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The Gerontologist Aug 2023Demands for home-based care have surged alongside population aging, preferences for aging in place, policy-driven reforms incentivizing lower hospital utilization, and...
Demands for home-based care have surged alongside population aging, preferences for aging in place, policy-driven reforms incentivizing lower hospital utilization, and public concerns around coronavirus disease 2019 transmissions in institutional care settings. However, at both macro and micro levels, sociopolitical, and infrastructural contexts are not aligned with the operational needs of home health care organizations, presenting obstacles to home health care equity. We integrate the social-ecological model and organizational theory to highlight contextual forces shaping the delivery of home-based care services between 2010 and 2020. Placing home-based health care organizations at the center of observation, we discuss patterns and trends of service delivery as systematic organizational behaviors reflecting the organizations' adaptations and responses to their surrounding forces. In this light, we consider the implications of provision and access to home care services for health equity, discuss topics that are understudied, and provide recommendations for home-based health care organizations to advance home health care equity. The article represents a synthesis of recent literature and our research and industry experiences.
Topics: Aged; Humans; Independent Living; COVID-19; Home Care Services; Delivery of Health Care
PubMed: 35921664
DOI: 10.1093/geront/gnac113 -
American Journal of Infection Control Jun 2021Infection Prevention and Control (IPC) practices have been established in home health care. Adherence to IPC practices has been suboptimal with limited available...
BACKGROUND
Infection Prevention and Control (IPC) practices have been established in home health care. Adherence to IPC practices has been suboptimal with limited available evidence. The study aim was to examine the impact of individual, home environment, and organizational factors on IPC practices using human factors model.
METHODS
Three hundred and fifty-three nurses were surveyed across two large home care agencies to examine the relationship between IPC adherence and individual, home environment, and organizational factors.
RESULTS
Nurses reported multiple barriers to IPC practices in patients' homes (mean = 4.34, standard deviation = 2.53). Frequent barriers included clutter (reported by 74.5% of nurses) and a dirty environment (70.3%). Nurses also reported limited availability of some IPC supplies (mean = 7.76, standard deviation = 2.44), including personal protective equipment. Home environment factors were significant barriers, and availability of IPC supplies were significant enablers of IPC adherence. Agency-provided training and decision-making resources were not significant factors for IPC adherence in the presence of home environment barriers and IPC supplies.
CONCLUSIONS
This study findings suggest that IPC adherence strategies point to addressing barriers in the home environment and increasing availability of IPC supplies. The relationship between the patient's home environment, organizational factors, and IPC practices among home health care nurses warrants further study.
Topics: Home Care Services; Humans; Infection Control; Nurses; Personal Protective Equipment
PubMed: 33157183
DOI: 10.1016/j.ajic.2020.10.021 -
Journal of Aging & Social Policy 2009Few studies have analyzed for-profit and nonprofit differences in the home health care sector. Using data from the National Home and Hospice Care Survey, we found that... (Comparative Study)
Comparative Study
Few studies have analyzed for-profit and nonprofit differences in the home health care sector. Using data from the National Home and Hospice Care Survey, we found that patients in nonprofit agencies were more likely to be discharged within 30 days under Medicare cost-based payment compared to patients in for-profit agencies. However, this difference in length of enrollment did not translate into meaningful differences in discharge outcomes between nonprofit and for-profit patients, suggesting that-under a cost-based payment system-nonprofits may behave more efficiently relative to for-profits. These results highlight the importance of organizational and payment factors in the delivery of home health care services.
Topics: Aged; Aged, 80 and over; Commerce; Female; Home Care Services; Hospices; Humans; Male; Multivariate Analysis; Organizations, Nonprofit; Ownership; Patient Discharge; Private Sector; Public Sector; Quality of Health Care; United States
PubMed: 19333838
DOI: 10.1080/08959420902728751 -
Research in Gerontological Nursing May 2020Social, economic, and environmental factors contribute to patients' recovery following hospitalization. However, little is known about how home health nurses make...
Social, economic, and environmental factors contribute to patients' recovery following hospitalization. However, little is known about how home health nurses make decisions based on their assessment of these factors. The purpose of the current study was to explore the nonclinical factors that home health nurses evaluate and describe how these factors influence care planning decisions. Semi-structured interviews conducted with 20 visiting nurses from three home health agencies were analyzed using conventional content analysis. Three nonclinical factor themes emerged: Social Support, Home Environment and Neighborhood, and Finances and Insurance Barriers. Nurses' assessments guided them to include family caregivers in the plan of care, evaluate their own safety to complete home visits, and refer patients to useful resources. Findings highlight the role of home health nurses in supporting older adults with limited resources and the need to address the social determinants of health across the care continuum. [Research in Gerontological Nursing, 13(3), 130-137.].
Topics: Caregivers; Continuity of Patient Care; Environment; Female; Home Care Services; Humans; Insurance, Health; Interviews as Topic; Male; Middle Aged; Nurses, Community Health; Qualitative Research; Residence Characteristics; Social Support
PubMed: 31834411
DOI: 10.3928/19404921-20191210-01 -
Home Health Care Services Quarterly 2008To (1) compare home health and informal (unpaid) services utilization among patients with Alzheimer's disease (AD), (2) examine longitudinal changes in services use, and... (Comparative Study)
Comparative Study
OBJECTIVES
To (1) compare home health and informal (unpaid) services utilization among patients with Alzheimer's disease (AD), (2) examine longitudinal changes in services use, and (3) estimate possible interdependence of home health and informal care utilization.
METHODS
The sample is drawn from the Predictors Study, a large, multicenter cohort of patients with probable AD, prospectively followed annually for up to 7 years in three university-based AD centers. Bivariate probit models estimated the effects of patient characteristics on home health and informal care utilization.
RESULTS
A large majority of the patients (80.6%) received informal care with a smaller proportion (18.6%) receiving home health services. Home health services utilization increased from 9.9% at baseline to 34.5% in year 4. Among users, number of days that services were provided in three-month recall increased from 21.9 to 56 days over time. Home health services utilization was significantly associated with function, depressive symptoms, being female, and not living with a spouse. Informal care utilization was significantly associated with cognition, function, comorbidities, and living with a spouse or child.
CONCLUSIONS
Home health and informal care utilization relate differently to patient characteristics. Utilization of home health care or informal care was not influenced by utilization of the other.
Topics: Aged; Aged, 80 and over; Alzheimer Disease; Caregivers; Cohort Studies; Female; Health Care Costs; Home Care Services; Humans; Longitudinal Studies; Male; United States
PubMed: 18510196
DOI: 10.1300/J027v27n01_01 -
JAMA Network Open Jun 2021New Centers for Medicare & Medicaid Services waivers created a payment mechanism for hospital at home services. Although it is well established that direct admission to...
IMPORTANCE
New Centers for Medicare & Medicaid Services waivers created a payment mechanism for hospital at home services. Although it is well established that direct admission to hospital at home from the community as a substitute for hospital care provides superior outcomes and lower cost, the effectiveness of transfer hospital at home-that is, completing hospitalization at home-is unclear.
OBJECTIVE
To evaluate the outcomes of the transfer component of a Veterans Affairs (VA) Hospital in Home program (T-HIH), taking advantage of natural geographical limitations in a program's service area.
DESIGN, SETTING, AND PARTICIPANTS
In this quality improvement study, T-HIH was offered to veterans residing in Philadelphia, Pennsylvania, and their outcomes were compared with those of propensity-matched veterans residing in adjacent Camden, New Jersey, who were admitted to the VA hospital from 2012 to 2018. Data analysis was performed from October 2019 to May 2020.
INTERVENTION
Enrollment in the T-HIH program.
MAIN OUTCOMES AND MEASURES
The main outcomes were hospital length of stay, 30-day and 90-day readmissions, VA direct costs, combined VA and Medicare costs, mortality, 90-day nursing home use, and days at home after hospital discharge. An intent-to-treat analysis of cost and utilization was performed.
RESULTS
A total of 405 veterans (mean [SD] age, 66.7 [0.83] years; 399 men [98.5%]) with medically complex conditions, primarily congestive heart failure and chronic obstructive pulmonary disease exacerbations (mean [SD] hierarchical condition categories score, 3.54 [0.16]), were enrolled. Ten participants could not be matched, so analyses were performed for 395 veterans (all of whom were men), 98 in the T-HIH group and 297 in the control group. For patients in the T-HIH group compared with the control group, length of stay was 20% lower (6.1 vs 7.7 days; difference, 1.6 days; 95% CI, -3.77 to 0.61 days), VA costs were 20% lower (-$5910; 95% CI, -$13 049 to $1229), combined VA and Medicare costs were 22% lower (-$7002; 95% CI, -$14 314 to $309), readmission rates were similar (23.7% vs 23.0%), the numbers of nursing home days were significantly fewer (0.92 vs 7.45 days; difference, -6.5 days; 95% CI, -12.1 to -0.96 days; P = .02), and the number of days at home was 18% higher (81.4 vs 68.8 days; difference, 12.6 days; 95% CI, 3.12 to 22.08 days; P = .01).
CONCLUSIONS AND RELEVANCE
In this study, T-HIH was significantly associated with increased days at home and less nursing home use but was not associated with increased health care system costs.
Topics: Aged; Female; Health Care Costs; Home Care Services; Hospitalization; Humans; Male; Middle Aged; Patient Transfer; Philadelphia; Quality Improvement; Time Factors; Veterans
PubMed: 34185069
DOI: 10.1001/jamanetworkopen.2021.14920 -
BMC Palliative Care Jun 2020In the last years of life, burden of disease and disability and need of health- and social care often increase. Social, functional and psychological factors may be...
BACKGROUND
In the last years of life, burden of disease and disability and need of health- and social care often increase. Social, functional and psychological factors may be important in regard to social- and health care utilization. This study aims to describe use of health- and social care during the last year of life among persons living in ordinary housing or in assisted living facilities.
METHODS
A retrospective study examining health- and social care utilization during their last year of life, using a subsample from the Swedish twin registries individually linked to several Swedish national quality registries (NQR). Persons that died during 2008-2009 and 2011-2012 (n = 1518) were selected.
RESULTS
Mean age at death was 85.9 ± 7.3 (range 65.1-109.0). Among the 1518 participants (women n = 888, 58.5%), of which 741 (49%) were living in assisted living facilities and 1061 (69.9%) had at least one hospitalization during last year of life. The most common causes of death were cardiovascular disease (43.8%) and tumors (15.3%). A multivariable logistic regression revealed that living in ordinary housing, younger age and higher numbers of NQR's increased the likelihood of hospitalization.
CONCLUSIONS
Persons in their last year of life consumed high amount of health- and social care although 12% did not receive any home care. Married persons received less home care than never married. Persons living in ordinary housing had higher numbers of hospitalizations compared to participants in assisted living facilities. Older persons and persons registered in fewer NQR's were less hospitalized.
Topics: Aged; Aged, 80 and over; Delivery of Health Care; Female; Home Care Services; Humans; Male; Middle Aged; Retrospective Studies; Social Support; Sweden; Terminal Care
PubMed: 32576290
DOI: 10.1186/s12904-020-00598-x -
Journal of Racial and Ethnic Health... Apr 2024Despite being the fastest growing minority group in the USA, Asian Americans are among the least studied ones, particularly in the home and community-based services...
OBJECTIVE
Despite being the fastest growing minority group in the USA, Asian Americans are among the least studied ones, particularly in the home and community-based services settings. This study aimed to review and synthesize extant evidence on Asian American's access, utilization, and outcomes of home health care.
METHODS
This is a systematic review study. A comprehensive literature search was conducted in PubMed and CINAHL as well as hand search. Each study was screened, reviewed, and evaluated for quality by at least two reviewers independently.
RESULTS
Twelve articles were determined eligible and included for review. Asian Americans were less likely to be discharged to home health care following hospitalization. At admission to home health care, Asian Americans had a high rate of inappropriate medication issues (28%) and they also had poorer functional status compared to White Americans. Asian Americans were also reported with less improvement in functional status at the end of home health care; however, there were some inconsistencies in the evidence on Asian Americans' utilization of formal/skilled home health care. Quality evaluation indicated that findings from some studies were limited by small sample size, single site/home health agency, analytic approaches, and other methodologic limitations.
CONCLUSIONS
Asian Americans often experience inequities in home health care access, utilization, and outcomes. Multilevel factors may contribute to such inequities, including structural racism. Robust research using population-based data and advanced methodology is needed to better understand home health care to Asian Americans.
Topics: Humans; Asian; Home Care Services; Hospitalization; Patient Discharge
PubMed: 36940075
DOI: 10.1007/s40615-023-01568-8 -
Health Policy (Amsterdam, Netherlands) Apr 1991Home health care in the United States is growing rapidly, as reflected in numbers of persons treated and national expenditures for care. Recent growth in this sector... (Review)
Review
Home health care in the United States is growing rapidly, as reflected in numbers of persons treated and national expenditures for care. Recent growth in this sector reflects the emergence of 'high-tech' care, such as intravenous infusion therapy, total parenteral nutrition and home dialysis. This focus on device-based therapy detracts from a larger issue, the efficient production of medical care subject to acceptable levels of cost and quality. The structure of payment and quality assurance mechanisms will shape the emergence of advanced home health care in the 1990's and beyond.
Topics: Durable Medical Equipment; Health Services Research; Hemodialysis, Home; Home Care Services; Insurance, Long-Term Care; Medical Laboratory Science; Parenteral Nutrition, Home; Quality Assurance, Health Care; United States
PubMed: 10113627
DOI: 10.1016/0168-8510(91)90126-i -
American Family Physician Nov 1998
Topics: Cost Control; Financing, Government; Home Care Services; Humans; Insurance Claim Reporting; Medicare; Physician's Role; Prospective Payment System; Reimbursement Mechanisms; United States
PubMed: 9824954
DOI: No ID Found