Home care is medical care or specialist care offered directly by an expert caregiver in the patient’s home, rather than primary care offered in nursing homes or group facilities such as clinics. Home care is also sometimes referred to as domiciliary healthcare, community care or in-house care. There are many types of home care. These include assisted living communities, adult day care centers, residential treatment centers and respite care agencies.
Studies indicate that both positive and negative factors associated with home health care patients are related to the environment in which they reside. Those patients who reside in low-income housing, for example, are more likely to experience health problems and have higher rates of hospitalizations. Similarly, those who are young, black, female and/or old are more likely to experience poor health outcomes and hospitalizations. One study has shown that a rise in neighborhood crime has been correlated with increased hospitalization rates among Medicare and Medicaid home health care patients. This was especially true of assaults.
It is important to identify the sources of these observations, as well as the nature of care given by these caregivers. For example, did the caregiver(s) explain the need for safety during one of their weekly visits to the patient? What were the circumstances surrounding one of the planned hospital admissions? What kinds of medications were being administered at these home health visits? These are some of the research implications that should be examined in light of these observations.
Home health nursing is often controversial due to its focus on non-medical care giving and its emphasis on time and schedule management rather than acute care. However, this focus does not necessarily translate to poor outcomes. For example, many studies have demonstrated that home health nursing has significantly lower rates of unplanned hospital admissions, compared to traditional inpatient care. Also, patients who receive preventative services such as immunizations, receive personalized care and are aware of their health status are less likely to visit the hospital. It is important to note that these findings are only those attributed to nursing-related home health services; other studies have shown that patients who receive both inpatient and declarative care are at no greater risk for hospitalization or mortality.
The second set of research implications focuses on quality measures. Studies have indicated that the most common complaints regarding informal caregivers are inadequate time management and inappropriate levels of support. Both of these areas can be addressed through improved communication and self-care practices. A systematic review and meta-analysis of data from five different settings indicated that self-care and better time management are associated with lower rates of hospitalization, emergency room use and mortality among elderly patients.
It is important to note that although research has identified many potential benefits of home health care, more research is needed to examine the specific areas that should be improved. Some potential areas of concern include medication errors, dehydration, safety practices and the transfer of care recipients between venues. The evidence-based practice implications of this research point to several improvements that need to be made on the front end to effectively reduce risks and create a safer environment. Further studies are necessary to address the possible impact of these risk factors.
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