Home Health Care Management & Practice

Purpose: The purpose of this qualitative analysis was to evaluate perceived safety threats and the impact of these treats on home health nurses.

Background: Nurses in the home health setting have safety concerns which can be heightened when caring for persons with severe and persistent mental illnesses (SPMIs).

Methods: This was a secondary analysis of data from a parent grounded theory study exploring home health and hospice nurse’s strategies for caring for persons with SPMIs in a home setting, however, the examples provided are not specific to persons with SPMIs alone, and provide insight into nuanced safety threats.

Results: Findings included overarching themes of fear and safety. Fear within practicing nurses was a consequence of impaired safety in the home setting. The theme of safety had 2 sub-themes: risks to safety, and nursing actions to enhance safety.

Conclusion: Effective training and awareness for nuanced safety concerns, such as when caring for persons with SPMIs in a home setting, are required to enhance nurse safety and retention as well as optimize patient care.

To address the risks associated with potentially inappropriate prescribing (PIP) in older adults, this study aimed to determine the prevalence of PIP in home health care patients in the Taif Health Cluster, Saudi Arabia. Using the Beers, STOPP, and START criteria, a retrospective analysis was conducted on 400 older adults aged 65 and over who received home health care between February and October 2023. Results indicated that 38.5% of patients had at least one PIP incident, with polypharmacy present in 80.6% of PIP cases. PIP was more prevalent among females and those aged 75 and older. Potentially inappropriate medications (PIMs) were noted in 80.6% of cases, while potentially inappropriate omissions (PIOs) were recorded in 26.5%. The most frequent cause of PIMs was a lack of a clear indication, affecting 23.3% of total prescriptions. Angiotensin-converting enzyme inhibitors (ACEIs) or angiotensin II receptor antagonists (AIIRAs) were commonly omitted in diabetic patients with renal disease. Findings highlight the need for regular prescription reviews to reduce PIP and improve patient outcomes.

After hospitalizations, many older adults experience a rapid functional decline and rely on home health (HH) care services to regain physical function. Understanding rehabilitation treatment elements that improve physical function is important for optimizing care. Two randomized controlled trials demonstrated similar physical function improvement in older adults (≥65 years, ≥3 comorbidities) receiving either high intensity (n=133) or standardized usual care (n=140) HH approaches in the 60 days following hospitalization. This secondary analysis examined the relationship between patient characteristics, treatment elements, and physical function improvements measured by the Short Physical Performance Battery (SPPB). In the high intensity group, lower baseline SPPB performance was associated with greater improvements (β=-0.23, p<0.01). Completing an additional exercise component per session further increased SPPB scores by 0.65-points (β = 3.94, p<0.01). For every two visits completed, there was an associated with a 0.58-point increase in SPPB (β=0.29, p<0.01), exceeding the small meaningful changes threshold (0.5 points). In contrast, four visits in usual care were associated with a 0.56-point change in SPPB (β=0.14, p<0.05). Neither approach demonstrated an association between environmental challenge exercises and functional improvement, potentially due to lower session frequency and shorter duration. These findings suggest that consistent attendance and full participation in high intensity HH components are critical for maximizing recovery. HH therapists should educate patients to prioritize attending 12 sessions and completing all prescribed treatment components to optimize physical function recovery in the 60 days after hospitalization.[AQ3]

The aim of the study is to examine the effect of Wellness Recovery Action Plan (WRAP) based psychoeducation program on health of caregivers of Alzheimer’s Disease (AD) patients. This is a quasi-experimental study of pre- and posttest, control group design. WRAP based psychoeducation was applied to the intervention group and compared with the standard caregiver education group and the control group. A total of 60 caregiver for AD patients constituted the sample. The data were collected with the perception of health, caregiver burden, and quality of life scales. It was found that there were no differences between the mean pre- and posttest scores of all group participants on the perception of health and caregiving burden scales (p > .05). Exclusively the increase in the quality of life score of the standard caregiver education group was statistically significant (p < .05). It was found that the WRAP-based psychoeducation program applied to the intervention group did not have an impact on the perception of health, caregiving burden, and quality of life of caregivers of AD patients.

Mobile vaccination units administered COVID-19 vaccines to homebound populations in Greece. This study explores the perspectives of public healthcare providers involved in the COVID-19 home vaccination program, aiming to identify challenges and propose improvements in the delivery of healthcare services at home. This study employed a cross-sectional mixed-methods design and was conducted within public Primary Health Care (PHC) facilities. It utilized a questionnaire consisting of both closed- and open-ended questions. The study population included healthcare professionals and administrative staff involved in vaccination units. Data were collected from April to July 2022 and analyzed using descriptive statistics for quantitative data and thematic analysis for qualitative data. The integration of both data types enhanced the depth and reliability of the findings. Ethical approval for the study was granted by the Bioethics Committee of the Aristotle University of Thessaloniki. Twelve hundred participants from 168 facilities across six Health Districts responded. The majority were nurses (34.1%) and general practitioners (24.7%). Participants overwhelmingly praised the concept of home-based care, aligning it with PHC, and expressed readiness for future involvement, despite time constraints. Four main themes emerged from the thematic analysis of 1,072 text responses. Challenges in providing such services included difficulties in balancing home care with existing workload, addressing understaffing, and achieving effective time management to prevent staff burnout and service disruptions. Participants’ experiences in the national COVID-19 home vaccination project highlight their positive attitudes toward home care while also underscoring several potential challenges in organizing similar home-based services.