Profit and Non-Profit Home Health Care Agency Outcomes

The home health care industry, traditionally an industry of non-profit organizations, has increasingly become, as has the rest of the health care industry, invaded by for-profit organizations. The impetus for this invasion was the Omnibus Reconciliation Act (OBRA) of 1980 which encouraged previously restricted for-profit organizations to participate in the Medicare and Medicaid home health care program. Following enactment of OBRA, the number of for-profit organizations grew rapidly and the advantages and disadvantages of their presence in the market has been widely debated. The purpose of this study was to describe differences in behaviors and industry outcomes generated by non-profit and for-profit organizations in Massachusetts. Data for the study was from the Massachusetts State Department of Public Hcalth's Annual Reports of Home Health Agencies. Results suggest that while profit and non-profit agencies behave similarly in many areas, there are areas of difference, with significant differences found in the amount of service delivered and the rates charged.     

An Analysis of Injuries Among Home Health Care Workers Using the Washington State Workers' Compensation Claims Database

An examination of the Washington State workers' compensation claims for home health care workers was conducted. Some comparisons were made with nursing homes, acute care hospitals, and all other industries in the state. Between 1998 and 2007, the average claims rate for home health care workers was 1,375 claims/10,000 full-time equivalents (FTEs) compared to 862 claims/10,000 FTEs for all other industries. The proportion of home health care workers' injuries resulting from interactions with another person (89.6%) was comparable to those for nursing homes and hospitals. Although this industry has important economic and social value, risks are poorly characterized. Continued research is necessary.     

Home care workers' assessment of differences between nonprofit and for-profit organizations delivering home care services to the Israeli elderly

This paper presents research findings analyzing home care workers' assessment of the differences between nonprofit and for-profit organizations delivering home care services to Israel's frail elderly. The study focuses in particular on the workers' motives for choosing a particular employer, their empowerment, the training and enrichment programs available to them, and their perceptions of organizational fairness and performance. Nonprofit organizations received higher evaluations from workers than did for-profit organizations and invested more in the management of human resources.     

Intention to Leave the Job Among Live-In Foreign Home Care Workers in Israel

In Israel, almost all around-the-clock home care services are provided by foreign workers. Despite the fact that these workers are considered temporary, the Israeli government has acknowledged the need for consistency in care and now allows workers to stay in the country for as long as their care recipient is alive. Nonetheless, there have been increasing concerns about the tendency of foreign home care workers to view Israel as a temporary station on their way to more attractive destinations, such as Canada or England. Using the job rewards and concerns model, this article evaluates determinants of foreign home care workers' intentions to leave their job. This study was a cross-sectional analysis of 178 Filipino home care workers in Israel. Only 15 workers (8.4%) reported that they would be likely or very likely to leave their job within the next 3 months. The final model suggested that negative experiences within the home/work environment as well as within Israeli society at large contribute to depression and posttraumatic stress symptoms. However, caring for an older adult with dementia was the only predictor of intention to leave the job. The majority of workers do not report an intention to leave their job. Nonetheless, greater supervision of this caregiving arrangement in an attempt to protect the rights of foreign home care workers within the home/work environment is an important step, which has to be followed up by attitudinal changes within society at large. Specific training in dementia care is also warranted.     

Leadership and Quality of Working Life in Home Health Care

Home health care has undergone startling changes in the past decade and, in the process, become a strategically important ingredient of health care delivery. However, the question remains whether home health care organizations can deliver the benefits anticipated for integrated care delivery systems. The answer to this question depends to a great extent on whether home health care organizations build vibrant, visionary leadership capable of transforming organizations and motivating staff to deliver high quality and low cost services. This paper examines a case study of transformational leadership as it relates to the quality of working life for nurses, homemakers, and staff. The findings indicate that leader behavior is strongly associated with homemakers', and to a lesser extent staff members', job satisfaction, job involvement, and propensity to remain with the organization. These job attitudes have been shown to be related to higher job performance. The implications for leadership in home health agencies are discussed.     

Non-Profit and For-Profit Organizations in Home Care Services:

The paper analyzes differences in the organizational, structural and strategic behavior of Non-Profit Organizations and For-Profit Organizations in Israel which provide home care services for the frail elderly.

In contrastw to other studies which have analyzed differences between institutions delivering various social services in the profit and non-profit sectors, this paper focuses on those organizations supplying home care services in the community. The findings suggest that NPO's have qualitative and operational advantages over FPO's.     

Job Stress and Job Satisfaction: Home Care Workers in a Consumer-Directed Model of Care

Objective. To investigate determinants of job satisfaction among home care workers in a consumer‐directed model. Data Sources/Setting. Analysis of data collected from telephone interviews with 1,614 Los Angeles home care workers on the state payroll in 2003. Data Collection and Analysis. Multivariate logistic regression analysis was used to determine the odds of job satisfaction using job stress model domains of demands, control, and support. Principal Findings. Abuse from consumers, unpaid overtime hours, and caring for more than one consumer as well as work‐health demands predict less satisfaction. Some physical and emotional demands of the dyadic care relationship are unexpectedly associated with greater job satisfaction. Social support and control, indicated by job security and union involvement, have a direct positive effect on job satisfaction. Conclusions. Policies that enhance the relational component of care may improve workers' ability to transform the demands of their job into dignified and satisfying labor. Adequate benefits and sufficient authorized hours of care can minimize the stress of unpaid overtime work, caring for multiple consumers, job insecurity, and the financial constraints to seeking health care. Results have implications for the structure of consumer‐directed models of care and efforts to retain long‐term care workers.     

Profit and non-profit home health care agency outcomes: a study of one state's experience

The home health care industry, traditionally an industry of non-profit organizations, has increasingly become, as has the rest of the health care industry, invaded by for-profit organizations. The impetus for this invasion was the Omnibus Reconciliation Act (OBRA) of 1980 which encouraged previously restricted for-profit organizations to participate in the Medicare and Medicaid home health care program. Following enactment of OBRA, the number of for-profit organizations grew rapidly and the advantages and disadvantages of their presence in the market has been widely debated. The purpose of this study was to describe differences in behaviors and industry outcomes generated by non-profit and for-profit organizations in Massachusetts. Data for the study was from the Massachusetts State Department of Public Health's Annual Reports of Home Health Agencies. Results suggest that while profit and non-profit agencies behave similarly in many areas, there are areas of difference, with significant differences found in the amount of service delivered and the rates charged.     

Correlates of Caregiver Strain in Home Health Care

Family caregivers(N = 183) caring for persons admitted to home health care agencies in Washington State were interviewed regarding their perceived caregiver strain. Perceived subjective strain was found to be significantly related to factors beyond home health care agency control such as age of the caregiver, sex of the care receiver, and the caregiver's health. Objective strain, however, was significantly related to factors such as the care receiver's functional status, types of tasks with which they require help, the number of caregiver hours spent performing these tasks, and the number of days the care receiver spends in bed. It is hypothesized that agencies can reduce perceived objective strain by improving patients' functional independence through nursing and therapy visits.     

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.     

Working Conditions in Home Care

Home care services make it possible for millions of older Americans to continue living in the community. Such services may enhance the recipients' quality of life while providing essential respite to family caregivers. But while there has been increasing recognition of the burden borne by the predominantly female family caregivers, there has been less attention to the plight of the home care workforce. With the growth of the home care industry, the burden of care has to some extent shifted from one category of female caregivers to another. This paper, based on a survey of 16 agencies and 1,900 workers, examines the employment conditions of home care workers in Washington state. The study reveals a pattern of harsh working conditions, low wages, and few benefits. The findings raise questions about the ethics and efficacy of government policies that are based on the exploitation of home care workers.     

Development of a Quality Ranking Model for Home Health Care Providers

This research aims to increase transparency and simplify consumer decision-making regarding the selection of a home health care provider. Currently, quality information on home health care providers is fragmented and difficult to interpret. In this study, a quality-ranking model is developed by selecting multidimensional quality indicators across multiple sources and respective weights using expert judgment. Given the weights and providers' performance on each quality indicator, a composite score is calculated that summarizes a home health care provider's overall quality level. This quality information empowers consumers to narrow their search and select the best-performing, most efficient providers.     

Older Widows' Expectations of Home Care Nurses

ABSTRACT

The concept of expectations has been integral to research on home care satisfaction, but little is known about expectations of home care. The aim of this longitudinal phenomenological study was to describe part of the personal-social context of older widows' experience of home care-that of holding expectations of home care nurses. Data were drawn from interviews over three years with the 11 women who had home care nurses. The context of the home care experience was featured by leaning on helpers more at this stage and by expecting the nurse to do what the nurse is supposed to do, with its five parts including expecting the nurse to know how to do what needs to be done. Findings exemplified conceptual overlap among standard realms of expectations, such as behaviors and outcomes, and revealed the relevance of such data in appraisals of home care quality.     

Home Care Resource Consumption and Patient Outcomes: What Are the Relationships?

ABSTRACT

This study examined empirical relationships between measures of home care resource consumption and patient outcome measures in a sample of 201 patients who began new episodes of home care with one often Medicare-certified home care agencies in Ohio. We found that, while the total volume of home care resource consumption (i.e., total visits and costs) was similar for patients whose episodes ended with discharge at home vs. hospitalization, patients discharged to hospitals consumed home care resources in a much shorter period of time. We also found that resource consumption patterns were very similar regardless of whether patients improved or declined in clinical and functional health during the episode of home care. Results suggest that home care agencies should carefully project both resource consumption and patient outcome targets when negotiating service contracts with managed care organizations, especially for Medicare patients.     

The Continuation of Home Care to Severely Impaired Children and Aged in Israel:

There are a growing number of children and aged with severe chronic health problems in the community. Mothers become the prime caregivers to these children and aging spouses or middle-aged offspring the caregivers to these aged. The services offered to these families are determined by economic and social conditions, as well as changing fashions, rather than knowledge of the patients' and caregivers' needs. The purpose of this study was to assess the impact of homecare upon families caring for children versus those caring for aged and these families' attitudes toward continuation of home care versus institutionalization. The families included in the study were drawn randomly from the case load of community nurses in central Israel. In-depth interviews were conducted with 92 families of severely impaired children and 181 families of severely impaired adults and aged in their homes. While the majority of both populations carry a heavy burden of caregiving over years. they also receive gratification from their ability to care for their patient at home. There is little difference between those caring for children and those caring for adults in their attitudes toward continuation of home care. Mental rather than physical impairment, a deteriorating illness trajectory; depression, aggression and tension of the care-giver, the absence of sufficient social support and home care services correspond with negative feelings toward continued home care. The perceived impact of caregiving responsibilities upon the caregivers' lives, the ability to tolerate and manage symptoms and above all the quality of the patient-caregiver relationship influenced the caregivers' attitudes toward institutionalization in both populations. Family attitude toward continued homecare and institutionalization of children and adults are compared and the needs for services discussed.     

Creating a Health-Promoting Group for Elderly Couples on a Home Health Care Program

The hospital home care social worker has a unique opportunity to develop a home-keeping, health-promoting group for frail elderly couples within his or her caseload. Through home visits, working as a filial professional, the worker enters, then strengthens the couples' pre-illness formal and informal support networks, and then goes on to create an additional informal peer support group, that meets in each others' homes. The group is capable of decreasing the chance of nursing home placement for all its members. It is proposed that home health care agencies within hospitals incorporate such groups into their regular programs.     

Exploring new operational research opportunities within the Home Care context: the chemotherapy at home

Home Care (HC) services provide complex and coordinated medical and paramedical care to patients at their homes. As health care services move into the home setting, the need for developing innovative approaches that improve the efficiency of home care organizations increases. We first conduct a literature review of investigations dealing with operation planning within the area of home care management. We then address a particular issue dealing with the planning of operations related to chemotherapy at home as it is an emergent problem in the French context. Our interest is focused on issues specific to the anti-cancer drug supply chain. We identify various models that can be developed and analyze one of them.     

Essential but Excluded: Building Disaster Preparedness Capacity for Home Health Care Workers and Home Care Agencies

COVID-19 has demonstrated the essential role of home care services in supporting community-dwelling older and disabled individuals through a public health emergency. As the pandemic overwhelmed hospitals and nursing homes, home care helped individuals remain in the community and recover from COVID-19 at home. Yet unlike many institutional providers, home care agencies were often disconnected from broader public health disaster planning efforts and struggled to access basic resources, jeopardizing the workers who provide this care and the medically complex and often marginalized patients they support. The exclusion of home care from the broader COVID-19 emergency response underscores how the home care industry operates apart from the traditional health care infrastructure, even as its workers provide essential long-term care services. This special article (1) describes the experiences of home health care workers and their agencies during COVID-19 by summarizing existing empiric research; (2) reflects on how these experiences were shaped and exacerbated by longstanding challenges in the home care industry; and (3) identifies implications for future disaster preparedness policies and practice to better serve this workforce, the home care industry, and those for whom they care.