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Medication adherence poses a significant challenge for older adults with chronic diseases. However, the evidence regarding the effectiveness of medication adherence interventions remains inconsistent. This review examined interventions designed to help this population adhere to their prescribed medications. PubMed, ProQuest, Ovid, Wiley Online Library, and the Cochrane databases were searched to identify full-text articles in English published between 2012 and 2022. Fifteen studies were included in the final analysis, encompassing a total of 7,093 older adults, of whom 3,793 were assigned to intervention groups and 3,300 to control groups. Various interventions were implemented, including health education, counseling, medication reminders, and assistive devices. Nurses or multidisciplinary teams administered most interventions. All studies demonstrated an improvement in medication adherence following the interventions. Notably, combining multiple interventions-particularly education and counseling with reminders and devices-proved to be more effective than a single intervention alone. Findings also suggest that strategies to improve adherence at home should emphasize practical aspects, including simplified medication regimens, the use of reminders or digital health tools, caregiver education, and regular follow-up from healthcare providers. Tailoring interventions to the realities of the home environment is crucial for enhancing treatment adherence and achieving better health outcomes for older adult patients with chronic diseases.

Serious illness conversations (SICs) are often delayed or avoided in community-based healthcare due to clinician discomfort and lack of training. Given that many patients wish to die at home, yet often do not, there is a need for structured communication training in home care and hospice settings to ensure the care we provide aligns with patient and family preferences. This quality improvement project aimed to assess whether a brief, structured, in-person training session could improve clinician confidence in conducting SICs. A pre-test/post-test design was used. Clinicians participated in a 1.5-hour in-person educational session that included a PowerPoint presentation. Surveys assessing clinician confidence were administered before and after the session. Subjects included 77 clinicians: registered nurses, licensed practical nurses, physical therapists, physical therapy assistants, occupational therapists, occupational therapy assistants, and social workers. Clinician confidence was measured using the End-of-Life Professional Caregiver Survey (EPCS), a validated 28-item Likert-style survey tool. Of 77 participants, 45 complete survey pairs were analyzed. Mean EPCS scores improved significantly from 2.4329±0.3959 pre-training to 2.6593±0.2979 post-training (p < .001). A 63% increase in palliative bridge patient identification was also observed. A brief, structured SIC training significantly improved clinician confidence and increased identification of palliative care bridge patients. By embedding SIC training within a community-based organization, this work demonstrated how modest interventions can catalyze a change in practice, reinforcing the idea that SICs are a standard of quality care rather than an optional enhancement.

HF is the most common reason for hospital admission and readmission of older adults and those readmitted within 30 days have a higher mortality rate at 6 months. The transition from hospital to community has been identified as a vulnerable time when patients must assume responsibility for their own care. No one strategy has been found to reduce 30-day readmissions or 6-month mortality rates. The Heart Failure Nurse Navigator (HFNN) is a home health registered nurse with specialized training in HF care. In this IRB-approved study, an HFNN visited intervention group participants once in the hospital, followed by weekly home visits for 1 month. Control group participants received usual care, with discharge teaching by nursing and follow-up with their provider. The qualitative research question was "What are the perceptions of older adults (≥65) with a diagnosis of HF who transition from hospital to home regarding care received from a Heart Failure Nurse Navigator?" Qualitative data were transcribed verbatim, then key thoughts and concepts were identified and organized into similar categories. Two main categories emerged: Personal Clarification of Patient Education, especially related to diet, exercise, and medications, and Feelings of Support, Reassurance, and Safety. Meeting the HFNN in the hospital was the beginning of the caring relationship that continued through the home visits. As the caring relationship developed, the HFNN, patient, and family determined together what mattered most during this crucial transition. Providing specialized HF instruction to home health nurses may give them a stronger base from which to offer comprehensive education, support, and reassurance to patients with HF.

Medication reconciliation was adopted as a National Patient Safety Goal by the Joint Commission in 2005 and is now standard practice across care settings. More recently, the concept of medication optimization has gained attention, recognizing that safe medication use requires more than reconciliation alone. Home healthcare (HHC) is one setting with a critical need for medication optimization. This work describes a pharmacist-led interdisciplinary team (IDT) effort to reduce hospitalization rates at Providence VNA Home Health by improving medication reconciliation, evaluation, and prescriber communication. The IDT developed a tool and a 1-hour training with operational definitions and scenarios for reconciliation and documentation, along with a separate training focused on medication evaluation. To assess training effectiveness, the primary outcome was to reduce 30-day hospitalizations among high-risk heart failure patients to below 12%. This outcome was met and sustained for 8 weeks post-implementation. A secondary goal-reducing 30-day rehospitalizations per Strategic Healthcare Programs (SHP)-was also met and sustained from April to December 2020. This quality improvement project demonstrated that enhancing medication reconciliation and evaluation in high-risk patients reduces hospitalizations. Reconciliation may be especially important in patients with two or more self-reported unreconciled medications in the EHR, which may signal suboptimal medication evaluation. Addressing the challenges HHC clinicians face in optimizing medications and reinforcing best practices can improve outcomes. Pharmacists play a key role in interdisciplinary teams in HHC, given the complexity of medications and their impact on quality measures.

Sutter Care at Home (SCAH), part of the not-for-profit Sutter Health integrated system, serves Northern California's Valley and Bay Areas through 14 licensed home health and nine hospice agencies, many of which reach rural communities. Like many home health organizations, SCAH has faced a persistent registered nurse (RN) shortage, challenging its ability to maintain care delivery standards. In response, executive leadership launched a 12-month Registered Nurse New Graduate Residency Program to recruit and support newly graduated RNs. This innovative program blends simulation and field-based learning to develop the clinical competence, confidence, and independence required for effective home health practice. The initiative addresses a critical regulatory challenge: California Department of Public Health requirements mandate 1 year of experience for home health nurses, historically limiting hiring to experienced RNs. Prior to the residency, administrators had to submit individual program flexibility requests for each new RN. This residency model demonstrates a sustainable and scalable solution to the home health nursing shortage. It allows organizations to safely integrate new graduates into the workforce while meeting state regulatory requirements. Other home health agencies facing similar workforce pressures may benefit from adopting structured residency programs and engaging with regulatory bodies to establish pathways for new graduate integration. By investing in new nurses early, organizations can build a more stable, prepared, and loyal home health workforce equipped to meet the growing demand for community-based care.

Managing wounds at home after hospital discharge is challenging when patients lack adequate wound care supplies. Many patients leave with only a limited supply, and navigating the complex process of acquiring additional materials through insurance often leads to delays. This disruption can impede healing and increase the risk of complications and hospital readmissions. Financial constraints, limited provider knowledge about insurance procedures, and rushed discharge processes further exacerbate this issue. Home health nurses are uniquely positioned to provide practical guidance on accessing affordable wound care supplies. This paper identifies evidence-based strategies that nurses can teach patients and caregivers to minimize costs while maintaining effective wound care. Key approaches include proactive advocacy for insurance-covered supplies, distinguishing between essential and non-essential products, reusing non-sterile items when appropriate, and purchasing affordable alternatives from low-cost retailers or online marketplaces. Additionally, practical case studies are presented to demonstrate how patients can optimize supply usage by substituting expensive products with cost-effective options, ensuring continuity of care without financial strain. By empowering patients with resourceful strategies and encouraging informed decision-making, home health nurses can play a pivotal role in reducing healthcare expenses and enhancing patient outcomes. Implementing these strategies can promote equitable access to essential wound care supplies, ultimately supporting successful home-based wound management. Further research, however, is needed to expand the evidence base on cost-effective wound care practices, particularly in resource-limited settings.