Evidence Based Practice Implications in Home Health Care

Home care is non-medical, direct health care or personalized supportive care given by an adult caregiver in the patient’s home rather than care given in specialized group facilities such as nursing homes or clinics. Home care is sometimes also referred to as domiciliary care, non-medical care or residential care. The types of services range from helping with basic daily chores like meal planning, bathing, dressing and walking to assisting in managing emotional and physical difficulties that are a part of the aging process or can be a result of a traumatic illness or accident. Some home health professionals work with patients who have either a physical disability or long-term illness.

There are a variety of providers of home health and community care services. Many offer a range of integrated solutions that cover all areas of patient care from routine tasks such as cleaning, hygiene and medication administration to more complex services such as patient safety and quality-improvement initiatives. Providers are required by law to follow quality standards established by the U.S. Department of Health and Human Services’ Office of Medicare. Ensuring high standards of patient safety and quality of care is one of the keys to patient satisfaction, which in turn promotes recovery and maintain a healthy and productive society.

Based on a review of five quality improvement programs held across the country, a common theme emerged: that most participants identified one or more factors associated with their satisfaction (e.g., fewer errors when using bed rails and adult diapers, feeling safe with caregivers and staff members, obtaining necessary medications and assistance). Similarly, a literature review found that patients were more likely to remain in their homes when offered assistance such as help with transportation or shopping. Additionally, one study demonstrated that home health care patients who were given cognitive behavior therapy were less likely to return to their providers for subsequent care. In fact, participants who experienced positive behavioral changes (e.g., improved coping skills, decreased use of alcohol or medications) were much less likely to experience a relapse into their previous behaviors or conditions within one year of the treatment. However, given the mixed results of these studies, researchers have some concerns about the quality of the evidence and how factors associated with patient care are influenced by social and environmental variables.

On the one hand, research implications from this literature review reveal that factors associated with home health care are influenced by social and environmental variables. These factors include neighborhood crime rates, the prevalence of job turnover and unemployment, access to appropriate care, elderly care preferences (e.g., age, safety, cleanliness), cultural diversity (e.g., religious beliefs, lower educational levels, etc.) and health care needs (e.g., medication needs, emotional distress). These findings suggest that specific strategies to promote optimal care should be developed in light of these various environments. In addition, some researchers note that home health agencies may need to develop better ways of tracking unplanned hospital admissions because the frequency of hospital stays may become an indicator of care quality.

On the other hand, research implications also suggest that factors related to the caregiver’s behavior may also affect the outcomes of the process. One example is the likelihood of patients reporting higher levels of stress and depression. This likelihood is linked to caregiver characteristics such as compliance with instructions, compliance with policies, attitudes and compliance with staff needs. According to research, people who display these characteristics are most likely to report higher levels of stress and depression. However, if those same people were to learn and practice good bedside manners, they may reduce the likelihood of experiencing higher rates of hospitalization and wound care. Likewise, if bedside manner is taught early on, caregivers could potentially prevent the development of psychological issues, such as depression and substance abuse.

The quality of care received by individuals in a home health care setting has been linked to increased levels of recovery. According to the American Association of Home Health Dentistry, patients who receive care from dentists with evidence based practice implications are more likely to experience at least one year of recovery from their injuries and illnesses. Moreover, when such individuals are re-employed after a year of hospitalization, they experience less pain and trauma. Thus, evidence related to the results of a patient’s care may play an important role in promoting quality of life improvements. In addition to the aforementioned studies, according to the U.S. Bureau of Labor Statistics, the following characteristics are associated with a lower rate of emergency room visits for patients who received care from dentists: male gender, Caucasian race, no evidence of tooth decay or pain, fair to above average annual earnings, and no history of falls or broken bones. Such evidence related to care from the dental profession shows that a more attractive option to potential patients is the dental health care provider who demonstrates evidence-based practice implications.

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