Cultural Competence in Home Healthcare Nursing: Disparity, Cost, Regulatory, Accreditation, Ethical, and Practice Issues

2019 ◽  
Vol 32 (2) ◽  
pp. 76-80
Author(s):  
Mary Curry Narayan
Keyword(s):  
Cultural Competence ◽  
Home Health Care ◽  
Ethical Issues ◽  
Quality Care ◽  
Home Health ◽  
Home Healthcare ◽  
Culturally Competent ◽  
Vulnerable Patient ◽  
Home Health Agencies ◽  
The Many

Home healthcare patients, who are members of minority, marginalized, or vulnerable patient populations, are at risk for healthcare disparities. Inadequate attention to the needs of the many different types of diverse patient populations seen by home health agencies could compromise an agency’s outcome indicators, reimbursement in value-based payment programs and responsibility to deliver equitable quality care. Culturally competent home health nurses may have a role in decreasing disparities and improving patient outcomes. This article discusses the incidence of disparities in home health care and highlights literature about the economic, regulatory, accrediting, policy, social justice, and ethical issues surrounding disparate and inequitable care for home healthcare patients. Patients in need of culturally competent care include those characterized by diversity related to race, ethnicity, language, religion, socioeconomic status, sexual orientation, gender identification, mental and physical disabilities, and stigmatized diagnoses (e.g., obesity and substance abuse). Home healthcare nurses who strengthen the cultural competence of their care may be able to decrease the incidence of disparate outcomes. By investing in the cultural competence of their home healthcare nurses, agencies may strengthen their commitment to their missions and the financial health of their agencies.

Disaster Preparedness for Vulnerable Persons Receiving In-Home, Long-Term Care in South Carolina

2008 ◽  
Vol 23 (2) ◽  
pp. 133-142 ◽  
Author(s):  
Sarah B. Laditka ◽  
James N. Laditka ◽  
Carol B. Cornman ◽  
Courtney B. Davis ◽  
Maggi J. Chandlee
Keyword(s):  
Health Care ◽  
South Carolina ◽  
Home Health Care ◽  
Disaster Planning ◽  
Home Health ◽  
Personal Care ◽  
Term Care ◽  
Care Services ◽  
Health Agencies ◽  
Home Health Agencies

AbstractPurpose:The purpose of this study was to examine how agencies in South Carolina that provide in-home health care and personal care services help older and/or disabled clients to prepare for disasters.The study also examines how agencies safeguard clients' records, train staff, and how they could improve their preparedness.Methods:The relevant research and practice literature was reviewed. Nine public officials responsible for preparedness for in-home health care and personal care services in South Carolina were interviewed. A telephone survey instrument was developed that was based on these interviews and the literature review. Administrators from 16 agencies that provide in-home personal care to 2,147 clients, and five agencies that provide in-home health care to 2,180 clients, were interviewed. Grounded theory analysis identified major themes in the resulting qualitative data; thematic analysis organized the content.Results:Federal regulations require preparedness for agencies providing inhome health care (“home health”). No analogous regulations were found for in-home personal care. The degree of preparedness varied substantially among personal care agencies. Most personal care agencies were categorized as “less” prepared or “moderately” prepared. The findings for agencies in both categories generally suggest lack of preparedness in: (1) identifying clients at high risk and assisting them in planning; (2) providing written materials and/or recommendations; (3) protecting records; (4) educating staff and clients; and (5) coordinating disaster planning and response across agencies. Home health agencies were better prepared than were personal care agencies.However, some home health administrators commented that they were unsure how well their plans would work during a disaster, given a lack of training. The majority of home health agency administrators spoke of a need for better coordination and/or more preparedness training.Conclusions:Agencies providing personal care and home health services would benefit from developing stronger linkages with their local preparedness systems. The findings support incorporating disaster planning in the certification requirements for home health agencies, and developing additional educational resources for administrators and staff of personal care agencies and their clients.

Ethical Aspects of Pediatric Home Care

PEDIATRICS ◽  
1992 ◽  
Vol 89 (5) ◽  
pp. 920-924
Author(s):  
John D. Lantos ◽  
Arthur F. Kohrman
Keyword(s):  
Health Care ◽  
Home Care ◽  
Home Health Care ◽  
Ethical Issues ◽  
Home Health ◽  
Critically Ill Children ◽  
Traditional Health ◽  
Advanced Medical Technology ◽  
Economic Forces ◽  
Traditional Health Care

This essay is a discussion of ethical issues that arise in the provision of home health care to technology-dependent children. Different ethical norms, especially with regard to the degree of professional responsibility for outcomes, traditionally have applied to home care and hospital care. In particular, parents generally are expected to do their best, but are not expected to have the same specialized knowledge of risks and benefits with regard to particular interventions as health professionals. When home health care involves the use of advanced medical technology, it strains traditional conceptions of parental responsibilities to care for the health of their children at home. It can also strain traditional concepts of professional responsibilities to care for critically ill children in hospitals. We discuss some of the tensions that arise as medical, psychological, and economic forces lead to the increasing use of high technology in the care of children outside of traditional health care institutions.

scholarly journals PATTERNS OF PERFORMANCE ON QUALITY OF CARE AMONG U.S. HOME HEALTH AGENCIES, 2015-2017

2019 ◽  
Vol 3 (Supplement_1) ◽  
pp. S494-S494
Author(s):  
Chenjuan Ma
Keyword(s):  
Quality Of Care ◽  
Home Health ◽  
Community Dwelling ◽  
Home Healthcare ◽  
Healthcare Sector ◽  
Star Rating ◽  
Health Agencies ◽  
The Us ◽  
Home Health Agencies

Abstract Home healthcare is a critical care source for community-dwelling older adults. As the fastest growing healthcare sector in the US, quality of home healthcare is under increasing scrutiny. The purpose of this study is to examine patterns of performance on quality of care among US home health agencies. This is a 3-year cohort study using 2015-2017 Home Health Compare data and Provider of Services (POS) Files. In the dataset, each HHA was assigned a star rating (1-5) to reflect the overall quality of care. This indicator was calculated based on two process measures (timely initiation of care and drug education) and six outcome measures (e.g., hospitalization). We examined 8,020 HHAs in the US. Over the 3-year period, the number of HHAs receiving a star rating of 4 or 5 increased from 27% in 2015, 31% in 2016, to 32% in 2017. Roughly, 32% of the HHAs received a lower star rating and another 32% received a higher star rating from 2015 to 2016. Similarly, 30% of the HHAs received a lower star rating and 29% of the HHAs received a higher star rating from 2016 to 2017. Hospital-based HHAs were less likely to receive a star rating of 4 or 5. Larger HHAs (OR 1.34; 95% CI, 1.13-1.59) and HHAs with ownership changes (OR, 1.38; 95% CI 1.20-1.59) were more likely to improve their star ratings overtime. Our finding indicates dynamic changes in the quality of care within the US home healthcare sector.

scholarly journals 2444. Infection Prevention in Home Healthcare: Results from a National Study of Home Health Agencies

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S845-S845
Author(s):  
Monika Pogorzelska-Maziarz ◽  
Jingjing Shang ◽  
Ashley Chastain ◽  
Patricia Stone
Keyword(s):  
Infection Prevention ◽  
Qualitative Interviews ◽  
Nationwide Survey ◽  
The United States ◽  
Home Health ◽  
Home Healthcare ◽  
Infection Prevention And Control ◽  
National Study ◽  
Health Agencies ◽  
Home Health Agencies

Abstract Background As the population of older Americans with chronic conditions continues to grow, the role of home healthcare (HHC) services in improving care transitions between acute care and independent living has become a national priority. This has led to the development of value-based purchasing (VBP) initiatives, changes in the Centers for Medicare and Medicaid Services’ Home Health Conditions of Participation, and the Joint Commission’s national patient safety goals for HHC. We aimed to describe the infection prevention and control (IPC) infrastructure in US home health agencies (HHA). Methods From March to November 2018, we conducted in-depth, phone interviews with 41 staff from 13 HHAs across the United States, including administrators, IPC and quality improvement (QI) personnel, registered nurses and home health aides. In October 2018, we launched a nationwide survey to a random sample of 1,500 HHAs stratified by census region, ownership status and urban/rural location, and achieved a 40% response rate. Transcripts of the qualitative interviews were coded and themes were identified using content analysis. Survey data were analyzed using descriptive statistics. Results Themes from the interviews included: 1) Uniqueness of HHC setting, 2) Importance of staff and patient/caregiver education, (3) Care coordination challenges, and, (4) Keys to success and innovation. From the surveys, we found that, at the majority of HHAs, the staff member in charge of IPC had other responsibilities including QI (57%), clinical/administrative/managerial (49%), supervision of clinical services/patient coordination (48%), and education/training (45%). For those staff members in charge of IPC, over a third had received no specific IPC training, and only 5% were certified in IPC. For those staff who received training, the training was provided by external consultants (26%) or a professional society/health department (28%). Respondents cited the most challenging aspect of IPC as collecting/reporting infection data (24%), adherence to/monitoring bag technique (15%) and adequate staff coverage (13%). Conclusion This work represents a current snapshot of IPC infrastructure and challenges in US HHC agencies and identifies important barriers to IPC in these settings. Disclosures All authors: No reported disclosures.

Untapped Potential of Home Health Care Innovations to Improve Outcomes With Bundled Payment Initiatives

2016 ◽  
Vol 29 (1) ◽  
pp. 53-55
Author(s):  
Teresa Lee ◽  
Jennifer Schiller
Keyword(s):  
Health Care ◽  
Home Health Care ◽  
Home Health ◽  
Bundled Payment ◽  
Home Based ◽  
Medicare Program ◽  
Health Agencies ◽  
Home Health Agencies ◽  
Home Based Care ◽  
Payment Models

A rapidly changing health care payment system creates opportunities for optimizing home health and home-based care for patients needing cardiac rehabilitation (CR). Home health agencies are poised to play a significant role in episode payment models in the context of post–acute care for patients with cardiovascular conditions. As the Medicare program expands its episode payment models to include patients with cardiovascular conditions, hospitals and other health care stakeholders that will be engaged in these bundled payment arrangements should consider use of home health care in the delivery of CR as a bridge to outpatient therapy and patient self-management.

scholarly journals Patient-Rated Performance of Home Health Agencies and Hospitalization Risk: A Propensity-Score Matched Analysis

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. 536-536
Author(s):  
Chenjuan Ma ◽  
Lisa Groom ◽  
Shih-Yin Lin ◽  
Daniel David ◽  
Abraham Brody
Keyword(s):  
Health Care ◽  
Propensity Score ◽  
Propensity Score Matching ◽  
Patient Experience ◽  
Home Health Care ◽  
Healthcare Providers ◽  
Home Health ◽  
High Performing ◽  
Health Agencies ◽  
Home Health Agencies

Abstract Home health care is the most commonly used home- and community-based service to older adults “Aging in Place”. Patient experience of healthcare services is a critical aspect of patient-centered care. Indeed, policymakers have linked patient-rated quality of care to payment to healthcare providers. This study aimed to examine the association between patient-rated care performance of home health agencies and risk for hospitalization among Medicare beneficiaries. This study used several national datasets from 2016 and included 491,718 individuals from 8,459 home health agencies. Home health agencies’ performance was measured using patient experience star rating from the Home Health Consumer Assessment of Healthcare Providers and Systems (HHCAHPS). Propensity score matching was used to balance the differences in patient characteristics at baseline between those receiving care from high-performing home health agencies and those in lower-performing agencies. On average, patients were 80.5 years old, 65% female, 81% White, 10% Black, and 6% Hispanic, with 90% taking 5 or more medications. Patients had a mean score of 1.73 (SD=1.69) on the Charlson Index. Respectively, 10% and 16% of patients were hospitalized within 30 and 60 days of home health care initiation. Estimates of logistic regression after propensity score matching found that patients receiving care from lower-performing agencies were at similar risk for both 30-day (OR=0.99, p=0.817) and 60-day (OR=1.02, p=0.616) hospitalization following the start of home health care, compared to those in high-performing agencies. Our findings suggest discrepancies (or no relationship) between patient experience and objective outcomes of home health care.

An Application for Routing Ambulance via ACO in Home Healthcare

2020 ◽  
pp. 102-110
Author(s):  
Şahin Inanç ◽  
Arzu Eren Şenaras
Keyword(s):  
Health Care ◽  
Ant Colony Optimization ◽  
Home Health Care ◽  
Home Health ◽  
Ant Colony ◽  
Home Healthcare ◽  
Heuristic Methods

In this study, rovers of ambulances were identified and determined quickly and practically via ant colony optimization. Non-intuitive methods can also be used to determine the routing, but when the number of nodes is large, and the number of operations is very large, the heuristic methods are more practical. The purpose of this work is to use ant colony optimization via C# for ambulance routing. The patients were served as soon as possible thanks to ambulance routing. In this the effectiveness of the ambulance has been increased. In this study, 12 nodes were selected as an application. The nodes were used to determine the route of the ambulance in-home health care.

scholarly journals Quantifying Supply of Home Health Services for Public Health Emergencies

2016 ◽  
Vol 29 (1) ◽  
pp. 20-34 ◽  
Author(s):  
Ashlea Bennett Milburn ◽  
Charleen McNeill
Keyword(s):  
Public Health ◽  
Home Health Care ◽  
Health Sector ◽  
Home Health ◽  
Public Health Emergency ◽  
Operating Conditions ◽  
Emergency Rooms ◽  
Surge Capacity ◽  
Health Agencies ◽  
Home Health Agencies

The number of persons seeking medical treatment during a public health emergency could quickly overwhelm the capacity of hospitals and emergency rooms. The amount of surge capacity home health care could provide during a public health emergency is unknown. The purpose of this research is to quantify the surge capacity of the home health sector in four emergency scenarios. According to the model developed, routine demand will exceed scenario capacity for almost all home health agencies in all pessimistic cases for the four scenarios discussed. However, home health agencies have the surge capacity to contribute to the provision of care for patients during times of demand under routine operating conditions as well as in conditions where demand may be moderately increased.

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