HOME HEALTH CARE SERVICES QUARTERLY最新文献

Peripheral arterial disease (PAD) causes narrowing of the lower extremity arteries and impacts daily living activities. This retrospective study (April 2023 - April 2024) examined 171 home care patients, with 31.6% diagnosed with PAD. Of these, 37.4% were fully dependent, 36.3% (n = 62) were severely dependent, 16.4% (n = 28) were moderately dependent, 7.0% (n = 12) were mildly dependent, 2.9% (n = 5) were independent, and PAD prevalence was higher among severely dependent patients. Dementia was identified as a significant risk factor for PAD. The high prevalence of PAD among severely dependent individuals suggests a potential link between lifestyle factors and PAD risk. The study highlights the need for further research on whether modifying PAD risk factors can enhance patient independence.

The COVID-19 pandemic has had serious consequences for older adults and individuals with chronic conditions, many of whom rely on long-term services and supports. In response to the pandemic, the federal government invested nearly $13 billion dollars for states to expand home and community-based services (HCBS) for older adults and persons with disabilities. States have several options to provide Medicaid-funded HCBS benefits including the 1915(i) HCBS benefit and 1915(k) Community First Choice program. This research uses event history analysis to model state adoption of these two optional Medicaid benefits. The results indicate that a Democratic governor and the state's unemployment rate were associated with states' adoption of the 1915(k) program, while the unemployment rate and the supply of home health agencies were associated with states' adoption of the 1915(i) benefit. Findings highlight similarities in factors associated with Medicaid HCBS program adoption as well as differences stemming from unique program attributes.

Telehealth, accelerated by the COVID-19 pandemic, has become essential in-home health care, particularly for individuals with spinal cord injury (SCI). However, traditional telehealth often lacks adequate remote intervention and monitoring for SCI patients. This study evaluated a novel telehealth trial using transcutaneous electrical stimulation (TES) with innovative approaches to improve bladder function in SCI patients. Fifteen participants completed daily 15-minute TES sessions over four weeks, supported by courier-delivered equipment, video conferencing, and online assessments with self-reported monitoring at home. The trial achieved 100% adherence, with 80% of participants expressing confidence in device use and 87% indicating willingness to continue TES. Most participants found the device user-friendly, and 66% reported symptom improvement. This study highlights the potential of telehealth trials to enhance access to care, improve patient outcomes, and promote health equity in home care settings, particularly during periods of restricted in-person healthcare delivery.

Community Home-Based Care (CHBC) workers around the world have not been satisfied with their work over the years. In South Africa, unfair labor practices and poor organization of CHBC work have recently led to strikes and unionization by caregivers. At the frontline of caregiving are black working-class women whose dominance illuminates how the intersections of gender, class and race contribute to care workers' precariat position. Regardless of the gendered precarious encounters, the 20 female CHBC workers from Soweto, South Africa, who participated in this study, are optimistic and resilient. This article visibilizes the optimism, resilience, positivity, self-empowerment, control, the gendered power, and agency that care workers exercise in response to the challenges that characterize care work. Beyond merely illuminating the gendered oppositional binaries, the article calls for the deconstruction of gendered hierarchies in care work to disrupt the exclusive participation of women in the global labor markets as care workers.

Elderly Health Care Voucher Scheme represents a form of demand-side subsidy given to the elders to choose a spectrum of medical services in the private medical sector. The current paper aims at (a) conducting a needs assessment of the scheme with an analytical framework of the Four A 's approach (i.e., availability, awareness, accessibility, and acceptance regarding a social program) and (b) evaluating whether the outcome measures of the scheme (i.e., the use of private healthcare services, the use of primary care and the empowerment of the elders in the choice of services) were achieved. The needs assessment concludes that the utilization rate of the elders, awareness and satisfaction rate are high. The positive sides concluded from the needs assessment, however, failed to turn into the fulfillment of outcome measures due to the structural barriers. Recommendations at short-term, medium-term and long-term are made.

This study assesses the impacts of the COVID-19 pandemic on healthcare access for Washington State Home Care Aides (HCAs). Analyzing 62 months of medical claims data from over 35,000 HCAs, the research reveals significant healthcare disruptions during the early pandemic, especially in outpatient settings. However, healthcare utilization rebounded swiftly, surpassing pre-COVID levels as new variants emerged. Furthermore, the analysis indicated significant decreases in healthcare utilization for respiratory conditions in later stages of the pandemic, suggesting that the implementation of non-pharmaceutical and pharmaceutical interventions played a crucial role in preventing the transmission of respiratory diseases. Notably, behavioral health-related utilization among HCAs increased significantly throughout most pandemic phases, underscoring the importance of enhancing behavioral health support during public health crises. This research represents the first comprehensive study unveiling the effects of the COVID-19 pandemic on HCAs' healthcare access and opening avenues for further research and policy development to support this essential workforce.

This study, conducted in June and July 2022 through purposive sampling, aimed to explore the relationship between sleep and health performance in 33 pairs of elderly individuals and their migrant caregivers in southern Taiwan. Participants completed a structured questionnaire and wore an Actiwatch for seven days. Pearson correlation and independent t-test were used for analysis. Nearly 50% of foreign home care workers suffered from insomnia, and 80% of elderly care recipients with disabilities experienced sleep disorders. The number of chronic illnesses and/or dementia among the elderly and insomnia among care workers were associated with poor self-perceived health (r = -0.667, p < .001) and sleep disorders among the elderly (r = 0.368, p = .035). The problem of caregiving should be addressed. Future studies should increase the sample size and extend the duration of the study to enhance the generalizability of the findings.

Systematic assessments of interprofessional collaboration barriers and enablers in long-term care settings are critical for delivering person-centered healthcare. However, research on factors influencing interprofessional collaboration in long-term care settings is limited. For this study, 65 healthcare professionals across multiple facilities experienced in long-term care in Japan participated in online focus group discussions and individual interviews to discuss cases. The qualitative data were analyzed using qualitative content analysis. Seven themes emerged: coordination, the need for care manager training, hierarchy among healthcare professionals, specialization but not the mind-set of overspecialization, casual conversations, electronic group communication tools, and excessive fear of personal information protection. These findings highlight the need to develop coordinator roles and for interprofessional education on the proper approach to personal information protection laws. Furthermore, daily casual conversations, the use of online platforms, and the prevention of patients being left behind due to overspecialization are required.

Critical nursing shortages and experiences of burnout present a significant challenge in the home and community care (HCC) health sector. Determining what factors influence resiliency could inform HCC organizations in developing recruitment and retention resources and strategies. This scoping review identified factors that influence professional resilience in nurses working in the HCC sector. From 1819 documents identified from database searches, using a librarian-informed strategy, eight articles were included. Two domains emerged for HCC nurses, that is, i) professional and work-related characteristics of being resilient; and ii) strategies to promote professional nurse resilience. One domain emerged addressing organizational infrastructure, policy and practices contributing to professional nurse resilience in the HCC sector. The findings revealed that resiliency in HCC nurses extends beyond individual characteristics as nurse professionals, and their personal "self-care" strategies as individual people. Further research is needed to disentangle personal and professional resilience in nurses working in the HCC sector.

The Hospital at Home model, called Hospital-in-Home (HIH) in the Department of Veterans Affairs, delivers coordinated, high-value care aligned with older adult and caregiver preferences. Documenting implementation barriers and corresponding strategies to overcome them can address challenges to widespread adoption. To evaluate HIH implementation barriers and identify strategies to address them, we conducted interviews with 8 HIH staff at 4 hospitals between 2010 and 2013. We utilized qualitative directed content analysis guided by the Consolidated Framework for Implementation Research (CFIR) and mapped identified barriers to possible strategies using the CFIR-Expert Recommendations for Implementing Change (ERIC) Matching Tool. We identified 11 barriers spanning 5 CFIR domains. Three implementation strategies - identifying and preparing champions, conducting educational meetings, and capturing and sharing local knowledge - achieved high expert endorsement for each barrier. A mix of strategies targeting resources, organizational readiness and fit, and leadership engagement should be considered to support the sustainability and spread of HIH.