Health status and work burden of Alzheimer patients' informal caregivers: comparisons of five different care programs in the European Union

BACKGROUND: In 1998, a research study was conducted to compare existing programs in the European Union providing both care to people with senile dementia of the Alzheimer type, and support to their informal caregiver. METHOD: Five programs were selected in seven centres. Home social services (Denmark), Day centres (Germany), Expert Centres (Belgium, Spain), Group Living/Cantou (Sweden, France), Respite hospitalization (France). In each centre, 50 patients were randomly selected. The questionnaire addressed informal caregivers (or referents). It included the Nottingham Health Profile (NHP), the Zarit Scale, and it collected data on age, sex and position (spouse or child) of the informal caregiver, as well as age, level of mental deterioration and disabilities of the patient. RESULTS: (n=322 subjects) Comparatively with caregivers of Respite hospitalization patients chosen as the reference, caregivers of patients cared by Group living/Cantou and Home social services experienced a significantly lower burden. The benefit from the Expert centre program concerned emotional reactions (depression) (odds ratio=0.32; P=0.02) and work burden (Zarit) (OR=0.32; P=0.04). The main benefit for caregivers who received Day centre help was the important reduction of feelings of social isolation (OR=0.13; P=0.0003). CONCLUSIONS: The Group Living/Cantou program appeared as the most efficient way to reduce informal caregiver burden, independently from the country considered.     

Characteristics of elderly home health care users: data from the 1996 National Home and Hospice Care Survey

OBJECTIVE: This report presents demographic characteristics, service utilization, and primary admission diagnoses of elderly users of home health care services. Included are home health care services used by both current and discharged clients (called patients). These services are provided by home health care agencies and hospices. The focus of the report is on services used by both current patients and discharges aged 65 years and over. METHODS: The data used for this report are from the National Center for Health Statistics 1996 National Home and Hospice Care Survey's (NHHCS) sample of current patients and discharges. The 1996 NHHCS is the fourth survey of home health care agencies and hospices and their current patients and discharges. RESULTS: The overall results of the survey indicate that, as in previous years, the elderly current patients and discharges were predominantly women, 75-84 years old, white, non-Hispanic, widowed, and most often lived in a private residence with members of their family. For elderly men and women, the most commonly used home health care service was skilled nursing services and the primary admission diagnosis was diseases of the circulatory system, including heart disease.     

Comorbidity and social factors predicted hospitalization in frail elderly patients

OBJECTIVE: Studies on factors predicting the hospital admission of geriatric patients have reported different findings. The present study was undertaken to examine the rate of hospitalization among a large sample of frail elderly people living in the community and to identify the most important clinical and patient-centered factors associated with the hospital admission. STUDY DESIGN AND SETTING: This is an observational cohort study. All patients (n = 1,291) in six Italian home health care agencies were assessed by a trained staff who collected data on the Minimum Data Set for Home Care (MDS-HC) form. We constructed a longitudinal database including MDS-HC data and information on hospital utilization by each patient. RESULTS: During the follow-up of 12 months, the rate of hospitalization was about 26% of the studied sample. Persons living alone were more likely to have a hospital admission than those living with an informal caregiver (odds ratio OR = 2.59, 95% confidence interval CI = 1.82-3.69). Similarly, persons with economic hardship were more frequently hospitalized than those without these problems(OR = 3.01, 95% CI = 1.75-5.18). Comorbidity and previous hospital admission were associated with a higher risk to be hospitalized, too. CONCLUSION: Our results support the hypothesis that a mix of social and health problems are independent predictors of hospitalization.Identification of those factors that best predict hospital admissions and readmissions gives direction for potential interventions and further research toward reducing unnecessary hospitalizations.     

Public financial support receipt and non-medical resource utilization in Alzheimer's disease results from the PLASA study

A major health policy objective is to encourage and sustain informal caregiving networks for people with Alzheimer's disease (AD). This goal can be reached by providing financial assistance to patients facing difficulties in the accomplishment of activities of daily living, in order to encourage utilization of professional service and therefore alleviate informal caregiver burden. The main issue is to understand if and how financial assistance is correlated with the distribution between informal and professional care. We used a cross-sectional sample of 1131 French elderly patients (≥65) with mild to moderate AD. Informal and professional service resource use was measured in hours per month using a validated instrument, the Resource Use in Dementia questionnaire. Our results confirmed the utter dominance of informal care, which represented more than 80% of total care even among patients receiving public financial support. However financial support receipt was associated with differences in care utilization: higher use of total non-medical care (formal and informal) and lower proportion of informal care in total non-medical care. Our results suggested the presence of a threshold effect that would influence non-medical care demand decisions. Even if on average the use of informal care in total was 13.3% lower among patients receiving public financial support, informal care use represented more than 80% of total non-medical care use. Providing robust evidence of these associations is crucial to further identify the right dosage between professional service demand and informal care utilization that could be associated with a lower burden and therefore a lower probability of institutionalization.     

Home health care and rapid rehospitalization

Early release from the hospital of the elderly ill patient may lead to failure of the home care plan and rapid rehospitalization. Review of 330 consecutive admissions to a large urban home health agency in 1980 revealed that 43 patients (13%) were rehospitalized within 2 weeks of admission. This high risk patient population is contrasted with the average home care population in terms of living arrangements, ambulatory status, primary diagnosis, age, sex, medications, etc. Home care was probably the appropriate long-term placement if better coordination between discharge planners, PSROs, physicians and home care staff could have been established with the extension of the hospital stay by 1-2 days and/or the provision of more intensive supportive care in the home at the time of admission to the home care agency. Simple guidelines for medical/social discharge planning to provide safer transfer of ill elderly patients from hospital to home are listed.     

Utilization Of Benefits For Home Nursing Care In The German Statutory Nursing Care In Insurance

The aim of this study was to identify factors associated with the utilization of professional versus financial aid for home care from the German statutory nursing care insurance. The study included 6550 people having applied for statutory home care benefits for the most severely disabled persons in 1995. The relation of individual factors of the participants as well as characteristics of the living area (sociodemographic variables and the supply with health and nursing care services) with the type of benefits applied for were examined cross-sectionally in a logistic regression model. 11.3% of the study sample applied for professional home care, 66.2% preferred financial aid instead and 22.5% applied for a combination of both. Persons previously relying on informal care had a much lower probability (OR=0.02) of applying for professional support compared to persons relying on both informal and professional care. High age, living alone and limitation in basic activities of daily living were associated with an increased likelihood of applying for professional aid. No strong associations with the type of benefits applied for were observed for the characteristics of the living area. This study clearly identified certain individual factors as the key determinants of the type of requested home care benefits, and should therefore be useful as empirical basis for developing long-term care policy.     

Is longer waiting time associated with health and social services utilization before treatment? A randomized study

OBJECTIVE: To determine whether longer waiting time for major joint replacement is associated with health and social services utilization before treatment. METHODS: When placed on the waiting list, patients were randomized to short (相似文献   

Observational study of home visits in Slovene general practice: patient characteristics, practice characteristics and health care utilization

BACKGROUND: Home visits are an important way of delivering primary health care, but there is a long-term decrease in home visit rates in many countries. OBJECTIVE:The aim of this study was to evaluate patient characteristics, morbidity, functional status, quality of life, satisfaction with care, practice characteristics and health care utilization in general practice patients visited at home at least once in a study year. METHODS:The design of the study was a cross-sectional survey of the patients of a stratified sample of 36 GP offices in Slovenia using a self-administered questionnaire. Sixty consecutive patients in sampled practices contacting the doctor in the office in the study period in March 1998 were included in the analysis. The age, sex, educational status, residence, presence of chronic condition, measures of anxiety or depressive symptoms, rates of patients who expressed a need for emergency care in 1 year, rates of self-care, measures of functional status, quality of life, satisfaction with care, rates of using GP practice visits and out-of-hours services and rates of using specialist or hospital services were recorded in a home-visited group versus a non-visited group. RESULTS: A total of 277 patients (15.4%) were reported to have at least one visit in the study year. Patients visited in their homes were older, predominantly female, better educated, had lower perceptions of their functional status and well-being and they used primary health services more frequently than others. Their GPs were more likely to be males, and were more likely to practise in rural areas, in solo practices as private practitioners. CONCLUSION: Home visits remain an important part of GP work in countries in transition, such as Slovenia, especially for more seriously ill patients.     

Continuity in home health care: is consistency in nursing personnel associated with better patient outcomes?

A growing body of evidence suggests that patients who receive coordinated and uninterrupted health care services have better outcomes, more efficient resource utilization, and lower costs of health care. However, limited research has considered whether attributes of continuity in home health care service delivery are associated with improved patient outcomes. The present study examines the relationship between one dimension of continuity of care, consistency in nursing personnel, and three patient outcomes: hospitalization, emergent care, and improvement in activities of daily living. Analyses of data from a large population of home health patients (N=59,854) suggest that greater consistency in nursing personnel decreases the probability of hospitalization and emergent care, and increases the likelihood of improved functioning in activities of daily living between admission and discharge from home health care. These results provide preliminary evidence that efforts to decrease dispersion of nursing personnel across a series of home visits to patients may lead to improved outcomes. The implications of these findings for clinical practice and further research are discussed in the paper.     

Home health care utilization: a review of the research for social work

The author reviewed the literature to identify the variables associated with home health care utilization using the Andersen-Newman model as a framework for analysis. Sixty-four studies published between 1985 and 2000 were identified through PUBMED, Sociofile, and PsycINFO databases. Home health care was defined as in-home skilled nursing, homemaker, mobile meals, home health aide, physical therapy, occupational therapy, or social work services. The review indicates that the client most likely to use home health care is elderly, has a high number of ADL/IADL impairments, lives alone, has a low level of informal support, and has Medicaid coverage. In the presence of informal support or when care recipients live with others, the initiation of formal services may be delayed until physical impairment of the care recipient is severe or caregiver burden is high. Implications for social work practice and research are discussed.     

Socio-spatial patterns of home care use in Ontario, Canada: A case study

Home care is the fastest growing segment of Canada's health care system. Since the mid-1990s, the management and delivery of home care has changed dramatically in the province of Ontario. The objective of this paper is to examine the socio-spatial characteristics of home care use (both formal and informal) in Ontario among residents aged 20 and over. Data are drawn from two cycles of the Canadian Community Health Survey (CCHS Cycle 3.1 2005 and Cycle 4.1 2007) and are analyzed at a number of geographical scales and across the urban to rural continuum. The study found that rural residents were more likely than their urban counterparts to receive government-funded home care, particularly nursing care services. However, rural residents were less likely to receive nursing care that was self-financed through for-profit agencies and were more reliant on informal care provided by a family member. The study also revealed that women and seniors were far more dependent on services that they paid for as compared to informal services. People with lower incomes and poorer health status, as well as rural residents, were also more likely to use informal services. The paper postulates that the introduction of managed competition in Ontario's home care sector may be effective in more populated parts of the province, including large cities, but at the same time may have left a void in access to for-profit formal services in rural and remote regions.     

The Association of Service Use and Other Client Factors with the Time to Transition from Home Care to Facility-Based Care

ObjectivesPeople are living longer with complex health needs and wish to remain in their homes as their care needs change. We examined which client factors (sociodemographic, health service use, health, and function) influenced older persons’ (≥65 years) time to transition from home living to assisted living (AL) or long-term care (LTC) facilities.DesignRetrospective cohort study.Setting and ParticipantsLong-term services and supports in Alberta, Canada. Long-stay home care clients (≥65 years) who received a Resident Assessment Instrument–Home Care (RAI-HC) assessment between 2014 and 2018.MeasuresWe assessed time from initial receipt of long-term home care to AL and LTC facility transitions, using Cox proportional hazard regressions, and a provincial continuing care data repository (Alberta Continuing Care Information System). We adjusted for client sociodemographic, health, function, and health service use variables. The outcome was time from initial long-term home care receipt to transition to facility living.ResultsWe included 33,432 home care clients. Clients who were visited by care aides once in the last 7 days transitioned to AL later than those with no care aide visits [hazard ratio (HR) 0.976, 95% confidence interval (CI) 0.852, 0.964]. Clients receiving physical therapy services once or more a week transitioned to LTC later than those who did not receive these services (HR 0.767, CI 0.672, 0.875). Institutionalizations happened sooner if the client's caregiver was unable to continue (AL: HR 1.335, CI 1.306, 1.365; LTC: HR 1.339, CI 1.245, 1.441) and if clients socialized less (AL: HR 1.149, CI 1.079, 1.223; LTC: HR 1.087, CI 1.018, 1.61).Conclusions and ImplicationsThe diverse role of care aides needs to be explored to determine which specific services help to delay AL transitions. Physical therapy exercises that require minimal supervision should be integrated early into care plans to delay LTC transitions. Social/recreational programs to improve older adults’ socialization and informal caregiver support could delay transitions.     

The quick response initiative in the emergency department: who benefits?

Objectives: This collaborative project between two community hospitals, a Metropolitan Home Care Program and the University, was designed to quantify the applicability (who is eligible for) and acceptability (who will likely comply with) Home Care services, provided through a Quick Response Program (QRP) initiative as compared to usual hospital care services, to patients, families and physicians. Methods: During a 6 week period of sampling (5 days per week, 8 hours per day) in two Emergency Departments (ED) in moderately sized community hospitals in a major metropolitan city, all patients triaged to the urgent category were assessed for eligibility for QRP services by on-site Home Care Coordinators using specific criteria. Patients meeting the criteria initially were reviewed by the ED physician for approval for QRP services and then randomized to experimental and control conditions. Patients not meeting the eligibility criteria were managed by the usual ED services procedures. Demographic and clinical data were obtained on all urgent category patients at presentation to the ED. Additionally, the nature and cost of all health care services used by the ED patients during the ED event and 10 days follow up, were obtained through hospital and Home Care record abstraction and compared among the different sample groups. Results: The QRP Initiative was applicable to 2% of the total ED patient population and 5% of the urgent category of patients triaged in the ED. It was acceptable to 97% of this eligible group. One hundred and fifty-five patients who initially qualified for QRP were excluded from eligibility at a subsequent assessment. Ninety of these patients were admitted to hospital and 65 were discharged home. In the total “exclusion” group, 37 refused Home Care services including the QRP. Health care practice implications: The sampling results raise important questions about broader system issues concerning the role of the hospital and community in providing health care services and the social value or utility that guides the allocation of health care funds. What level of applicability and acceptability would justify priority services for certain target groups. In the future, policy makers will need to be able to show that it is in the best interest of patients and society to prioritize mixtures of services to certain target groups. This revised version was published online in July 2006 with corrections to the Cover Date.     

Health status and work burden of Alzheimer patients’ informal caregivers: Comparisons of five different care programs in the European Union

Background: In 1998, a research study was conducted to compare existing programs in the European Union providing both care to people with senile dementia of the Alzheimer type, and support to their informal caregiver. Method: Five programs were selected in seven centres. Home social services (Denmark), Day centres (Germany), Expert Centres (Belgium, Spain), Group Living/Cantou (Sweden, France), Respite hospitalization (France). In each centre, 50 patients were randomly selected. The questionnaire addressed informal caregivers (or referents). It included the Nottingham Health Profile (NHP), the Zarit Scale, and it collected data on age, sex and position (spouse or child) of the informal caregiver, as well as age, level of mental deterioration and disabilities of the patient. Results: (n=322 subjects) Comparatively with caregivers of Respite hospitalization patients chosen as the reference, caregivers of patients cared by Group living/Cantou and Home social services experienced a significantly lower burden. The benefit from the Expert centre program concerned emotional reactions (depression) (odds RATIO=0.32; P=0.02) and work burden (Zarit) (OR=0.32; P=0.04). The main benefit for caregivers who received Day centre help was the important reduction of feelings of social isolation (OR=0.13; P=0.0003). Conclusions: The Group Living/Cantou program appeared as the most efficient way to reduce informal caregiver burden, independently from the country considered.     

Home Health Care With Telemonitoring Improves Health Status for Older Adults With Heart Failure

Home telemonitoring can augment home health care services during a patient's transition from hospital to home. Home health care agencies commonly use telemonitors for patients with heart failure although studies have shown mixed results in the use of telemonitors to reduce rehospitalizations. This randomized trial investigated if older patients with heart failure admitted to home health care following a hospitalization would have a reduction in rehospitalizations and improved health status if they received telemonitoring. Patients were followed up to 180 days post-discharge from home health care services. Results showed no difference in the time to rehospitalization or emergency visit between those who received telemonitoring versus usual care. Older heart failure patients who received telemonitoring had better health status by home health care discharge than those who received usual care. Therefore, for older adults with heart failure, telemonitoring may be an important adjunct to home health care services to improve health status.     

Unmet home healthcare needs and quality of life in cancer patients: a hospital‐based Turkish sample

Home healthcare services in Turkey are provided primarily to patients that are bedridden or seriously disabled. There are no such services integrated with hospital services that are specifically designed for cancer patients. The present study aimed to explore the home healthcare needs of cancer patients and their experiences related to unmet home healthcare needs. The study included 394 adult cancer patients who were followed up at the surgical oncology department of a university hospital. A 37‐item, study‐specific questionnaire and the European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire for cancer patients (EORTC‐QLQ‐C30) were administered, and patient clinical records were evaluated. Home healthcare was provided primarily by the patients' immediate family members; the professional home healthcare usage rate was only 2.8%. Patient quality of life (QoL) was negatively affected by cancer, especially those with stage three and four disease. The frequency of the need for home healthcare services due to disease‐related health problems during the 30 days prior to administration of the questionnaires was as follows: pain (62.9%), surgical wound care (44.9%), injection of therapeutics (52.3%), gastrointestinal complaints (51.8%), anxiety (87.1%), psychosocial assistance (77.2%) and information about cancer (94.4%). In the absence of home healthcare services, the patients primarily used institutional healthcare services to meet their needs; otherwise, their needs were not met. The physical and psychosocial problems that cancer patients experience could be solved in most cases by professional home healthcare services. Hospital‐integrated home healthcare services might not only improve cancer patient QoL but might also increase the effectiveness of hospital‐based healthcare services.     

Cost-effectiveness: the case of home health care physician services in New Brunswick, Canada

Home health care programs have direct and indirect effects within a health care system. A complete cost-benefit evaluation would include all such effects. A study of New Brunswick's Extra-Mural Hospital (EMH) home health care program used population-based administrative data on physician services utilization to examine whether home care services act indirectly as substitutes for physician services. Evidence suggests that the introduction and expansion of New Brunswick's EMH home health care program had unanticipated substitution effects, which reduced health system costs by reducing the rate of growth of per-capita utilization of physician services.     

Utilization of home care among people with HIV infection.

OBJECTIVE: To examine factors affecting the utilization of formal and informal home care services by people with HIV infection. DATA SOURCES AND STUDY SETTING: Study participants are adults with HIV infection receiving services at major providers of medical care in ten U.S. cities. Six interviews were conducted over an 18-month period (March 1991 to September 1992). DATA COLLECTION METHODS: Data on home care utilization, personal background characteristics, insurance status, and functional status are based on self-report. Disease stage is based on medical record data. STUDY DESIGN: This is an observational study using a panel survey design. Cross-tabular and longitudinal regression analyses (N = 1,727) were conducted to determine the effects of sociodemographic factors, functional status, disease stage, and insurance status on the receipt of home care from nurses, paraprofessionals, other professional providers, household residents, nonresident family and friends, and volunteers. PRINCIPAL FINDINGS: Over a 12-month period, 16 percent of respondents received home nursing visits; 11 percent received paraprofessional care (e.g., nurse's aides, helpers); 4 percent received help from volunteers; 11 percent from non-resident family or friends, and 21 percent from household members. Among the subgroup with AIDS (n = 837), corresponding percentages were 29, 20, 7, 17, and 29 percent for each provider type. In multivariate analyses, illness stage and functional status had strong effects on odds of utilization. Blacks and Hispanics were less likely than whites to have nursing care, but racial/ethnic group did not affect receipt of informal care. CONCLUSIONS: Home care utilization is concentrated among people with AIDS, compared to those at less advanced disease stages. In addition to functional limitations, fatigue is associated with the use of home care. Nursing and non-nursing home care have somewhat different correlates. Medicaid may provide better coverage of personal care services than private insurance.