Sarah Miner

Home health care (HHC) focuses on delivering skilled health care services to patients in their homes. Over 82% of HHC patients are 65 and older, and living with chronic health conditions. In an effort to respond to the risk the COVID-19 pandemic presented for patients, a HHC agency designed “The Outreach Phone Call Project”. This program was developed to provide telephone support to at-risk patients who had received HHC prior to the COVID-19 lockdown. In total, 16 Care Transition Managers participated in the project and over 4,000 patients received a call from the clinical team. Approximately 44% of the calls did not require any further follow up, 20% of the patients did not answer the call, and 3% of patients were referred back to HHC. Another 13% needed education and assistance with social issues. The calls provided a means of safe connection and support between providers and patients during the pandemic and facilitated access to health and social resources. However, the most beneficial aspect of the program was the opportunity for seasoned HHC nurses to identify clinical changes in the health of patients and to assist them in the triage process. Results of this study demonstrate that the implementation of a calling project during the pandemic shutdown provided invaluable connection and outreach to vulnerable populations. This simple change in practice enabled HHC professionals to reach patients who were isolated and in need of education and assistance. As a result of the implementation of an “Outreach Phone Call Project”, the HHC agency learned many lessons which may be helpful to others who would like to create a similar program in the future. It facilitated clinical assessment, education and intervention for isolated patients during the COVID 19 pandemic and implementation of similar practice should be considered in the post-pandemic world.

Background: Home health care (HHC) is a leading form of home and community-based services for persons with dementia (PWD). Nurses are the primary providers of HHC; however, little is known of nursing care delivery and quality. Objective: The objective of this study was to examine the association between continuity of nursing care in HHC and rehospitalization among PWD. Research Design: This is a retrospective cohort study using multiple years (2010−2015) of HHC assessment, administrative, and human resources data from a large urban not-for-profit home health agency. Subjects: This study included 23,886 PWD receiving HHC following a hospitalization. Measures: Continuity of nursing care was calculated using the Bice and Boxerman method, which considered the number of total visits, nurses, and visits from each nurse during an HHC episode. The outcome was all-cause rehospitalization during HHC. Risk-adjusted logistic regression was used for analysis. Results: Approximately 24% of PWD were rehospitalized. The mean continuity of nursing care score was 0.56 (SD=0.33). Eight percent of PWD received each nursing visit from a different nurse (no continuity), and 26% received all visits from one nurse during an HHC episode (full continuity). Compared with those receiving high continuity of nursing care (third tertile), PWD receiving low (first tertile) or moderate (second tertile) continuity of nursing care had an adjusted odds ratio of 1.33 (95% confidence interval: 1.25−1.46) and 1.30 (95% confidence interval: 1.22−1.43), respectively, for being rehospitalized. Conclusions: Wide variations exist in continuity of nursing care to PWD. Consistency in nurse staff when providing HHC visits to PWD is critical for preventing rehospitalizations.

According to the U.S. census Bureau, close to 20% of the U.S. population speaks a language other than English at home. Home health care (HHC) patients who speak English less than very well or have limited English proficiency (LEP) are at an increased risk for medication mismanagement and serious health consequences. The purpose of this study was to examine if there were differences in medication management between English-speaking patients and patients with LEP receiving HHC services. Data for this cross-sectional observation study were collected from 2010 to 2014. Medication management was measured by two items in the Centers for Medicare and Medicaid Services–mandated Outcomes Assessment Information Set (OASIS). All patients in the database who were taking medications and had a valid admission and discharge assessment from HHC were included in the analysis. Inverse probability of treatment weighting (IPTW) with a marginal structural model was used to address potential imbalances in observed patient characteristics when estimating the effect of having LEP or being an English-speaking HHC patient on changes in medication management over the course of a HHC episode. Estimates from marginal structural model with inverse probability weighting indicate that being LEP was associated with less improvement in medication management and increased likelihood of getting worse over the course of a HHC episode. This study is one of the first to demonstrate that patients with LEP experience disparities in medication management when compared to English-speaking patients in HHC.

Many studies have identified the vulnerability of ethnic elders, and there is promising evidence indicating home health care (HHC) services can improve the health outcomes of Somali older adults. This study used a community-engaged qualitative descriptive approach with the participation of non-profit organization Refugees Helping Refugees. The purpose of this study was to explore and describe Somali older adults’ and their families’ perceptions of and experiences with HHC services in order to improve its use and access. Data collection included home visits (n = 15), semi-structured interviews (n = 17) and debriefing sessions (n = 16) with 19 individuals from 14 Somali families. Somali families recognized HHC services were needed and believed having services in the home facilitated learning but HHC agencies should work more with the Somali community. HHC agencies need to work with community organizations to facilitate cultural and health understanding, and better health care for Somali older adults.

The United States resettles close to 70,000 refugees each year more than any other country in the world. Adult refugees are at risk for negative health outcomes and inefficient health resource use, and meeting the multiple health needs of this vulnerable population is a challenge. The purpose of this study was to assess the impact of a home health care (HHC) pilot project on meeting the needs of older adult refugee patients. A retrospective chart review of 40 refugee adult patients who participated in an HHC pilot was done to analyze their health outcomes using OASIS-C data. Participants’ pain level, anxiety level, medication management, and activities of daily living management all significantly improved over the course of their HHC episode. Results of this study indicate that HHC has great potential to improve the health of vulnerable refugee populations and assist the families involved in their care.