scholarly journals Feasibility of Telehealth-Delivered Home Safety Evaluations for Caregivers of Clients With Dementia

2019 ◽  
Vol 40 (1) ◽  
pp. 42-49 ◽  
Author(s):  
Megan E. Gately ◽  
Scott A. Trudeau ◽  
Lauren R. Moo
Keyword(s):  
Safety Evaluation ◽  
Functional Independence ◽  
Veterans Health ◽  
Health Administration ◽  
Home Safety ◽  
Cognitive Changes ◽  
Age In Place ◽  
Home Based ◽  
Resource Requirements ◽  
Videoconferencing Technology

Video telehealth can increase access to home-based care, thus allowing older adults to maintain functional independence and age-in-place. This is particularly salient for persons with dementia whose cognitive changes increase home safety risk. Little is known about the technological and safety challenges of in-home assessment via video. This feasibility study explored the process and resource requirements of a remotely delivered telehealth occupational therapy home safety evaluation from a Veterans Health Administration (VHA) site. A total of 10 caregivers of veterans with dementia received home safety evaluations using videoconferencing technology using a variety of portable computing devices. Most telehealth evaluations experienced technological difficulties, but formal technical support was only required twice. Videoconferencing is a feasible service delivery option for home safety evaluations; however, infrastructure must support technological needs and client or provider gaps in knowledge. Implications for non-VHA settings and other interventions using videoconferencing are discussed.

scholarly journals IMPLEMENTING HOME SAFETY TOOLKIT TO CAREGIVERS OF VETERANS WITH DEMENTIA

2019 ◽  
Vol 3 (Supplement_1) ◽  
pp. S243-S243
Author(s):  
Scott A Trudeau
Keyword(s):  
Formative Evaluation ◽  
Veterans Health ◽  
Health Administration ◽  
Home Safety ◽  
Structured Interviews ◽  
Potential Benefits ◽  
Facilitators And Barriers ◽  
Key Staff ◽  
Type 3 ◽  
Selection Of

Abstract The purpose of this project was to study the processes necessary to make a Home Safety Toolkit (HST) for Veterans with dementia accessible to veterans and their caregivers. This Type 3 Implementation–Effectiveness Hybrid Research Design, included diagnostic analyses of the current processes by which Veterans receive home safety items, and identification of modifications necessary in order to provide the HST to Veterans with dementia. Two Veterans Health Administration Networks, one in the Northeast and one in the Mid-Atlantic region, participated. A formative evaluation used semi-structured interviews with key staff informants and caregivers identified facilitators and barriers to successful acquisition and use of home safety items. Qualitative data analysis reveals key barriers of time and cost, selection of best items, and caregiver reluctance to change. There was resounding support from caregivers regarding the potential benefits of self-paced toolkit including education and home safety items to implement for their veteran.

scholarly journals Creating and disseminating a home-based cardiac rehabilitation program: experience from the Veterans Health Administration

2019 ◽  
Vol 19 (1) ◽  
Author(s):  
Bonnie J. Wakefield ◽  
Kariann Drwal ◽  
Monica Paez ◽  
Sara Grover ◽  
Carrie Franciscus ◽  
...  
Keyword(s):  
Cardiac Rehabilitation ◽  
Qualitative Data ◽  
Document Analysis ◽  
Veterans Health Administration ◽  
Rehabilitation Program ◽  
Veterans Health ◽  
High Uptake ◽  
Health Administration ◽  
Home Based ◽  
Uptake Sites

Abstract Background Cardiac rehabilitation (CR) programs provide significant benefit for people with cardiovascular disease. Despite these benefits, such services are not universally available. We designed and evaluated a national home-based CR (HBCR) program in the Veterans Health Administration (VHA). The primary aim of the study was to examine barriers and facilitators associated with site-level implementation of HBCR. Methods This study used a convergent parallel mixed-methods design with qualitative data to analyze the process of implementation, quantitative data to determine low and high uptake of the HBCR program, and the integration of the two to determine which facilitators and barriers were associated with adoption. Data were drawn from 16 VHA facilities, and included semi-structured interviews with multiple stakeholders, document analysis, and quantitative analysis of CR program attendance codes. Qualitative data were analyzed using the Consolidated Framework for Implementation Research codes including three years of document analysis and 22 interviews. Results Comparing high and low uptake programs, readiness for implementation (leadership engagement, available resources, and access to knowledge and information), planning, and engaging champions and opinion leaders were key to success. High uptake sites were more likely to seek information from the external facilitator, compared to low uptake sites. There were few adaptations to the design of the program at individual sites. Conclusion Consistent and supportive leadership, both clinical and administrative, are critical elements to getting HBCR programs up and running and sustaining programs over time. All sites in this study had external funding to develop their program, but high adopters both made better use of those resources and were able to leverage existing resources in the setting. These data will inform broader policy regarding use of HBCR services.

Assessing Readiness to Change of a High Fall Risk Patient: A Case Report

2012 ◽  
Vol 13 (1) ◽  
pp. 2-7
Author(s):  
Alexandra Lee ◽  
Julia Neily ◽  
Peter Mills ◽  
Cheryl Coutermarsh ◽  
Melissa Gates-Cantrell
Keyword(s):  
Case Report ◽  
Transtheoretical Model ◽  
Fall Risk ◽  
Readiness To Change ◽  
Risk Patient ◽  
Veterans Health ◽  
Health Administration ◽  
Home Based ◽  
Informal Interview ◽  
History Of

The case report discusses a patient with an extensive history of falls living in the community. The patient’s medical record was analyzed, and an informal interview was conducted with the patient to provide an overview of his care provided by the Veterans Health Administration (VHA) Home-Based Primary Care (HBPC) program from June 2008 to February 2011. The report will also apply the transtheoretical model of behavioral change to discuss the behavior change process of a high fall risk patient. Applying this model to the high fall risk population may assist with decreasing the frustration of clinicians and caregivers, as it acknowledges the “smaller gains” with fall prevention.

scholarly journals Association of Veterans Health Administration Home-Based Programs With Access to and Participation in Cardiac Rehabilitation

2018 ◽  
Vol 178 (5) ◽  
pp. 715 ◽  
Author(s):  
David W. Schopfer ◽  
Nirupama Krishnamurthi ◽  
Hui Shen ◽  
Claire S. Duvernoy ◽  
Daniel E. Forman ◽  
...  
Keyword(s):  
Cardiac Rehabilitation ◽  
Veterans Health Administration ◽  
Veterans Health ◽  
Health Administration ◽  
Home Based

Disaster Preparedness in Home-based Primary Care: Policy and Training

2015 ◽  
Vol 30 (4) ◽  
pp. 337-343 ◽  
Author(s):  
Maria L. Claver ◽  
Tamar Wyte-Lake ◽  
Aram Dobalian
Keyword(s):  
Primary Care ◽  
Disaster Preparedness ◽  
Community Dwelling ◽  
Veterans Health ◽  
Health Administration ◽  
Care Policy ◽  
Home Based Primary Care ◽  
Home Based ◽  
Increased Risk ◽  
And Training

AbstractIntroductionVeterans served by Veterans Health Administration (VHA) home-based primary care (HBPC) are an especially vulnerable population due to high rates of physical, functional, and psychological limitations. Home-bound patients tend to be an older population dealing with normal changes that accompany old age, but may not adequately be prepared for the increased risk that often occurs during disasters. Home health programs are in an advantageous position to address patient preparedness as they may be one of the few outside resources that reach community-dwelling adults.ProblemThis study further explores issues previously identified from an exploratory study of a single VHA HBPC program regarding disaster preparedness for HBPC patients, including ways in which policy and procedures support the routine assessment of disaster preparedness for patients, including patient education activities.MethodsThis project involved semi-structured interviews with 31 practitioners and leadership at five VHA HBPC programs; three urban and two rural. Transcripts of the interviews were analyzed using content analysis techniques.ResultsPractitioners reported a need for further training regarding how to assess properly patient disaster preparedness and patient willingness to prepare. Four themes emerged, validating themes identified in a prior exploratory project and identifying additional issues regarding patient disaster preparedness: (1) individual HBPC programs generally are tasked with developing their disaster preparedness policies; (2) practitioners receive limited training about HBPC program preparedness; (3) practitioners receive limited training about how to prepare their patients for a disaster; and (4) the role of HBPC programs is focused on fostering patient self-sufficiency rather than presenting practitioners as first responders. There was significant variability across the five sites in terms of which staff have responsibility for preparedness policies and training.ConclusionVariability across and within sites regarding how patient needs are addressed by preparedness policies, and in terms of preparedness training for HBPC providers, could place patients at heightened risk of morbidity or mortality following a disaster. Despite the diversity and uniqueness of HBPC programs and the communities they serve, there are basic aspects of preparedness that should be addressed by these programs. The incorporation of resources in assessment and preparedness activities, accompanied by increased communication among directors of HBPC programs across the country, may improve HBPC programs’ abilities to assist their patients and their caregivers in preparing for a disaster.ClaverML, Wyte-LakeT, DobalianA. Disaster preparedness in home-based primary care: policy and training. Prehosp Disaster Med. 2015;30(4):17.

Assessing Patients' Disaster Preparedness in Home-Based Primary Care

Gerontology ◽  
2016 ◽  
Vol 62 (3) ◽  
pp. 263-274 ◽  
Author(s):  
Tamar Wyte-Lake ◽  
Maria Claver ◽  
Aram Dobalian
Keyword(s):  
Primary Care ◽  
Disaster Preparedness ◽  
Assessment Tools ◽  
High Rate ◽  
Veterans Health ◽  
Health Administration ◽  
Caregiver Support ◽  
Medical Needs ◽  
Home Based Primary Care ◽  
Home Based

Background: Chronic conditions paired with normal aging put home-bound individuals at risk of harm during a disaster. Because of their high rate of comorbidities, veterans receiving care from the Veterans Health Administration (VHA)'s home-based primary care (HBPC) program are especially vulnerable, which may prevent them from being prepared for disaster. With intimate knowledge of their patients' home environments, medical needs, resources, and limitations, HBPC practitioners are uniquely positioned to assess and improve disaster preparedness of patients. Objective: This study explored issues regarding disaster preparedness for HBPC patients, including ways in which policy and procedures support routine assessment of disaster preparedness for patients as well as patient education activities. Methods: This project involved 32 semi-structured interviews with practitioners and leadership at 5 VHA HBPC programs - 3 urban and 2 rural. Transcripts of the interviews were analyzed using content analysis techniques. Results: Three themes emerged regarding the assessment of a patient's disaster preparedness: (1) assessment tools are rudimentary and, in some cases, individually developed by practitioners; (2) comprehension of criteria for assigning risk categories varies among practitioners, and (3) patients' cognitive impairment, limited resources, and out-of-date or inaccessible materials are the primary challenges to their preparedness. A fourth additional theme emerged as well: (4) the interdisciplinary nature of the HBPC team allows for unique innovative practices, such as a central focus on caregiver support and personal safety, as it relates to assessment and preparedness of the patient. Conclusion: Health and functional limitations may prevent home-bound patients from being adequately prepared for disasters. Standardized strategies and tools concerning disaster preparedness assessment for HBPC patients, which allow flexibility in consideration of factors such as local hazards, could assist in creating more comprehensive planning approaches and, in turn, more prepared persons. This is a work of the US Government and is not subject to copyright protection in the USA. Foreign copyrights may apply. Published by S. Karger AG, Basel

scholarly journals CAREGIVER EXPERIENCE OF TELEHEALTH-DELIVERED HOME SAFETY EVALUATIONS

2019 ◽  
Vol 3 (Supplement_1) ◽  
pp. S243-S243
Author(s):  
Megan Gately
Keyword(s):  
Safety Evaluation ◽  
Work Force ◽  
Specialty Care ◽  
Complex Nature ◽  
Home Safety ◽  
Home Video ◽  
Innovative Strategies ◽  
People With Dementia ◽  
Home Based ◽  
Home Telehealth

Abstract People with dementia are living in the community, necessitating in-home supports for their day-to-day needs. Given geriatrics work force shortages, innovative strategies that increase the reach of extant providers while maintaining quality are needed. Home-based video telehealth may increase access to specialty care such as a dementia-focused home safety evaluation by an occupational therapist; however, little is known about the technological demands and caregiver experience of a home safety evaluation delivered by telehealth. Our study employed video telehealth to deliver a dementia-focused home safety evaluation compared to in-person evaluation for caregivers (n=10) of veterans with dementia. Most video visits encountered technological problems. Caregiver experience between the video and in-person evaluations differed. Our findings reflect the highly dynamic, complex nature of in-home video telehealth which requires maximal collaboration with caregivers. By explicating the resource demands and potential burden of video telehealth for caregivers, development of effective in-home telehealth evaluation is enhanced

Developing a Home-Based Primary Care Disaster Preparedness Toolkit

2016 ◽  
Vol 11 (1) ◽  
pp. 56-63 ◽  
Author(s):  
Tamar Wyte-Lake ◽  
Maria Claver ◽  
Claudia Der-Martirosian ◽  
Darlene Davis ◽  
Aram Dobalian
Keyword(s):  
Primary Care ◽  
Disaster Preparedness ◽  
Online Survey ◽  
Vital Role ◽  
Clinical Expertise ◽  
Veterans Health ◽  
Health Administration ◽  
Preparedness Plan ◽  
Home Based Primary Care ◽  
Home Based

AbstractObjectiveHealth agencies working with the homebound play a vital role in bolstering a community’s resiliency by improving the preparedness of this vulnerable population. Nevertheless, this role is one for which agencies lack training and resources, which leaves many homebound at heightened risk. This study examined the utility of an evidence-based Disaster Preparedness Toolkit in Veterans Health Administration (VHA) Home-Based Primary Care (HBPC) programs.MethodsWe conducted an online survey of all VHA HBPC program managers (N=77/146; 53% response rate).ResultsRespondents with fewer years with the HBPC program rated the toolkit as being more helpful (P<0.05). Of those who implemented their program’s disaster protocol most frequently, two-thirds strongly agreed that the toolkit was relevant. Conversely, of those who implemented their disaster protocols very infrequently or never, 23% strongly agreed that the topics covered in the toolkit were relevant to their work (P<0.05).ConclusionThis toolkit helps support programs as they fulfill their preparedness requirements, especially practitioners who are new to their position in HBPC. Programs that implement disaster protocols infrequently may require additional efforts to increase understanding of the toolkit’s utility. Engaging all members of the team with their diverse clinical expertise could strengthen a patient’s personal preparedness plan. (Disaster Med Public Health Preparedness. 2017;11:56–63)

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