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The aim of this scoping review was to examine the national and international literature on the response of adult Hospital at Home (HAH) services to the global Covid-19 pandemic and explore key themes to emerge and make recommendations for further research. The databases were searched using agreed search terms and Arksey and O'Malley's scoping review framework was utilized and papers were identified and analyzed for common themes. Thirty-one papers were included in the review. Of the papers included, general adult medicine was the largest service group (n = 15) with geriatric services the next largest (n = 12). Most papers were European in origin (n = 19). Key themes to emerge include (1) similar outcomes for HAH patients compared with traditional inpatient care, (2) expansion of capacity for inpatient care due to HAH use, (3) growth of virtual monitoring in HAH setting, (4) reduction in infection transmission in HAH setting, and (5) cost reduction due to HAH utilization. Hospital at home demonstrated good outcomes for both patients with Covid-19 and other conditions during the pandemic. These services also expanded capacity during a global healthcare crisis. Remote monitoring played a major role in the expansion of capacity and the reduction of infection transmission during the pandemic. Although some papers discuss how HAH is more cost effective than traditional hospital, more work is needed around this as many of the patients may not have been as sick as those admitted to traditional hospital during the pandemic. [ABSTRACT FROM AUTHOR]

Journaling has been around for many centuries but continues to be a vital modality in the realm of complementary alternative medicine. This modality is discussed relative to the technique, outcomes, and benefits derived from regularly using journaling for expression and relaxation. The response to journaling by different individuals and application techniques are an integral part of this article. The key considerations—patience, practice, and consistency—are presented as they relate to the successful development of regular journaling. [ABSTRACT FROM AUTHOR]

The onset of the COVID-19 pandemic has accelerated the adoption of virtual care as a modality for home-based care delivery to individuals and cohorts who might not otherwise have access. While a number of positive outcomes have been reported, rapid growth has occurred without critical consideration of clinician education and training. Little is known about the curricular and pedagogical requirements for educating current and future clinicians in virtual care provision. This review was informed by Arksey and O'Malley's five-stage methodological framework for scoping reviews, first published in 2005. Using a clearly articulated search strategy and reporting process, over 4000 pieces of literature were analysed to inform this review. A final 17 papers were included. Common themes emerging in relation to curricula content include the basics of virtual care, cultural awareness, interprofessional collaboration/training, telepresence, encompassing non-verbal, verbal and environmental considerations, and virtual care clinical skills. Standalone modules are recommended for delivering 'the basics' of virtual care, while the interactive/participative approach is endorsed as an appropriate method of instruction. The reviewed literature reviewed offers a set of core inclusions and pedagogical approaches for a virtual care education program, although these are often mentioned in general terms and are not always well described. Moving beyond the COVID-19 pandemic, virtual care education for current and future clinicians requires a consistent and cohesive approach to curricula and pedagogies. These approaches should be rigorously evaluated as part of a continuous quality improvement process. [ABSTRACT FROM AUTHOR]

In Asia where family caregiving is part of the culture, palliative home care becomes the most suitable service to keep patients close to their family and to reduce costs. There is a wide variety of palliative home care services due to different cultures and levels of involvement of the family. This review aims to explore the implementation of palliative home care in East and Southeast Asian countries. The articles reviewed in this study were obtained from 3 electronic databases: EbscoHost, PubMed, and Scopus. Journal articles that discussed palliative home care for patients with cancer in East and Southeast Asia countries were included. Review papers were excluded. Seven studies were used in the current review. In general, there are 6 services provided for palliative home care in this region, which are daily activity living care, planning and preparation for palliative home care, education and counseling, patients' follow-up, symptom management, and direct care for family. Most of the programs involve family caregivers during the treatment. The palliative home care team consists of at least a doctor and a nurse. Symptom management is the most common service and direct care for family is the least offered palliative home care service in this region. Alleviating symptoms is one of the targets in palliative care, therefore involving family in symptom management for palliative home care is fundamental. Although caregiving is part of the culture, family members need to be supported to maintain their quality of life. [ABSTRACT FROM AUTHOR]

Annual turnover of home care workers represents a huge loss of revenue and is a key source of inefficiency in the home health care industry. In this article, we propose a data-driven approach to monitor employee churn and to capture the evolution of employee intent to leave. Unlike most papers in the literature, we use machine learning techniques to analyze over 2 million visits in the US, Canada, and Australia between 2016 and 2019. Results show that the gap between the number of hours worked and in the contract is the most important factor to predict employee intent to leave, which means an employee should be given as many hours as requested in the contract to improve retention. Secondary results show that having diverse shift lengths and continuity in services and patients seem to be associated with less turnover. [ABSTRACT FROM AUTHOR]

Transitional care is a designed plan to ensure the continuity of care received by patients as they transfer between different locations or levels of care. The aim of this paper is to explore nurses' experiences of transitional care in multiple chronic conditions. A qualitative method with a conventional content analysis approach was utilized. The study was conducted at university hospitals in 2 big cities (Isfahan and Tehran) of Iran. This study is performed from November 2018 to December 2019 using deep, semi-structured, and face-to-face interviews which are focused on nurses' experiences of transitional care. Data collection continued until saturation was reached. Finally, 15 nurses take part in this study. Data collection and data analysis were conducted concurrently. Data were analyzed using Graneheim and Lundman's techniques. Two main themes providing a descriptive summary of the major elements of transitional care identified: "threat to patient safety" and "Care breakdown". Findings showed an exclusive image of unsafe transitional care which was done unplanned without appropriate delegating care to family and threat patient safety. There is still a gap in the transition from hospital to home. Nursing managers can address this issue by creating a culture of teamwork, training competent nurses by continuum education, and more supervision of nursing care. Policymakers can ensure continuity of care by developing policies and programs about transitional care. [ABSTRACT FROM AUTHOR]

This study aimed to examine the concept of Managed Long Term Care service from a care manager's perspective. The Walker and Avant concept analysis approach was applied. The defining attributes include (1) chronic disease or disability, (2) coordination of care, and (3) services. Core components of Managed Long Term Care service were found to be a network of providers and capitation. A conceptual model of Managed Long Term Care service was developed with Managed Long Term Care service operationally defined as "a program with a set of services delivered to patients who have a chronic illness or disability and wish to stay safe and healthy at home in the community. The services or benefits are coordinated by a care manager who serves as a point of contact for the patient and provider(s), and are delivered by providers in the network." Care management is a core concept of Managed Long Term Care. The triple aims of Managed Long Term Care are to deliver the right care at the right time at the right cost to Managed Long Term Care eligible patients. This paper sought to illuminate and clarify varied perspectives on the concept of Managed Long Term Care service. Without a clear understanding of a community-based service or program, delivery of nursing care may be less effective. This study was the first to examine this widely used but often imprecisely defined community health service from a case manager's point of view. [ABSTRACT FROM AUTHOR]

Health information technology (HIT) holds potential to transform Home Health Care (HHC), yet, little is known about its adoption in this setting. In the context of infection prevention and control, we aimed to: (1) describe challenges associated with the adoption of HIT, for example, electronic health records (EHR) and telehealth and (2) examine HHC agency characteristics associated with HIT adoption. We conducted in-depth interviews with 41 staff from 13 U.S. HHC agencies (May-October 2018), then surveyed a stratified random sample of 1506 agencies (November 2018-December 2019), of which 35.6% participated (N = 536 HHC agencies). We applied analytic weights, generating nationally-representative estimates, and computed descriptive statistics, bivariate and multivariable analyses. Four themes were identified: (1) Reflections on providing HHC without EHR; (2) Benefits of EHR; (3) Benefits of other HIT; (4) Challenges with HIT and EHR. Overall, 10% of the agencies did not have an EHR; an additional 2% were in the process of acquiring one. Sixteen percent offered telehealth, and another 4% were in the process of acquiring telehealth services. In multivariable analysis, EHR use varied significantly by geographic location and ownership, and telehealth use varied by geographic location, ownership, and size. Although HIT use has increased, our results indicate that many HHC agencies still lack the HIT needed to implement technological solutions to improve workflow and quality of care. Future research should examine the impact of HIT on patient outcomes and the impact of the COVID-19 pandemic on HIT use in HHC. [ABSTRACT FROM AUTHOR]

The study was conducted to review, categorize and organize early tele-homecare follow-up research in premature infants based on research type, the focus of tele-homecare, and measured outcomes. This narrative review was conducted in 2021 through international databases, including PubMed, Scopus, ProQuest, and Web of Science databases. Studies selected for this purpose included original articles on premature infants. We reviewed 16 out of 267 identified articles. These studies were analyzed according to general characteristics, elements, and characteristics of tele-homecare intervention. Based on the obtained data, most studies had been conducted in Nordic countries as the pioneer in tele homecare. Also, most of them were on the psychological status of premature infants' parents. Phone calls, video consultation, and applications were considered dominant tele-homecare communication tools. Overall, the qualitative studies on parents' and health providers' views about tele homecare revealed its hidden aspects as a supportive tool. The tele-homecare studies were distributed across different fields and countries, resulting in positive outcomes for infants and parents. However, further studies in the long-term periods are recommended to follow up on premature infants. [ABSTRACT FROM AUTHOR]

The objective of this study was to optimize a planned audit and feedback (A&F) intervention for home and community care through incorporating user-centered design principles. Phase 1 comprised the development of a paper prototype, followed by testing of the prototype using semistructured interviews and focus groups. Phase 2 involved the development of a revised and online prototype based on the results of Phase 1, followed by user testing. A total of 39 participants across Phase 1 (n = 33) and Phase 2 (n = 6) provided input into the design of the A&F intervention. Key changes included improving clarity of the variables, reducing cognitive load, and highlighting opportunities for action. Preliminary findings suggest potential usefulness in this approach to optimize home care management. [ABSTRACT FROM AUTHOR]

The development of new management solutions is needed to generate great changes in the health sector, especially in addressing the current collision course between growing health care demands, rising costs, and limited resources. One of these solutions is the hospital at home (HAH). This article aims to explore the existing literature, regarding possible health gains and economical outcomes in HAH programs versus traditional inpatient hospitalization. A search of literature was conducted to identify papers regarding HAH programs and their respective health and economical outcomes. The concept of HAH encompasses different levels or care schemes. Several examinations and treatments can be carried out at home. Hospital at home may optimize patient flow and relieve pressure on hospital bed availability. However, questions are raised regarding the uncertainty of the efficacy of HAH and the limited evidence on which model setting is most appropriate. [ABSTRACT FROM AUTHOR]

Teaching a graduate-level nursing research course can be quite challenging, especially one that is offered online and asynchronously. One of the assignments required of master of science in nursing (MSN) students is to develop a paper that examines a clinical problem that might be improved by using research knowledge. Students are then required to review the studies in this problem area, summarize what is known and not known regarding this problem, and summarize the gaps in the literature. They then are to write a critique supporting or refuting this practice. This assignment has proven to be both challenging and rewarding for the MSN students. They often comment that they had no idea that the research was or was not available to support (or refute) their clinical practice. The lack of research in these clinical problem areas has led some students to conduct research in these areas. [ABSTRACT FROM AUTHOR]

A mixed methods descriptive study explored 38 nurses’ perceptions of usability and factors influencing the use of 13 symptom management protocols when caring for patients with cancer in the home. Descriptive analysis of the usability survey revealed protocols had high readability, right amount of information, appropriate terms, and were self-evident to complete. Thematic analysis of transcripts identified barriers to using the protocols including lack of time, paper-based documentation systems, and length of the protocols. Facilitating factors included high usability of the protocols, integration of a remote symptom support nursing role, and the usefulness for education and training. In summary, the protocols were described as a useful resource and beneficial for nursing orientation but required support to overcome some barriers and improve fit with clinical workflow. [ABSTRACT FROM AUTHOR]

This paper is an examination of the relationship between continuity of care with home health physical therapists following hospitalization and the likelihood of readmission. We conducted a retrospective cohort study. Using rehospitalization as the dependent variable, a continuity of care indicator variable was analyzed with a multivariable logistic regression. The indicator variable was created using the Bice-Boxerman Index to measure physical therapist continuity of care. The mean of the index (0.81) was used to separate between high continuity (0.81 or greater) of care and low continuity of care (lower than 0.81). The sample included 90,220 patients, with data coming from the linking of the Outcome Assessment and Information Set (OASIS) and an administrative dataset. All subjects lived in the NYC metro area. Inclusion criteria was a patient’s admission to their first home health care site following discharge occurring between 2010 and 2015, and individuals who identified as Male or Female. In comparison to low continuity of physical therapy, high continuity of physical therapy significantly decreased hospital readmissions (OR = 0.74, 95% CI 0.71-0.76, p ≤ .001, AME = −4.28%). Interpersonal continuity of physical therapy care has been identified as a key factor in decreasing readmissions from the home care setting. The research suggests an increased emphasis in preserving physical therapist continuity following hospitalization should be explored, with the potential to reduce hospital readmissions. [ABSTRACT FROM AUTHOR]

Teamwork is considered something positive. While there is much research on teamwork in healthcare, research on teamwork in home care nursing is limited. As the need for home care nursing is likely to increase in the future, it is of great interest to investigate the circumstances associated with the implementation of teamwork in home care nursing. The present study compares the results from a large change initiative intended to foster inter-organizational teamwork between municipal home care nurses and doctors employed by the region, with success factors identified by forerunners and contemporary team theory. Eighteen participants representing the organizations involved in the change initiative, and 6 participants from the forerunners, were interviewed, and 3 success factors were identified: fixed doctors in team, co-location of staff, and a shared team identity. However, for the studied change initiative, few of the success factors were present. Since the success factors are similar to factors associated with effective teamwork in the literature, this is problematic. The results indicate that there was a focus on the division of labor between the municipalities and the region rather than on interdisciplinary cooperation. They also suggest that the change initiative, as it worked in practice, did not always make sense from the perspective of the nurses and doctors involved. Thus, we suggest that measures are taken to ensure that change initiatives, like the 1 studied, also make sense on the local level in the organization where most of the implementation takes place. [ABSTRACT FROM AUTHOR]

Palliative care improves the quality of life for patients; however, its value-for-money is not yet established. The objective of the present study was to identify and critically assess published studies which investigate the cost-effectiveness of palliative care. A defined strategy was applied; the identified records were assessed with specific inclusion-exclusion criteria (PICO). Methodological quality of the included studies was assessed with the Drummond checklist. An electronic search was conducted in PubMed, SCOPUS, Cochrane Database of Systematic Reviews, and Cochrane Central Register of Controlled Trials, from January 2010 up to December 2022. A narrative synthesis approach was used. From a total of 3857 records, 21 studies were included in the analysis. Almost half (n = 10) the studies were conducted along randomized controlled trials, while the most common setting was home-based palliative care (n = 9). Quality of life was the most commonly assessed outcome (n = 14), measured almost exclusively in Quality-Adjusted Life Years (n = 13). In more than half of the included studies (n = 13), palliative care was found to lead to improved outcomes, while 3 studies did not find any difference in outcomes between comparators. Also, palliative care yielded lower costs in 13 studies and increased costs in 5 studies. Overall, 11 studies concluded that palliative care was a cost-effective intervention. The results of the review indicate that palliative care has the potential to be a cost-efficient allocation of healthcare resources or, at least, a cost saving approach. However, the need for a commonly aligned methodological framework still remains. [ABSTRACT FROM AUTHOR]

Transition from a paper-driven system to a computerized clinical record is one of the most significant performance improvement activities in which any home health care organization may embark. Implementation of computerized documentation is a change that will impact virlually every aspect of operations within the organization. Although selection of hardware and sof tware is critical, the ultimate success of the project is dependent upon the commitment and effort of the people within the organization. This article will focus on one home care organization's experience implementing laptop technology. The results of this performance improvement activity include increased productivity of both in-of fice and field staff, decreased aggregate visit costs, and continued staff and patient satisfaction. [ABSTRACT FROM PUBLISHER]

This study assessed the prevalence of Adverse Childhood Experiences (ACEs) among Home Care Aides (HCAs) and explored the relationship between ACEs and mental health. A 2017 survey of 424 HCAs assessed childhood trauma using the CDC-BRFSS ACE module. Approximately 27% of HCAs had a high ACE score (between 4 and 10). There were no associations found between ACE score and respondent demographic characteristics. HCAs with high ACE scores reported lower rates of social and emotional support and higher rates of past-month hopelessness compared with those with no or limited experience of adverse childhood events. This research suggests that HCAs have higher than average rates of ACEs, known to be linked to various negative physical and mental health outcomes. [ABSTRACT FROM AUTHOR]

India is currently experiencing a demographic and epidemiological transition characterized by an aging population and an increase in chronic diseases, resulting in a greater demand for home healthcare services. Despite the critical nature and expansion of this area, home healthcare delivery in India remains under-researched. There is a dearth of information about the services, providers and organizations that offer services at home. There are various concerns in the provision of home healthcare services. These relate to accessibility and availability, information on providers, regulatory issues, standards of care, costs, safety concerns, and grievance redressal mechanisms for providers and users, which are among the topics discussed in this article. The article concludes that there is a need to recognize the "home" as a place for providing healthcare and as a "workplace" of care providers, develop standardized processes and guidelines for delivering care for different conditions at home, adopt standard human resource practices in deployment of care providers, bring transparency in the calculation of the cost of services and regulation of costs, and establish grievance redressal mechanisms for users, providers, and organizations. Further research is recommended on aspects such as user and provider perspective, training and supervision of providers, and financing, accreditation, and quality of services. [ABSTRACT FROM AUTHOR]

The availability of personal support workers (PSWs) is a limiting factor for home care system capacity, as this workforce provides 70% to 80% paid care in this sector. Without sufficient support to live at home, many seniors and people with disabilities experience poorer outcomes and require care in more expensive and less preferred institutional long-term care or hospital settings. Insufficient PSW availability is limiting access to necessary care in the community. Capacity challenges are particularly pronounced on weekends. The Essential Care on Weekends (ECoW) program was co-developed as one solution to adapt current PSW scheduling practices to increase the number of clients with high-intensity care needs who can be served within the constraints of PSW availability. ECoW focused on increasing weekend capacity and care consistency, particularly for clients with the highest care needs, through prioritizing essential care and moving less time sensitive tasks to weekdays. ECoW was operationalized through 4 activities: communication and engagement, clinical care plan review, geographic review of PSW schedules and the creation of the ECoW schedule. Implementation of ECoW demonstrated success in increasing access to and consistency of care for clients with the highest care needs: weekend capacity increased, access to care improved for clients requiring daily or near-daily care and missed care rates decreased both on weekends and weekdays. This strategy represents a change in scheduling practices that organizations can use to provide consistent service to a growing number of clients with high-intensity care needs in the context of increasingly limited health human resource capacity. [ABSTRACT FROM AUTHOR]

There is significant literature on social determinants of health (SDOH) to improve health outcomes. In response, Congress and the Centers for Medicare and Medicaid Services (CMS) have expanded Medicare Advantage Plans' ability to cover SDOH-related services through supplemental benefits and Special Needs Plans (SNPs). Congress has not authorized Traditional Medicare to cover such services. A literature review indicates no studies of Medicare home health social worker awareness of this dichotomy and their resulting perceptions of the impacts of the lack of such coverage. This article summarizes an initial, exploratory study to address the literature gap, based on interviews of a convenience sample of 44 home care social workers from 5 different home health agencies in the New York City metropolitan area between November 1, 2021, and May 31, 2022. Results indicate social workers lacked awareness of the dichotomy in coverage of SNPs and supplemental benefits in Medicare Advantage Plans and traditional Medicare. Once made aware of the dichotomy, 4 additional themes emerged from the interviews: documented patient needs were being ignored; the supplemental needs coverage permitted for Medicare Advantage plans should be extended to beneficiaries receiving traditional Medicare; and the lack of such coverage increased the risk of onset of mental and physical health conditions, and revolving door-admissions and costs. Policymakers are urged to consider adding coverage of special needs and supplemental benefits covered in Medicare Advantage to traditional Medicare, through Medicare home health. [ABSTRACT FROM AUTHOR]

Despite poor outcomes for older adults following hospitalization, practice patterns of post-acute care clinicians and factors impacting quality of care are not well studied, which limits advancements in clinical care. Qualitative research on the factors that influence physician practice patterns with respect to older adults has been studied and may provide a framework for hypothesizing factors relevant to other post-acute care clinicians. Three themes emerged from this qualitative metasynthesis: (1) Current medical education and clinical guidelines are not aligned with the multifaceted care needed for older adults, (2) communication gaps impact quality of care, and (3) health policies constrain quality of care. Identifying potential factors that impact practice patterns in post-acute care providers may guide future research initiatives that shape health professional education and system policies. [ABSTRACT FROM AUTHOR]

Palliative care is a comprehensive approach aimed at improving the quality of life of patients with serious illness and their families. Nevertheless, there exists a dearth of systematically synthesized empirical evidence regarding the key elements that contribute to good home palliative care (HPC) from a familial standpoint in the context of South and Southeast Asia. This paper aims to describe family perspectives on key elements of good home palliative care in both regions. We conducted a scoping review using Arksey and O’Malley’s methodological framework. The search was done in 6 electronic databases: PubMed, Ovid MEDLINE, EMBASE, Web of Science, APA PsycINFO, and APA PsycArticles Full Text. Inclusion criteria were (1) exploring family experiences of palliative care, (2) home setting, and (3) South and Southeast Asian countries. Twenty-four studies were included from Bangladesh (n = 1), India (n = 6), Indonesia (n = 7), Malaysia (n = 2), Singapore (n = 2), and Thailand (n = 6). Five key elements of HPC from family perspectives were comprehensive moral and psychological support; religious and spiritual activities with religious figures involvement; empathetic, responsive, and continued home palliative care; adequate access to information and skills training; and facilitation in dealing with systemic barriers. The crucial role of religious and spiritual activities and the need for facilitation in facing systemic barriers were specific to South and Southeast Asia. HPC teams should be able to provide holistic support for patients and their families, which is influential for the quality of care. Improving care on a systemic level in these regions should be a policy priority. [ABSTRACT FROM AUTHOR]

Low HPV vaccination rates among US Hispanics/Latinos remain a public health issue. This cross-sectional study investigated the perceived barriers and recommended sources related to HPV vaccination among 209 Hispanic/Latino college students in the United States. From a self-report questionnaire, barriers were insufficient provider recommendations and not having a regular care provider. Doctors, parents, and nurses were identified as the most effective sources for recommending HPV vaccination. Uncertain effectiveness was more likely to be reported as a barrier to HPV vaccination by participants who identified as Catholic. Participants born outside the U.S. were more likely to report "no recommendation received" and "not knowing where to get vaccine." Health care providers can promote HPV vaccination by acknowledging familial allegiances of Hispanic/Latino college students. The role of religion and cultural beliefs in HPV vaccination among Hispanics/Latinos underscores the need for further research in this area. Universities could be a place of HPV awareness initiatives, as having more formal education does not translate into having more HPV knowledge. To decrease HPV vaccination barriers, the home-based vaccination program could potentially impact HPV vaccine uptake among Hispanic/Latino populations and should be further explored. [ABSTRACT FROM AUTHOR]

Due to demographic changes and structural developments in the healthcare system, an increasing number of patients receive home care nursing in Denmark. Little is known about the complexity of home care. The aim of this paper was to investigate the challenges that home care nurses experience in their clinical practice by studying factors related to home care nurses’ experiences of encounters with patients as burdensome. A population-based survey was undertaken involving all nurses in homecare services in one municipality in Denmark. The participating nurses registered all home care contacts by the patients during the daytime for 1 week. A registration form was used including a series of items designed to identify factors related to the perceived burden of each visit. Statistical frequency analyses were used to examine factors related to the home care nurses’ experiences of encounters with patients as burdensome, and to investigate the challenges that home care nurses meet in their clinical practice. Home care nurses estimated 7.6% of 941 representative homecare visits as burdensome. Assessment of burden was associated with patients being below 60 years of age, time consumption and unexpected problems during the visit, especially of a psychosocial nature. Even though <10% of the encounters were considered burdensome, there is reason to believe that an increase can be expected due to ongoing emphasis on achieving greater efficiency in the healthcare system. [ABSTRACT FROM AUTHOR]

As utilization of home care increases across Canada, questions are emerging concerning the extent to which home care expenses, many of which are not publicly covered, are borne by unpaid caregivers of home care recipients. In this systematic review, we review English-language literature published between 2001 and 2022 exploring the magnitude and sources of home care costs incurred by unpaid caregivers in Canada. Of particular interest were empirical, cost-of-illness studies that describe the implications of these costs across domains of financial risk, including caregivers' income level, employment status, and personal health. Following the screening of 492 studies derived across 6 databases (OVID Medline, CINAHL, PsycINFO, AMED, EconLit, and EMBASE), 24 studies were included in this review. Overall, few studies describe how home care expenses incurred by unpaid caregivers contribute to their financial risk. While some studies characterize the direct costs of caregiving incurred by caregivers, including out-of-pocket expenditure on transportation to medical appointments, respite care, home renovations, supplemental housekeeping, and prescription medications, limited studies attempt to estimate the magnitude of these expenses. Concerning financial risk, the literature is chiefly concerned with indirect costs of caregiving, including consequences on caregivers' employment (foregone wages). Findings from this literature review suggest further work is needed in Canadian context to document costs associated with unpaid home care provision. [ABSTRACT FROM AUTHOR]

Early identification and follow-up of sub-acute and acute functional decline in older persons living with multimorbidity at home require integrated and proactive care by interdisciplinary health personnel. Yet, in the context of the task-oriented and fragmented home healthcare services, early identification is challenging. Therefore, the aim of this study was to identify preconditions for the success of a proactive and interdisciplinary follow-up of older recipients of home healthcare. We conducted a qualitative secondary analysis of data from 6 focus group interviews with registered nurses and nurse leaders. In addition, we performed and analyzed data from 2 new focus group interviews with general practitioners and RNs who had a role as super users in a developmental project which introduced a clinical instrument for early identification of sub-acute and acute functional decline (sub-acute functional decline in the elderly—SAFE). Their experiences with using SAFE constituted the backdrop for the study. In total, 41 representatives of the interprofessional primary care staff of 3 city districts participated. Having a common goal, sharing tasks and having reciprocal understanding of each health profession's contribution, systems and tools and clinical leadership were all seen as important factors for succeeding in the proactive and interdisciplinary follow-up of older recipients of home healthcare. Clinical leadership was deemed the strongest precondition, and clear leadership which promotes integrative and proactive care by facilitating interdisciplinary collaboration appears to be the main key for success. [ABSTRACT FROM AUTHOR]

As global aging increases, the issue of long-term care is becoming increasingly important. This study examined the factors influencing the preferences of older Japanese people for long-term care. Three hundred Japanese people over 65 years old were recruited to participate in this online survey on preferences for long-term care. Structural Equation Modeling (SEM) was conducted to demonstrate the effects of various variables. The results showed that support from the community, family savings, awareness of family caregiving, psychological indebtedness, and self-efficacy directly affected the preferences for long-term care. Gender, age, social participation, cohabitation, and health status self-assessment indirectly affected the preferences. This study demonstrated the influence of relevant factors, especially psychological factors, on the long-term care preferences of older Japanese people. [ABSTRACT FROM AUTHOR]

To develop and validate a scale, the Self-management of Dementia by Carers (SMDC). Mixed-methods were used. First, the domains of the SMDC Scale were identified through a systematic literature review and interviews with expert professionals and carers. Then the following psychometrics were performed: content and face validity, internal consistency, test-retest reliability, and construct validity. The final scale had 58-item grouped into 6 factors. The internal consistency and test-retest reliability coefficients were excellent. This scale can be used to determine carers' ability to assist the person living with dementia to self-manage this condition in clinical practice and research. [ABSTRACT FROM AUTHOR]

Many older adults across all settings are on antipsychotic medications; all too frequently for long periods of time. There are very few studies about the long-term effects of these medications, especially when used in those with declining physiological ability to metabolize medications. This paper looks at the three most commonly prescribed classes of antipsychotic medications used in older adults. A second purpose is to increase knowledge and potential strategies home health nurses can use to help their patients. [ABSTRACT FROM AUTHOR]

The Fourth Annual Conference of State Nursing Workforce Centers took place on April 27-28, 2006, in Jersey City, New Jersey. This is a summation of participant's activities at the workforce centers conference, including information regarding the North Carolina Center for Nursing, Legislative Leadership Immersion Institute, George Mason University, Colleagues in Caring, and the New Jersey Collaborative Center for Nursing. Key topics discussed included critical analysis of the national workforce issues such as shortage (supply and demand), work regarding nursing satisfaction, turnover, and workforce issues' impact on patient outcomes. In addition, nursing practice and work design were discussed, along with national and local policy issues, including successful strategies for nurse policy advocacy and communication of nursing needs and potential problem solutions to multiple stakeholders. This article summarizes the highlights of this important conference. [ABSTRACT FROM AUTHOR]

Appropriate and efficient provision of services at home requires more than skilled personnel} effective communication between the primary care provider and the agency is an often overlooked but essential tool for maintaining the patient's health in the community. A method was developed to create home care orders (the "e-485") that guides the physician through the order writing process, uploads data from the electronic medical record, and creates a legible, complete order set that can be faxed quickly to the agency. This paper describes this tool and the challenges and rewards of its implementation in an academic medical center. [ABSTRACT FROM AUTHOR]

Patients with advanced chronic illness receive increasingly fragmented care as they near the end of life. Multiple hospital readmissions are the rule, followed by intermittent episodes of home health care. Pain management, advance care planning, and preparation for dying may be lacking. Because prognosis is uncertain, particularly in noncancer cases, access to hospice and palliative care services is often denied to these patients until they are very near death. Home-based transition management can provide high-risk chronically ill patients better continuity of care until they are eligible and emotionally ready for hospice, and can manage their dying if referral to hospice is refused. Home care is positioned to provide innovative services that would increase access to end of life care. This paper outlines limitations of current approaches to end of life care, proposes potential components of transition management services, and discusses operational, regulatory, and reimbursement challenges to implementation. [ABSTRACT FROM AUTHOR]

Communication with culturally diverse children is challenging for home health care professionals. Art is an integral part of every culture and this article advocates that health care professionals engage children and elicit their perspectives and experiences with art. Specific techniques highlight art interventions that enhance communication and understanding for all children. [ABSTRACT FROM PUBLISHER]

Given the situation of cancer patients as vulnerable patients and the threat of COVID-19 in the society, integration of home-based palliative care services into the healthcare system is essential. The aim of this qualitative study was to explore the current barriers of integration of palliative care services from hospital to home for cancer patients during the COVID-19 Pandemic and to provide suggestions to resolve them. Semi-structured interviews were conducted with 25 stakeholders in the healthcare system, including health policy makers, healthcare providers, clinical home healthcare experts, home healthcare researchers, university faculty members, clergy, family caregivers, and cancer patients. Data were analyzed using directed content analysis method based on the World Health Organization Public Health Strategy for Palliative Care. Challenges were extracted in 4 main categories, containing education barriers (3 subcategories), implementation barriers (9 subcategories), policy barriers (5 subcategories), and drug availability barriers (2 subcategories). Based on the results, removing the barriers and establishing a strong infrastructure for home-based palliative care services is recommended in the healthcare system by concentrating on 4 essential factors, that is, utilizing a coordinating nurse during the process of patient's hospital discharge, establishment of connecting outpatient palliative care clinics to home healthcare centers, access to palliative care tele-medicine and development of a comprehensive and flexible home-based palliative cancer care model in our context. [ABSTRACT FROM AUTHOR]

Type 1 diabetes (T1DM) is a common chronic health condition in children that necessitates close monitoring and care. Parents face numerous challenges when caring for children with T1DM, particularly at home owing to self-care. There is little information available about Arab parents' experiences and educational needs when caring for children with TIDM. The purpose of this study was to explore the experiences and educational needs of Arab parental caregivers in Saudi Arabia who live with and care for children diagnosed with T1DM. An inductive qualitative descriptive design was used in this study. The data were amassed over a 4 month period through audio-recorded semi-structured interviews with 16 Arab parents of children aged 18 years and under who had been diagnosed with T1DM within the previous 6 months. Data were analyzed through a qualitative content analysis. The results could be classified into 3 categories related to the parents' experience of caring for a child newly diagnosed with T1DM and their educational needs and can be described as follows: (1) management of uncertainty regarding T1DM; (2) management of new daily life situations; and (3) self-care management within the family. The Arab parents of children with T1DM accentuated the need for continuous professional support to manage uncertainty due to changes in everyday life situations. The findings confirmed the significance of culturally and contextually relevant education regarding T1DM for parents, children, and school personnel. Educational interventions and support in the community are recommended to improve daily life situations for families and children with T1DM. [ABSTRACT FROM AUTHOR]

Since the inception of the first nurse-managed wellness clinic (NMWC) in 1994 by the school of nursing faculty, the NMWCs have served the older residents of 2 high-rise apartment buildings. In addition, students have experienced the challenges of application of theory to practice. One such challenge is measuring outcomes. This paper describes both the process and outcome of developing a chart audit tool that was adapted from the Omaha System and Focus Charting®. The author hopes that a dialogue of common concerns and challenges will be initiated and creative solutions will be generated. [ABSTRACT FROM PUBLISHER]

In the United Kingdom (UK), mental health nurses have worked in the community since the mid-1950s. From modest beginnings, the community mental health nursing workforce has grown dramatically in size, with just under 7,000 community mental health nurses (CMHNs) estimated to have been working in England and Wales in 1996. Mirroring this expansion in numbers, CMHNs over the years have extended the scope of their professional activities, and now work in a variety of settings with a wide range of client groups. For the benefit of a US audience, this paper commences with a review of the origins and development of the CMHN profession in the UK. Prevailing UK National Health Service policies and priorities, along with data from a recent national census of CMHNs,l are then used to provide an analysis of the context and characteristics of contemporary community mental health nursing. [ABSTRACT FROM PUBLISHER]

Sleep is not only an integral part of everyone's life, but provides an incredibly accurate mirror on the quality of life. Disturbed sleep equates with disturbed daytime functioning. Such a correlation makes great sense, particularly with the realization that sleep and wake cycles are based in the same biological rhythms. While everyone has a few nights of suboptimal sleep from time to time, some people live their lives sleeping poorly, experiencing daytime sleepiness, and functioning marginally. The causes of these patterns of poor sleep are many, and this paper will focus on how to focus a lens on clinical assessment of sleep to make sense out of sleep-related complaints and related behaviors in persons receiving home care services. [ABSTRACT FROM PUBLISHER]

To meet the challenges of a changing home care industry, the technologic implementation of a clinical information system is necessary to enable an organization to manage and use clinical data in an accurate and timely manner. Abandoning the traditional paper documentation system for an automated field system using laptop computers, an agency has the ability and opportunity to enhance staff effectiveness and productivity. The current, accurate, and complete information in the system is readily and conveniently accessible to administrators, staff, and support personnel. [ABSTRACT FROM PUBLISHER]

Home health care staff members often feel that they are literally drowning in paper. There is also increasing concern among agencies about cost-effectiveness in view of recent cuts in Medicare reimbursement, increasing enrollments in managed care plans, and the possibility of health care reform. Some are exploring the possibilities of electronic record keeping in attempts to address these issues. Key words: risk management, home health care [ABSTRACT FROM PUBLISHER]

Cera, a homecare provider, uses digital care plans (DCP), to streamline the provision of home care. DCP rollout is part of a larger digitization initiative, including carer visit reports collected through a mobile app and branch actions recorded in a web application supported by a secure central database. This retrospective cohort study aimed to assess the association of a DCP rollout with service user hospitalization rates. his study utilized retrospective data from 2 groups of service users, those for whom their first 30 days of Cera membership occurred prior to DCP rollout (pre-DCP group) versus those whose first 30 days of Cera membership occurred after DCP rollout (post-DCP group). The 30-day hospitalization rate was the primary outcome measure and was determined through a combination of carer reports, reporting from service users or their families, and branch staff follow-up. There were 55 hospitalizations among 392 users in the pre-DCP group in the 30 days after joining Cera (14.0% hospitalization rate), compared to 23 hospitalizations among 297 users in the post-DCP group (7.7% hospitalization rate). This represented a significant reduction in hospitalizations in the post-DCP group (6.3% absolute difference in hospitalization rate; 45% relative reduction; P <.001). This result was robust to multiple sensitivity analyses. The implementation of a DCP was associated with a 45% relative reduction in the 30-day hospitalization rate for new service users when compared to pre-DCP enrollment. These benefits could be further amplified by combining the DCP with additional initiatives aimed at the prediction and prevention of avoidable hospitalizations. [ABSTRACT FROM AUTHOR]

Prescribed home-based exercise programs have been found to be an effective non-pharmacological treatment for the management of chronic low back pain. However, such programs rely on continued patient adherence to performing the exercises. The purpose of this integrative review is to present the key factors that influence adherence to prescribed home-based exercise for individuals with chronic low back pain. Searches of AMED, SPORTDiscus, CINAHL, MEDLINE, ScienceDirect, and Cochrane Library databases were performed for the period 2015 to 2021, using the following key search terms: exercise adherence, exercise compliance, exercise therapy, home-based exercise, chronic low back pain, and enabler, barrier or factor. Eight studies met the inclusion criteria and included Qualitative, Prospective Observation, Feasibility, Case Series and Randomised Controlled Trial studies. All participants were adults ranging from 18 to 85 years old with chronic low back pain and there was an overall female representation of 53.4%. Studies were assessed for methodological quality using the Critical Appraisal Skills Programme (CASP) checklist. The findings highlighted 2 key factors influencing adherence to home-based exercise programs for individuals with chronic low back pain: (1) the need for practitioners to develop effective communication skills that focus on the individual's needs, including personalisation of exercise programs aimed at an individual's symptoms, lifestyle and treatment goals; and (2) follow-up feedback and support strategies via electronic (virtual) or face to face in-clinic and home visits. Adherence to home-based exercise programs requires effective practitioner communication and targeted follow-up support and feedback. [ABSTRACT FROM AUTHOR]