Community-Based Home Healthcare Project for Korean Older Adults

ObjectivesThe aim of this study was to identify the effects of community-based home healthcare projects that influence service performances with regard to Korean national long-term care insurance services in older adults.MethodsThe project's applicants were 18 operational agencies in national long-term care institutions in Korea, and participants were care recipients (n = 2263) registered in long-term care institutions. We applied our healthcare system to the recruited participants for a 3-month period from October 2012 to December 2012. We measured the community-based home healthcare services such as long-term care, health and medical service, and welfare and leisure service prior to and after applying the community-based home healthcare system.ResultsAfter the implementation of community-based home healthcare project, all community-based home healthcare services showed an increase than prior to the project implementation. The nutrition management service was the most increased and its increase rate was 628.6%. A comparison between the long-term care insurance beneficiaries and nonbeneficiaries showed that health and medical services’ increase rate of nonbeneficiaries was significantly higher than beneficiaries (p < 0.001).ConclusionOur community-based home healthcare project might improve the service implementation for older adults and there was a difference in the increase rate of health and medical services between Korean national long-term care insurance beneficiaries and nonbeneficiaries.     

Retention of Clients in Service Under Two Models of Home Health Care for HIV/AIDS

ABSTRACT

Objective: To determine if a Transprofessional, care-management approach (experimental group) produces different patterns of retention in home treatment as compared to a Traditional treatment approach (control group). The care-management approach utilizes an interdisciplinary mix of allied health professionals who adhere to a service delivery protocol based on active medical, surgical treatment (curative services) as well as on pain, symptoms, and emotional care (palliative services). Initially, the Transprofessional Model should lead to a greater retention rate in the program as patients bond to blended care managers, but in later stages clients needing hospice should be moved off-services resulting in lower retention rates in the medical-surgical home care venue.

Data Sources and Study Setting: Data were collected from 549 AIDS patients admitted for medical/surgical home-care services to the Visiting Nurse Association of Los Angeles (VNA-LA). Demographic and disease-specific data were collected from admitting records; service-utilization data were collected from the VNA-LA's computerized data system.

Study Design: Upon admission for home-care services, patients were randomly assigned to an experimental (Transprofessional) or control (Traditional) treatment group. Service levels were comparable.

Primary Finding: In the earliest stages, Transprofessional patients tend to be more likely to stay in treatment, probably due to the greater bonding to the program. After about one year, the Transprofessional patients are more likely to leave the program as they are transitioned into hospice care.

Conclusions: An integrated model of service delivery, which is based on interdisciplinary care-management and blended modalities of service, provides a quality of life enhancing and a cost-effective method in the provision of home-care services for terminally ill AIDS patients.     

The Association of Long-Term Opioid Use With Health Care and Home Care Service Use Among Aged Home Care Clients

ObjectivesTo compare health care and home care service utilization, mortality, and long-term care admissions between long-term opioid users and nonusers among aged home care clients.DesignA retrospective cohort study based on the Resident Assessment Instrument–Home Care (RAI-HC) assessments and electronic medical records.Setting and ParticipantsThe study sample included all regular home care clients aged ≥65 years (n = 2475), of whom 220 were long-term opioid users, in one city in Finland (population base 222,000 inhabitants).MethodsHealth care utilization, mortality, and long-term care admissions over a 1-year follow-up were recorded from electronic medical records, and home care service use from the RAI-HC. Negative binomial and multivariable logistic regression, adjusted for several socioeconomic and health characteristics, were used to analyze the associations between opioid use and health and home care service use.ResultsCompared with nonusers, long-term opioid users had more outpatient consultations (incidence rate ratio 1.26; 95% CI 1.08−1.48), home visits (1.23; 1.01−1.49), phone contacts (1.38; 1.13−1.68), and consultations without a patient attending a practice (1.22; 1.04−1.43) after adjustments. A greater proportion of long-term opioid users than nonusers had at least 1 hospitalization (49% vs 41%) but the number of inpatient days did not differ after adjustments. The home care nurses’ median work hours per week were 4.3 (Q₁-Q₃ 1.5−7.7) among opioid users and 2.8 (1.0−6.1) among nonusers. Mortality and long-term care admissions were not associated with opioid use.Conclusions and ImplicationsLong-term opioid use in home care clients is associated with increased health care utilization regardless of the severity of pain and other sociodemographic and health characteristics. This may indicate the inability of health care organizations to produce alternative treatment strategies for pain management when opioids do not meet patients’ needs. The exact reasons for opioid users’ greater health care utilization should be examined in future.     

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.     

Impact of the COVID-19 Pandemic on Home Care Services Among Community-Dwelling Adults With Dementia

ObjectiveTo examine how the COVID-19 pandemic impacted use of home care services for individuals with dementia across service types and sociodemographic strata.DesignPopulation-based time series analysis.Setting and ParticipantsCommunity-dwelling adults with dementia in Ontario, Canada, from January 2019 to September 2020.MethodsWe used health administrative databases (Ontario Registered Persons Database and Home Care Database) to measure home care services used by participants. Poisson regression models were fit to compare weekly rates of home care services during the pandemic to historical trends with rate ratios (RRs) and 95% confidence intervals (CIs) stratified by service type (nursing, personal care, therapy), sex, rurality, and neighborhood income quintile.ResultsDuring the first wave of the pandemic, personal care fell by 16% compared to historical levels (RR 0.84, 95% CI 0.84, 0.85) and therapies fell by 50% (RR 0.50, 95% CI 0.48, 0.52), whereas nursing did not significantly decline (RR 1.02, 95% CI 1.00, 1.04). All rates had recovered by September 2020, with nursing and therapies higher than historical levels. Changes in services were largely consistent across sociodemographic strata, although the rural population experienced a larger decline in personal care and smaller rebound in nursing.Conclusions and ImplicationsPersonal care and therapies for individuals with dementia were interrupted during the early months of the pandemic, whereas nursing was only minimally impacted. Pandemic responses with the potential to disrupt home care for individuals living with dementia must balance the impacts on individuals with dementia, caregivers, and providers.     

Specialist training of family physicians in non-UEMO countries: An Estonian experience

ABSTRACT

Background: Because of the growth of the older population and the prevalence of chronic diseases, home care services (HCS) have become an important aspect of healthcare worldwide. However, various difficulties and deficiencies are present in the provision of these recently implemented services in Turkey. Modifications to home healthcare services are in progress.

Objective: Physicians have an active role in home healthcare services. The present study was performed to examine physicians’ attitudes toward this service in detail.

Methods: Twenty-six physicians who provide home healthcare services in the city of Ankara were included in the study. We conducted in-depth, semi-structured, face-to-face interviews. The interviews were audio-recorded, transcribed, and qualitatively analysed.

Results: Most physicians thought that home care could be provided to patients who are bedridden, are very old, have a chronic disease, have problems leaving the house, or do not have family support. They also expressed displeasure about the abuse of services and discordance of organization between hospitals and primary care centres. They noted that real circumstances in practice were not compatible with regulations and that cooperation and coordination between departments are necessary and important.

Conclusion: The current study underlines physicians’ interest in and support of the home care system, which has various drawbacks and limitations. Legislation needs to be further changed to improve the quality of service and eliminate deficiencies in home healthcare.     

Utilisation des services d’aide et de soins à domicile pour les personnes âgées en situations complexes : comparaison entre trois types de coordination gérontologique

BackgroundOlder people with complex needs live mainly at home. Several types of gerontological coordinations have been established on the French territory to meet their needs and to implement social and primary health care services. But we do not have any information on the use of these services at home as a function of the coordination method used.MethodsWe compared the use of home care services for older people with complex needs in three types of coordination with 12 months’ follow-up. The three coordinations regrouped a gerontological network with case management (n = 105 persons), a nursing home service (SSIAD) with a nurse coordination (n = 206 persons) and an informal coordination with a non-professional caregiver (n = 117 persons).ResultsAt t0, the older people addressed to the gerontological network had less access to the services offered at home; those followed by the SSIAD had the highest number of services and of weekly interventions. Hours of weekly services were two-fold higher in those with the informal coordination. At t12, there was an improvement in access to services for the network group with case management and an overall increase in the use of professional services at home with no significant difference between the three groups.ConclusionThe use of social and primary health care services showed differences between the three gerontological coordinations. The one-year evolution in the use of home services was comparable between the groups without an explosion in the number of services in the network group with case management.     

Out-of-hours primary care services: Demands and patient referral patterns in a Veneto region (Italy) Local Health Authority

PurposeThe aim of this study was to describe the characteristics of patients admitted to an out-of-hours (OOH) service and to analyze the related outputs.SettingA retrospective population-based cohort study was conducted by analyzing an electronic database recording 23,980 OOH service contacts in 2011 at a Local Health Authority in the Veneto Region (North-East Italy).MethodA multinomial logistic regression was used to compare the characteristics of contacts handled by the OOH physicians with cases referred to other services.ResultsOOH service contact rates were higher for the oldest and youngest age groups and for females rather than males. More than half of the contacts concerned patients who were seen by a OOH physician. More than one in three contacts related problems managed over the phone; only ≈10% of the patients were referred to other services. Many factors, including demographic variables, process-logistic variables and clinical characteristics of the contact, were associated with the decision to visit the patient's home (rather than provide telephone advice alone), or to refer patients to an ED or to a specialist. Our study demonstrated, even after adjusting, certain OOH physicians were more likely than their colleagues to refer a patient to an ED.ConclusionOur study shows that OOH services meet composite and variously expressed demands. The determining factors associated with cases referred to other health care services should be considered when designing clinical pathways in order to ensure a continuity of care. The unwarranted variability in OOH physicians’ performance needs to be addressed.     

Utilization of social workers in home care: An analysis of service use

ABSTRACT

Social workers are well positioned to address mental health complications impacting home care populations, yet social work has one of the lowest utilization rates of offered home care supports in Ontario. This study analyzed care plan data of frontline in-home social work services. Results identified adjustment to illness as the most common category and that seniors required significantly fewer visits and days on service than non-seniors. Most patients were able to accomplish their social work-based goals. Results highlight a need for further research and for capitalizing on the untapped potential value of social work home care services for patients.     

Risk of Rehospitalization or Emergency Department Visit is Significantly Higher for Patients who Receive Their First Home Health Care Nursing Visit Later than 2 Days After Hospital Discharge

ObjectivesThis study explored the association between the timing of the first home health care nursing visits (start-of-care visit) and 30-day rehospitalization or emergency department (ED) visits among patients discharged from hospitals.DesignOur cross-sectional study used data from 1 large, urban home health care agency in the northeastern United States.Setting/ParticipantsWe analyzed data for 49,141 home health care episodes pertaining to 45,390 unique patients who were admitted to the agency following hospital discharge during 2019.MethodsWe conducted multivariate logistic regression analyses to examine the association between start-of-care delays and 30-day hospitalizations and ED visits, adjusting for patients’ age, race/ethnicity, gender, insurance type, and clinical and functional status. We defined delays in start-of-care as a first nursing home health care visit that occurred more than 2 full days after the hospital discharge date.ResultsDuring the study period, we identified 16,251 start-of-care delays (34% of home health care episodes), with 14% of episodes resulting in 30-day rehospitalization and ED visits. Delayed episodes had 12% higher odds of rehospitalization or ED visit (OR 1.12; 95% CI: 1.06–1.18) compared with episodes with timely care.Conclusions and ImplicationsThe findings suggest that timely start-of-care home health care nursing visit is associated with reduced rehospitalization and ED use among patients discharged from hospitals. With more than 6 million patients who receive home health care services across the United States, there are significant opportunities to improve timely care delivery to patients and improve clinical outcomes.     

The Impact of a Decade of Policy on Home Health Care Utilization

ABSTRACT

The Medicare home health care eligibility changes, which occurred during the 1980s, were designed to make home health care more accessible to older adults. Ideally, by the 1990s, older adults in need of home health care services should no longer have encountered barriers to accessing this benefit Therefore, an individual's need for home health care services should have been the primary determinant of service utilization. This paper examined whether need was predictive of home health care use. Client-level data on the case mix of home health care agencies in San Francisco and Philadelphia, as well as agency administrator interview data, were analyzed to determine which characteristics were the best predictors of home health care use. The regression analyses results revealed that, although client characteristics were important predictors of the amount and type of home health care services received during an episode of care, client characteristics alone did not adequately predict the amount and type of home health care services received by older adults.     

A Research and Policy Agenda for Transitions from Nursing Homes to Home

SUMMARY

More than 1 million adults make the transition from nursing homes to the community every year, often using formal health services including Medicare Part A skilled home health care. Although the need for discharge planning is well described, and the risks associated with care transitions are increasingly recognized, there is very limited information about the process and outcomes as patients move from nursing home to home. This paper reviews pertinent published data and health services research as background information and outlines a research agenda for studying these important transitions.     

Use of Home-Based Clinical Care and Long-Term Services and Supports Among Homebound Older Adults

ObjectivesDescribe use of home-based clinical care and home-based long-term services and supports (LTSS) using a nationally representative sample of homebound older Medicare beneficiaries.DesignCross-sectional study.Setting and ParticipantsHomebound, community-dwelling fee-for-service Medicare beneficiaries participating in the 2015 National Health and Aging Trends Study (n = 974).MethodsUse of home-based clinical care [ie, home-based medical care, skilled home health services, other home-based care (eg, podiatry)] was identified using Medicare claims. Use of home-based LTSS (ie, assistive devices, home modification, paid care, ≥40 hours/wk of family caregiving, transportation assistance, senior housing, home-delivered meals) was identified via self or proxy report. Latent class analysis was used to characterize patterns of use of home-based clinical care and LTSS.ResultsApproximately 30% of homebound participants received any home-based clinical care and about 80% received any home-based LTSS. Latent class analysis identified 3 distinct patterns of service use: class 1, High Clinical with LTSS (8.9%); class 2, Home Health Only with LTSS (44.5%); and class 3, Low Care and Services (46.6% homebound). Class 1 received extensive home-based clinical care, but their use of LTSS did not meaningfully differ from class 2. Class 3 received little home-based care of any kind.Conclusions and ImplicationsAlthough home-based clinical care and LTSS utilization was common among the homebound, no single group received high levels of all care types. Many who likely need and could benefit from such services do not receive home-based support. Additional work focused on better understanding potential barriers to accessing these services and integrating home-based clinical care services with LTSS is needed.     

Intention of Use of Long-Term Care Facilities and Home Support Services by Chinese-Canadian Family Caregivers

ABSTRACT

One common myth about ethno-cultural minority family caregivers is that they do not use formal services. This study examined the intention of using home support and long-term care facilities by a random sample of 339 Chinese-Canadian family caregivers, using a modified version of the Andersen-Newman service utilization model. Filial piety, caregiving burden, care receivers, and health conditions are the common predictors identified. Filial obligation is most likely manifested through facilitating the care receivers to make use of the services needed, particularly for caregivers who reported a high level of caregiving burden.     

Factors Associated with Achievement of Goals for Home Health Care

ABSTRACT

With the introduction of Medicare's Prospective Payment System (PPS) and DRGs, the economic value of home health care services lies in its ability to reduce total patient care costs by the substitution of outpatient home care for inpatient hospital care. Analysis of service delivery patterns utilized by home health agencies in meeting goals for patient care will be an important ingredient in meeting these objectives. The purpose of this study was to determine if important patient characteristics known at the onset of home health care are predictive of utilization of home health services and/or the likelihood of meeting goals for home care established at the time of certification of care. Multivariate models were developed which predicted the odds of terminating with goals met based upon age, intensity of utilization, functional limitations, prognosis, presence of a caregiver, and type of patient condition. Results indicated that variability in likelihood of meeting goals for care is much better predicted by patient characteristics than by utilization of home care services.     

Publicly funded home care service use in the first 2 years after spinal cord injury in Ontario,Canada

ABSTRACT

The objectives of this study were to describe home care utilization and costs in community-dwelling individuals 2 years post-spinal cord injury (SCI) in Ontario, Canada. This retrospective incident cohort study uses administrative health care data to identify individuals with traumatic SCI (tSCI). Time to service delivery and frequency of service delivery and costs were calculated. A total of 798 individuals with tSCI comprised the cohort. In the first 2 years, personal support/homemaking was the most utilized service. Median cumulative home care 2 years post-discharge was $7,200 ($1,240–35,410 25–75% interquartile range). This study highlights the importance of home care to individuals with SCI.     

Health care service use among vulnerable adolescents

Abstract

This article describes the patterns of health care service use among a cohort of vulnerable adolescents with a history of homelessness and uses the Expanded Behavioral Model for Vulnerable Populations to examine factors associated with use of ambulatory and emergent care. We incorporated a health care interview into an existing longitudinal study of newly homeless adolescents, at their 24-month assessment (n?=?183) and assessed their sociodemographic characteristics, including living situation, health insurance rates, having a regular source of care, substance use and health care service use in the past 3 months. By the 24-month assessment, 63% of youth had returned home and 37% were currently homeless. In comparing youth who were currently homeless and those who had returned home, we found similar rates for ambulatory care use (48%) and for emergent care use (15%). The most common reason for seeking ambulatory care related to sexually transmitted disease (STD) testing/HIV testing/reproductive health for both groups. However, currently homeless youth were more likely to seek emergent care for trauma (15% vs. 4%, p?<?0.01) and for common conditions such as skin problems/respiratory infections/gastrointestinal problems/other problems (16% vs. 7%, p?<?0.05). Using multivariate logistic regression, we found older age [odds ratio (OR) 2.6, 95% confidence interval (CI) 1.0–6.5] and health insurance (OR 2.3, 95% CI 1.1–4.5) to be associated with use of ambulatory care; however, only older age (OR 2.7, 95% CI 1.0–7.0) was found to be associated with use of emergent care. Housing status, emotional distress and substance use were not found to be associated with ambulatory or emergent care use. Our findings suggest that facilitating health insurance coverage for vulnerable adolescents with a history of homelessness may lead to increased use of ambulatory care services and may consequently prevent use of emergent care services for conditions that may be treated in the ambulatory care setting.     

One-Year Medical Utilization and Mortality in Home Health and Nursing Home Care Recipients from Northern Taiwan

ObjectivesHome health care (HHC) and nursing home care (NHC) are mainstays of long-term service in the aged population. Therefore, we aimed to investigate the factors associated with 1-year medical utilization and mortality in HHC and NHC recipients in Northern Taiwan.DesignThis study employed a prospective cohort design.Setting and ParticipantsWe enrolled 815 HHC and NHC participants who started receiving medical care services from the National Taiwan University Hospital, Beihu Branch between January 2015 and December 2017.MethodsMultivariate Poisson regression modeling was used to quantify the relationship between care model (HHC vs NHC) and medical utilization. Cox proportional-hazards modeling was used to estimate hazard ratios and factors associated with mortality.ResultsCompared with NHC recipients, HHC recipients had higher 1-year utilization of emergency department services [incidence rate ratio (IRR) 2.04, 95% CI 1.16-3.59] and hospital admissions (IRR 1.49, 95% CI 1.14-1.93), as well as longer total hospital length of stay (LOS) (IRR 1.61, 95% CI 1.52-1.71) and LOS per hospital admission (IRR 1.31, 95% CI 1.22-1.41). Living at home or in a nursing home did not affect the 1-year mortality.Conclusions and ImplicationsCompared with NHC recipients, HHC recipients had a higher number of emergency department services and hospital admissions, as well as longer hospital LOS. Policies should be developed to reduce emergency department and hospitalization utilization in HHC recipients.