Chronic kidney disease and support provided by home care services: a systematic review

BACKGROUND

Chronic diseases, such as chronic kidney disease (CKD), are growing in incidence and prevalence, in part due to an aging population. Support provided through home care services may be useful in attaining a more efficient and higher quality care for CKD patients.

METHODS

A systematic review was performed to identify studies examining home care interventions among adult CKD patients incorporating all outcomes. Studies examining home care services as an alternative to acute, post-acute or hospice care and those for long-term maintenance in patients' homes were included. Studies with only a home training intervention and those without an applied research component were excluded.

RESULTS

Seventeen studies (10 cohort, 4 non-comparative, 2 cross-sectional, 1 randomized) examined the support provided by home care services in 15,058 CKD patients. Fourteen studies included peritoneal dialysis (PD), two incorporated hemodialysis (HD) and one included both PD and HD patients in their treatment groups. Sixteen studies focused on the dialysis phase of care in their study samples and one study included information from both the dialysis and pre-dialysis phases of care. Study settings included nine single hospital/dialysis centers and three regional/metropolitan areas and five were at the national level. Studies primarily focused on nurse assisted home care patients and mostly examined PD related clinical outcomes. In PD studies with comparators, peritonitis risks and technique survival rates were similar across home care assisted patients and comparators. The risk of mortality, however, was higher for home care assisted PD patients. While most studies adjusted for age and comorbidities, information about multidimensional prognostic indices that take into account physical, psychological, cognitive, functional and social factors among CKD patients was not easily available.

CONCLUSIONS

Most studies focused on nurse assisted home care patients on dialysis. The majority were single site studies incorporating small patient populations. There are gaps in the literature regarding the utility of providing home care to CKD patients and the impact this has on healthcare resources.

[The admission to Nursing Homes and Home care services of elderly patients: analysis of the trend from 2008 to 2011 in a North Italian district]

INTRODUCTION

The effects of the economic crisis impact on several aspects, included the use of health and social services.

AIM

To analyze the effects of the economic recession on the request of in-home and long run social-health services.

METHODS

Retrospective research. The databases of a In-home Nursing Service, the Social Services and the Welfare area of a Social-Health Local Service in North of Italy have been consulted, with reference to the period between 31st December 2008 to 31st December 2011.

RESULTS

From 2008 to 2011 the users supported by the In-Home Nursing Service increased by 30.3% while a decrease in the waiting lists for public and private nursing homes was observed. The users of In-Home Assistance Service decreased by 11%, as well as recipients of In-Home Meal Service (33%). Since 2008, the number of regional economic allowance beneficiaries dramatically increased; these allowances are dispensed as a support to In-Home Nursing Service and to social frailty.

CONCLUSIONS

Profound changes of the offer and use of long term care services is evident. The endurance of this trend could impair the In-Home Nursing Services ability to answer to health needs of citizens. Health care professionals should strengthen the educational interventions to improve the level of patients'self care.

Decreasing role strain for caregivers of veterans with dependence in performing activities of daily living

In response to the implementation of new Patient Aligned Care Teams (PACT) within the Veterans Administration health care system, the interdisciplinary nature of social work in health care settings is expanding to address emerging needs of veterans and their caregivers. One such area of expansion is the receipt of extended care services in the veteran's home environment. Social workers within PACT, also known as the patient-centered medical home, are tasked with movement of health care resources and care coordination centered around veterans in their residences. This presents social workers in the health care setting with new challenges for dealing with high burden and role strain for caregivers of veterans in noninstitutional settings who are dependent in performing activities of daily living. The current article establishes an approach, grounded in community science, for interventions within the Veterans Health Administration aimed at alleviating caregivers' role strain when caring for veterans with functional disabilities while optimizing implementation of home care and care coordination.

Study protocol: translating and implementing psychosocial interventions in aged home care the lifestyle engagement activity program (LEAP) for life

BACKGROUND

Tailored psychosocial activity-based interventions have been shown to improve mood, behaviour and quality of life for nursing home residents. Occupational therapist delivered activity programs have shown benefits when delivered in home care settings for people with dementia. The primary aim of this study is to evaluate the effect of LEAP (Lifestyle Engagement Activity Program) for Life, a training and practice change program on the engagement of home care clients by care workers. Secondary aims are to evaluate the impact of the program on changes in client mood and behaviour.

METHODS/DESIGN

The 12 month LEAP program has three components: 1) engaging site management and care staff in the program; 2) employing a LEAP champion one day a week to support program activities; 3) delivering an evidence-based training program to care staff. Specifically, case managers will be trained and supported to set meaningful social or recreational goals with clients and incorporate these into care plans. Care workers will be trained in and encouraged to practise good communication, promote client independence and choice, and tailor meaningful activities using Montessori principles, reminiscence, music, physical activity and play. LEAP Champions will be given information about theories of organisational change and trained in interpersonal skills required for their role. LEAP will be evaluated in five home care sites including two that service ethnic minority groups. A quasi experimental design will be used with evaluation data collected four times: 6-months prior to program commencement; at the start of the program; and then after 6 and 12 months. Mixed effect models will enable comparison of change in outcomes for the periods before and during the program. The primary outcome measure is client engagement. Secondary outcomes for clients are satisfaction with care, dysphoria/depression, loneliness, apathy and agitation; and work satisfaction for care workers. A process evaluation will also be undertaken.

DISCUSSION

LEAP for Life may prove a cost-effective way to improve client engagement and other outcomes in the community setting.

TRIAL REGISTRATION

Australian New Zealand Clinical Trials Registry ACTRN12612001064897.

The home care industry in California is growing and largely unregulated

The home care industry is growing rapidly and coincides with increases in the growth of the elderly population, who are more frequently chronically ill and disabled and need assistance. This policy brief provides a profile of the home care industry and patients/consumers of these services in California, assessing available data on licensure and certification as a mechanism for promoting safety and quality of care. The findings indicate a dearth of information on the characteristics and care delivery of home care agencies and individual providers of nonmedical home care. The findings also illustrate that licensure and certification of home health agencies may enhance the capacity for improvements in quality of care. Establishing licensure and basic safety standards for home care agencies is a reasonable public health policy for reducing the potential for adverse consequences among the growing aging and disabled populations.