Functional Recovery Within a Formal Home Care Program

Practice Patterns and Responses to the Patient-Driven Groupings Model and Coronavirus Disease 2019 Pandemic in Home Health Occupational Therapy: A Pilot Survey Study

The purpose of the pilot survey was to understand current practice patterns and responses to the Patient-Driven Groupings Model and the coronavirus disease 2019 (COVID-19) pandemic in home health occupational therapy care. Fifty home health occupational therapy practitioners from 27 states in the United States completed the survey. Descriptive analysis was used to organize and summarize survey responses. The survey items on practice patterns included assessment tools, treatment approaches, and care coordination with physical therapy colleagues. The most reported assessment of occupational performance was the Barthel Index. The common treatment approaches included activities of daily living retraining, energy conservation, and functional mobility and transfer. The majority of respondents (n = 44) communicated with their physical therapy colleagues at least once a week. The communications were often related to scheduling and changes in a patient's condition. Seventy percent of practitioners experienced a reduction in home visits during the recent Medicare payment reform and the pandemic. These practitioners perceived that some patients might have been discharged from home health care prematurely. Additional studies to investigate the impact of policy changes and the pandemic on therapy intensity and patients' functional outcomes are warranted.

Demand and influencing factors of "Internet + Traditional Chinese Medicine" home nursing service for older adult patients with chronic diseases: a mixed research perspective

Background

In the context of global aging, the characteristics of chronic diseases seriously affect the quality of life of older adults. It is urgent to carry out continuous nursing basis for older adult patients with chronic diseases. In view of the remarkable efficacy of Chinese medicine in the treatment of chronic diseases, this study may help to understand the demand for "Internet + Chinese medicine" home care service and its influencing factors of older adult chronic disease patients, and to provide a reference basis for improving the quality of life of the older adult chronic disease population.

Methods

This is a mixed study. The quantitative study adopted the convenience sampling method, and a total of 308 patients in a third-grade hospital in Shaanxi Province were investigated by general data questionnaire, traditional Chinese medicine service demand questionnaire, traditional Chinese medicine knowledge questionnaire, older adult Chinese medicine attitude questionnaire, and home care demand questionnaire from March to April 2022. In the qualitative study, semi-structured interviews were adopted, and patients were interviewed until the content was saturated. Colaizzi analysis method was used to analyze and summarize the topic of the interview data.

Results

308 valid questionnaires were collected, and the patients scored (58.42 ± 17.16) on the demand for TCM nursing services, (59.86 ± 11.54) on the knowledge of TCM, (73.03 ± 9.11) on the attitude toward TCM, and (136.84 ± 46.39) on the demand for home care. The results of multiple linear regression showed that learning about the nursing service pathway, knowledge of general knowledge of Chinese medicine, and attitude toward Chinese medicine among the older adult and home care demand were the influencing factors of the demand for Chinese medicine nursing services for older adult patients with chronic diseases (p < 0.05). The results of the in-depth interviews were summarized into three themes: facilitating factor, hindering factor, and the "Internet + Chinese medicine" multiple needs of home care.

Conclusion

Older adult patients with chronic diseases have a high intention of home care demand and they are affected by multiple factors. Consequently, the actual demand situation of older adult patients with chronic diseases should be used as a guide to provide directed and diversified Chinese medicine home care services to meet the individualized needs of the older adult.

Inter-provincial variation in older home care clients and their pathways: a population-based retrospective cohort study in Canada

BACKGROUND

In Canada, publicly-funded home care programs enable older adults to remain and be cared for in their home for as long as possible but they often differ in types of services offered, and the way services are delivered. This paper examines whether these differing approaches to care shape the pathway that home care clients will take. Older adult client pathways refer to trajectories within, and out of, the home care system (e.g., improvement, long term care (LTC) placement, death).

METHODS

A retrospective analysis of home care assessment data (RAI-HC was linked with health administrative data, long-term care admissions and vital statistics in Nova Scotia Health (NSH) and Winnipeg Regional Health Authority (WRHA). The study cohort consists of clients age 60 + years, admitted to home care between January 1, 2011 to December 31, 2013 and up to four years from baseline. Differences in home care service use, client characteristics and their pathways were tested across the two jurisdictions overall, and among the four discharge streams within jurisdictions using t-tests and chi-square tests of significance.

RESULTS

NS and WHRA clients were similar in age, sex, and marital status. NS clients had higher levels of need (ADL, cognitive impairment, CHESS) at base line and were more likely discharged to LTC (43% compared to 38% in WRHA). Caregiver distress was a factor correlated with being discharged to LTC. While a third remained as home care clients after 4 years; more than half were no longer in the community - either discharged to LTC placement or death. Such discharges occurred on average at around two years, a relatively short time period.

CONCLUSIONS

By following older clients over 4 years, we provide enhanced evidence of client pathways, the characteristics that influence these paths, as well as the length of time to the outcomes. This evidence is central to identification of clients at risk in the community and aids in planning for future home care servicing needs that will allow more older adults to remain living in the community.

Biomarkers of aging in real life: three questions on aging and the comprehensive geriatric assessment

Measuring intrinsic, biological age is a central question in medicine, which scientists have been trying to answer for decades. Age manifests itself differently in different individuals, and chronological age often does not reflect such heterogeneity of health and function. We discuss here the value of measuring age and aging using the comprehensive geriatric assessment (CGA), cornerstone of geriatric medicine, and operationalized assessment tools for prognosis. Specifically, we review the benefits of employing the multidimensional prognostic index (MPI), which collects information about eight domains relevant for the global assessment of the older person (functional and cognitive status, nutrition, mobility and risk of pressure sores, multi-morbidity, polypharmacy, and co-habitation), in the evaluation of the functional status, and in the prediction of health outcomes for older adults. Further integration of biological markers of aging into multidimensional prognostic tools is warranted, as well as actions which could facilitate prognostic assessments for older persons in all healthcare settings.

Examining the effect of the first wave of the COVID-19 pandemic on home care recipients’ instrumental activities of daily living capacity

Objective

To examine the effect of the pandemic on, and factors associated with, change in home care (HC) recipients’ capacity for instrumental activities of daily living.

Design

Retrospective cohort study.

Setting and participants

HC recipients in Ontario, Canada, between September 1, 2018, and August 31, 2020, who were not totally dependent on others and not severely cognitively impaired at baseline.

Methods

Data were collected with the interRAI Home Care assessment. Outcomes of interest were declines in instrumental activities of daily living. Factors hypothesized to be associated with declining function were entered as independent variables into multivariable generalized estimating equations, and results were expressed as odds ratios (ORs) with 95% confidence intervals (CIs). Those significant at P < .01 were retained in the final models.

Results

There were 6786 and 5019 HC recipients in the comparison and pandemic samples, respectively. Between baseline and follow-up for the 2 groups, 34.1% and 42.1% of HC recipients declined in shopping, whereas 25.2% and 30.5% declined in transportation capacity in the comparison and pandemic sample, respectively. For shopping, those with cognitive impairment (OR 0.83, 95% CI 0.76-0.89) and receiving formal care (OR 0.72, 95% CI 0.62-0.85) were less likely to decline, whereas those who were older (OR 1.91, 95% CI 1.69-2.16) and had unstable health (OR 1.31, 95% CI 1.16-1.48) were more likely. For transportation, those receiving informal (OR 0.71, 95% CI 0.61-0.81) or formal care (OR 0.56, 95% CI 0.47-0.67) were less likely to decline, whereas those who were older (OR 1.81, 95% CI 1.58-2.07) and had unstable health (OR 1.35, 95% CI 1.119-1.54) were more likely.

Conclusions and implications

The pandemic was associated with a decline in HC recipients’ capacity for shopping and transportation. HC recipients who are older and have unstable health may benefit from preventive strategies.

Predictors of Frailty Change in Home and Community-Based Services Populations

OBJECTIVES

With unprecedented demand for Medicaid long-term services and supports, states are seeking to allocate resources in the most efficient way. Understanding the prevalence of frailty and how it varies across home and community-based services (HCBS) populations can assist states with more precise identification of individuals most in need of services. Early identification of individuals more likely to experience frailty changes could allow for enhanced care planning to prevent or slow the progression of decline.

DESIGN

Longitudinal study.

SETTING AND PARTICIPANTS

Data from Connecticut's assessment tool (based on interRAI-HC) were analyzed at 2 time points for 16,309 individuals receiving HCBS. The sample included assessments completed between November 1, 2017 and July 15, 2020 across 4 groups: older adults 65+ years old meeting nursing facility level of care (NF LOC), older adults 65+ years old not meeting NF LOC, individuals with acquired brain injury, and individuals <65 years old with physical disability.

METHODS

We measured frailty using the Frailty Index (FI) and examined change in FI between baseline and follow-up. A change in FI score of at least ±0.03 was classified as a clinically meaningful change. We compared predictors of clinically meaningful decline or improvement using multivariate logistic regression.

RESULTS

In our sample, 54% of individuals experienced a clinically meaningful change: 42% declined and 12% improved. Individuals receiving in-home care services had lower odds of improvement across all HCBS groups and multiple frailty categories with odds ratios ranging from 0.35 to 0.68. Frail older adults 65+ years old meeting nursing facility level of care receiving physical therapy were 21% less likely to experience decline and 1.4 times more likely to improve.

CONCLUSIONS AND IMPLICATIONS

The nature of HCBS support provided can impact changes in frailty status. More reactive services such as in-home care may contribute to frailty decline while rehabilitative services such as physical therapy may protect against decline.