Older Australian home-care clients who screen positive for depression

Unmet Behavioral Health and Social Needs of Home Healthcare Patients and Their Caregivers

Lack of recognition and treatment of mental health disorders in the home healthcare (HHC) population has been recognized as a national public health problem. However, there is a gap in understanding the behavioral health needs of HHC patients and caregivers from the perspectives of HHC patients, caregivers, and HHC personnel. These perspectives are critical for informing an acceptable and scalable integrated care model. We conducted semi-structured interviews with HHC patients, caregivers, and HHC personnel to assess the unmet behavioral health needs of HHC patients and their caregivers. Participants were recruited from a Medicare-certified HHC agency that is part of a large health system on the east coast. We completed a total of 31 interviews between January and May 2020. Findings suggest that HHC patients have significant unmet behavioral health and social needs and their caregivers are emotionally and physically drained. Reasons that patients may not be receiving adequate behavioral health services include denial, cost, culture, lack of awareness of available resources, lack of transportation, and homebound status. While most patients discussed the emotional toll of their illness, few were connected to services. HHC personnel offered suggestions on how to meet the behavioral health needs of patients, with the primary focus on providing in-home options. Gaps in meeting the needs of the HHC population necessitate integrated care models that can effectively address the behavioral health and social needs of HHC patients and their families. Future research should develop and test patient and caregiver-directed integrated care models in the HHC setting.

Screening for Depression Among Older Adults Referred to Home Care Services: A Single-Item Depression Screener Versus the Geriatric Depression Scale

Older adults requiring home care service have a high risk of depression. Instruments for detecting depression among older adults, however, are often too long and detailed for easy administration by nontrained staff in large service-based settings.This study examined the measurement properties (test—retest reliability, concurrent validity, and cross-modality correspondence) of a single-item screener for depressive symptoms among older adults receiving home care services. Reliability was assessed ( n = 65) by administering the single-item depression screener to the same participants on two occasions 7 days apart. Validity was assessed ( n = 191) by comparing depressed participants from the single-item depression screener versus Geriatric Depression Scale (criterion measure). Responses to the single-item depression screener administered by telephone and face-to-face interview were also compared. Findings suggest that the single-item depression screener has fair levels of reliability, validity, and cross-modality correspondence and could be used among home care recipients as a screening tool, provided that depression status is confirmed via in-depth questionnaires, interviews, or a clinical diagnosis.