"This case is closed": family caregivers and the termination of home health care services for stroke patients

Policies promoting home- and community-based services and disease management models implicitly rely on family care, still the bedrock of long-term and chronic care in the United States. The United Hospital Fund studied family caregivers of stroke and brain injury patients when home care cases were opened and closed and found that even with short-term formal services, family caregivers provided three-quarters of the care. Patients' mobility impairments and Medicaid eligibility were the main factors in determining the amount and duration of formal services. Between one-third and one-half of family caregivers reported being inadequately prepared for the case closing. At all stages, family caregivers expressed significant isolation, anxiety, and depression. Therefore, home care agency practice and public policies should provide better education, support, and services for family caregivers.     

家庭远程监护网络系统设计

本文设计了一种家庭医疗保健远程监护网络系统，并详细介绍了远程监护技术与家庭医疗保健相结合的应用实例——家庭远程监护网络。     

Role perceptions and clinical reasoning of community health occupational therapists undertaking home visits

This paper presents the findings of a survey that aimed to: (i) describe the work of metropolitan Community Health Occupational Therapists (CHOTs) in Victoria; and (ii) to obtain basic information regarding the clinical reasoning CHOTs use during home visit assessments. Based on a literature review and clinical experience, a questionnaire was designed to elicit information about CHOT role perceptions and clinical reasoning. Questionnaires were mailed to all 50 CHOTs in metropolitan Melbourne. Thirty-six responses were received (a response rate of 72%). Exploratory data analysis procedures were used to summarize the demographic data and closed questions. A series of open-ended questions and four case scenarios were analysed qualitatively. The findings indicated that the majority of community health occupational therapists were mature in age, widely experienced, and client centred in their diverse practice roles. Generally, they were highly confident of their skills in client-related tasks and enjoyed the main components of their roles, particularly home visiting. Participant responses to the four case scenarios indicated that they used procedural, interactive and conditional reasoning to identify the most important factors to consider, the action they would take, and whether they would see the client again. In conclusion, while the findings of this survey provide an overview of CHOT work in Victoria, further studies are urgently required to explore the clinical reasoning that supports this aspect of occupational therapy practice.     

Disparities in home health service providers among Medicare beneficiaries with stroke

This study examined the intensity of home health services, as defined by the number of visits and service delivery by rehabilitation specialists, among Medicare beneficiaries with stroke. A cross-sectional secondary data analysis was conducted using 2009 home health claims data obtained from the Centers for Medicare and Medicaid Services’ Research Data Assistance Center. There were no significant rural-urban differences in the number of home health visits. Rural beneficiaries were significantly less likely than urban beneficiaries to receive services from rehabilitation specialists. Current home health payment reform recommendations may have unintended consequences for rural home health beneficiaries who need therapy services.     

Excellence in regional stroke care: An evaluation of the implementation of a stroke care unit in regional Australia

Objective: To assess the effectiveness of a formalised stroke service in a regional hospital. Design: A pretest post‐test design. Setting: An acute stroke unit in a regional health service. Participants: Overall sample comprised 80 patients with 36 (45.0%) men. Forty patients (19 men, 21 women) comprised pre‐intervention group and 40 (17 men, 23 women) post‐intervention group. Interventions: Establishment of an acute stroke unit. Main outcome measure(s): Increased frequency in meeting key performance indicators for acute stroke care as recommended by National Stroke Foundation. Results: On discharge, fewer survivors in the pre‐intervention group were independent (n = 5) and returned home (n = 9) than the post‐intervention group (n = 13) for both independent and returned home. More survivors in the pre‐intervention group were discharged to aged care or inpatient rehab (n = 22) than the post‐intervention group (n = 12). Within required time frames, the frequency of CT scans (χ² (1, 80) = 4.1, P < 0.05), swallow assessments (χ² (1, 80) = 9.0, P < 0.01), occupational therapy assessments (χ² (1, 80) = 14.5, P < 0.0001), multidisciplinary meetings involving patient and family (χ² (1, 80) = 19.9, P < 0.0001) and self‐management plans (χ² (1, 80) = 10.9, P < 0.05) all increased significantly. Conclusions: Our evaluation demonstrated that introduction of formalised stroke care to a regional hospital resulted in improved compliance with key performance indicators and better patient outcomes. Thus evidence‐based specialised stroke care can be offered with confidence in regional populations.     

The mortality effects of changing public funding for home health care: An empirical analysis of Medicare home health care in the United States

In light of population aging, it is important to understand whether limiting public in‐kind transfers to the elderly affects elderly mortality. I focus on home health care—a popular in‐kind transfer—and I exploit variation in the Medicare home health care reimbursement that arose in 1997 in the United States to study whether cuts to government coverage of home health care affected elderly mortality. Under the identifying assumptions of the DID model, I find that the cuts affected total mortality for some men but not women, suggesting that changes in home health care can affect elderly mortality and differences in mortality between men and women. For men aged between 65 and 74, the Interim Payment System was associated with an increase in mortality equal to 0.6%, an effect in absolute value comparable to the mortality response to a one percentage point change in unemployment rates and within the range of other estimates of the impact of health insurance on elderly mortality.     

Predictors and patterns of home health care utilization among older adults in Shanghai,China

The objective of this study is to explore the predictors and patterns of home health care among older adults in Shanghai, China. A cross-sectional survey was conducted in the Yangpu and Pudong Districts of Shanghai from August to September of 2015. A total of 982 eligible seniors were chosen for interviews based on a stratified random sample. Four home health care patterns were identified through an exploratory factor analysis: daily living care, skilled nursing care, chronic care, and episodic care. Findings suggest that need factors have more influence on home health care use than predisposing factors.     

A qualitative exploration of oral health care among stroke survivors living in the community

BackgroundDental disease is highly prevalent in people with stroke. Stroke survivors regard oral hygiene as an important, yet neglected, area. The aim was to explore experiences of and barriers to oral care, particularly in relation to oral hygiene practice and dental attendance, among stroke survivors in the community.MethodsThis was a qualitative study incorporating a critical realist approach. Interviews were conducted with community‐dwelling stroke survivors requiring assistance with activities of daily living, and focus groups were held with health and care professionals. Interviews and focus groups were recorded and transcribed verbatim. Thematic analysis was conducted.ResultsTwenty‐three stroke survivors were interviewed, and 19 professionals took part in 3 focus groups. Professionals included nurses, speech and language therapists, occupational therapists, dieticians, professional carers and dental staff. Interviews revealed difficulties in carrying out oral hygiene self‐care due to fatigue, forgetfulness and limb function and dexterity problems. Routine was considered important for oral hygiene self‐care and was disrupted by hospitalization resulting from stroke. Professionals highlighted gaps in staff training and confidence in supporting patients with oral care. Access to dental services appeared particularly problematic for those who were not registered with a dentist pre‐stroke.ConclusionOral hygiene routines may be disrupted by stroke, and resulting disabilities may make regular oral self‐care more difficult. This study has identified specific barriers to oral hygiene self‐care and dental service access. Findings from this study are feeding into the development of an intervention to support stroke survivors with oral care.     

Evolution of a 90-day model of care for bundled episodic payments for congestive heart failure in home care

The Centers for Medicare and Medicaid Services Innovation Center’s Episode-Based Payment initiatives propose a large opportunity to reduce cost from waste and variation and stand to align hospitals, physicians, and postacute providers in the redesign of care that achieves savings and improve quality. Community-based organizations are at the forefront of this care redesign through innovative models of care aimed at bridging gaps in care coordination and reducing hospital readmissions. This article describes a community-based provider’s approach to participation under the Bundled Payments for Care Improvement initiative and a 90-day model of care for congestive heart failure in home care.