1
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Tsui EK, Reckrey JM, Franzosa E, LaMonica M, Gassama S, Boerner K. Awareness, Acceptance, Avoidance: Home Care Aides' Approaches to Death and End-of-Life Care. Omega (Westport) 2024; 89:550-566. [PMID: 35245148 DOI: 10.1177/00302228221078348] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Death and dying are woven throughout the work of home care aides, and yet the care they provide at the end of life (EOL) remains poorly understood. This is due in part to the multiple circumstances under which aides provide EOL care. In this paper, we elucidate the EOL care experiences of aides working in home care agencies in New York City. We conducted in-depth interviews with 29 home care aides, and we analyzed these data using inductive, team-based methods. Our findings show that aides may not be aware of or accept a client's EOL status, and they may avoid EOL care. These conditions shape EOL care, and we detail the committed forms of care aides provide when they are aware and accepting. We recommend improved training, support systems, and policy change to enhance aides' contributions to EOL care, while protecting aides' health and well-being.
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Affiliation(s)
- Emma K Tsui
- Department of Community Health & Social Sciences, CUNY Graduate School of Public Health & Health Policy, New York, NY, USA
| | - Jennifer M Reckrey
- Brookdale Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Emily Franzosa
- Brookdale Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Geriatric Research Education and Clinical Center (GRECC), James J. Peters, VA Medical Center, Bronx, NY, USA
| | - Marita LaMonica
- Department of Community Health & Social Sciences, CUNY Graduate School of Public Health & Health Policy, New York, NY, USA
| | - Seedoumuktar Gassama
- Department of Community Health & Social Sciences, CUNY Graduate School of Public Health & Health Policy, New York, NY, USA
| | - Kathrin Boerner
- Department of Gerontology, University of Massachusetts Boston, Boston, MA, USA
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2
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Quach ED, Franzosa E, Zhao S, Ni P, Hartmann CW, Moo LR. Home and Community-Based Service Use Varies by Health Care Team and Comorbidity Level of Veterans with Dementia. J Gerontol Soc Work 2024; 67:242-257. [PMID: 37584150 DOI: 10.1080/01634372.2023.2246520] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Accepted: 08/07/2023] [Indexed: 08/17/2023]
Abstract
Home and community-based services (HCBSs) such as home care and adult day centers are vital to supporting adults with dementia in community settings. We investigated whether HCBS use (use of both home care and adult day, use of one service, and use of neither service) varied between adults receiving care from three types of health-care teams with case management from social workers and nurses, and by comorbidity level, using 2019 data of 143,281 patients with dementia in the Veterans Health Administration. We compared HCBS use by patients' type of case-managed team (Home-Based Primary Care, geriatrics-based primary care, and dementia-focused specialty care) to patients in none of these teams, stratified by patients' non-dementia comorbidities (<4 or ≥4). Each type of health-care team was associated with both home care and adult day services, at each level of comorbidity. Home-Based Primary Care was most consistently associated with other forms of HCBS use, followed by Dementia Clinics and geriatrics-based primary care, for patients with ≥4 non-dementia comorbidities. Our findings suggest that case management in primary and specialty care settings is a contributor to the use of critical community supports by patients with the most complex needs.
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Affiliation(s)
- Emma D Quach
- Center for Healthcare Organization and Implementation Research, VA Bedford Healthcare System (152), Bedford, Massachusetts, USA
- New England Geriatric Research Education and Clinical Center, VA Bedford Healthcare System, Bedford, Massachusetts, USA
- Department of Gerontology, McCormack Graduate School of Policy and Global Studies, University of Massachusetts Boston, Boston, Massachusetts, USA
| | - Emily Franzosa
- Brookdale Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
- Geriatrics Research, Education, and Clinical Center, James J. Peters VA Medical Center, Bronx, New York, USA
| | - Shibei Zhao
- Center for Healthcare Organization and Implementation Research, VA Bedford Healthcare System, Bedford, Massachusetts, USA
| | - Pengsheng Ni
- Health Law, Policy & Management, Department of Health Law, Policy and Management, Boston University School of Public Health, Boston, Massachusetts, USA
| | - Christine W Hartmann
- Center for Healthcare Organization and Implementation Research, VA Bedford Healthcare System, Bedford, Massachusetts, USA
- Department of Public Health, Zuckerberg College of Health Sciences, University of Massachusetts Lowell, Lowell, Massachusetts, USA
| | - Lauren R Moo
- New England Geriatric Research Education and Clinical Center, Bedford, Massachusetts, USA
- Harvard Medical School, Neurology, Boston, Massachusetts, USA
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3
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Rogers M, Heitner R, Frydman JL, Bowman B, Meier DE, Aldridge M, Franzosa E. Perceptions of Palliative Care Program Viability During the Pandemic: Qualitative Results From a National Survey. Am J Hosp Palliat Care 2023; 40:1394-1399. [PMID: 36636994 PMCID: PMC9841202 DOI: 10.1177/10499091231152610] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
Background: Palliative care programs have played a significant role during the COVID-19 pandemic. However, the financial impact of the pandemic and operational challenges for palliative care programs have raised concerns for their future viability. Objectives: To explore palliative care program leaders' perceptions of the future viability of their programs in the context of the pandemic and inform future educational and program development. Methods: Surveys were sent to 1430 specialist palliative care program leaders, identified through the Center to Advance Palliative Care's contact lists, via email in May 2020 and January 2021. Leaders were asked why they were or were not concerned about the viability of their palliative care programs. Qualitative content analysis was applied to determine themes. Results: We received 440 responses. Most programs served hospital settings and were geographically located across all US regions. We identified four themes: 1) The importance of being valued by organizational leadership and peers, 2) The importance of adequate and supported palliative care staff, 3) The pandemic validated and accelerated the need for palliative care, and 4) The pandemic perpetuated organizational financial concerns. Conclusion: Findings provide insights about palliative care program viability from the perspective of program leaders during a global pandemic. Technical assistance to support palliative care teams and their relationships with stakeholders, methods to measure the impact of peer support, efforts to educate administrators about the value of palliative care, and efforts to reduce burnout are needed to sustain palliative care programs into the future.
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Affiliation(s)
- Maggie Rogers
- Center to Advance Palliative Care
at the Brookdale Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount
Sinai, New York, NY, USA
| | - Rachael Heitner
- Center to Advance Palliative Care
at the Brookdale Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount
Sinai, New York, NY, USA
| | - Julia L. Frydman
- Brookdale Department of Geriatrics
and Palliative Medicine, Icahn School of Medicine at Mount
Sinai, New York, NY, USA
| | - Brynn Bowman
- Center to Advance Palliative Care
at the Brookdale Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount
Sinai, New York, NY, USA
| | - Diane E. Meier
- Center to Advance Palliative Care
at the Brookdale Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount
Sinai, New York, NY, USA
| | - Melissa Aldridge
- Brookdale Department of Geriatrics
and Palliative Medicine, Icahn School of Medicine at Mount
Sinai, New York, NY, USA
- James J. Peters VA Medical
Center, Bronx, NY, USA
| | - Emily Franzosa
- Brookdale Department of Geriatrics
and Palliative Medicine, Icahn School of Medicine at Mount
Sinai, New York, NY, USA
- James J. Peters VA Medical
Center, Bronx, NY, USA
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4
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Fong MC, Russell D, Gao O, Franzosa E. Contextual Forces Shaping Home-Based Health Care Services Between 2010 and 2020: Insights From the Social-Ecological Model and Organizational Theory. Gerontologist 2023; 63:1117-1128. [PMID: 35921664 PMCID: PMC9384634 DOI: 10.1093/geront/gnac113] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Indexed: 12/02/2022] Open
Abstract
Demands for home-based care have surged alongside population aging, preferences for aging in place, policy-driven reforms incentivizing lower hospital utilization, and public concerns around coronavirus disease 2019 transmissions in institutional care settings. However, at both macro and micro levels, sociopolitical, and infrastructural contexts are not aligned with the operational needs of home health care organizations, presenting obstacles to home health care equity. We integrate the social-ecological model and organizational theory to highlight contextual forces shaping the delivery of home-based care services between 2010 and 2020. Placing home-based health care organizations at the center of observation, we discuss patterns and trends of service delivery as systematic organizational behaviors reflecting the organizations' adaptations and responses to their surrounding forces. In this light, we consider the implications of provision and access to home care services for health equity, discuss topics that are understudied, and provide recommendations for home-based health care organizations to advance home health care equity. The article represents a synthesis of recent literature and our research and industry experiences.
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Affiliation(s)
- Mei-Chia Fong
- Business Intelligence and Analytics, VNS Health, New York, New York, USA
| | - David Russell
- Center for Home Care Policy & Research, VNS Health, New York, USA
- Department of Sociology, Appalachian State University, Boone, North Carolina, USA
| | - Oude Gao
- Business Intelligence and Analytics, VNS Health, New York, New York, USA
| | - Emily Franzosa
- Geriatric Research Education and Clinical Center (GRECC), James J. Peters VA Medical Center, Bronx, New York, USA
- Brookdale Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, USA
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5
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Xu EL, Kim PS, Yee C, Zhang M, Reckrey JM, Lubetsky S, Zhao D, Ornstein KA, Franzosa E. "I Depend on Her for Everything": A Retrospective Chart Review of Home Care Worker Service Disruptions for Homebound Older Adults During the COVID-19 Pandemic. J Appl Gerontol 2023; 42:561-570. [PMID: 36283965 PMCID: PMC9597284 DOI: 10.1177/07334648221135584] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Revised: 10/07/2022] [Accepted: 10/11/2022] [Indexed: 11/15/2022] Open
Abstract
Home care workers played critical roles in meeting the complex medical and social needs of homebound adults during COVID-19, yet their contributions remain underappreciated. This study characterizes home care workers' roles during COVID-19 and examines how home care disruptions impacted homebound individuals and caregivers. Using a qualitative analysis of electronic medical records among a randomly sampled subset of homebound patients in a home-based primary care practice, we found that home care workers were essential in meeting existing and new needs of homebound individuals. Insufficient home care worker services, including unstable schedules and inadequate hours of paid care, became particularly disruptive, leading to risks for patients and their caregivers. Given their integral role on care teams, home care workers must be a policy focus to prepare for emergent situations and ensure that homebound individuals have access to high quality, stable home care.
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Affiliation(s)
- Emily L Xu
- Department of Medical Education, 5925Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Patricia S Kim
- Brookdale Geriatric Research, Education and Clinical Center, New York, NY, USA
| | - Cynthia Yee
- Brookdale Geriatric Research, Education and Clinical Center, New York, NY, USA
| | - Meng Zhang
- Department of Internal Medicine, 5925Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Jennifer M Reckrey
- Brookdale Geriatric Research, Education and Clinical Center, New York, NY, USA
| | - Sara Lubetsky
- Brookdale Geriatric Research, Education and Clinical Center, New York, NY, USA
| | - Duzhi Zhao
- Brookdale Geriatric Research, Education and Clinical Center, New York, NY, USA
| | | | - Emily Franzosa
- Brookdale Geriatric Research, Education and Clinical Center, New York, NY, USA
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6
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Reckrey JM, Perez S, Watman D, Ornstein KA, Russell D, Franzosa E. The Need for Stability in Paid Dementia Care: Family Caregiver Perspectives. J Appl Gerontol 2023; 42:607-616. [PMID: 35512123 PMCID: PMC9636070 DOI: 10.1177/07334648221097692] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Paid caregivers (e.g., home health aides, home care workers) provide essential care to people with dementia living at home; this study explored family caregiver perspectives on the role and impact of paid caregivers in home-based dementia care. We conducted semi-structured interviews with family caregivers (n = 15) of people with advanced dementia who received long-term paid care at home in New York between October 2020 and December 2020. We found that given the vulnerability resulting from advanced dementia, family caregivers prioritized finding the "right" paid caregivers and valued continuity in the individual providing care. The stable paid care that resulted improved outcomes for both the person with advanced dementia (e.g., eating better) and their family (e.g., ability to work). Those advocating for high quality, person-centered dementia care should partner with policymakers and home care agencies to promote the stability of well-matched paid caregivers for people with advanced dementia living at home.
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Affiliation(s)
| | - Sasha Perez
- 5925Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Deborah Watman
- 5925Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | | | | | - Emily Franzosa
- 5925Icahn School of Medicine at Mount Sinai, New York, NY, USA.,20071James J. Peters Veterans Affairs Medical Center, Bronx, NY, USA
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7
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Shalev A, Ringel JB, Riegel B, Vellone E, Stawnychy MA, Safford M, Goyal P, Tsui E, Franzosa E, Reckrey J, Sterling M. Does Connectedness Matter? The Association Between Mutuality and Job Satisfaction Among Home Health Aides Caring for Adults With Heart Failure. J Appl Gerontol 2023; 42:747-757. [PMID: 36541188 PMCID: PMC9992152 DOI: 10.1177/07334648221146772] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Home health aides (HHAs) provide care to many adults with heart failure (HF) in the home. As the demand for HHAs increases, there is a need to promote HHAs' job satisfaction and retention. In this cross-sectional community-partnered study, we examined whether mutuality (e.g., quality of the HHA-patient relationship), is associated with job satisfaction among HHAs caring for adults with HF. Mutuality was assessed with the Mutuality Scale, which measures overall mutuality and its four domains (reciprocity, love and affection, shared pleasurable activities, and shared values). Our final sample of 200 HHAs was primarily female. The mean overall mutuality score was 2.92 out of 4 (SD 0.79). In our final model, overall mutuality and each of the four domains were associated with increased job satisfaction; however, only the shared pleasurable activities domain was significant (aPR: 1.15 [1.03-1.32]). Overall, mutuality may play a role in promoting job satisfaction among HHAs.
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Affiliation(s)
- Ariel Shalev
- 12295Weill Cornell Medical College, New York, NY, USA
| | | | - Barbara Riegel
- 16142University of Pennsylvania School of Nursing, Philadelphia, PA, USA
| | - Ercole Vellone
- University of Rome Tor Vergata, Italy; Wroclaw Medical University, Poland
| | | | | | - Parag Goyal
- 12295Weill Cornell Medical College, New York, NY, USA
| | - Emma Tsui
- CUNY Graduate School of Public Health & Health Policy, New York, NY, USA
| | - Emily Franzosa
- 5925Icahn School of Medicine at Mount Sinai, New York, NY, USA
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8
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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9
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Aldridge MD, Franzosa E, Kim P, Xu E, Reckrey J, Zhang M, Zhao D, Ornstein KA. Disruptions in Home Hospice Care due to the COVID-19 Pandemic. J Palliat Med 2023; 26:244-247. [PMID: 36394438 PMCID: PMC9894593 DOI: 10.1089/jpm.2022.0037] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/19/2022] [Indexed: 11/19/2022] Open
Abstract
Background: There is limited evidence regarding the challenges of providing hospice care to those dying at home during the COVID-19 pandemic. Objective: To describe the challenges of home hospice care and the specific types of disruptions in care processes experienced by patients and families. Design: Qualitative study of the electronic medical record notes of a large New York City (NYC) home-based primary care program. Setting/Subjects: Subjects were 58 patients referred to hospice who died during the initial NYC COVID-19 surge from March to June 2020. Results: We identified six domains of disruptions in home hospice care: delayed hospice enrollment, inability to conduct home visits, lack of needed supplies, communication failures, strained caregivers, and limitations of telehealth. Conclusions: This study provides a critical first analysis of disruptions in home hospice care that can feasibly be addressed and must be prioritized by hospices throughout the ongoing pandemic and in advance of future emergencies.
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Affiliation(s)
- Melissa D. Aldridge
- Brookdale Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
- Geriatrics Research, Education, and Clinical Center, James J. Peters VA Medical Center, Bronx, New York, USA
| | - Emily Franzosa
- Brookdale Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
- Geriatrics Research, Education, and Clinical Center, James J. Peters VA Medical Center, Bronx, New York, USA
| | - Patricia Kim
- Brookdale Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Emily Xu
- Brookdale Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Jennifer Reckrey
- Brookdale Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
- Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Meng Zhang
- Brookdale Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
- Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Duzhi Zhao
- Brookdale Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Katherine A. Ornstein
- Brookdale Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
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10
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Franzosa E, Kim P, Reckrey JM, Zhang M, Xu E, Aldridge MD, Federman AD, Ornstein KA. Care Disruptions and End-Of-Life Care Experiences Among Home-Based Primary Care Patients During the COVID-19 Pandemic in New York City: A Retrospective Chart Review. Am J Hosp Palliat Care 2023; 40:225-234. [PMID: 35775300 PMCID: PMC9253522 DOI: 10.1177/10499091221104732] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
Background: Research on deaths during COVID-19 has largely focused on hospitals and nursing homes. Less is known about medically complex patients receiving care in the community. We examined care disruptions and end-of-life experiences of homebound patients receiving home-based primary care (HBPC) in New York City during the initial 2020 COVID-19 surge. Methods: We conducted a retrospective chart review of patients enrolled in Mount Sinai Visiting Doctors who died between March 1-June 30, 2020. We collected patient sociodemographic and clinical data and analyzed care disruptions and end-of-life experiences using clinical notes, informed by thematic and narrative analysis. Results: Among 1300 homebound patients, 112 (9%) died during the study period. Patients who died were more likely to be older, non-Hispanic white, and have dementia than those who survived. Thirty percent of decedents had confirmed or probable COVID-19. Fifty-eight (52%) were referred to hospice and 50 enrolled. Seventy-three percent died at home. We identified multiple intersecting disruptions in family caregiving, paid caregiving, medical supplies and services, and hospice care, as well as hospital avoidance, complicating EOL experiences. The HBPC team responded by providing clinical, logistical and emotional support to patients and families. Conclusion: Despite substantial care disruptions, the majority of patients in our study died at home with support from their HBPC team as the practice worked to manage care disruptions. Our findings suggest HBPC's multi-disciplinary, team-based model may be uniquely suited to meet the needs of the most medically and socially vulnerable older adults at end of life during public health emergencies.
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Affiliation(s)
- Emily Franzosa
- Brookdale Department of Geriatrics
and Palliative Medicine, Icahn School of Medicine at Mount
Sinai, New York, NY, USA
- Geriatric Research, Education, and
Clinical Center (GRECC), James J. Peters
VA Medical Center, Bronx, NY, USA
| | - Patricia Kim
- Brookdale Department of Geriatrics
and Palliative Medicine, Icahn School of Medicine at Mount
Sinai, New York, NY, USA
| | - Jennifer M. Reckrey
- Brookdale Department of Geriatrics
and Palliative Medicine, Icahn School of Medicine at Mount
Sinai, New York, NY, USA
| | - Meng Zhang
- Department of Medicine, Icahn School of Medicine at Mount
Sinai, New York, NY, USA
| | - Emily Xu
- Department of Medical Education,
Icahn School of Medicine at Mount
Sinai, New York, NY, USA
| | - Melissa D. Aldridge
- Brookdale Department of Geriatrics
and Palliative Medicine, Icahn School of Medicine at Mount
Sinai, New York, NY, USA
| | - Alex D. Federman
- Brookdale Department of Geriatrics
and Palliative Medicine, Icahn School of Medicine at Mount
Sinai, New York, NY, USA
- Department of Medicine, Icahn School of Medicine at Mount
Sinai, New York, NY, USA
| | - Katherine A. Ornstein
- Brookdale Department of Geriatrics
and Palliative Medicine, Icahn School of Medicine at Mount
Sinai, New York, NY, USA
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11
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Gorbenko K, Baim-Lance A, Franzosa E, Wurtz H, Schiller G, Masse S, Ornstein KA, Federman A, Levine DM, DeCherrie LV, Leff B, Siu A. A national qualitative study of Hospital-at-Home implementation under the CMS Acute Hospital Care at Home waiver. J Am Geriatr Soc 2023; 71:245-258. [PMID: 36197021 DOI: 10.1111/jgs.18071] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Revised: 08/16/2022] [Accepted: 08/21/2022] [Indexed: 01/25/2023]
Abstract
BACKGROUND The Centers for Medicare & Medicaid Services (CMS) announced the Acute Hospital Care at Home (AHCaH) waiver program in November 2020 to help expand hospital capacity to cope with the COVID-19 pandemic. The AHCaH waived the 24/7 on-site nursing requirement and enabled hospitals to obtain full hospital-level diagnosis-related group (DRG) reimbursement for providing Hospital-at-Home (HaH) care. This study sought to describe AHCaH implementation processes and strategies at the national level and identify challenges and facilitators to launching or adapting a HaH to meet waiver requirements. METHODS We conducted semi-structured interviews to explore barriers and facilitators of HaH implementation. The analysis was informed by the Exploration, Preparation, Implementation, and Sustainment (EPIS) implementation framework. Interviews were audio recorded for transcription and thematic coding. PRINCIPAL FINDINGS We interviewed a sample of clinical leaders (N = 18; clinical/medical directors, operational and program managers) from 14 new and pre-existing U.S. HaH programs diverse by size, urbanicity, and geography. Participants were enthusiastic about the AHCaH waiver. Participants described barriers and facilitators at planning and implementation stages within three overarching themes influencing waiver program implementation: 1) institutional value and assets; 2) program components, such as electronic health records, vendors, pharmacy, and patient monitoring; and 3) patient enrollment, including eligibility and geographic limits. CONCLUSIONS Implementation of AHCaH waiver is a complex process that requires building components in compliance with the requirements to extend the hospital into the home, in coordination with internal and external partners. The study identified barriers that potential adopters and proponents should consider alongside the strategies that some organizations have found useful. Clarity regarding the waiver's future may expedite HaH model dissemination and ensure longevity of this valuable model of care delivery.
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Affiliation(s)
- Ksenia Gorbenko
- Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, New York, USA.,Institute for Health Care Delivery Science, Mount Sinai Health System, New York, New York, USA
| | - Abigail Baim-Lance
- Brookdale Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA.,Department of Veteran Affairs, James J. Peters VA Medical Center and Geriatric Research Education and Clinical Center, Bronx, New York, USA
| | - Emily Franzosa
- Brookdale Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA.,Department of Veteran Affairs, James J. Peters VA Medical Center and Geriatric Research Education and Clinical Center, Bronx, New York, USA
| | - Heather Wurtz
- Human Rights Institute, University of Connecticut, Storrs, Connecticut, USA
| | - Gabrielle Schiller
- Brookdale Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Sybil Masse
- Department of Medicine, Division of General Internal Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Katherine A Ornstein
- Brookdale Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Alex Federman
- Brookdale Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - David M Levine
- Department of Medicine, Division of General Internal Medicine and Primary Care, Brigham and Women's Hospital, Boston, Massachusetts, USA.,Harvard Medical School, Boston, Massachusetts, USA.,Ariadne Labs, Boston, Massachusetts, USA
| | - Linda V DeCherrie
- Brookdale Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Bruce Leff
- Division of Geriatric Medicine and Gerontology, Center for Transformative Geriatric Research, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Albert Siu
- Brookdale Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA.,Department of Veteran Affairs, James J. Peters VA Medical Center and Geriatric Research Education and Clinical Center, Bronx, New York, USA
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12
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Gorbenko K, Franzosa E, Baim-Lance A, Schiller G, Wurtz H, Masse S, Levine D, Siu A. CONTENDING WITH UNCERTAINTY: IMPLEMENTING THE CMS ACUTE HOSPITAL CARE AT HOME WAIVER PROGRAM IN THE UNITED STATES. Innov Aging 2022. [PMCID: PMC9770143 DOI: 10.1093/geroni/igac059.994] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
As Congress considers renewing the Acute Hospital Care At Home (AHCaH) waiver, which provides a full hospital payment for Hospital at Home (HaH) care, evaluating uncertainty around the future of HaH payment is critical. Our qualitative study explored HaH leaders’ experiences with implementing HaH (N=18, clinical/medical directors, operational and program managers) from 14 new and pre-existing programs across the U.S. We conducted semi-structured interviews with HaH programs diverse by size, urbanicity, and geography. We analyzed transcripts using a thematic approach. Participants across settings and regions wanted greater clarity about the waiver’s future. Lack of clarity affected staffing (nurses reluctant to take temporary jobs) and investment in establishing programs (building EMR components, changing workflows, creating inpatient processes in an outpatient setting). Programs adapted to uncertainty in multiple ways: 1) operating parallel waiver and non-waiver programs; 2) seeking to determine/ calculate the HaH value for their institution; 3) determining which patients would benefit most from HaH; and 4) seeking additional health system financing options beyond the CMS reimbursement (new programs) or relying on existing contracts with payers (existing programs). Implementing HaH is a complex and resource intensive process. Greater clarity from CMS regarding the waiver’s future state will encourage programs to invest the resources that they need to establish their programs long-term. Waiver extension/ permanence would also enable programs to develop and test measures of value, making rigorous evaluations possible to optimize different HaH components.
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Affiliation(s)
- Ksenia Gorbenko
- Icahn School of Medicine at Mount Sinai, New York, New York, United States
| | - Emily Franzosa
- Icahn School of Medicine at Mount Sinai, New York, New York, United States
| | - Abigail Baim-Lance
- Icahn School of Medicine at Mount Sinai, New York, New York, United States
| | | | - Heather Wurtz
- Icahn School of Medicine at Mount Sinai, New York, New York, United States
| | - Sybil Masse
- Icahn School of Medicine at Mount Sinai, New York, New York, United States
| | - David Levine
- Mass General Brigham, Boston, Massachusetts, United States
| | - Albert Siu
- Icahn School of Medicine at Mount Sinai, New York, New York, United States
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Xu E, Kim P, Zhang M, Reckrey J, Ornstein K, Franzosa E. “HE JUST WANTS HIS SERVICES BACK”: IMPACTS OF HOME CARE WORKER DISRUPTIONS ON PATIENTS AND CAREGIVERS DURING COVID-19. Innov Aging 2022. [PMCID: PMC9766911 DOI: 10.1093/geroni/igac059.2347] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Home care workers (HCWs) have played a critical role in keeping homebound older adults safely at home during COVID-19, yet their essential work is often understudied. This study characterized the roles of HCWs during COVID-19 and examined how HCW service disruptions impacted patients and their caregivers. We performed a thematic analysis of medical records from 53 patients with HCWs in a home-based primary care practice in New York City. We abstracted unstructured clinical notes into a priori and emergent categories and identified core themes via team discussion. The following themes emerged: 1) Shifts to remote medical care and changing patient needs led to task shifting and new tasks for HCWs (i.e. getting food for patients experiencing food insecurity), 2) The risks associated with HCW tasks, such as exposure from caring for patients with COVID-19, increased during the pandemic, 3) Patient and family refusal of HCW services to avoid COVID-19 exposure as well as abrupt loss of HCW services due to HCW precarity or COVID-19 exposure left family caregivers with additional caregiving responsibilities, 4) Regulations surrounding return to work following COVID-19 exposure created additional difficulties in reinstating HCWs and left patients without adequate care, putting them at risk of hospitalization. In conclusion, pandemic-related disruptions created barriers to adequate home care, putting both patients and caregivers at risk. This analysis suggests a need for more robust HCW training and established regulations to protect HCW safety as well as a need for policies to support caregivers and ensure continuity of care during emergencies.
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Affiliation(s)
- Emily Xu
- Icahn School of Medicine at Mount Sinai, New York, New York, United States
| | - Patricia Kim
- Icahn School of Medicine at Mount Sinai, New York, New York, United States
| | - Meng Zhang
- Icahn School of Medicine at Mount Sinai, New York, New York, United States
| | - Jennifer Reckrey
- Icahn School of Medicine at Mount Sinai, New York, New York, United States
| | | | - Emily Franzosa
- Icahn School of Medicine at Mount Sinai, New York, New York, United States
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14
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Quach E, Franzosa E, Hartmann C, Moo L. FACTORS INFORMING CLINICIAN CHOICE OF TELEHEALTH MODALITY TO SUPPORT DEMENTIA CAREGIVERS. Innov Aging 2022. [PMCID: PMC9770475 DOI: 10.1093/geroni/igac059.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
In summer 2020, 68 clinicians in the New England area caring for Veterans with dementia as part of a specialty team were surveyed regarding caregiver support services, with a 46% response rate (n=31). When faced with the need to abruptly discontinue in-person dementia support services, the majority of respondents offered caregivers support via telephone rather than video telehealth. Only 4 of 31 (13%) mentioned offering video visits for the first time to replace face-to-face visits. Clinician choice of modality largely reflected shifts among preestablished communication modalities/patterns and were influenced by clinician perception that older patients and their caregivers would prefer the telephone. Clinicians without experience using video telehealth with older adults were unlikely to offer video visits despite evidence that many older adults are willing and able to participate. Assessing caregiver wish/ability to participate in video visits may inform and shape clinician choice of telehealth modality.
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Affiliation(s)
- Emma Quach
- VA Bedford Health Care System, Bedford, Massachusetts, United States
| | - Emily Franzosa
- Icahn School of Medicine at Mount Sinai, New York City, New York, United States
| | | | - Lauren Moo
- VA Bedford Health Care System, Bedford, Massachusetts, United States
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Franzosa E, Gorbenko K, Baim-Lance A, Schiller G, Wurtz H, Masse S, Ornstein K, Leff B. PROVIDING INPATIENT CARE BEYOND HOSPITAL WALLS: GEOGRAPHIC FACTORS IN ACUTE HOSPITAL CARE AT HOME WAIVER PROGRAMS. Innov Aging 2022. [PMCID: PMC9765209 DOI: 10.1093/geroni/igac059.084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
The Centers for Medicare and Medicaid Services’ (CMS) Acute Hospital Care at Home waiver offers hospital-level reimbursement to provide acute hospital-level care in patients’ homes for the first time. While this initiative may make acute care at home more financially viable for health systems, it also requires aligning Hospital at Home (HaH) operations with inpatient, rather than outpatient, regulatory requirements. We aimed to understand how participating HaH programs adapted to these requirements. We conducted semi-structured interviews with multiple leaders from 14 HaH waiver programs (n=18 clinical/medical, operational and program directors) varying in size, urbanicity, structure, and region, examining data through thematic analysis. Both urban and rural participants described geographic effects of waiver requirements. For instance, to ensure response to patient emergencies within 30 minutes, programs contracted with paramedic services to expand service areas, added program locations or moved primary locations to other system hubs. Programs maximized staff capacity across service areas by “leasing” staff from other home-based programs, focusing on urban hubs with more staff, balancing in-person visits with remote monitoring, and providing “hybrid” in-person/video appointments. However, travel time, length of acute care visits, staffing shortages, the need for new skills (e.g., acute care nurses, dietitians) and limited state scope of practice regulations, particularly for paramedics, limited the area and populations served. Adapting to waiver requirements required significant efforts to address staffing, logistical and regulatory challenges. Future waiver improvements should explicitly consider the unique resources needed to expand hospital-level care in geographically diverse ambulatory environments.
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Affiliation(s)
- Emily Franzosa
- Icahn School of Medicine at Mount Sinai, New York City, New York, United States
| | - Ksenia Gorbenko
- Icahn School of Medicine at Mount Sinai, New York City, New York, United States
| | - Abigail Baim-Lance
- Icahn School of Medicine at Mount Sinai, New York City, New York, United States
| | | | - Heather Wurtz
- Icahn School of Medicine at Mount Sinai, New York City, New York, United States
| | - Sybil Masse
- Icahn School of Medicine at Mount Sinai, New York City, New York, United States
| | | | - Bruce Leff
- Johns Hopkins University School of Medicine, Baltimore, Maryland, United States
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16
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Reckrey JM, Kim PS, Zhao D, Zhang M, Xu E, Franzosa E, Ornstein KA. Care disruptions among the homebound during the COVID-19 pandemic: An analysis of the role of dementia. J Am Geriatr Soc 2022; 70:3585-3592. [PMID: 35997146 PMCID: PMC9539366 DOI: 10.1111/jgs.18008] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Revised: 07/25/2022] [Accepted: 07/29/2022] [Indexed: 12/24/2022]
Abstract
INTRODUCTION Seriously ill people with dementia living at home may be particularly vulnerable to disruptions in their care during times of crisis. The study sought to describe care experiences of those receiving home-based primary care in New York City during the COVID-19 pandemic and compare the experiences of people with and without dementia. METHODS We conducted a retrospective review of all electronic medical record notes between March 1, 2020 and December 30, 2020 among a sample of home-based primary care recipients (n = 228), including all deaths that occurred in the spring of 2020. Drawing from administrative records and using an abstraction tool that included both structured (e.g., documented COVID-19 exposure) and unstructured (e.g., text passage describing caregiver burden) data, we identified salient COVID-19 related care experiences and identified and categorized major disruptions in care. RESULTS Both people with and without dementia experienced significant disruptions of paid caregiving, family caregiving, and home-based services during the COVID-19 pandemic. While the paid caregivers of people with dementia reported more burden to the home-based primary care team as compared to people without dementia, we found little evidence of differences in quantity or type of COVID-19 related disruptions relative to dementia status. DISCUSSION While those with dementia have distinct care needs, our findings emphasize the way that dementia may be one piece of a larger clinical picture of serious illness. In order to support all patients with high care needs in crisis, we need to understand the interdependence of clinical care, long-term care, and family caregiving support for older adults and view dementia within the larger context of serious illness and care need.
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Affiliation(s)
- Jennifer M. Reckrey
- Brookdale Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Patricia S. Kim
- Brookdale Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Duzhi Zhao
- Brookdale Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Meng Zhang
- Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Emily Xu
- Department of Medical Education, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Emily Franzosa
- Brookdale Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA,Geriatric Research, Education, and Clinical Center (GRECC), James J. Peters Veterans Administration, Bronx, New York, USA
| | - Katherine A. Ornstein
- Brookdale Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA,Institute for Translational Epidemiology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
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17
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Franzosa E, Wyte-Lake T, Tsui EK, Reckrey JM, Sterling MR. Essential but Excluded: Building Disaster Preparedness Capacity for Home Health Care Workers and Home Care Agencies. J Am Med Dir Assoc 2022; 23:1990-1996. [PMID: 36343702 PMCID: PMC9634621 DOI: 10.1016/j.jamda.2022.09.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Revised: 09/29/2022] [Accepted: 09/30/2022] [Indexed: 11/06/2022]
Abstract
COVID-19 has demonstrated the essential role of home care services in supporting community-dwelling older and disabled individuals through a public health emergency. As the pandemic overwhelmed hospitals and nursing homes, home care helped individuals remain in the community and recover from COVID-19 at home. Yet unlike many institutional providers, home care agencies were often disconnected from broader public health disaster planning efforts and struggled to access basic resources, jeopardizing the workers who provide this care and the medically complex and often marginalized patients they support. The exclusion of home care from the broader COVID-19 emergency response underscores how the home care industry operates apart from the traditional health care infrastructure, even as its workers provide essential long-term care services. This special article (1) describes the experiences of home health care workers and their agencies during COVID-19 by summarizing existing empiric research; (2) reflects on how these experiences were shaped and exacerbated by longstanding challenges in the home care industry; and (3) identifies implications for future disaster preparedness policies and practice to better serve this workforce, the home care industry, and those for whom they care.
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Affiliation(s)
- Emily Franzosa
- Brookdale Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA,Geriatric Research, Education, and Clinical Center (GRECC), James J. Peters VA Medical Center, Bronx, NY, USA,Address correspondence to Emily Franzosa DrPH, Geriatrics Research, Education, and Clinical Center (GRECC), James J. Peters VA Medical Center, Bronx, NY
| | - Tamar Wyte-Lake
- Veterans Emergency Management Evaluation Center, Department of Veterans Affairs, North Hills, CA, USA
| | - Emma K. Tsui
- Graduate School of Public Health and Health Policy, City University of New York, New York, NY, USA
| | - Jennifer M. Reckrey
- Brookdale Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA,Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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18
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Boockvar KS, Koufacos NS, May J, Schwartzkopf AL, Guerrero VM, Judon KM, Schubert CC, Franzosa E, Dixon BE. Effect of Health Information Exchange Plus a Care Transitions Intervention on Post-Hospital Outcomes Among VA Primary Care Patients: a Randomized Clinical Trial. J Gen Intern Med 2022; 37:4054-4061. [PMID: 35199262 PMCID: PMC9708976 DOI: 10.1007/s11606-022-07397-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Accepted: 01/04/2022] [Indexed: 01/04/2023]
Abstract
BACKGROUND Health information exchange (HIE) notifications when patients experience cross-system acute care encounters offer an opportunity to provide timely transitions interventions to improve care across systems. OBJECTIVE To compare HIE notification followed by a post-hospital care transitions intervention (CTI) with HIE notification alone. DESIGN Cluster-randomized controlled trial with group assignment by primary care team. PATIENTS Veterans 65 or older who received primary care at 2 VA facilities who consented to HIE and had a non-VA hospital admission or emergency department visit between 2016 and 2019. INTERVENTIONS For all subjects, real-time HIE notification of the non-VA acute care encounter was sent to the VA primary care provider. Subjects assigned to HIE plus CTI received home visits and telephone calls from a VA social worker for 30 days after arrival home, focused on patient activation, medication and condition knowledge, patient-centered record-keeping, and follow-up. MEASURES Primary outcome: 90-day hospital admission or readmission. SECONDARY OUTCOMES emergency department visits, timely VA primary care team telephone and in-person follow-up, patients' understanding of their condition(s) and medication(s) using the Care Transitions Measure, and high-risk medication discrepancies. KEY RESULTS A total of 347 non-VA acute care encounters were included and assigned: 159 to HIE plus CTI and 188 to HIE alone. Veterans were 76.9 years old on average, 98.5% male, 67.8% White, 17.1% Black, and 15.1% other (including Hispanic). There was no difference in 90-day hospital admission or readmission between the HIE-plus-CTI and HIE-alone groups (25.8% vs. 20.2%, respectively; risk diff 5.6%; 95% CI - 3.3 to 14.5%, p = .25). There was also no difference in secondary outcomes. CONCLUSIONS A care transitions intervention did not improve outcomes for veterans after a non-VA acute care encounter, as compared with HIE notification alone. Additional research is warranted to identify transitions services across systems that are implementable and could improve outcomes.
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Affiliation(s)
- Kenneth S Boockvar
- James J. Peters VA Medical Center, Geriatrics Research Education & Clinical Center, Bronx, NY, 10468, USA.
- Brookdale Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
- The New Jewish Home, New York, NY, USA.
| | - Nicholas S Koufacos
- James J. Peters VA Medical Center, Geriatrics Research Education & Clinical Center, Bronx, NY, 10468, USA
| | - Justine May
- Richard L. Roudebush VA Medical Center, Center for Health Information and Communication, Indianapolis, IN, USA
| | - Ashley L Schwartzkopf
- Richard L. Roudebush VA Medical Center, Center for Health Information and Communication, Indianapolis, IN, USA
| | - Vivian M Guerrero
- James J. Peters VA Medical Center, Geriatrics Research Education & Clinical Center, Bronx, NY, 10468, USA
| | - Kimberly M Judon
- James J. Peters VA Medical Center, Geriatrics Research Education & Clinical Center, Bronx, NY, 10468, USA
| | - Cathy C Schubert
- Richard L. Roudebush VA Medical Center, Center for Health Information and Communication, Indianapolis, IN, USA
- Indiana University School of Medicine, Indianapolis, IN, USA
| | - Emily Franzosa
- James J. Peters VA Medical Center, Geriatrics Research Education & Clinical Center, Bronx, NY, 10468, USA
- Brookdale Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Brian E Dixon
- Richard L. Roudebush VA Medical Center, Center for Health Information and Communication, Indianapolis, IN, USA
- Department of Epidemiology, Indiana University Fairbanks School of Public Health, Indianapolis, IN, USA
- Center for Biomedical Informatics, Regenstrief Institute, Indianapolis, IN, USA
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Sullivan JL, Yousefi-Nooraie R, D’Arcy D, Levine A, Zimmerman L, Shin MH, Franzosa E, Hung W, Intrator O. Hospital In Home: Evaluating Need and Readiness for Implementation (HENRI) in the Department of Veterans Affairs: protocol for a mixed-methods evaluation and participatory implementation planning study. Implement Sci Commun 2022; 3:93. [PMID: 36038952 PMCID: PMC9422109 DOI: 10.1186/s43058-022-00338-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Accepted: 08/09/2022] [Indexed: 11/12/2022] Open
Abstract
Background and objectives The Department of Veterans Affairs (VA) Hospital-In-Home (HIH) program delivers patient-centered, acute-level hospital care at home. Compared to inpatient care, HIH has demonstrated improved patient safety, effectiveness, and patient and caregiver satisfaction. The VA Office of Geriatrics & Extended Care (GEC) has supported the development of 12 HIH program sites nationally, yet adoption in VA remains modest, and questions remain regarding optimal implementation practices to extend reach and adaptability of this innovation. Guided by theoretical and procedural implementation science frameworks, this study aims to systematically gather evidence from the 12 HIH programs and to develop a participatory approach to engage stakeholders, assess readiness, and develop/adapt implementation strategies and evaluation metrics. Research design and methods We propose a multi-phase concurrent triangulation design comprising of (1) qualitative interviews with key informants and document review, (2) quantitative evaluation of effectiveness outcomes, and (3) mixed-methods synthesis and adaptation of a Reach Effectiveness Adoption Implementation Maintenance (RE-AIM)-guided conceptual framework. Results The prospective phase will involve a participatory process of identifying stakeholders (leadership, HIH staff, veterans, and caregivers), engaging in planning meetings informed by implementation mapping, and developing implementation logic models and blueprints. The process will be assessed using a mixed-methods approach through participant observation and document review. Discussion and implication This study will support the continued spread of HIH programs, generate a catalog of HIH implementation evidence, and create implementation tools and infrastructure for future HIH development. The multi-phase nature of informing prospective planning with retrospective analysis is consistent with the Learning Health System framework. Supplementary Information The online version contains supplementary material available at 10.1186/s43058-022-00338-7.
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Cole HVS, Franzosa E. Correction: Advancing urban health equity in the United States in an age of health care gentrification: a framework and research agenda. Int J Equity Health 2022; 21:84. [PMID: 35710412 PMCID: PMC9204909 DOI: 10.1186/s12939-022-01686-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Affiliation(s)
- Helen V S Cole
- Barcelona Lab for Urban Environmental Justice and Sustainability, Institut de Ciencia i Tecnologia Ambientals (ICTA-UAB), Universitat Autonoma de Barcelona, Barcelona, Spain. .,Healthy Cities research group, Department of Epidemiology and Public Health, Institut Hospital del Mar d'Investigacions Mèdiques (IMIM), Barcelona, Spain.
| | - Emily Franzosa
- Research Health Science Specialist, Geriatric Research Education and Clinical Center (GRECC), James J. Peters VA Medical Center, Bronx, USA.,Brookdale Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, USA
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21
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Franzosa E, Judon KM, Gottesman EM, Koufacos NS, Runels T, Augustine M, Hartmann CW, Boockvar KS. Home Health Aides' Increased Role in Supporting Older Veterans and Primary Healthcare Teams During COVID-19: a Qualitative Analysis. J Gen Intern Med 2022; 37:1830-1837. [PMID: 35319082 PMCID: PMC8939490 DOI: 10.1007/s11606-021-07271-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Accepted: 11/02/2021] [Indexed: 11/24/2022]
Abstract
BACKGROUND Home health aides are important but often overlooked members of care teams, providing functional and emotional support to patients. These services became increasingly important during the COVID-19 pandemic as older adults faced disruptions in in-person medical services and family caregiving. Understanding how aides supported healthcare teams is important for informing emergency planning and better integrating home health services with primary care. OBJECTIVE To describe aides' roles in supporting veterans and working with primary care teams during COVID-19 and identify COVID-related changes in tasks. DESIGN Semi-structured interviews. PARTICIPANTS Eight home health aides, 6 home health agency administrators, and 9 primary care team members (3 RNs, 3 social workers, 3 MDs) serving veterans at a large, urban, Veterans Affairs medical center. APPROACH Combined deductive and inductive analysis to identify a priori concepts (aide roles; changes in tasks and new tasks during COVID-19) and emergent ideas. Aide, administrator, and provider interviews were analyzed separately and compared and contrasted to highlight emergent themes and divergent perspectives. KEY RESULTS Participants reported an increase in the volume and intensity of tasks that aides performed during the pandemic, as well as the shifting of some tasks from the medical care team and family caregivers to the aide. Four main themes emerged around aides' roles in the care team during COVID-19: (1) aides as physically present "boots on the ground" during medical and caregiving disruptions, (2) aides as care coordination support, (3) aides as mental health support, and (4) intensification of aides' work. CONCLUSIONS Home health aides played a central role in coordinating care during the COVID-19 pandemic, providing hands-on functional, medical, and emotional support. Integrating aides more formally into healthcare teams and expanding their scope of practice in times of crisis and beyond may improve care coordination for older veterans.
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Affiliation(s)
- Emily Franzosa
- Geriatric Research, Education and Clinical Center (GRECC), James 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), James J. Peters VA Medical Center, Bronx, NY, USA
| | - Eve M Gottesman
- Geriatric Research, Education and Clinical Center (GRECC), James J. Peters VA Medical Center, Bronx, NY, USA
| | - Nicholas S Koufacos
- Geriatric Research, Education and Clinical Center (GRECC), James J. Peters VA Medical Center, Bronx, NY, USA
| | - Tessa Runels
- Pain, Research, Informatics, Medical Comorbidities, and Education (PRIME) Center, VA Connecticut Healthcare System, West Haven, CT, USA
| | - Matthew Augustine
- Geriatric Research, Education and Clinical Center (GRECC), James J. Peters VA Medical Center, Bronx, NY, USA
- Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Christine W Hartmann
- Bedford VA Healthcare System, Bedford, MA, USA
- Department of Public Health, Zuckerberg College of Health Sciences, University of Massachusetts Lowell, Lowell, MA, USA
| | - Kenneth S Boockvar
- Geriatric Research, Education and Clinical Center (GRECC), James 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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22
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Cole HVS, Franzosa E. Title: advancing urban health equity in the United States in an age of health care gentrification: a framework and research agenda. Int J Equity Health 2022; 21:66. [PMID: 35546673 PMCID: PMC9092322 DOI: 10.1186/s12939-022-01669-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2021] [Accepted: 04/20/2022] [Indexed: 11/22/2022] Open
Abstract
Background Access to health care has traditionally been conceptualized as a function of patient socio-demographic characteristics (i.e., age, race/ethnicity, education, health insurance status, etc.) and/or the system itself (i.e., payment structures, facility locations, etc.). However, these frameworks typically do not take into account the broader, dynamic context in which individuals live and in which health care systems function. Purpose The growth in market-driven health care in the U.S. alongside policies aimed at improving health care delivery and quality have spurred health system mergers and consolidations, a shift toward outpatient care, an increase in for-profit care, and the closure of less profitable facilities. These shifts in the type, location and delivery of health care services may provide increased access for some urban residents while excluding others, a phenomenon we term “health care gentrification.“ In this commentary, we frame access to health care in the United States in the context of neighborhood gentrification and a concurrent process of changes to the health care system itself. Conclusions We describe the concept of health care gentrification, and the complex ways in which both neighborhood gentrification and health care gentrification may lead to inequitable access to health care. We then present a framework for understanding health care gentrification as a function of dynamic and multi-level systems, and propose ways to build on existing models of health care access and social determinants of health to more effectively measure and address this phenomenon. Finally, we describe potential strategies applied researchers might investigate that could prevent or remediate the effects of health care gentrification in the United States.
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Affiliation(s)
- Helen V S Cole
- Barcelona Lab for Urban Environmental Justice and Sustainability, Institut de Ciencia i Tecnologia Ambientals (ICTA-UAB), Universitat Autonoma de Barcelona, Barcelona, Spain. .,Healthy Cities research group, Department of Epidemiology and Public Health, Institut Hospital del Mar d'Investigacions Mèdiques (IMIM), Barcelona, Spain.
| | - Emily Franzosa
- Research Health Science Specialist, Geriatric Research Education and Clinical Center (GRECC), James J. Peters VA Medical Center, Bronx, USA.,Brookdale Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, USA
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23
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Tsui EK, Franzosa E, Vignola EF, Cuervo I, Landsbergis P, Zelnick J, Baron S. Recognizing careworkers' contributions to improving the social determinants of health: A call for supporting healthy carework. New Solut 2022; 32:9-18. [PMID: 34913377 DOI: 10.1177/10482911211066963] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Workers engaged in reproductive labor-the caring work that maintains society and supports its growth-contribute to societal health while also enduring the harms of precarious labor and substantial work stress. How can we conceptualize the effects of reproductive labor on workers and society simultaneously? In this commentary, we analyze four types of more relational and less relational careworkers-homeless shelter workers, school food workers, home care aides, and household cleaners-during the COVID-19 pandemic. We then make a case for a new model of societal health that recognizes the contributions of careworkers and healthy carework. Our model includes multi-sectoral social policies supporting both worker health and societal health and acknowledges several dimensions of work stress for careworkers that have received insufficient attention. Ultimately, we argue that the effects of reproductive labor on workers and society must be considered jointly, a recognition that offers an urgent vision for repairing and advancing societal health.
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Affiliation(s)
- Emma K Tsui
- CUNY Graduate School of Public Health & Health Policy, New York, USA
| | - Emily Franzosa
- 20071James J Peters VA Medical Center, New York, USA
- 5925Icahn School of Medicine at Mount Sinai, New York, USA
| | - Emilia F Vignola
- CUNY Graduate School of Public Health & Health Policy, New York, USA
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24
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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25
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Reinhardt JP, Franzosa E, Mak W, Burack O. In Their Own Words: The Challenges Experienced by Certified Nursing Assistants and Administrators During the COVID-19 Pandemic. J Appl Gerontol 2022; 41:1539-1546. [PMID: 35343299 PMCID: PMC8958287 DOI: 10.1177/07334648221081124] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
This qualitative study aimed to provide an in-depth understanding of the
challenges experienced by certified nursing assistants and administrators during
the unprecedented COVID-19 crisis. We conducted 6 administrator interviews and
10 remote focus groups with day and evening CNAs at 5 nursing homes
(N = 56) in downstate New York. Content analysis was
conducted, and emerging themes were identified across sites and roles. Results
showed numerous challenges for both CNAs and administrators including many that
were personal. These personal challenges included feeling helpless, anxious, or
fearful; experience of COVID illness; and balancing high concurrent demands of
work and family. There were also many operational challenges such as a lack of
COVID testing capacity, information, and consistent guidance and support,
staffing and equipment. Understanding these challenges can facilitate goals to
promote future safety, skill refinement, and enhanced resilience in the
workforce.
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Affiliation(s)
- Joann P Reinhardt
- 5863The New Jewish Home Research Institute on Aging, New York, NY, USA
| | - Emily Franzosa
- Brookdale Department of Geriatrics and Palliative Medicine, Geriatric Research, Education and Clinical Center, 20071James J. Peters VA Medical Center, New York, NY, USA
| | - Wingyun Mak
- 5863The New Jewish Home Research Institute on Aging, New York, NY, USA
| | - Orah Burack
- 5863The New Jewish Home Research Institute on Aging, New York, NY, USA
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26
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Franzosa E, Mak W, R Burack O, Hokenstad A, Wiggins F, Boockvar KS, Reinhardt JP. Perspectives of certified nursing assistants and administrators on staffing the nursing home frontline during the COVID-19 pandemic. Health Serv Res 2022; 57:905-913. [PMID: 35274293 PMCID: PMC9111312 DOI: 10.1111/1475-6773.13954] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Revised: 01/24/2022] [Accepted: 02/08/2022] [Indexed: 11/28/2022] Open
Abstract
Objective To identify best practices to support and grow the frontline nursing home workforce based on the lived experience of certified nursing assistants (CNAs) and administrators during COVID‐19. Study setting Primary data collection with CNAs and administrators in six New York metro area nursing homes during fall 2020. Study design Semi‐structured interviews and focus groups exploring staffing challenges during COVID‐19, strategies used to address them, and recommendations moving forward. Data collection We conducted interviews with 6 administrators and held 10 focus groups with day and evening shift CNAs (n = 56) at 6 nursing homes. Data were recorded and transcribed verbatim and analyzed through directed content analysis using a combined inductive and deductive approach to compare perceptions across sites and roles. Principal findings CNAs and administrators identified chronic staffing shortages that affected resident care and staff burnout as a primary concern moving forward. CNAs who felt most supported and confident in their continued ability to manage their work and the pandemic described leadership efforts to support workers' emotional health and work–life balance, teamwork across staff and management, and accessible and responsive leadership. However, not all CNAs felt these strategies were in place. Conclusions Based on priorities identified by CNAs and administrators, we recommend several organizational/industry and policy‐level practices to support retention for this workforce. Practices to stabilize the workforce should include 1) teamwork and person‐centered operational practices including transparent communication; 2) increasing permanent staff to avoid shortages; and 3) evaluating and building on successful COVID‐related innovations (self‐managed teams and flexible benefits). Policy and regulatory changes to promote these efforts are necessary to developing industry‐wide structural practices that target CNA recruitment and retention.
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Affiliation(s)
- Emily Franzosa
- Brookdale Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA.,Geriatric Research, Education and Clinical Center, James J. Peters VA Medical Center, Bronx, New York, USA
| | - Wingyun Mak
- The New Jewish Home Research Institute on Aging, New York, New York, USA
| | - Orah R Burack
- The New Jewish Home Research Institute on Aging, New York, New York, USA
| | - Alene Hokenstad
- Ladders to Value Workforce Investment Organization, 1199SEIU Training and Employment Funds, New York, New York, USA
| | - Faith Wiggins
- 1199SEIU Training and Employment Funds, New York, New York, USA
| | - Kenneth S Boockvar
- Brookdale Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA.,Geriatric Research, Education and Clinical Center, James J. Peters VA Medical Center, Bronx, New York, USA
| | - Joann P Reinhardt
- The New Jewish Home Research Institute on Aging, New York, New York, USA
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27
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Koufacos NS, May J, Judon KM, Franzosa E, Dixon BE, Schubert CC, Schwartzkopf AL, Guerrero VM, Traylor M, Boockvar KS. Improving Patient Activation among Older Veterans: Results from a Social Worker-Led Care Transitions Intervention. J Gerontol Soc Work 2022; 65:63-77. [PMID: 34053407 PMCID: PMC8982469 DOI: 10.1080/01634372.2021.1932003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Revised: 05/14/2021] [Accepted: 05/16/2021] [Indexed: 06/12/2023]
Abstract
Older veterans enrolled in the Veterans Health Administration (VHA) often use both VHA and non-VHA providers for their care. This dual use, especially around an inpatient visit, can lead to fragmented care during the time of transition post-discharge. Interventions that target patient activation may be valuable ways to help veterans manage complex medication regimens and care plans from multiple providers. The Care Transitions Intervention (CTI) is an evidence-based model that helps older adults gain confidence and skills to achieve their health goals post-discharge. Our study examined the impact of CTI upon patient activation for veterans discharged from non-VHA hospitals. In total, 158 interventions were conducted for 87 veterans. From baseline to follow-up there was a significant 1.7-point increase in patient activation scores, from 5.4 to 7.1. This association was only found among those who completed the intervention. The most common barriers to completion were difficulty reaching the veteran by phone, patient declining the intervention, and rehospitalization during the 30 days post-discharge. Care transitions guided by social workers may be a promising way to improve patient activation. However, future research and practice should address barriers to completion and examine the impact of increased patient activation on health outcomes.
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Affiliation(s)
- Nicholas S Koufacos
- Geriatric Research Education and Clinical Center, James J. Peters VA, Bronx, New York, USA
| | - Justine May
- Center for Health Information and Communication, Health Services Research & Development Service, Richard L. Roudebush VA, Indianapolis, Indiana, USA
| | - Kimberly M Judon
- Geriatric Research Education and Clinical Center, James J. Peters VA, Bronx, New York, USA
| | - Emily Franzosa
- Geriatric Research Education and Clinical Center, James J. Peters VA, Bronx, New York, USA
- Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Brian E Dixon
- Center for Health Information and Communication, Health Services Research & Development Service, Richard L. Roudebush VA, Indianapolis, Indiana, USA
- Department of Epidemiology, Indiana University, Fairbanks School of Public Health, Indianapolis, Indiana, USA
- Center for Biomedical Informatics, Regenstrief Institute, Center for Biomedical Informatics, Indianapolis, Indiana, USA
| | - Cathy C Schubert
- Center for Health Information and Communication, Health Services Research & Development Service, Richard L. Roudebush VA, Indianapolis, Indiana, USA
- Department of Medicine, Indiana University, School of Medicine, Indianapolis, Indiana, USA
| | - Ashley L Schwartzkopf
- Center for Health Information and Communication, Health Services Research & Development Service, Richard L. Roudebush VA, Indianapolis, Indiana, USA
| | - Vivian M Guerrero
- Geriatric Research Education and Clinical Center, James J. Peters VA, Bronx, New York, USA
| | - Morgan Traylor
- Center for Health Information and Communication, Health Services Research & Development Service, Richard L. Roudebush VA, Indianapolis, Indiana, USA
| | - Kenneth S Boockvar
- Geriatric Research Education and Clinical Center, James J. Peters VA, Bronx, New York, USA
- Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
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28
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Gorbenko K, Franzosa E, Masse S, Brody A, Ripp J, Ornstein K, Federman A. The Psychological Impact of COVID-19 on Home Based Primary Care Providers in New York: A Qualitative Study. Innov Aging 2021. [PMCID: PMC8679756 DOI: 10.1093/geroni/igab046.1477] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Research on professional burnout during the pandemic has focused on hospital-based health care workers. This study examined the psychological impact of the pandemic on home-based primary care (HBPC) providers. We interviewed 13 participants from six HBPC practices in the New York including medical/clinical directors, program managers, nurse practitioners, and social workers and analyzed the transcripts using inductive qualitative analysis approach. HBPC providers experienced emotional exhaustion and a sense of reduced personal accomplishment. They reported experiencing grief of losing many patients at once and pressure to adapt to changing circumstances quickly. They also reported feeling guilty for failing to protect their patients and reduced confidence in their professional expertise. Strategies to combat burnout included shorter on-call, regular condolence meetings to acknowledge patient deaths, and peer support calls. Our study identifies potential resources to improve the well-being and reduce the risk of burnout among HBPC providers.
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Affiliation(s)
- Ksenia Gorbenko
- Icahn School of Medicine at Mount Sinai, New York, New York, United States
| | - Emily Franzosa
- Icahn School of Medicine at Mount Sinai, Icahn School of Medicine at Mount Sinai, New York, United States
| | - Sybil Masse
- Icahn School of Medicine at Mount Sinai, New York, New York, United States
| | - Abraham Brody
- NYU Hartford Institute for Geriatric Nursing, New York, New York, United States
| | - Jonathan Ripp
- Mount Sinai Health System, New York, New York, United States
| | - Katherine Ornstein
- Icahn School of Medicine at Mount Sinai, New York, New York, United States
| | - Alex Federman
- Icahn School of Medicine at Mount Sinai, New York, New York, United States
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29
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Reinhardt J, Franzosa E, Mak W, Burack O. Challenges Reported by Certified Nursing Assistants During COVID-19: A Qualitative Study. Innov Aging 2021. [PMCID: PMC8969911 DOI: 10.1093/geroni/igab046.957] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Certified nursing assistants (CNAs) who care for vulnerable nursing home residents faced unprecedented circumstances due to the COVID-19 pandemic. While staff and PPE shortages were ubiquitous and widely known, the focus of this qualitative work was to gain a broader understanding of the numerous challenges they faced. We conducted 10 remote focus groups with CNAs at 5 nursing homes (N=56) in downstate New York. Content analysis was conducted, and emerging themes identified. Results showed a myriad of emotional challenges including helplessness, fear and anxiety. Operational challenges focused on lack of COVID testing capacity, information, and consistent guidance and support, in addition to staff and equipment. Individual challenges included personal experience of COVID illness and that of colleagues, and balancing high concurrent demands of work and family. These results are discussed in the context of developing recommendations to promote future safety, skill refinement and enhanced resilience in the workforce moving forward.
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Affiliation(s)
| | - Emily Franzosa
- Icahn School of Medicine at Mount Sinai, Icahn School of Medicine at Mount Sinai, New York, United States
| | - Wingyun Mak
- The New Jewish Home, New York, New York, United States
| | - Orah Burack
- The New Jewish Home, New York, New York, United States
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30
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Moody K, Kalicki A, Gliatto P, Franzosa E, Ornstein K. Providers’ Perceptions of Telehealth Barriers Among Homebound Adults in in a Home-Based Primary Care Practice. Innov Aging 2021. [PMCID: PMC8680442 DOI: 10.1093/geroni/igab046.2060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
The COVID-19 pandemic resulted in a dramatic shift to video-based telehealth use in home-based primary care. We conducted an online 11-item survey exploring provider perceptions of patients’ experience with and barriers to telehealth in a large HBPC program in New York City. More than one-third (35%) of patients (mean age of 82.7; 46.6% with dementia; mean of 4 comorbidities/patient) engaged in first-time video-based telehealth encounters between April and June 2020. The majority (82%) required assistance from a family member and/or paid caregiver. Among patients who had not used telehealth, providers deemed 27% (n=153) “unable to interact over video” for reasons including cognitive or sensory ability. Fourteen percent lacked caregivers. Physicians were not knowledgeable about patients’ internet connectivity, ability to pay for cellular plans, and video-capable device access. These findings highlight the need for novel approaches to facilitating telehealth and systematic data collection before targeted interventions to increase video-based telehealth use.
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Affiliation(s)
- Kate Moody
- Icahn School of Medicine at Mount Sinai, New York, New York, United States
| | - Alex Kalicki
- Icahn School of Medicine at Mount Sinai, New York, New York, United States
| | - Peter Gliatto
- Icahn School of Medicine at Mount Sinai, New York, New York, United States
| | - Emily Franzosa
- Icahn School of Medicine at Mount Sinai, Icahn School of Medicine at Mount Sinai, New York, United States
| | - Katherine Ornstein
- Icahn School of Medicine at Mount Sinai, New York, New York, United States
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31
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Franzosa E, Kim P, Zhang M, Reckrey J, Lubetsky S, Xu E, Ornstein K. Disruptions and Adaptations in End-of-Life Care Delivery for Homebound Patients During COVID-19. Innov Aging 2021. [PMCID: PMC8969913 DOI: 10.1093/geroni/igab046.2056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
The initial COVID-19 pandemic surge in New York City caused widespread delays and disruption in end-of-life services. This study examined the impact of disruptions among homebound adults in an HBPC practice who died between March-June 2020. Through an in-depth mixed-methods chart review, we identified 113 patient deaths (mean age: 87, 73% female, 67% with dementia). Forty-nine (43%) of deaths occurred in April 2020. Through a content analysis of clinician notes, we identified key COVID-related themes, including a shift to intensive phone-based care and to a lesser degree, telehealth; delays in hospice referrals and admissions; and an increase in treatment for behavioral symptoms. Our analysis also demonstrated the central role of family and paid caregivers in coordinating care, and efforts by patients, caregivers and providers to avoid hospital admissions. These findings demonstrate the importance of care coordination across medical, home and community partners to support end-of-life care in emergencies and beyond.
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Affiliation(s)
- Emily Franzosa
- Icahn School of Medicine at Mount Sinai, Icahn School of Medicine at Mount Sinai, New York, United States
| | - Patricia Kim
- Icahn School of Medicine at Mount Sinai, New York, New York, United States
| | - Meng Zhang
- Icahn School of Medicine at Mount Sinai, New York, New York, United States
| | - Jennifer Reckrey
- Icahn School of Medicine at Mount Sinai, Icahn School of Medicine at Mount Sinai, New York, United States
| | - Sara Lubetsky
- Icahn School of medicine at Mount Sinai, New York, New York, United States
| | - Emily Xu
- Icahn School of Medicine at Mount Sinai, New York, New York, United States
| | - Katherine Ornstein
- Icahn School of Medicine at Mount Sinai, New York, New York, United States
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32
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Gorbenko K, Franzosa E, Brody A, Leff B, Ritchie C, Kinosian B, Federman A, Ornstein K. Provider Perceptions of Video Telehealth in Home-Based Primary Care During COVID-19. Innov Aging 2021. [PMCID: PMC8680074 DOI: 10.1093/geroni/igab046.2059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Abstract
The COVID-19 pandemic accelerated the adoption of virtual care. In this qualitative study, we sought to determine provider perceptions of video telehealth during the first wave of COVID-19 in NYC to inform practice for home-based primary care providers nationwide. We conducted semi-structured interviews with clinical directors, program managers, nurse practitioners, nurse managers, and social workers at 6 NYC practices (N=13) in spring 2020. We used combined open and focused coding to identify themes. Participants employed both hospital-supported and commercial technological platforms to maintain care during COVID-19. Benefits of video telehealth included improved efficiency, capacity and collaboration between providers. Barriers included patients’ physical, cognitive or technological abilities, dependence on caregivers and aides to facilitate video visits, challenges establishing trust with new patients and addressing sensitive topics over video, and concerns over missing important patient information. Considering patient, clinical, and technological conditions can help optimize telehealth implementation among older homebound adults.
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Affiliation(s)
- Ksenia Gorbenko
- Icahn School of Medicine at Mount Sinai, New York, New York, United States
| | - Emily Franzosa
- Icahn School of Medicine at Mount Sinai, Icahn School of Medicine at Mount Sinai, New York, United States
| | - Abraham Brody
- NYU Hartford Institute for Geriatric Nursing, New York, New York, United States
| | - Bruce Leff
- The Center For Transformative Geriatric Research, Johns Hopkins School of Medicine, Baltimore, Maryland, United States
| | - Christine Ritchie
- Massachusetts General Hospital, Boston, Massachusetts, United States
| | - Bruce Kinosian
- University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, United States
| | - Alex Federman
- Icahn School of Medicine at Mount Sinai, New York, New York, United States
| | - Katherine Ornstein
- Icahn School of Medicine at Mount Sinai, New York, New York, United States
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Franzosa E, Mak W, Burack O, Boockvar K, Reinhardt J. It Was Trial by Fire: Recommendations for Building a Stronger Nursing Home Workforce After COVID-19. Innov Aging 2021. [PMCID: PMC8682125 DOI: 10.1093/geroni/igab046.958] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
The COVID-19 crisis showed the urgent need for a unified, well-supported nursing home workforce. The objective of this qualitative study was to examine the lived experience of certified nursing assistants (CNAs) and administrators during COVID-19 to identify best practices moving forward. Six administrator interviews and 10 remote focus groups with CNAs at 5 nursing homes (N=56) were examined through directed content analysis. Based on priorities identified by CNAs and administrators, the following practices may be most impactful: 1) ongoing and responsive staff training; 2) transparent, direct, and two-way communication channels; 3) prioritizing hiring permanent staff to avoid shortages and reliance on agency staff; 4) building collaborative staff-management relationships; 5) providing flexible job benefits; 6) providing staff-centered emotional support resources; and 7) appraising COVID-19 innovations. Our results suggest that rather than returning to “business as usual,” nursing homes can draw on these lessons to build a more sustainable workforce and industry.
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Affiliation(s)
- Emily Franzosa
- Icahn School of Medicine at Mount Sinai, Icahn School of Medicine at Mount Sinai, New York, United States
| | - Wingyun Mak
- The New Jewish Home, New York, New York, United States
| | - Orah Burack
- The New Jewish Home, New York, New York, United States
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Franzosa E, Judon K, Gottesman E, Runels T, Koufacos N. Navigating COVID-19: Communication and Coordination Between Home Care Agencies and Aides Caring for Older Veterans. Innov Aging 2021. [PMCID: PMC8681967 DOI: 10.1093/geroni/igab046.837] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Home health aides are essential members of the home care team, but often report limited communication with agency supervisors. To explore the impact of COVID-19 on these dynamics, we conducted semi-structured interviews with providers (n=9), contracted home health agencies (n=6), and aides caring for veterans (n=8) at an urban Veterans Affairs medical center. Data were analyzed through thematic analysis. Agencies relied on aides to observe and report on patients’ conditions, including COVID-19 symptoms, but aides were not always aware of follow-up and wanted more information about their patients’ health and COVID-19 status. Agencies also reported providing personal protective equipment (PPE) and infection prevention guidance to aides; however, some aides reported purchasing their own PPE and seeking out private COVID-19 testing. Supporting aides by providing needed training and protective resources, and engaging them more collaboratively in medical care, may help improve job satisfaction and quality of care.
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Affiliation(s)
- Emily Franzosa
- Icahn School of Medicine at Mount Sinai, Icahn School of Medicine at Mount Sinai, New York, United States
| | - Kimberly Judon
- James J. Peters VA Medical Center, Bronx, New York, United States
| | - Eve Gottesman
- US Department of Veterans Affairs, Bronx, New York, United States
| | - Tessa Runels
- West Haven VAMC, West Haven, Connecticut, United States
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Mak W, Franzosa E, Burack O, Reinhardt JP. Research Needed on Microlearning as a Training Strategy for CNAs in Skilled Nursing Facilities. J Am Med Dir Assoc 2021; 22:2610-2611. [PMID: 34416151 PMCID: PMC8415732 DOI: 10.1016/j.jamda.2021.07.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Accepted: 07/18/2021] [Indexed: 11/28/2022]
Affiliation(s)
- Wingyun Mak
- The New Jewish Home Research Institute on Aging, New York, NY, USA
| | - Emily Franzosa
- Geriatric Research, Education and Clinical Center, James J. Peters VA Medical Center, Bronx, NY, USA; Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Orah Burack
- The New Jewish Home Research Institute on Aging, New York, NY, USA
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Gorbenko K, Franzosa E, Masse S, Brody AA, Sheehan O, Kinosian B, Ritchie CS, Leff B, Ripp J, Ornstein KA, Federman AD. "I felt useless": a qualitative examination of COVID-19's impact on home-based primary care providers in New York. Home Health Care Serv Q 2021; 40:1-15. [PMID: 34301160 PMCID: PMC8783921 DOI: 10.1080/01621424.2021.1935383] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Research on professional burnout during the pandemic has focused on hospital-based health care workers. This study examined the psychological impact of the pandemic on home-based primary care (HBPC) providers. We interviewed 13 participants from six HBPC practices in New York City including medical/clinical directors, program managers, nurse practitioners, and social workers and analyzed the transcripts using inductive qualitative analysis approach. HBPC providers experienced emotional exhaustion and a sense of reduced personal accomplishment. They reported experiencing grief of losing many patients at once and pressure to adapt to changing circumstances quickly. They also reported feeling guilty for failing to protect their patients and reduced confidence in their professional expertise. Strategies to combat burnout included shorter on-call schedules, regular condolence meetings to acknowledge patient deaths, and peer support calls. Our study identifies potential resources to improve the well-being and reduce the risk of burnout among HBPC providers.
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Affiliation(s)
- Ksenia Gorbenko
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, New York, USA
- Institute of Health Care Delivery Science, Mount Sinai Health System, New York, New York, USA
| | - Emily Franzosa
- Brookdale Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
- Geriatrics Research, Education, and Clinical Center (GRECC), James J. Peters VA Medical Center, Bronx, New York, USA
| | - Sybil Masse
- Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Abraham A Brody
- Hartford Institute of Geriatric Nursing, Rory Meyers College of Nursing, New York University, New York, New York, USA
| | - Orla Sheehan
- Center on Aging and Health, Division of Geriatric Medicine and Gerontology, Johns Hopkins University, Baltimore, Maryland, USA
| | - Bruce Kinosian
- Center for Health Equity Research and Promotion, Corporal Crescenz Veterans Affairs Medical Center, Philadelphia, Pennsylvania, USA
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, Pennsylvania, USA
- Division of Geriatrics, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Christine S. Ritchie
- Division of Palliative Care and Geriatric Medicine, Mongan Institute Center for Aging and Serious Illness, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Bruce Leff
- Center for Transformative Geriatric Research, Division of Geriatrics, Department of Medicine, School of Medicine, Johns Hopkins University, Baltimore, Maryland, USA
| | - Jonathan Ripp
- Department of Medical Education, Icahn School of Medicine at Mount Sinai, NY, New York, USA
| | - Katherine A. Ornstein
- Brookdale Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Alex D. Federman
- Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
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Franzosa E, Gorbenko K, Brody AA, Leff B, Ritchie CS, Kinosian B, Sheehan OC, Federman AD, Ornstein KA. "There Is Something Very Personal About Seeing Someone's Face": Provider Perceptions of Video Visits in Home-Based Primary Care During COVID-19. J Appl Gerontol 2021; 40:1417-1424. [PMID: 34210200 DOI: 10.1177/07334648211028393] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
The rapid deployment of video visits during COVID-19 may have posed unique challenges for home-based primary care (HBPC) practices due to their hands-on model of care and older adult population. This qualitative study examined provider perceptions of video visits during the first wave of the COVID-19 crisis in New York City (NYC) through interviews with HBPC clinical/medical directors, program managers, nurse practitioners/nurse managers, and social work managers (n = 13) at six NYC-area practices. Providers reported a combination of commercial (health system-supported) and consumer (e.g., FaceTime) technological platforms was essential. Video visit benefits included triaging patient needs, collecting patient information, and increasing scheduling capacity. Barriers included cognitive and sensory abilities, technology access, reliance on caregivers and aides, addressing sensitive topics, and incomplete exams. Effectively integrating video visits requires considering how technology can be proactively integrated into practice. A policy that promotes platform flexibility will be crucial in fostering video integration.
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Affiliation(s)
- Emily Franzosa
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
- James J. Peters VA Medical Center, Bronx, NY, USA
| | | | | | - Bruce Leff
- Johns Hopkins University, Baltimore, MD, USA
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Ritchie CS, Gallopyn N, Sheehan OC, Sharieff SA, Franzosa E, Gorbenko K, Ornstein KA, Federman AD, Brody AA, Leff B. COVID Challenges and Adaptations Among Home-Based Primary Care Practices: Lessons for an Ongoing Pandemic from a National Survey. J Am Med Dir Assoc 2021; 22:1338-1344. [PMID: 34111388 PMCID: PMC8184288 DOI: 10.1016/j.jamda.2021.05.016] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Revised: 05/13/2021] [Accepted: 05/16/2021] [Indexed: 12/02/2022]
Abstract
Objectives Approximately 7.5 million US adults are homebound or have difficulty accessing office-based primary care. Home-based primary care (HBPC) provides such patients access to longitudinal medical care at home. The purpose of this study was to describe the challenges and adaptations by HBPC practices made during the first surge of the COVID-19 pandemic. Design Mixed-methods national survey. Setting and Participants HBPC practices identified as members of the American Academy of Homecare Medicine (AAHCM) or participants of Home-Centered Care Institute (HCCI) training programs. Methods Online survey regarding practice responses to COVID-19 surges, COVID-19 testing, the use of telemedicine, practice challenges due to COVID-19, and adaptations to address these challenges. Descriptive statistics and t tests described frequency distributions of nominal and categorical data; qualitative content analysis was used to summarize responses to the open-ended questions. Results Seventy-nine practices across 29 states were included in the final analyses. Eighty-five percent of practices continued to provide in-person care and nearly half cared for COVID-19 patients. Most practices pivoted to new use of video visits (76.3%). The most common challenges were as follows: patient lack of familiarity with telemedicine (81.9%), patient anxiety (77.8%), clinician anxiety (69.4%), technical difficulties reaching patients (66.7%), and supply shortages including masks, gown, and disinfecting materials (55.6%). Top adaptive strategies included using telemedicine (95.8%), reducing in-person visits (81.9%), providing resources for patients (52.8%), and staff training in PPE use and COVID testing (52.8%). Conclusions and Implications HBPC practices experienced a wide array of COVID-19–related challenges. Most continued to see patients in the home, augmented visits with telemedicine and creatively adapted to the challenges. An increased recognition of the need for in-home care by health systems who observed its critical role in caring for fragile older adults may serve as a silver lining to the otherwise dark sky of the COVID-19 pandemic.
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Affiliation(s)
- Christine S Ritchie
- Massachusetts General Hospital Department of Medicine, Division of Palliative Care and Geriatric Medicine, Boston, MA, USA; Massachusetts General Hospital Mongan Institute, Boston, MA, USA; Harvard Medical School Center for Palliative Care, Boston, MA, USA.
| | - Naomi Gallopyn
- Massachusetts General Hospital Department of Medicine, Division of Palliative Care and Geriatric Medicine, Boston, MA, USA; Massachusetts General Hospital Mongan Institute, Boston, MA, USA
| | - Orla C Sheehan
- Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Shanaz Ahmed Sharieff
- Massachusetts General Hospital Department of Medicine, Division of Palliative Care and Geriatric Medicine, Boston, MA, USA; Massachusetts General Hospital Mongan Institute, Boston, MA, USA
| | - Emily Franzosa
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | | | | | | | | | - Bruce Leff
- Johns Hopkins University School of Medicine, Baltimore, MD, USA
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Franzosa E, Traylor M, Judon KM, Guerrero Aquino V, Schwartzkopf AL, Boockvar KS, Dixon BE. Perceptions of event notification following discharge to improve geriatric care: qualitative interviews of care team members from a 2-site cluster randomized trial. J Am Med Inform Assoc 2021; 28:1728-1735. [PMID: 33997903 DOI: 10.1093/jamia/ocab074] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Revised: 04/02/2021] [Accepted: 04/09/2021] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE To assess primary care teams' perceptions of a health information exchange (HIE) event notification intervention for geriatric patients in 2 Veterans Health Administration (VHA) medical centers. MATERIALS AND METHODS We conducted a qualitative evaluation of an event notification alerting primary care teams to non-VHA hospital admissions and emergency department visits. Data were collected through semistructured interviews (n = 23) of primary care team physicians, nurses and medical assistants. Study design and analysis were guided by the Consolidated Framework for Implementation Research (CFIR). RESULTS Team members found the alerts necessary, helpful for filling information gaps, and effective in supporting timely follow-up care, although some expressed concern over scheduling capacity and distinguishing alerts from other VHA notices. Participants also suggested improvements including additional data on patients' diagnosis and discharge instructions, timing alerts to patients' discharge (including clear next steps), including additional team members to ensure alerts were acted upon, and implementing a single sign-on. DISCUSSION Primary care team members perceived timely event notification of non-VHA emergency department visits and hospital admissions as potentially improving post-discharge follow-up and patient outcomes. However, they were sometimes unsure of next steps and suggested the alerts and platform could be streamlined for easier use. CONCLUSIONS Event notifications may be a valuable tool in coordinating care for high-risk older patients. Future intervention research should explore the optimal amount and types of information and delivery method across sites and test the integration of alerts into broader care coordination efforts.
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Affiliation(s)
- Emily Franzosa
- Geriatric Research, Education, and Clinical Center, James J. Peters VA Medical Center, Bronx, New York, USA.,Brookdale Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Morgan Traylor
- Department of Veterans Affairs, Health Services Research & Development Service, Center for Health Information and Communication, Indianapolis, Indiana, USA
| | - Kimberly M Judon
- Geriatric Research, Education, and Clinical Center, James J. Peters VA Medical Center, Bronx, New York, USA
| | - Vivian Guerrero Aquino
- Geriatric Research, Education, and Clinical Center, James J. Peters VA Medical Center, Bronx, New York, USA
| | - Ashley L Schwartzkopf
- Department of Veterans Affairs, Health Services Research & Development Service, Center for Health Information and Communication, Indianapolis, Indiana, USA
| | - Kenneth S Boockvar
- Geriatric Research, Education, and Clinical Center, James J. Peters VA Medical Center, Bronx, New York, USA.,Brookdale Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Brian E Dixon
- Department of Veterans Affairs, Health Services Research & Development Service, Center for Health Information and Communication, Indianapolis, Indiana, USA.,Fairbanks School of Public Health, Indiana University, Indianapolis, Indiana, USA.,Center for Biomedical Informatics, Regenstrief Institute, Indianapolis, Indiana, USA
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Reckrey JM, Boerner K, Franzosa E, Bollens-Lund E, Ornstein KA. Paid Caregivers in the Community-Based Dementia Care Team: Do Family Caregivers Benefit? Clin Ther 2021; 43:930-941. [PMID: 33972126 DOI: 10.1016/j.clinthera.2021.03.022] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Revised: 03/18/2021] [Accepted: 03/30/2021] [Indexed: 10/21/2022]
Abstract
PURPOSE Older adults with dementia often rely on both paid caregivers (ie, home health aides, personal care attendants, other direct care workers) and family caregivers (ie, spouses, children, other unpaid individuals) to remain in the community. This study conceptualizes paid caregivers as part of the collaborative dementia care team and examines the association between receipt of paid care and primary family caregiver experience. METHODS Using data from 3 waves (2011, 2015, and 2017) of the National Health and Aging Trends Study linked to the National Study of Caregiving, community-dwelling Medicare beneficiaries aged ≥67 years with advanced dementia (n = 338 observations) were identified. Primary family caregiver experiences were compared among those with zero, part-time (<40 hours/week), and full-time (≥40 hours/week) paid care, and multivariable models were used to evaluate the associations between full-time paid care and family caregiver strain (eg, being overwhelmed due to caregiving) and activity restriction (eg, being unable to work for pay due to caregiving). FINDINGS About one half of the community-dwelling older adults with advanced dementia received paid care: 30% had part-time paid care and 18% had full-time paid care. The experiences of family caregivers of those receiving part-time and no paid care were not significantly different. After adjusting for family caregiver and care recipient characteristics, receipt of full-time paid care was associated with a nearly 70% reduced odds of having activity restrictions due to caregiving (odds ratio, 0.31; P = 0.01) and a reduction in mean caregiver strain score (-0.73; P = 0.04). There was no statistically significantly association between the odds of high caregiver strain (score ≥5) and receipt of paid care (odds ratio, 0.65; P = 0.33). IMPLICATIONS The provision of paid care for individuals with dementia in the community may benefit family caregivers. Future work should acknowledge the important ways that paid caregivers contribute to outcomes for all members of the collaborative dementia care team.
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Affiliation(s)
- Jennifer M Reckrey
- Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, NY.
| | - Kathrin Boerner
- Department of Gerontology, McCormack Graduate School of Policy and Global Studies, University of Massachusetts, Boston, MA
| | - Emily Franzosa
- Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai and Geriatrics Research, Education, and Clinical Center, James J. Peters VA Medical Center, New York, NY
| | - Evan Bollens-Lund
- Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Katherine A Ornstein
- Department of Geriatrics and Palliative Medicine and Institute for Translational Epidemiology, Icahn School of Medicine at Mount Sinai, New York, NY
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Kalicki AV, Moody KA, Franzosa E, Gliatto PM, Ornstein KA. Barriers to telehealth access among homebound older adults. J Am Geriatr Soc 2021; 69:2404-2411. [PMID: 33848360 PMCID: PMC8250614 DOI: 10.1111/jgs.17163] [Citation(s) in RCA: 82] [Impact Index Per Article: 27.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Revised: 03/16/2021] [Accepted: 03/24/2021] [Indexed: 12/17/2022]
Abstract
Background/Objectives To identify major barriers to video‐based telehealth use among homebound older adults. Design Cross‐sectional survey. Setting A large home‐based primary care (HBPC) program in New York City (NYC) serving 873 homebound patients living in the community. Participants Sixteen primary care physicians. Measurements An 11‐item assessment of provider perceptions of patients' experience with and barriers to telehealth. Results According to physicians in the HBPC program, more than one‐third (35%) of homebound patients (mean age of 82.7; 46.6% with dementia; mean of 4 comorbidities/patient) engaged in first‐time video‐based telehealth encounters between April and June 2020 during the first COVID‐19 surge in NYC. The majority (82%) required assistance from a family member and/or paid caregiver to complete the visit. Among patients who had not used telehealth, providers deemed 27% (n = 153) “unable to interact over video” for reasons including cognitive or sensory impairment and 14% lacked access to a caregiver to assist them with technology. Physicians were not knowledgeable of their patients' internet connectivity, ability to pay for cellular plans, or video‐capable device access. Conclusion The COVID‐19 pandemic resulted in a large and dramatic shift to video‐based telehealth use in home‐based primary care. However, 4 months into the pandemic a majority of patients had not participated in a video‐based telehealth encounter due to a number of barriers. Patients lacking caregiver support to assist with technology may benefit from novel approaches such as the deployment of community health workers to assist with device setup. Physicians may not be able to identify potentially modifiable barriers to telehealth use among their patients, highlighting the need for better systematic data collection before targeted interventions to increase video‐based telehealth use.
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Affiliation(s)
- Alexander V Kalicki
- Medical Education, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Kate A Moody
- Medical Education, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Emily Franzosa
- Geriatric Research, Education, and Clinical Center, James J. Peters VA Medical Center, Bronx, New York, USA.,Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Peter M Gliatto
- Division of General Internal Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Katherine A Ornstein
- Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA.,Division of General Internal Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
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Tsui EK, Franzosa E, Reckrey JM, LaMonica M, Cimarolli VR, Boerner K. Interventions to Reduce the Impact of Client Death on Home Care Aides: Employers' Perspectives. J Appl Gerontol 2021; 41:332-340. [PMID: 33522367 DOI: 10.1177/0733464821989859] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
For home care agencies and aides, the death of clients has important, yet often unrecognized, workforce implications. While research demonstrates that client death can cause grief and job insecurity for aides, we currently lack home care agencies' perspectives on this issue and approaches to addressing it. This study uses key informant interviews with leaders from a diverse sample of eight New York City home care agencies to explore facilitators and barriers to agency action. We found that agencies engaged primarily in a range of informal, reactive practices related to client death, and relatively few targeted and proactive efforts to support aides around client death. While leaders generally acknowledged a need for greater aide support, they pointed to a lack of sustainable home care financing and policy resources to fund this. We recommend increased funding to support wages, paid time off, and supportive services, and discuss implications for future research.
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Affiliation(s)
- Emma K Tsui
- The City University of New York Graduate School of Public Health & Health Policy, New York City, USA
| | - Emily Franzosa
- James J. Peters VA Medical Center and Geriatric Research Education and Clinical Center, Bronx, NY, USA.,Icahn School of Medicine at Mount Sinai, New York City, NY, USA
| | | | - Marita LaMonica
- The City University of New York Graduate School of Public Health & Health Policy, New York City, USA
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Franzosa E, Gorbenko K, Brody AA, Leff B, Ritchie CS, Kinosian B, Ornstein KA, Federman AD. "At Home, with Care": Lessons from New York City Home-based Primary Care Practices Managing COVID-19. J Am Geriatr Soc 2021; 69:300-306. [PMID: 33179761 PMCID: PMC8285037 DOI: 10.1111/jgs.16952] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Revised: 10/09/2020] [Accepted: 11/02/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND/OBJECTIVES COVID-19 required rapid innovation throughout the healthcare system. Home-based primary care (HBPC) practices faced unique challenges maintaining services for medically complex older populations for whom they needed to adapt a traditionally hands-on, model of care to accommodate restrictions on in-person contact. Our aim was to determine strategies used by New York City (NYC)-area HBPC practices to provide patient care during the first wave of the COVID-19 pandemic with the goal of informing planning and preparation for home-based practices nationwide. DESIGN Cross-sectional qualitative design using semi-structured interviews. SETTING HBPC practices in the NYC metro area during spring 2020. PARTICIPANTS HBPC leadership including clinical/medical directors, program managers, nurse practitioners/nursing coordinators, and social workers/social work coordinators (n = 13) at 6 NYC-area practices. MEASUREMENTS Semi-structured interviews explored HBPC practices' COVID-19 care delivery challenges, adaptations, and advice for providers. Interviewers probed patient care, end-of-life care, telehealth, community-based services and staffing. Interviews were recorded and transcribed. Data were analyzed through a combined inductive and deductive thematic approach. RESULTS Participants described care delivery and operational adaptations similar to those universally adopted across healthcare settings during COVID-19, such as patient outreach and telehealth. HBPC-specific adaptations included mental health services for patients experiencing depression and isolation, using multiple modalities of patient interactions to balance virtual care with necessary in-person contact, strategies to maintain patient trust, and supporting team connection of staff through daily huddles and emotional support during the surge of deaths among long-standing patients. CONCLUSION NYC-area HBPC providers adapted care delivery and operations rapidly during the height of the COVID-19 pandemic. Keeping older, medically complex patients safe in their homes required considerable flexibility, transparency, teamwork, and partnerships with outside providers. As the pandemic continues to surge around the United States, HBPC providers may apply these lessons and consider resources needed to prepare for future challenges.
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Affiliation(s)
- Emily Franzosa
- Brookdale Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
- Geriatrics Research, Education, and Clinical Center (GRECC), James J. Peters VA Medical Center, Bronx, New York, USA
| | - Ksenia Gorbenko
- Department of Population Health Science and Policy, Institute of Healthcare Delivery Science, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Abraham A Brody
- Hartford Institute of Geriatric Nursing, Rory Meyers College of Nursing, New York University, New York, New York, USA
| | - Bruce Leff
- Center for Transformative Geriatric Research, Division of Geriatrics, Department of Medicine, School of Medicine, Johns Hopkins University, Baltimore, Maryland, USA
| | - Christine S Ritchie
- Division of Palliative Care and Geriatric Medicine, Mongan Institute Center for Aging and Serious Illness, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Bruce Kinosian
- Center for Health Equity Research and Promotion, Corporal Crescenz Veterans Affairs Medical Center, Philadelphia, Pennsylvania, USA
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, Pennsylvania, USA
- Division of Geriatrics, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Katherine A Ornstein
- Brookdale Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Alex D Federman
- Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
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Franzosa E, Traylor M, Aquino VG, Judon K, Schwartzkopf A, Dixon B, Boockvar K. Care Team Members’ Perceptions of an Informatics Intervention to Improve Geriatric Care Across Multiple sites. Innov Aging 2020. [PMCID: PMC7743665 DOI: 10.1093/geroni/igaa057.1675] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Electronic health information exchange (HIE) may improve care for geriatric patients receiving care across multiple sites by reducing test duplication, medication prescribing errors, and adverse events. This project evaluated the implementation of an HIE intervention at two VA medical centers offering VA providers real-time notification of non-VA inpatient or ED use, followed by post-hospital geriatric care coordination. We interviewed 23 providers (physicians, nurses, social workers and other care team staff) about their experiences with the program. Interviews were analyzed using the Consolidated Framework for Implementation Research (CFIR) to examine 1) goals and expectations for notifications and transitional care; 2) barriers to effective use of notifications and coordination; and 3) suggestions for improvement. Overall, care team members were positive about the intervention, noting it cut down on time searching for outside medical records and that care coordination visits were helpful in answering patients’ questions and clarifying discharge instructions. However, some providers were not aware of the alerts, found the HIE interface challenging to use, or were concerned that expanding the program would create workflow issues. Suggestions for improvements included sharing information about newly prescribed medications, lab and radiological tests, and progress alerts during the episode of care; and including non-VA providers to facilitate care coordination. Social workers also asked to be included on alerts to improve follow-up. Our findings suggest HIE can be a useful tool for coordinating care across sites, provided information can be easily shared between all care team members and HIE interfaces are streamlined to reduce additional work.
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Affiliation(s)
- Emily Franzosa
- James J. Peters VA Medical Center, Brooklyn, New York, United States
| | - Morgan Traylor
- Richard L. Roudebush VA Medical Center, Indianapolis, Indiana, United States
| | | | - Kimberly Judon
- US Department of Veterans Affairs - James J. Peters VA Medical Center, Bronx, New York, United States
| | - Ashley Schwartzkopf
- Richard L. Roudebush VA Medical Center, Indianapolis, Indiana, United States
| | - Brian Dixon
- Center for Health Information and Communication, Health Services Research & Development Service, Indianapolis, Indiana, United States
| | - Kenneth Boockvar
- James J. Peters VA Medical Center, Bronx, New York, United States
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Franzosa E, Tsui E. We Treat Them Better Than the Family They Have: Negotiating Aide-Family Relationships in the Home Care Setting. Innov Aging 2020. [PMCID: PMC7742046 DOI: 10.1093/geroni/igaa057.1895] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
Unpaid and paid care in the home are closely intertwined, but a lack of outside supervision and support often forces family and non-family caregivers to negotiate care tasks and boundaries alone, leading to role conflict and role ambiguity. This analysis drew on two qualitative studies of home health aides (S1 n = 27, S2 n =26) to explore 1) aides’ perception of their caretaking role; 2) aides’ experiences co-producing care with family members; and 3) factors affecting these relationships. Data were analyzed through grounded theory and discourse analysis. We identified three relationship dynamics between aides and family members: independent, where aides and families provided care separately; competitive, where aides and families struggled over control of care tasks; and carative, where aides considered family part of the unit of care. We propose strategies for employer agencies to better support paid and unpaid caregivers in negotiating boundaries and co-producing care.
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Affiliation(s)
- Emily Franzosa
- James J. Peters VA Medical Center, Brooklyn, New York, United States
| | - Emma Tsui
- CUNY Graduate School of Public Health & Health Policy, New York, New York, United States
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Quach E, Franzosa E, Scali R, Moo L, Hartmann C. Dementia care providers’ delivery of family caregiver support during COVID-19. Innov Aging 2020. [PMCID: PMC7741508 DOI: 10.1093/geroni/igaa057.3447] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Family caregiver support is a cornerstone of dementia care. Yet the transition to virtual care during COVID raised questions about the ability of dementia care teams to maintain caregiver support services. We surveyed Veterans Affairs clinicians about dementia caregiver support delivery following the COVID surge in the six New England states. 38 out of 68 (55%) clinicians from 6 states responded in June and July 2020. We found: 1) Clinicians continued providing the same types of support services for family caregivers before and after COVID, with over 50% of providers interacting with caregivers daily or multiple times per week. The most prevalent services were caregiver needs assessments, information and referrals, and assistance with accessing services. Two-thirds reported continuing to offer caregiver skills training and counseling, including peer support groups. 2) Caregiver support modality changed, most frequently through the combined use of phone and video, followed by only phone, and rarely, by only video. 3) Providers indicated that phone, more than video, increased to replace in-person interactions, because of multiple factors: caregivers (who continued to call for support on an as-needed basis but declined video encounters), providers (who began to provide group support via phone), and service factors (ad hoc versus scheduled encounters). Results suggest clinicians continued providing caregiver support despite suspension of in-person interactions, but future research is needed to assess the impacts of caregiver support delivery mostly by phone and factors underlying the limited use of video in delivering caregiver support.
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Affiliation(s)
| | - Emily Franzosa
- James J. Peters VA Medical Center, Bronx, New York, United States
| | - Rachael Scali
- Bedford VA Research Corporation, Inc., Belmont, Massachusetts, United States
| | - Lauren Moo
- Bedford VA Medical Center, Bedford, Massachusetts, United States
| | - Christine Hartmann
- Edith Nourse Rogers Memorial Veterans Hospital, Bedford, Massachusetts, United States
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Tsui E, Franzosa E, Boerner K. What Is Important at the End of Life? Perspectives From Experienced Home Care Workers. Innov Aging 2020. [PMCID: PMC7740708 DOI: 10.1093/geroni/igaa057.230] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Home care workers (HCWs) make up a large and rapidly growing sector of the American health care workforce serving older adults. This study focuses on a common but understudied feature of home care labor: workers’ thoughts around what makes a "good" or "bad" patient death. While researchers have investigated patients’, families’, physicians’, and other care providers’ perspectives on this issue, the perspectives of HCWs, who contribute substantially to home-based care at the end of life, have yet to be explored. We conducted 40 in-depth interviews with HCWs in New York City on their experiences with and reflections on patient death. We used a inductive, iterative approach to analyze data on what HCWs believe is important for dying patients. HCWs described EOL values that align well with the views held in common by patients, families, and other care providers, like the importance of not being alone when dying and being physically comfortable (not in pain and not suffering). In particular, HCWs conceptualized a detailed role for themselves when providing EOL care near the time of death. HCWs’ sustained presence and relationships with patients may uniquely position them to assist in the attainment of patients’ EOL goals, particularly when HCWs understand what these goals are. HCWs’ potential for playing this role, however, is jeopardized by a lack of training in EOL care and by the limited information they receive about a patient’s health status.
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Affiliation(s)
- Emma Tsui
- CUNY Graduate School of Public Health & Health Policy, New York, New York, United States
| | - Emily Franzosa
- James J. Peters VA Medical Center, Bronx, New York, United States
| | - Kathrin Boerner
- University of Massachusetts Boston, Boston, Massachusetts, United States
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Bernstein MF, Cinnick SE, Franzosa E, Murrman MK, Freudenberg N. Rationale and Design of Distance-Based Training to Persuade Local Health Department Employees that Addressing Social Determinants of Health Is Their Job, Too. J Public Health Manag Pract 2020; 25:448-453. [PMID: 31348159 DOI: 10.1097/phh.0000000000000827] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Public health workers in local health departments frequently rate skills needed to address social determinants of health among their top training needs. These workers have the ability to impact social determinants of health, but many may believe this responsibility is not part of their job description or that they do not have the necessary skills or resources. Guided by the Elaboration Likelihood Model of Persuasion and employing the case study method of instruction, the Region 2 Public Health Training Center designed a 45-minute, self-paced, online training module, titled Strategies to Advance Health Equity: How Health Departments Can Promote Living Wages, to persuade public health workers that addressing social determinants of health, especially those related to income disparities, is part of their day-to-day responsibilities. This article describes the module design, promising preliminary assessment data, and the formal evaluation plan.
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Affiliation(s)
- Melissa F Bernstein
- Centre for Health Equity Training Research and Evaluation, Ingham Institute for Applied Medical Research, Sydney, New South Wales, Australia (Ms Bernstein); Region 2 Public Health Training Center, Department of Sociomedical Sciences, Columbia University Mailman School of Public Health, New York City, New York (Ms Cinnick, Dr Murrman); and City University of New York School of Public Health and Health Policy, New York City, New York (Drs Franzosa and Freudenberg)
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Abstract
While there is a growing literature on home care workers, less is known about how home care companies market their services. Through a content analysis of the 19 largest U.S. home care and home health providers' websites, we examined how companies describe services, desired outcomes of care, and job responsibilities and qualifications. Companies actively market family-like relationships as central to "good care". However, companies' emphasis on unmeasurable skills such as compassion and warmth may also create exploitative work environments. Supporting "good care" requires improved data collection, industry oversight, and policy change to recognize socio-emotional care and protect a marginalized workforce.
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Affiliation(s)
- Emily Franzosa
- Brookdale Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai , New York, NY, USA.,Geriatric Research, Education, and Clinical Center (GRECC), James J. Peters VA Medical Center , Bronx, NY, USA
| | - Emma K Tsui
- Department of Community Health and Social Sciences, City University of New York (CUNY), Graduate School of Public Health and Health Policy , New York, NY, USA
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Franzosa E, Tsui EK, Baron S. "Who's Caring for Us?": Understanding and Addressing the Effects of Emotional Labor on Home Health Aides' Well-being. Gerontologist 2020; 59:1055-1064. [PMID: 30124808 DOI: 10.1093/geront/gny099] [Citation(s) in RCA: 43] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2018] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Interventions to strengthen the home care workforce focus on workers' economic and physical well-being, without acknowledging the caring labor affecting emotional well-being. Our study examined workers' perceptions of the emotional effects of caring work, coping mechanisms, and desired support. RESEARCH DESIGN AND METHODS We conducted 4 worker focus groups (n = 27). Moderators cross-checked codes and themes, and aides provided input through report-backs. RESULTS Building close, trusting relationships with clients was central to aides' emotional well-being. Well-being was also influenced by relationships with client families and agency supervisors, work-life balance, and the level to which aides felt their work was valued. Aides were largely alone in managing job stressors and desired more communication, connection, and support from supervisors and peers. DISCUSSION AND IMPLICATIONS Recognizing and supporting the emotional demands of caring work is crucial to strengthening the workforce. Policy makers and agencies must realign reimbursement systems, job descriptions, and care plans to include measures of emotional labor, improve communication between workers and supervisors, and provide training, mental health benefits, and peer support.
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Affiliation(s)
- Emily Franzosa
- Department of Community Health and Social Sciences, City University of New York (CUNY) Graduate School of Public Health and Health Policy
| | - Emma K Tsui
- Department of Community Health and Social Sciences, City University of New York (CUNY) Graduate School of Public Health and Health Policy
| | - Sherry Baron
- Barry Commoner Center for Health and the Environment, Queens College, CUNY, Flushing, New York
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