Evidence Shows that Home Care is No Better Than the Normal Care

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.

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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Important Research Implications Of A Home Care Primer

Home care is medical care or specialized care given by an expert caregiver at the patient’s home where the patient or senior citizen is living, rather than care given in a nursing home or clinic. Homecare is also referred to as domiciliary care, public care or in home care. The goal of home health care is to help the senior citizen remain independent and able-bodied to aid in their recovery process and aid in their everyday function. Home care is provided by licensed professionals who are trained to provide personal care to their patients.

There are many factors associated with why there is a rising trend of home health care patients turning to the Internet for information and assistance. One study conducted on a representative sample of three hundred seniors found that more than one-third were not using the Internet to obtain needed assistance. Factors that were identified were the frequency of the patient’s need for assistance, the type of services they needed, types of providers they used and factors related to their level of comfort. The Internet is becoming a viable source for receiving medical care that can be done from the comfort of one’s home.

One factor that was identified was the lack of quality-improvement and patient safety within the home health care industry. In the past, medical professionals and consumers alike have placed a lot of blame on the care provider for not maintaining adequate standards of care. This blame is often based on the notion that a physician will simply look out for themselves and not consider patient safety, which could result in a catastrophic event. In the case of the home health care industry, however, it is becoming increasingly clear that physician negligence has reached a high-degree. Studies show that many of the patients involved in accidents sustained in nursing home facilities are suffering from long-term consequences brought about by medical care and neglect.

Another area of significant concern is the use of unannounced hospital admissions. A recent study conducted by a national organization focusing on home health and safety showed that nearly two-thirds of home health agencies had a system in place that resulted in an unplanned hospital admission for patients. The organization called for a national dialogue on the issue of patient safety and evidence-based decision making. The research implications of this study are staggering. The evidence suggests that there is nothing safe about giving a patient the unannounced hospital visit and many of the patients who suffer injuries at home may not have been properly evaluated or had any evidence presented to support the recommended course of treatment.

There are also research implications related to the use of off-site pharmacies. It is widely believed that there are currently in place practices in many home health care populations that lead to medication errors that can lead to death. For example, research suggests that there are inefficiencies that make it difficult for elderly patients to correctly identify the appropriate medication to take on a daily basis. In addition, there are likely to be scheduling and inventory challenges that will make it impossible for home health professionals to ensure that the proper medication is always available. This can result in medication errors that result in undue stress and pain for the patient as well as unnecessary emergency room visits.

In a time when evidence suggests that more people are falling than ever before, the importance of fall prevention cannot be overemphasized. Effective fall prevention programs should incorporate both the needs of the patients and the professional expertise of the home health professionals. Such programs should focus on ensuring that the patient receives necessary medications and receives preventative care such as periodic heartworm testing and other vaccinations.