HOME HEALTH CARE SERVICES QUARTERLY最新文献

The primary purpose of this study was to explore the needs and challenges of African American family caregivers of People living with dementia (PLWD) from the perspective of service providers including healthcare and social service providers. The study conducted three online semi-structured focus group interviews with service providers (n = 15). Data were analyzed using Braun & Clarke's guide to thematic analysis approach. Five themes emerged from the analysis of the focus group data: (i) Inadequate information about resources; (ii) Dementia education; (iii) Burden of dementia on families; (iv) Limited financial support and funding; and (v) Suggestions for needed resources. Service providers expressed the lack of community-based dementia service and support programs in African American communities. Findings from the study indicated the need to provide culturally appropriate information on dementia caregiving. This study adds to the scope of knowledge by exploring the processes of seeking help and using services.

Homecare workers face significant occupational risks, necessitating effective safety training programs. This paper presents a comprehensive Train-the-Trainer (TTT) program developed to enhance occupational safety in homecare organizations. Through an analysis of 229 reported safety events, the frequency and type of incidents, such as injuries during handling, road crashes, slips, trips, and falls, were identified and primarily attributed to human errors and violations. Based on the results, a TTT program was designed and implemented. The TTT successfully engaged Health, Safety, and Environment managers, fostering collaborative activities, knowledge sharing, and resource discussions. The program modules address critical areas, including distractions and inattentions, fatigue, time pressure, frustration and aggressiveness, and safety behaviors. This innovative approach provides valuable insights for organizations seeking to improve homecare workers' safety. The findings add to the broader comprehension of occupational safety in the homecare sector, proposing a pragmatic framework for future interventions.

Older adults with low incomes experience disproportionate rates of cognitive and functional impairment and an elevated risk of nursing home admission. Home health aides (HHAs) may have insight into how to optimize aging in place for this population, yet little is known about HHAs' perspectives on this topic. We conducted 6 focus groups with 21 English-speaking and 10 Spanish-speaking HHAs in Pennsylvania and New Jersey. Transcripts were analyzed using qualitative thematic analysis, and three themes emerged. First, HHAs described the uniqueness of their role within multidisciplinary care teams. Second, HHAs shared concrete interventions they employ to help their clients improve their function at home. Third, HHAs discussed barriers they face when helping clients age in place. Our findings suggest that HHAs have important insights into improving aging in place for older adults with low incomes and that their perspectives should be incorporated into care planning and intervention delivery.

Medicaid funding for home- and community-based services (HCBS) has increased substantially in recent decades. Prior research has investigated the effects of this expansion on outcomes for individuals as well as costs to Medicaid, often using state policy as a proxy for access to HCBS or implicitly assuming that more generous policies affect outcomes through access, an assumption that may not hold. In this study, using survey data linked to Medicaid claims, we assess the extent to which common measures of state Medicaid HCBS generosity correspond to increased individual use of HCBS among older adults with potential needs. We find several measures to have strong predictive power, but only with relatively large changes in policy generosity. Our findings imply that increased funding of HCBS is not sufficient to ensure access to services and that researchers should be careful when using state policy generosity as a proxy for access.

Rigorous assessments to better understand the person-environment interaction are essential to comprehend how neurocognitive disorders influence in-home functioning of older people living with dementia. No recent synthesis identifies validated instruments targeting the human (e.g. caregivers) and nonhuman (e.g. objects) elements of the home environment interacting with this population and used with the perspective of aging in place. Consequently, following Arksey and O'Malley's (2005) scoping review method, 2,182 articles were identified in six databases and in gray literature. Two reviewers independently selected 23 relevant articles describing 19 validated assessment tools targeting elements of the home interacting with older people with dementia, namely: nonhuman environment (n = 13), human environment (n = 3), and person-environment interaction (n = 3). This overview highlights the scarcity of tools addressing the human environment and the person-environment interaction to foster sustainable at-home living for older people with neurocognitive disorders, demonstrating the need to incorporate new evidence-based, holistic methods into dementia home care.

Hospital to home transfers for older people require effective communication, coordination and collaboration across multiple service settings. Rural Nursing Theory and the Beyond Periphery model explain why this is particularly difficult in rural areas, but there are few examples of how rural services respond. This paper presents a case study of the district of Tärnaby in the inland north of Sweden. Data are drawn from interviews with health and care staff in Tärnaby, observations, and experiences of the researchers. Data were analyzed thematically, with four main themes emerging - role clarity, communication, geography, and understanding of the rural context. Responses to challenges included increasing opportunities for communication between service providers and improving documentation. The paper concludes that informal "workarounds" run the risk of further disconnecting rural service settings from "the city". Rather, the aim needs to be to improve contextual understanding through formally incorporating "the rural" in service design.

In Taiwan, the Integrated Home Care (IHC) project was introduced for medically compromised patients living at home receiving Home Health Care (HHC) in 2016. The focus of the project was on organizing care teams and managing care for patients. The aim of this study was to investigate the benefits and impacts of IHC in Taiwan. The primary outcome measure was the mortality rate of patients who received IHC versus those who did not receive IHC (non-IHC). The secondary outcomes were medical utilization and expenditure. The results showed that IHC was associated with a statistically significant reduction in mortality compared to non-IHC for home-dwelling patients over 90-, 180-, and 365-days periods. Additionally, IHC users were less likely to be hospitalized and had shorter hospitalization times compared to non-IHC users. Furthermore, IHC was found to reduce medical expenditure compared to non-IHC.

This observational-descriptive time and motion study was conducted to determine how heavy home care nurses' workload is and how they allocate their work time to home healthcare. It was carried out in the home health services of the district municipality.The Information form, Nursing Activities Report Form, Cheltenham Patient Classification Scale were used. The time-motion study method was implemented to perform the workload analysis. The nurses allocated 68.02 minutes to direct care, 61.02 minutes to indirect care, 53.26 minutes to their work unit-related activities, and 119.42 minutes to their personal activities.Among all the activities performed during the day, the longest time was allocated to educational activities. Another area that took a long time was the registration procedures. Performing workload analysis with different methods that will measure many concrete and intangible attempts of home care nurses will contribute to workforce planning in home care services, resolving of the unmet home care needs of patients and continuous quality improvement.

Evidence of effective self-care strategies to support Home Care Aides' (HCAs) mental health is limited. This study compares the feasibility of implementing one of two non-clinical, evidence-based stress-reduction treatments: mindful awareness practices (MAPs) meditation versus Korean-style Tai Chi. Program effectiveness was assessed on a range of self-reported health and mental health quantitative outcomes at three time-points. Both groups showed statistically significant improvements in depression, insomnia, and negative affect during the six weeks (all p. <0.05), but only the MAPs group demonstrated a sustained improvement in negative affect at three-month follow-up (p. <0.05). At three-month follow-up, 55% of Tai Chi participants continued practicing learned techniques, compared to 75% of MAPs participants. MAPs were found to be more practical and amenable to integration in daily life compared to Tai Chi. Showing positive results on both feasibility and effectiveness assessment, MAPs were chosen over Tai Chi to be scaled as a benefit to HCAs.