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Espinosa CG, Vergez S, McDonald MV, Safford MM, Cho J, Tobin JN, Mourad O, Marcus R, Joanna Bryan Ringel J, Banerjee S, Dell N, Feldman P, Sterling MR. Leveraging home health aides to improve outcomes in heart failure: A pilot study protocol. Contemp Clin Trials 2024; 143:107570. [PMID: 38740297 DOI: 10.1016/j.cct.2024.107570] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Revised: 11/07/2023] [Accepted: 05/10/2024] [Indexed: 05/16/2024]
Abstract
Heart failure (HF) affects six million people in the U.S., is associated with high morbidity, mortality, and healthcare utilization.(1, 2) Despite a decade of innovation, the majority of interventions aimed at reducing hospitalization and readmissions in HF have not been successful.(3-7) One reason may be that most have overlooked the role of home health aides and attendants (HHAs), who are often highly involved in HF care.(8-13) Despite their contributions, studies have found that HHAs lack specific HF training and have difficulty reaching their nursing supervisors when they need urgent help with their patients. Here we describe the protocol for a pilot randomized control trial (pRCT) assessing a novel stakeholder-engaged intervention that provides HHAs with a) HF training (enhanced usual care arm) and b) HF training plus a mobile health application that allows them to chat with a nurse in real-time (intervention arm). In collaboration with the VNS Health of New York, NY, we will conduct a single-site parallel arm pRCT with 104 participants (HHAs) to evaluate the feasibility, acceptability, and effectiveness (primary outcomes: HF knowledge; HF caregiving self-efficacy) of the intervention among HHAs caring for HF patients. We hypothesize that educating and better integrating HHAs into the care team can improve their ability to provide support for patients and outcomes for HF patients as well (exploratory outcomes include hospitalization, emergency department visits, and readmission). This study offers a novel and potentially scalable way to leverage the HHA workforce and improve the outcomes of the patients for whom they care. Clinical trial.gov registration: NCT04239911.
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Affiliation(s)
| | - Sasha Vergez
- Center for Home Care Policy & Research, VNS Health, New York, NY, USA
| | | | | | - Jacklyn Cho
- Renaissance School of Medicine at Stony Brook University, Stony Brook, NY, USA
| | - Jonathan N Tobin
- Clinical Directors Network (CDN) and The Rockefeller University Center for Clinical and Translational Science, New York, NY, USA
| | - Omar Mourad
- Weill Cornell Medicine- Qatar, Qatar Foundation - Education City, Doha, Qatar
| | - Rosa Marcus
- Center for Home Care Policy & Research, VNS Health, New York, NY, USA
| | | | | | | | - Penny Feldman
- Center for Home Care Policy & Research, VNS Health, New York, NY, USA
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2
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Franzosa E, Judon KM, Gottesman EM, Koufacos NS, Runels T, Augustine M, Van Houtven CH, Boockvar KS. Improving Care Coordination Between Veterans Health Administration Primary Care Teams and Community Home Health Aide Providers: A Qualitative Study. J Appl Gerontol 2023; 42:552-560. [PMID: 36464953 DOI: 10.1177/07334648221142014] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/09/2022] Open
Abstract
Effective coordination between medical and long-term services is essential to high-quality primary care for older adults, but can be challenging. Our study assessed coordination and communication through semi-structured interviews with Veterans Health Administration (VHA) primary care clinicians (n = 9); VHA-contracted home health agencies (n = 6); and home health aides (n = 8) caring for veterans at an urban VHA medical center. Participants reported (1) establishing home health services is complex, requiring collaboration between many individuals and systems; (2) communication between medical teams and agencies is often reactive; (3) formal communication channels between medical teams and agencies are lacking; (4) aides are an important source of patient information; and (5) aides report important information, but rarely receive it. Removing structural communication barriers; incentivizing reporting channels and information sharing between aides, agencies, and primary care teams; and integrating aides into interdisciplinary teams may improve coordination of medical and long-term care.
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Affiliation(s)
- Emily Franzosa
- Geriatric Research, Education and Clinical Center (GRECC), 20071James J. Peters VA Medical Center, Bronx, NY, USA.,Brookdale Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Kimberly M Judon
- Geriatric Research, Education and Clinical Center (GRECC), 20071James J. Peters VA Medical Center, Bronx, NY, USA
| | - Eve M Gottesman
- Geriatric Research, Education and Clinical Center (GRECC), 20071James J. Peters VA Medical Center, Bronx, NY, USA
| | - Nicholas S Koufacos
- Geriatric Research, Education and Clinical Center (GRECC), 20071James J. Peters VA Medical Center, Bronx, NY, USA
| | - Tessa Runels
- Pain, Research, Informatics, Medical Comorbidities, and Education (PRIME) Center, 583458VA Connecticut Healthcare System, West Haven, CT, USA
| | - Matthew Augustine
- Geriatric Research, Education and Clinical Center (GRECC), 20071James J. Peters VA Medical Center, Bronx, NY, USA.,Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Courtney H Van Houtven
- Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT), Durham VA Health System HSR&D, Durham, NC, USA.,Department of Population Health Sciences, School of Medicine, Duke University, Durham, NC, USA.,Duke-Margolis Center for Health Policy, Durham, NC, USA.,Duke Center for the Study of Aging and Human Development, Durham, NC, USA
| | - Kenneth S Boockvar
- Geriatric Research, Education and Clinical Center (GRECC), 20071James J. Peters VA Medical Center, Bronx, NY, USA.,Brookdale Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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3
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Russell D, Fong MC, Gao O, Lowenstein D, Haas M, Wiggins F, Brickner C, Franzosa E. Formative Evaluation of a Workforce Investment Organization to Provide Scaled Training for Home Health Aides Serving Managed Long-Term Care Plan Clients in New York State. J Appl Gerontol 2022; 41:1710-1721. [PMID: 35420904 DOI: 10.1177/07334648221084182] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
As part of its Medicaid program restructuring, New York State funded 11 Workforce Investment Organizations (WIO) to support training initiatives for the long-term care workforce. Focusing on one WIO, this formative evaluation examined quality improvement training programs delivered to 11,163 Home Health Aides employed by home care agencies serving clients of Managed Long-Term Care plans. Results are presented from a thematic analysis of qualitative interviews with organizational and program stakeholders examining contextual factors influencing program objectives, implementation, barriers and facilitators, and perceived outcomes. Findings suggested that WIO training programs were implemented during a period of shifting organizational strategies alongside value-based payment reforms and challenges to aide recruitment and retention. Stakeholders appraised WIO training programs positively and valued program flexibility and facilitation of communication and collaboration between agencies and plans. However, delivery and implementation challenges existed, and industry-wide structural fragmentation led stakeholders to question the WIO's larger impact.
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Affiliation(s)
- David Russell
- Department of Sociology, 1801Appalachian State University, Boone, NC, USA.,Center for Home Care Policy & Research, 44198Visiting Nurse Service of New York, New York, NY, USA
| | - Mei-Chia Fong
- Business Intelligence and Analytics, 44198Visiting Nurse Service of New York, New York, NY, USA
| | - Oude Gao
- Business Intelligence and Analytics, 44198Visiting Nurse Service of New York, New York, NY, USA
| | - Dan Lowenstein
- Business Intelligence and Analytics, 44198Visiting Nurse Service of New York, New York, NY, USA
| | - Marian Haas
- Business Intelligence and Analytics, 44198Visiting Nurse Service of New York, New York, NY, USA
| | - Faith Wiggins
- 1199SEIU Home Care Industry Education Fund, New York, NY, USA
| | - Carlin Brickner
- Business Intelligence and Analytics, 44198Visiting Nurse Service of New York, New York, NY, USA
| | - Emily Franzosa
- Geriatric Research Education and Clinical Center (GRECC), 20071James J Peters VA Medical Center, Bronx, NY, USA.,Icahn School of Medicine at Mount Sinai, New York, NY, USA
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4
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Scales K. Transforming Direct Care Jobs, Reimagining Long-Term Services and Supports. J Am Med Dir Assoc 2021; 23:207-213. [PMID: 34973168 DOI: 10.1016/j.jamda.2021.12.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Revised: 11/24/2021] [Accepted: 12/04/2021] [Indexed: 12/20/2022]
Abstract
The diverse array of individuals who receive long-term services and supports share one common experience, which is the need for assistance with personal care and/or other daily activities. The direct care workers (including nursing assistants, home health aides, and personal care aides) who provide this assistance play a critical role in keeping individuals safe, supporting their health and well-being, and helping prevent adverse outcomes. Yet despite decades of research, advocacy, and incremental policy and practice reform, direct care workers remain inadequately compensated, supported, and respected. Long-standing direct care job quality concerns are linked to high turnover and job vacancy rates in this workforce, which in turn compromise the availability and quality of essential care for older adults and people with disabilities-which has never been more evident than during the COVID-19 pandemic. This special article makes the case for transforming direct care jobs and stabilizing this workforce as a centerpiece of efforts to reimagine long-term services and supports system in the United States, as a public health priority, and as a social justice imperative. Drawing on research evidence and examples from the field, the article demonstrates that a strong, stable direct care workforce requires: a competitive wage and adequate employment benefits for direct care workers; updated training standards and delivery systems that prepare these workers to meet increasingly complex care needs across settings, while also enhancing career mobility and workforce flexibility; investment in well-trained frontline supervisors and peer mentors to help direct care workers navigate their challenging roles; and an elevated position for direct care workers in relation to the interdisciplinary care team. The article concludes by highlighting federal and state policy opportunities to achieve direct care job transformation, as well as discussing research and practice implications.
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5
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Kennedy MA, Hatchell KE, DiMilia PR, Kelly SM, Blunt HB, Bagley PJ, LaMantia MA, Reynolds CF, Crow RS, Maden TN, Kelly SL, Kihwele JM, Batsis JA. Community health worker interventions for older adults with complex health needs: A systematic review. J Am Geriatr Soc 2021; 69:1670-1682. [PMID: 33738803 PMCID: PMC8263299 DOI: 10.1111/jgs.17078] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Revised: 01/10/2021] [Accepted: 01/31/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND/OBJECTIVES The number of older adults with complex health needs is growing, and this population experiences disproportionate morbidity and mortality. Interventions led by community health workers (CHWs) can improve clinical outcomes in the general adult population with multimorbidity, but few studies have investigated CHW-delivered interventions in older adults. DESIGN We systematically reviewed the impact of CHW interventions on health outcomes among older adults with complex health needs. We searched for English-language articles from database inception through April 2020 using seven databases. PROSPERO protocol registration CRD42019118761. SETTING Any U.S. or international setting, including clinical and community-based settings. PARTICIPANTS Adults aged 60 years or older with complex health needs, defined in this review as multimorbidity, frailty, disability, or high-utilization. INTERVENTIONS Interventions led by a CHW or similar role consistent with the American Public Health Association's definition of CHWs. MEASUREMENTS Pre-defined health outcomes (chronic disease measures, general health measures, treatment adherence, quality of life, or functional measures) as well as qualitative findings. RESULTS Of 5671 unique records, nine studies met eligibility criteria, including four randomized controlled trials, three quasi-experimental studies, and two qualitative studies. Target population and intervention characteristics were variable, and studies were generally of low-to-moderate methodological quality. Outcomes included mood, functional status and disability, social support, well-being and quality of life, medication knowledge, and certain health conditions (e.g., falls, cognition). Results were mixed with several studies demonstrating significant effects on mood and function, including one high-quality RCT, while others noted no significant intervention effects on outcomes. CONCLUSION CHW-led interventions may have benefit for older adults with complex health needs, but additional high-quality studies are needed to definitively determine the effectiveness of CHW interventions in this population. Integration of CHWs into geriatric clinical settings may be a strategy to deliver evidence-based interventions and improve clinical outcomes in complex older adults.
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Affiliation(s)
- Meaghan A. Kennedy
- New England Geriatric Research, Education, and Clinical
Center, VA Bedford Healthcare System, Bedford, MA
- Department of Community and Family Medicine, Geisel School
of Medicine at Dartmouth and Dartmouth-Hitchcock Medical Center, Lebanon, NH
| | - Kayla E. Hatchell
- Department of Community and Family Medicine, Geisel School
of Medicine at Dartmouth and Dartmouth-Hitchcock Medical Center, Lebanon, NH
| | - Peter R. DiMilia
- Department of Community and Family Medicine, Geisel School
of Medicine at Dartmouth and Dartmouth-Hitchcock Medical Center, Lebanon, NH
| | | | | | | | - Michael A. LaMantia
- Division of Geriatric Medicine, Department of Medicine,
Larner College of Medicine at The University of Vermont, Burlington, VT
| | | | - Rebecca S. Crow
- Department of Medicine, Geisel School of Medicine at
Dartmouth and Dartmouth-Hitchcock Medical Center, Lebanon, NH
- Geriatrics and Extended Care, Veterans Affairs Medical Center, White River Junction,
White River Junction, VT
| | - Tara N. Maden
- Analytics Institute, Dartmouth-Hitchcock Clinic, Lebanon,
NH
| | | | | | - John A. Batsis
- Division of Geriatric Medicine and Gillings School of
Global Public Health, University of North Carolina, Chapel Hill, NC
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6
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Reckrey JM, Tsui EK, Morrison RS, Geduldig ET, Stone RI, Ornstein KA, Federman AD. Beyond Functional Support: The Range Of Health-Related Tasks Performed In The Home By Paid Caregivers In New York. Health Aff (Millwood) 2020; 38:927-933. [PMID: 31158023 DOI: 10.1377/hlthaff.2019.00004] [Citation(s) in RCA: 49] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Paid caregivers (for example, home health aides and personal care attendants) are formally tasked with helping older adults with functional impairment meet their basic needs at home. This study used thirty semistructured interviews with dyads of patients or their proxies and their paid caregivers in New York City to understand the range of health-related tasks that paid caregivers perform in the home and determine whether these tasks are taught in the New York State Department of Health's curriculum. We found that patients, proxies, and paid caregivers all reported that paid caregivers performed a wide range of health-related tasks that were often not part of their formal training. Creating clear competencies for paid caregivers that reflect the full breadth of health-related tasks they may perform in the home could help maximize the positive impact of the paid caregiver workforce on the lives of patients living at home with functional impairment.
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Affiliation(s)
- Jennifer M Reckrey
- Jennifer M. Reckrey ( ) is an associate professor in the Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York City
| | - Emma K Tsui
- Emma K. Tsui is an assistant professor of community health and social sciences at the City University of New York School of Public Health, in New York City
| | - R Sean Morrison
- R. Sean Morrison is a professor in the Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai
| | - Emma T Geduldig
- Emma T. Geduldig is a student in the Department of Medical Education, Icahn School of Medicine at Mount Sinai
| | - Robyn I Stone
- Robyn I. Stone is senior vice president for research at LeadingAge, in Washington, D.C
| | - Katherine A Ornstein
- Katherine A. Ornstein is an assistant professor in the Department of Geriatrics and Palliative Medicine and the Institute for Translational Epidemiology, Icahn School of Medicine at Mount Sinai
| | - Alex D Federman
- Alex D. Federman is a professor in the Division of General Internal Medicine, Icahn School of Medicine at Mount Sinai
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7
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Understanding the Workflow of Home Health Care for Patients with Heart Failure: Challenges and Opportunities. J Gen Intern Med 2020; 35:1721-1729. [PMID: 32026253 PMCID: PMC7280407 DOI: 10.1007/s11606-020-05675-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND Readmission rates are high among heart failure (HF) patients who require home health care (HHC) after hospitalization. Although HF patients who require HHC are often sicker than those who do not, HHC delivery itself may also be suboptimal. OBJECTIVE We aimed to describe the workflow of HHC among adults discharged home after a HF hospitalization, including the roles of various stakeholders, and to determine where along these workflow challenges and opportunities for improvement exist. DESIGN AND PARTICIPANTS In this qualitative study, we used purposeful sampling to approach and recruit a variety of key stakeholders including home health aides, nurses, HF patients, family caregivers, physicians, social workers, home care agency leaders, and policy experts. The study took place in New York, NY, from March to October 2018. APPROACH Using a semi-structured topic guide, we elicited participants' experiences with HHC in HF through a combination of one-on-one interviews and focus groups. Data were recorded, transcribed, and analyzed thematically. We also asked selected participants to depict in a drawing their understanding of HHC workflow after hospitalization for HF patients. We synthesized the drawings into a final image. KEY RESULTS Study participants (N = 80) described HHC for HF patients occurring in 6 steps, with home health aides playing a main role: (1) transitioning from hospital to home; (2) recognizing clinical changes; (3) making decisions; (4) managing symptoms; (5) asking for help; and (6) calling 911. Participants identified challenges and opportunities for improvement for each step. CONCLUSIONS Our findings suggest that HHC for HF patients occurs in discrete steps, each with different challenges. Rather than a one-size-fits-all approach, various interventions may be required to optimize HHC delivery for HF patients in the post-discharge period.
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8
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Reckrey JM, Geduldig ET, Lindquist LA, Morrison RS, Boerner K, Federman AD, Brody AA. Paid Caregiver Communication With Homebound Older Adults, Their Families, and the Health Care Team. THE GERONTOLOGIST 2020; 60:745-753. [PMID: 31112604 DOI: 10.1093/geront/gnz067] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2019] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Although paid caregivers (e.g., home health aides and home care workers) provide essential care for homebound older adults with serious illness in their homes, little is known about how and to whom paid caregivers communicate about the health needs they encounter. This study explored how paid caregivers (i) communicate when older adults experience symptoms or clinical changes and (ii) interact with the health care team. RESEARCH DESIGN AND METHODS We conducted separate one-on-one, semi-structured interviews (n = 30) lasting 40-60 min with homebound older adults (or their proxies if they had cognitive impairment) and their paid caregivers (provided they had worked with the older adult for ≥8 hr per week for ≥6 months). Interviews were audio-recorded, transcribed, and coded. RESULTS Thematic analysis identified four themes: (i) older adults or their families were the gatekeepers to paid caregiver communication with the health care team; (ii) communication between older adults, their families, and paid caregivers was enhanced when close relationships were present; (iii) paid caregivers responded to health care team inquiries but rarely communicated proactively; and (4) most older adults, families, and paid caregivers were satisfied with existing paid caregiver communication with the health care team. DISCUSSION AND IMPLICATIONS Rather than discuss concerns with the health care team, paid caregivers communicated directly with older adults or their families about the health needs they encounter. Understanding how communication occurs in the home is the first step to maximizing the potentially positive impact of paid caregivers on the health of older adults living at home.
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Affiliation(s)
- Jennifer M Reckrey
- Department of Geriatrics and Palliative Medicine, Division of General Internal Medicine, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Emma T Geduldig
- Department of Medical Education, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Lee A Lindquist
- Department of Medicine, Division of General Medicine and Geriatrics, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - R Sean Morrison
- Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, New York.,James J Peters Bronx VA Geriatric Research Education and Clinical Center, New York, New York
| | - Kathrin Boerner
- Department of Gerontology, University of Massachusetts Boston, New York
| | - Alex D Federman
- Division of General Internal Medicine, Icahn School of Medicine at Mount Sinai, New York
| | - Abraham A Brody
- Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, New York.,James J Peters Bronx VA Geriatric Research Education and Clinical Center, New York, New York.,New York University Rory Meyers College of Nursing
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9
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Sterling MR, Silva AF, Leung PBK, Shaw AL, Tsui EK, Jones CD, Robbins L, Escamilla Y, Lee A, Wiggins F, Sadler F, Shapiro MF, Charlson ME, Kern LM, Safford MM. "It's Like They Forget That the Word 'Health' Is in 'Home Health Aide'": Understanding the Perspectives of Home Care Workers Who Care for Adults With Heart Failure. J Am Heart Assoc 2019; 7:e010134. [PMID: 30571599 PMCID: PMC6405555 DOI: 10.1161/jaha.118.010134] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
Background Home care workers (HCWs) increasingly provide long‐term and posthospitalization care for community‐dwelling adults with heart failure (HF). They observe, assist, and advise these patients, yet few studies have examined their role in HF. As the foundation for future interventions, we sought to understand the perspectives of HCWs caring for adults with HF. Methods and Results We conducted 8 focus groups in partnership with the Home Care Industry Education Fund, a benefit fund of the 1199 Service Employees International Union United Healthcare Workers East, the largest healthcare union in the United States. English‐ and Spanish‐speaking HCWs with HF clients were eligible to participate. Data were analyzed thematically. Forty‐six HCWs employed by 21 unique home care agencies participated. General and HF‐specific themes emerged. Generally, HCWs (1) feel overworked and undervalued; (2) find communication and care to be fragmented; (3) are dedicated to clients and families but are caught in the middle; and, despite this, (4) love their job. With respect to HF, HCWs (1) find it frightening and unpredictable; (2) are involved in HF self‐care without any HF training; and (3) find the care plan problematic. Conclusions Although frequently involved in HF self‐care, most HCWs have not received HF training. In addition, many felt poorly supported by other healthcare providers and the care plan, especially when their clients’ symptoms worsened. Interventions that provide HF‐specific training and aim to improve communication between members of the home health care team may enhance HCWs’ ability to care for adults with HF and potentially lead to better patient outcomes.
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Affiliation(s)
- Madeline R Sterling
- 1 Division of General Internal Medicine Department of Medicine Weill Cornell Medicine New York NY
| | - Ariel F Silva
- 1 Division of General Internal Medicine Department of Medicine Weill Cornell Medicine New York NY
| | - Peggy B K Leung
- 1 Division of General Internal Medicine Department of Medicine Weill Cornell Medicine New York NY
| | - Amy L Shaw
- 2 Division of Geriatrics and Palliative Medicine Department of Medicine Weill Cornell Medicine New York NY
| | - Emma K Tsui
- 3 Department of Community Health and Social Sciences Graduate School of Public Health and Health Policy City University of New York NY
| | | | | | | | - Ann Lee
- 6 1199SEIU - Home Care Industry Education Fund New York NY
| | - Faith Wiggins
- 6 1199SEIU - Home Care Industry Education Fund New York NY
| | - Frances Sadler
- 6 1199SEIU - Home Care Industry Education Fund New York NY
| | - Martin F Shapiro
- 1 Division of General Internal Medicine Department of Medicine Weill Cornell Medicine New York NY
| | - Mary E Charlson
- 7 Division of Clinical Epidemiology and Evaluative Science Research Department of Medicine Weill Cornell Medicine New York NY
| | - Lisa M Kern
- 1 Division of General Internal Medicine Department of Medicine Weill Cornell Medicine New York NY
| | - Monika M Safford
- 1 Division of General Internal Medicine Department of Medicine Weill Cornell Medicine New York NY
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10
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Chase JAD, Russell D, Rice M, Abbott C, Bowles KH, Mehr DR. Caregivers' Experiences Regarding Training and Support in the Post-Acute Home Health-Care Setting. J Patient Exp 2019; 7:561-569. [PMID: 33062879 PMCID: PMC7534114 DOI: 10.1177/2374373519869156] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Background: Post-acute home health-care (HHC) services provide a unique opportunity to train and support family caregivers of older adults returning home after a hospitalization. To enhance family-focused training and support strategies, we must first understand caregivers’ experiences. Objective: To explore caregivers’ experiences regarding training and support for managing older adults’ physical functioning (PF) needs in the post-acute HHC setting. Method: We conducted a qualitative descriptive study using semi-structured telephone interviews of 20 family caregivers. Interviews were recorded, transcribed, and analyzed using conventional content analysis. Results: We identified the following primary categories: facilitators to learning (eg, past experience, learning methods), barriers to learning (eg, learning on their own, communication, timing/logistics, preferred information and timing of information delivery), and interactions with HHC providers (eg, positive/negative interactions, provider training and knowledge). Conclusion: Caregivers were responsive to learning strategies to manage older adults’ PF needs and, importantly, voiced ideas to improve family-focused training and support. HHC providers can use these findings to tailor training and support of family caregivers in the post-acute HHC setting.
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Affiliation(s)
- Jo-Ana D Chase
- Sinclair School of Nursing, University of Missouri, Columbia, MO, USA
| | - David Russell
- Department of Sociology, Appalachian State University, Boone, NC, USA.,Center for Home Care Policy & Research, Visiting Nurse Service of New York, New York, NY, USA
| | - Meridith Rice
- Sinclair School of Nursing, University of Missouri, Columbia, MO, USA
| | - Carmen Abbott
- Department of Physical Therapy, University of Missouri, Columbia, MO, USA
| | - Kathryn H Bowles
- School of Nursing, University of Pennsylvania, Philadelphia, PA, USA
| | - David R Mehr
- Department of Family and Community Medicine, University of Missouri School of Medicine, Columbia, MO, USA
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11
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Palesy D, Jakimowicz S. Health literacy training for Australian home care workers: Enablers and barriers. Home Health Care Serv Q 2019; 38:80-95. [PMID: 31007141 DOI: 10.1080/01621424.2019.1604458] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
The rapidly expanding Australian home care workforce represents an untapped resource for improving health literacy (HL) and health outcomes of their clients. Nine home care workers (HCWs) were interviewed for this study to gain data around their experiences of providing HL support to their clients, key HL needs and priorities, and training that would best these needs. Findings indicate that HCWs are providing HL support, and identify a number of enablers and barriers to providing this support. Core inclusions for a HL training checklist are suggested. Implications for future research are considered.
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Affiliation(s)
- Debra Palesy
- a Faculty of Health , University of Technology Sydney , Broadway , NSW , Australia
| | - Samantha Jakimowicz
- a Faculty of Health , University of Technology Sydney , Broadway , NSW , Australia
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12
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Dye C, Willoughby D, Aybar-Damali B, Grady C, Oran R, Knudson A. Improving Chronic Disease Self-Management by Older Home Health Patients through Community Health Coaching. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2018; 15:ijerph15040660. [PMID: 29614803 PMCID: PMC5923702 DOI: 10.3390/ijerph15040660] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/23/2018] [Revised: 03/22/2018] [Accepted: 03/29/2018] [Indexed: 11/16/2022]
Abstract
The purpose of the study was to pilot test a model to reduce hospital readmissions and emergency department use of rural, older adults with chronic diseases discharged from home health services (HHS) through the use of volunteers. The study's priority population consistently experiences poorer health outcomes than their urban counterparts due in part to lower socioeconomic status, reduced access to health services, and incidence of chronic diseases. When they are hospitalized for complications due to poorly managed chronic diseases, they are frequently readmitted for the same conditions. This pilot study examines the use of volunteer community members who were trained as Health Coaches to mentor discharged HHS patients in following the self-care plan developed by their HHS RN; improving chronic disease self-management behaviors; reducing risk of falls, pneumonia, and flu; and accessing community resources. Program participants increased their ability to monitor and track their chronic health conditions, make positive lifestyle changes, and reduce incidents of falls, pneumonia and flu. Although differences in the ED and hospital admission rates after discharge from HHS between the treatment and comparison group (matched for gender, age, and chronic condition) were not statistically significant, the treatment group's rate was less than the comparison group thus suggesting a promising impact of the HC program (90 day: 263 comparison vs. 129 treatment; p = 0.65; 180 day 666.67 vs. 290.32; p = 0.19). The community health coach model offers a potential approach for improving the ability of discharged older home health patients to manage chronic conditions and ultimately reduce emergent care.
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Affiliation(s)
- Cheryl Dye
- Institute for Engaged Aging, 2037 Barre Hall, Clemson University, Clemson, SC 29634, USA.
| | - Deborah Willoughby
- School of Nursing, 417 Edwards Hall, Clemson University, Clemson, SC 29634, USA.
| | - Begum Aybar-Damali
- Department of Tourism and Therapeutic Recreation, Memorial Hall 119, Winona State University, Winona, MN 55987, USA.
| | - Carmelita Grady
- Walsh Center for Rural Health Analysis, NORC at the University of Chicago, 4350 East-West Hwy, Bethesda, MD 20814, USA.
| | - Rebecca Oran
- Walsh Center for Rural Health Analysis, NORC at the University of Chicago, 4350 East-West Hwy, Bethesda, MD 20814, USA.
| | - Alana Knudson
- Walsh Center for Rural Health Analysis, NORC at the University of Chicago, 4350 East-West Hwy, Bethesda, MD 20814, USA.
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Feinberg JL, Russell D, Mola A, Trachtenberg M, Bick I, Lipman TH, Bowles KH. A Mixed Methods Evaluation of the Feasibility and Acceptability of an Adapted Cardiac Rehabilitation Program for Home Care Patients. Geriatr Nurs 2018; 39:191-198. [DOI: 10.1016/j.gerinurse.2017.08.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2017] [Revised: 08/22/2017] [Accepted: 08/23/2017] [Indexed: 11/27/2022]
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14
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Sustainable Urban Homecare Delivery with Different Means of Transport. SUSTAINABILITY 2018. [DOI: 10.3390/su10020398] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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