scholarly journals From village health volunteers to paid care givers: the optimal mix for a multidisciplinary home health care workforce in rural Thailand

2021 ◽  
Vol 19 (1) ◽  
Author(s):  
Nonglak Pagaiya ◽  
Thinakorn Noree ◽  
Penapa Hongthong ◽  
Karnwarin Gongkulawat ◽  
Pagaluk Padungson ◽  
...  

Abstract Background Thailand is a rapidly aging society, which places high demand on home health care services for the elderly. The shortage of health care workforce in rural areas is a crucial obstacle to the delivery of adequate home health care services. The appropriate skill-mix between multidisciplinary health team and care givers (CGs) is an attractive solution for improving home health care services in rural Thailand. This study assessed the potential of trained CGs to provide home health care services and projected what the optimal mix for a multidisciplinary home health care team in rural Thailand would be in 2030. Methods Eleven pilot districts in Thailand were recruited for the study. Secondary data were collected along with surveys of home health care providers. A total of 130 care managers (nurses) and 351 care givers (CG) were recruited for the survey. Workload, skill-mix potential, and acceptance of care givers were assessed in the surveys. The results from secondary data and the survey were used to project the health workforce requirements in 2030. Results It is projected that in 2030 the number of elderly living in rural areas will be 7,156,700 (27% of the projected rural population). Of this, 20.3% will be home-bound, 1.1% will be bed-ridden and 1.6% will need rehabilitation. The main members of the multidisciplinary health workforce involved in home health care were nurses, doctors, and physiotherapists. The home health care services that were provided by the multidisciplinary health workforce included patient assessment, development of a care plan and case conference, home visits, and teaching and supervision of CGs. The CGs were village health volunteers trained to carry out regular home visits to patients. The CGs provided assistance with the activities of daily living, basic health services, moral support to patients and relatives, and surveillance of the home environment during home visits. CGs were well accepted by both the health professionals and the patients. Projections showed that 16,094 nurses, 1,542 doctors, 1,022 physiotherapists and 50,148 CGs will be required in 2030 to meet the needs of the dependent elderly for home health care in rural Thailand. Conclusion With the increased need for home health care services in the future, appropriate team work between the members of the multidisciplinary health team and the CGs in the community is the appropriate solution for likely shortages of health professional workforce.

2019 ◽  
pp. 14-19
Author(s):  
Philip Collins ◽  
Stuti Jha ◽  
Alison Mancuso ◽  
John Bertagnolli ◽  
Sondra De Antonio ◽  
...  

Context: This study was conducted to gain a better understanding of patients’ understanding of homebound criteria and house call eligibility. Objective: To date, little empirical data exists assessing patient knowledge of home health care services. This study is designed to examine patients’ understanding of home health care services, eligibility criteria, costs, and interest in house calls. Methods: This study used an anonymous survey developed by the researchers and provided to patients in four separate office locations at a large academic Family Medicine practice. Questions about homebound criteria, eligibility, out of pocket cost, and patient interest were asked. Results: In total 393 surveys were collected. Approximately 47 percent of all respondents in the survey showed interest in having a home care visit by a healthcare professional, while only 59.6 percent were able to accurately identify the definition of homebound status. Approximately 60 percent of all respondents believe that they will have to pay more out of pocket for home visits, and the subgroup of respondents who have an interest in home visits showed that 63.4 percent of that group think that they will have to pay more out of pocket for such visits. Conclusion: These data have the potential to inform medical providers of a lack of understanding among patients regarding homebound criteria and home health care in general. While further studies could examine more specific details of this potential knowledge gap, the information provided by this study could prompt providers to begin educating patients on the possibility of home care.


Author(s):  
Jamie M. Smith ◽  
Haiqun Lin ◽  
Charlotte Thomas-Hawkins ◽  
Jennifer Tsui ◽  
Olga F. Jarrín

Older adults with diabetes are at elevated risk of complications following hospitalization. Home health care services mitigate the risk of adverse events and facilitate a safe transition home. In the United States, when home health care services are prescribed, federal guidelines require they begin within two days of hospital discharge. This study examined the association between timing of home health care initiation and 30-day rehospitalization outcomes in a cohort of 786,734 Medicare beneficiaries following a diabetes-related index hospitalization admission during 2015. Of these patients, 26.6% were discharged to home health care. To evaluate the association between timing of home health care initiation and 30-day rehospitalizations, multivariate logistic regression models including patient demographics, clinical and geographic variables, and neighborhood socioeconomic variables were used. Inverse probability-weighted propensity scores were incorporated into the analysis to account for potential confounding between the timing of home health care initiation and the outcome in the cohort. Compared to the patients who received home health care within the recommended first two days, the patients who received delayed services (3–7 days after discharge) had higher odds of rehospitalization (OR, 1.28; 95% CI, 1.25–1.32). Among the patients who received late services (8–14 days after discharge), the odds of rehospitalization were four times greater than among the patients receiving services within two days (OR, 4.12; 95% CI, 3.97–4.28). Timely initiation of home health care following diabetes-related hospitalizations is one strategy to improve outcomes.


1993 ◽  
Vol 10 (1) ◽  
pp. 39-51 ◽  
Author(s):  
Pamela J. Salsberry ◽  
Jennie T. Nickel ◽  
Muriel O'Connell ◽  
Nancy R. Reynolds ◽  
Diana L. Brady ◽  
...  

2018 ◽  
Vol 68 (4) ◽  
pp. 205-222
Author(s):  
Patrick Hirsch

Summary Home health care (HHC) services are faced with a rising demand in Austria. This is due to an increased life expectancy, changing family structures, and the trend to grow old at home. The percentage of their working time that is spent by the HHC staff for travelling from one client to the next one reaches 30% and even more in some rural areas. Changing the assignment of HHC staff to clients and the sequence of visits can lead to major reductions in the travel distances, and therefore, to more sustainable solutions. The aim of this paper is to provide a comprehensive overview on the logistical planning of HHC services in Austria. In order to meet the future requirements, it is important to analyze different mobility concepts for the HHC staff and to provide tailored solution approaches for routing and scheduling. The reader learns about the current HHC situation in Austria, the logistical requirements for planning these services, possible mobility concepts for the HHC staff, and potential threats for HHC operations. The developed solution methods are presented in brief and the main findings are highlighted and discussed. The paper concludes with an outlook on potential future research paths in HHC routing and scheduling.


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