Home care has become a growing segment of the healthcare industry over the last few years. Home care is basically health care or specialized care given by an active caregiver within the person’s home, rather than health care offered in more institutionalized settings such as nursing homes or clinics. Home care is also called domiciliary support, social assistance or in-home support. In addition, home care may also be provided by family members or friends, or an unrelated caregiver, whom the person has selected.
The increasing demand for home care has led to an increase in quality-of-life training programs and quality-of-care improvement programs in many healthcare organizations. Many home health agencies offer standardized patient care assessments and treatment protocols to improve quality of care, while maintaining accountability for quality improvement programs within the agency. There are several quality-improvement programs offered by patient safety organizations, such as the ADA (Americans with Disabilities Act) and Medicare Part B. These organizations require agencies providing home health services to train their staff on the standards set forth in these programs. In addition, patient safety organizations often coordinate with other agencies to provide coordinated safety measures.
One study conducted comparing home health care patients and hospital discharged patients found that one study had significantly greater quality-of-life outcomes among the former, when compared to the latter. This same study also found that one study had higher rates of hospital readmissions among its patient population. It is believed that this could be because the hospital discharged patients were already suffering from more severe conditions at the time of their admission to the home health care hospital. However, this study has been criticized by other researchers for a lack of rigorous methodology. Another study comparing home health care patients and those admitted to hospital found that the characteristics of the two groups did not differ significantly from each other, despite differences in physical problems and symptoms, indicating that the quality of care provided may not differ significantly between the two groups.
There are also three studies testing interventions based on medication management. Three studies found that medication interventions improved the physical condition of home health care patients; two of these studies found that patients’ adherence to medication treatment was also influenced by factors beyond the control of the patient. One study testing antidepressants found that long-term use of such drugs was associated with an increased risk of depression. The third study testing antidepressants specifically for ADHD found that ADHD children were less likely to respond to treatment when using such medications, regardless of the control group.
Other types of medication interventions tested in research include antipsychotic medications. A study testing the effects of antipsychotic drugs on patients’ aggression found that patients’ aggression increased in a significant way when the drugs were administered. Another study testing the effects of olanzapine on patients with a diagnosis of depression found that patients’ depression symptoms were not associated with an increased risk of violence. One of the last studies testing the use of antidepressants in children with an ADHD-type disorder found that children with this disorder were not at an increased risk of substance abuse when compared to other children.
Clearly there is strong evidence that a lot of care providers need to test new strategies for patient care in the home. If nurses, doctors, and other workers are still expecting to “treat” patients as though they are uncomplicated cases requiring only a little extra attention, then how are patients supposed to benefit? The results of some tests seem obvious: The usual care for the illness or injury does not help patients. What’s more problematic is that the usual care has been tried for so long and does not work. There needs to be an experimental approach, something new and different.