L. Wolff
Keyword(s):  
Older Adults ◽  
Health Care ◽  
Activities Of Daily Living ◽  
Family Caregivers ◽  
Older Adult ◽  
Home Health Care ◽  
Family Caregiver ◽  
Daily Living ◽  
Home Health ◽  
Clinical Severity

Family caregivers make important contributions to home health care for older adults, but knowledge of the specific roles they assume is lacking. We analyzed data from 1,758 community-dwelling Medicare beneficiaries aged 65+ receiving Medicare-funded home health care between 2011 and 2016, using linked National Health and Aging Trends Study and Outcomes and Assessment Information Set data. Most (86.7%) beneficiaries receiving home health care had an identified need for family caregiver assistance, and nearly 6 in 10 (57.9%) had identified need for caregiver assistance with five or more tasks. After examining significant associations between older adult characteristics and identified needs for caregiver assistance with specific tasks, we identified three profiles of older adults who demonstrate similar patterns of identified need for family caregiver assistance during home health. These profiles include: (1) older adults with greater functional impairment who more often had identified need for assistance with Instrumental Activities of Daily Living, advocacy, or Activities of Daily Living; (2) older adults with cognitive impairment who more often had identified need for assistance with medication administration or supervision; and (3) older adults with greater clinical severity who more often had identified need for assistance with medical procedures and equipment. Findings support calls to develop training interventions and strengthen the partnership between home health providers and family caregivers. These three profiles present a potential framework for the development of family caregiver training programs.

scholarly journals Caregivers’ Experiences Regarding Training and Support in the Post-Acute Home Health-Care Setting

2019 ◽  
Vol 7 (4) ◽  
pp. 561-569
Author(s):  
Jo-Ana D Chase ◽  
David Russell ◽  
Meridith Rice ◽  
Carmen Abbott ◽  
Kathryn H Bowles ◽  
...  
Keyword(s):  
Older Adults ◽  
Health Care ◽  
Family Caregivers ◽  
Learning Strategies ◽  
Home Health Care ◽  
Home Health ◽  
Barriers To Learning ◽  
Telephone Interviews ◽  
Qualitative Descriptive ◽  
Training And Support

Background: Post-acute home health-care (HHC) services provide a unique opportunity to train and support family caregivers of older adults returning home after a hospitalization. To enhance family-focused training and support strategies, we must first understand caregivers’ experiences. Objective: To explore caregivers’ experiences regarding training and support for managing older adults’ physical functioning (PF) needs in the post-acute HHC setting. Method: We conducted a qualitative descriptive study using semi-structured telephone interviews of 20 family caregivers. Interviews were recorded, transcribed, and analyzed using conventional content analysis. Results: We identified the following primary categories: facilitators to learning (eg, past experience, learning methods), barriers to learning (eg, learning on their own, communication, timing/logistics, preferred information and timing of information delivery), and interactions with HHC providers (eg, positive/negative interactions, provider training and knowledge). Conclusion: Caregivers were responsive to learning strategies to manage older adults’ PF needs and, importantly, voiced ideas to improve family-focused training and support. HHC providers can use these findings to tailor training and support of family caregivers in the post-acute HHC setting.

scholarly journals Impact of Family Caregiver Training on Hospitalization During Medicare Home Health Care

2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 252-253
Author(s):  
Julia Burgdorf ◽  
Jennifer Wolff
Keyword(s):  
Health Care ◽  
Family Caregivers ◽  
Acute Care ◽  
Home Health Care ◽  
Family Caregiver ◽  
Unmet Need ◽  
Home Health ◽  
Care Utilization ◽  
Caregiver Training ◽  
Acute Care Utilization

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 patient outcomes in home health or other care delivery settings. A better understanding of this relationship is necessary to guide development of caregiver training interventions and inform policy discussions surrounding family caregiver training access. This research assesses whether and how unmet need for family caregiver training is associated with acute care utilization 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) and received Medicare-funded home health care between 2011-2016. We link NHATS data with home health patient assessments and Medicare claims, drawing measures of family caregivers’ need for training from home health clinician reports and determining provision of training from Medicare claims. Using weighted, multivariable logistic regressions, we model the marginal change in probability of acute care utilization during home health as a function of family caregivers’ unmet need for training. We found that older adults whose family caregivers had an unmet need for training had a probability of acute care utilization during home health that was 18 percentage points (p=0.001) greater than those whose family caregivers both needed and received training, holding all covariates at their means. Findings support the importance of connecting family caregivers to training resources and suggest one avenue by which investing in caregiver training may be cost-effective for integrated payers and providers.

scholarly journals Family Caregiver Training During Medicare Home Health Care: Clinician Perspectives

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. 535-535
Author(s):  
Julia Burgdorf ◽  
Alicia Arbaje
Keyword(s):  
Health Care ◽  
Family Caregivers ◽  
Health Care Providers ◽  
Home Health Care ◽  
Family Caregiver ◽  
Home Health ◽  
Assessment Tools ◽  
Caregiver Training ◽  
Cyclic Process ◽  
Care Providers

Abstract During Medicare home health care, providers often rely on family caregivers to help meet patients’ care needs. Beginning in 2018, CMS requires home health agencies to provide training to family caregivers. This qualitative study is the first research to examine current patterns of family caregiver training, and related facilitators and barriers, during Medicare-funded home health care. We conducted semi-structured key informant interviews with home health nurses and physical therapists (n=19) from 4 diverse agencies, then performed thematic analysis of interview transcripts using a hybrid inductive and deductive coding approach. Clinicians described family caregiver education as a dynamic and cyclical process: simultaneously providing patient care, training family caregivers, and gathering additional information about patient needs and caregiver capabilities, then adjusting the care plan accordingly. We present a model of this cyclic process and describe its four major stages: Initial Assessment, Education, Reassessment, and Adjustment. Additionally, clinicians identified a range of structural, individual, and interpersonal factors which impact their ability to successfully train family caregivers. We define each factor and, using illustrative quotes from our interviews, elucidate its role as a facilitator and/or barrier to clinicians’ educational efforts. Findings provide the first model of caregiver training during home health care and highlight policy and practice changes to better support clinicians in these efforts; including greater visit flexibility, access to more experienced clinical mentors, and standardized caregiver assessment tools designed for this unique care setting.

scholarly journals INTEREST GROUP SESSION—FAMILY CAREGIVING: SUPPORTING FAMILY CAREGIVERS WITHIN SYSTEMS OF CARE DELIVERY

2019 ◽  
Vol 3 (Supplement_1) ◽  
pp. S206-S206
Author(s):  
Jennifer L Wolff ◽  
Lynn F Feinberg
Keyword(s):  
Older Adults ◽  
Primary Care ◽  
Health Care ◽  
Family Caregivers ◽  
Family Caregiver ◽  
Systems Of Care ◽  
Population Aging ◽  
Care Delivery ◽  
Well Being ◽  
Home Health

Abstract Family and other unpaid caregivers have a foundational role in supporting the health and well-being of older adults with complex health needs and disabilities and the demands imposed on them can be significant. The availability and adequacy of support provided by family and other unpaid caregivers has profound consequences for quality and outcomes of care delivery, but they are not well-supported in treatment decisions and care planning. Given population aging, the shift of long-term services and supports from nursing homes toward community settings, and technological advances that allow patients to be served in the community with higher acuity of care, there is a pressing need to develop systems-level processes to identify, engage, and support family caregivers in systems of care. This symposium will feature 5 presentations that provide novel insight regarding family caregivers’ experience within systems of care. We focus on family caregivers to older adults living in the community and receiving home and community-based services, primary care, or Medicare skilled home health services. Individual presentations will describe 1) differences in access to services and experiences of family caregivers by under-represented minority status; 2) a framework for health systems to include family caregivers as part of health care teams; 3) family caregivers’ capacity to help during the course of Medicare-funded skilled home health care; 4) perceived communication with health professionals, using a validated measure of family caregiver capacity; and 5) the feasibility of implementing a family caregiver screening instrument in primary care.

The association among knowledge of and confidence in home health care services, acculturation, and family caregivers' relationships to older adults of Mexican descent

2018 ◽  
Vol 39 (6) ◽  
pp. 689-695
Author(s):  
Janice D. Crist ◽  
Mary Lee Montgomery ◽  
Alice Pasvogel ◽  
Linda R. Phillips ◽  
Evangeline M. Ortiz-Dowling
Keyword(s):  
Older Adults ◽  
Health Care ◽  
Family Caregivers ◽  
Home Health Care ◽  
Health Care Services ◽  
Home Health ◽  
Mexican Descent ◽  
Care Services

scholarly journals COVID-19 as the sole cause of death is uncommon in frail home healthcare individuals: a population-based study

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Lena Nilsson ◽  
Christer Andersson ◽  
Rune Sjödahl
Keyword(s):  
Health Care ◽  
Activities Of Daily Living ◽  
Cause Of Death ◽  
Home Health Care ◽  
Daily Living ◽  
Population Based ◽  
Home Health ◽  
Home Healthcare ◽  
Population Based Study ◽  
Pandemic Wave

Abstract Background During the first pandemic wave, Sweden experienced a high mortality rate. Home healthcare reflects a group of people especially vulnerable to coronavirus disease 2019 (COVID-19). We aimed to evaluate the pattern of comorbidity and frailty in a group of individuals having fatal outcomes in home healthcare during the COVID-19 pandemic March to September 2020, and to assess the contribution of COVID-19 in the fatal outcomes. Methods A cohort of adults with confirmed COVID-19 diagnosis that deceased in home healthcare between March and September 2020 were analysed in a retrospective study comprising home healthcare in 136 facilities in one Swedish county. Main outcome measures were comorbidity and frailty. Results One hundred fifty-five individuals (88 women, 67 men) aged 57–106 (median 88) years were included in the analysis. Nine had considerable frailty (ability to perform various activities of daily living but confined to bed or chair on occasion) and the remaining 146 had severe frailty (unable to perform activities of daily living and/or confined to bed or chair; dementia necessitating care). Three or more diagnoses besides COVID-19 were present in 142 individuals and another eight had two diagnoses in addition to COVID-19. In 20 (13%) individuals, COVID-19 was assessed as the principal cause of death, in 100 (64.5%) a contributing cause, and for the remaining 35 (22.5%) death was probably caused by another comorbidity. This seemed to change over the course of the COVID − 19 pandemic, with its contributing role decreasing from the middle of the summer. Conclusions Death in home healthcare during the first wave of the pandemic mostly affected individuals with severe frailty and comorbidity at very advanced ages. One fifth of the individuals who died in home health care had another cause than Covid-19. Trial registration Clinical Trials.gov NCT04642196 date 24/11/2020.

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.

“Doing the Right Thing”: Family Caregivers Managing Medical and Nursing Tasks in the Postacute Home Health Care Setting

2020 ◽  
pp. 073346482096125
Author(s):  
Jo-Ana D. Chase ◽  
David Russell ◽  
Daniel B. Kaplan ◽  
Michael V. Bueno ◽  
Rungnapha Khiewchaum ◽  
...  
Keyword(s):  
Older Adults ◽  
Health Care ◽  
Family Caregivers ◽  
Health Care System ◽  
Home Health Care ◽  
Home Health ◽  
Future Research ◽  
Emotional Impact ◽  
Care Needs ◽  
Care System

Family caregivers often manage complex medical and nursing tasks (MNTs) for older adults transitioning from hospital to home. To explore caregivers’ experiences managing MNTs in the postacute home health care (HHC) setting, we interviewed by phone 20 caregivers of older adults who received HHC following a hospitalization. Interviews were recorded, transcribed, and analyzed using directed content analysis. Caregivers highlighted the technical complexity and emotional impact of performing MNTs, as well as social (e.g., family, friends) and environmental (e.g., neighborhood, housing) resources they leveraged to meet the older adults’ care needs. Caregivers also identified challenges coordinating care and services within HHC and the larger health care system. Caregiver engagement in the postacute HHC setting should incorporate tailored training and support, assessments of socioenvironmental context and resources, and facilitated navigation of the health care system. Future research should elucidate factors associated with successful collaborative relationships among HHC providers, older adults, and their caregivers in the postacute HHC setting.

scholarly journals Home Health Care Nursing Visit Intensity and Heart Failure Patient Outcomes

2011 ◽  
Vol 23 (6) ◽  
pp. 412-420 ◽  
Author(s):  
Jennifer S. Riggs ◽  
Elizabeth A. Madigan ◽  
Richard H. Fortinsky
Keyword(s):  
Heart Failure ◽  
Health Care ◽  
Activities Of Daily Living ◽  
Home Health Care ◽  
Daily Living ◽  
Secondary Analysis ◽  
Patient Characteristics ◽  
Home Health ◽  
Nursing Visit ◽  
The Impact

This study is a secondary analysis of data for 107 home health care heart failure patients. The authors investigate the impact of patient characteristics and nursing visit intensity on change in activities of daily living (ADL) status and instrumental activities of daily living (IADL) status and improvement/stabilization of dyspnea. Prior hospital stay (ß = .38, p = .001) and nursing visit intensity (ß = –.39, p = .001) predict improvement in ADL status. The model for change in IADL status is not significant. Patients with more than two comorbidities (OR = 6.5, p = .04) and patients who received higher nursing visit intensity (OR = 7.0, p = .04) are more likely to have improved/stabilized dyspnea at home care discharge.

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