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PubMed1998

Home alone: unmet need for formal support services among home health clients.

In order to remain in the home without family or other informal support, home health clients must have access to essential formal services such as nutritional support and homemaking chores to supplement medical and nursing care. In this study, we looked at client-related factors associated with the need for formal support services, and factors associated with whether those needs are adequately met. Data were collected from 2,013 home health clients in Massachusetts. According to the assessment of the skilled nurses treating them, 85 percent of the clients needed one or more support services; some or all needs were not adequately met in nearly half. Significant factors contributing to unmet need included: being non-white, having Medicaid as payer, being in a health maintenance organization, having AIDS, receiving maternal/child health services, and having an acute condition. This research suggests that even clients receiving skilled nursing care may not have many or most of their supportive needs met, and that there are identifiable factors which decrease the likelihood of having adequate care provided.

Acquired Immunodeficiency Syndrome↗
PubMed2002

A screening system for Michigan's home- and community-based long-term care programs.

PURPOSE: To develop a screening system for Michigan's MI Choice publicly funded home- and community-based services programs, to aid in identifying both individuals eligible for services and their most appropriate level of care (LOC). DESIGN AND METHODS: Identify assessment items from the Minimum Data Set for Home Care (MDS-HC) assessment instrument that are predictive of five LOCs determined by expert care managers: nursing home, home care, intermittent personal care, homemaker, and information and referral (without services). RESULTS: The algorithm based on approximately 30 client characteristics agrees with expert opinions substantially better (kappa =.62) than systems based on activities of daily living and instrumental activities of daily living only (kappa <.40). IMPLICATIONS: The screening algorithm can be used both over the telephone to identify clients who will not be fully assessed (as they are unlikely to receive services) and in person to recommend the appropriate LOC.

Algorithms↗
PubMed2006

A six-month profile of community case coordinated older adults.

The purpose of this study was to assess the needs of older case coordinated clients receiving community health services, by examining changes in cognitive status, physical and mental health status, social support, risk for institutionalization, and service use over a 6-month period from initial intake into home care. Significant predictors of professional and supportive home care, as well as emergency room use and hospital days, were also examined. Standardized interviews were conducted with 234 clients at the time of referral; follow-up interviews were conducted with 179 of these clients after 6 months of case coordination. Results reveal that physical and mental health improved, while cognitive status remained stable. Although social interaction and instrumental support decreased, subjective support remained stable. Risk of institutionalization decreased. Occupational therapy, nursing, and homemaking were the most frequently used services. The best predictor of professional and supportive home care was a risk of institutionalization score. The needs of this older adult population changed even within the relatively short span of 6 months. Frequent review of needs in some form may be warranted in order to maintain effective service plans.

Activities of Daily Living↗
PubMed1975

The point of diminishing returns in nutrition education through home visits by aides: an evaluation of EFNEP.

This three-year evaluation of field work with poor, rural homemakers by nutrition aides employed by the Expanded Food and Nutrition Education Program (EFNEP) of the Maryland Cooperative Extension Service is based on successive annual interviews with 93 homemakers and a control group of 58 designated friends. The results suggest various points of diminishing returns beyond which behavioral and attitudinal changes brought about by the specific educational strategies are too small to justify continued visits to a homemaker. To sustain cost-effective home visits after the first year, more emphasis must be placed on reinforcement of first-year gains, and on expanding the scope of nutrition education to include more health education of other kinds.

Adult↗
PubMed1993

Assuring the quality of in-home supportive services: an evolving challenge.

This article reports on the Ohio Quality Assurance Project, a two year demonstration. The project developed a model quality assurance system for in-home supportive services funded by Title III of the Older Americans Act including home health aide, personal care, homemaker, transportation and escort, home delivered meals, chore and home maintenance services. Using four planning and service areas in the state of Ohio comprising over 40 countries, the project developed, implemented and evaluated quality assurance standards and monitoring activities for Older Americans Act services. In addition, a second part of the project included in-depth case studies with consumers receiving in-home care.

Aged↗
PubMed1998

It hurts most around the heart: a phenomenological exploration of women's anger.

Women's anger experience has been poorly understood and insufficiently researched. Yet the emotion of anger is vitally important to women's physical and mental health, and to the quality of their relationships. This phenomenological study was undertaken as an expansion and extension of the Women's Anger Study, the first large survey of the genesis, manifestations and correlates of anger in American women. Although the earlier study contributed to understanding of anger, a deeper examination of the context and meanings of anger experience was sought. Twenty-nine Caucasian women ranging in age from 21 to 66 years were interviewed. Illustrative occupations ranged from homemaker, student, waitress to business executive, professor, and human service professional. Analysis involved thematizing by the researchers independently and within a multidisciplinary phenomenological research group. The thematic structure of women's anger involved a building over time of a confusing mixture of feelings (hurt, frustration, disillusionment) precipitated by a violation of the core values of the self. The precipitant of anger was unfair and/or disrespectful treatment or lack of reciprocity in relationships. When the anger was confined within self, the woman felt helpless and powerless. However, powerlessness was also evident when anger was externalized in an outburst. To the study participants, an angry outburst meant a loss of control rather than ability to achieve control. Women reported a sense of power when using anger to restore justice, respect, and relationship reciprocity. Clinicians can assist women to reflect on their core values and use the power of their anger effectively. Further studies are in progress to examine the relevance of these findings for women of other races and cultural contexts.

Adaptation, Psychological↗
PubMed1986

Health and health care of employed women and homemakers: family factors.

Women's increasing participation in the labor force has resulted from availability of fertility control, changed attitudes toward family size, a strong demand for occupations traditionally filled by women, and other factors. Despite many social changes, employed women continue to be concentrated in lower-income pursuits and frequently have major responsibility for the household. This paper is drawn from a study that explored the association of occupation and home responsibilities with the health of employed women and men and compared them with female homemakers. It also examined variations in the use of physician and hospital services. The principal data source was the National Health Interview Survey tapes for 1975-77. Nurturant role responsibilities were derived from records of members of the index adult's household. This paper reports on comparisons of employed women with homemakers using multiple regression analysis, and also on direct comparisons of the three work-sex groups. Study findings suggest that better health is associated with desired, positive roles such as marriage and married parenthood. Worse health is associated with unwelcome role expansions such as single parenthood, child disability, having a sick spouse and marital dissolution. Effects vary by both sex and work status. It is suggested that it is not the number of activities that may be burdensome to women's health but inability to choose one's roles and organize one's resources to meet their demands.

Absenteeism↗
PubMed1996

Cost-effectiveness of hospice care.

Is hospice cost-effective? What is perfectly clear is that hospice care overall provides different care than conventional care for the dying. There is much more home care, aimed at goals of comfort, dignity, and remaining at home, and that care is distributed over longer periods of time. There is less hospital care and less anticancer therapy. Nonhospice oncologic care provides more hospital services, particularly in the last month of life, and more effort to directly attack the malignant disease. There will always be those individuals whose goals and medical condition at a particular time make one type of care the best choice for that person. Current research strongly supports hospice care as cost-saving in the last month of life. The overall effect of hospice care on costs appears to be weakly positive. This is despite the fact that hospice benefits under Medicare include absence of co-payment, medications for the primary condition, and substantially more supportive services, which represent extra value and decreased out-of-pocket expenses to the consumer. A factor strongly favoring the development of cost-effective programs is the fact that most hospices began and developed as capitated systems of care. Thus the benefits derived from providers working with patients to control costs have accrued over time. The not-for-profit structures led savings to be put back into patient care, allowing more help for families and patients. An unresolved bias of available research is the question of the extent to which hospice patients are self-selected at the time of entry for their low interest in intensive and expensive services. The most positive estimates of cost-savings in hospice have required case-mix or time-of-entry adjustments to demonstrate savings. There is little support for cost-savings in the raw data comparing total costs in hospice and conventional care groups. However, there is also no evidence that hospice care adds to costs of care for the dying. Differences in outcomes between hospice- and conventional-care have been modest. Satisfaction with care has often been higher in hospice care, but care giver burden may also be higher. Other outcome measures have been inconsistently affected. The task of measuring differences is a difficult one. Hospice patients themselves are largely unavailable for measurement during the most critical periods of care, and proxy measures of benefit are necessary. Families also tend to be grateful (or critical) around the death of a loved one; this is related to complex family relationships and emotions not likely to be influenced by any health care program. It should also be noted that the task of measuring the success of hospice care has largely used measures originally developed for understanding the impact of conventional oncologic care. The tools for understanding the effects of spiritual counseling or homemaker assistance are much less well developed. The initial goals of the Medicare hospice benefit appear to have been met: a choice is available that responds to the needs and concerns of many dying people and their families, at no additional cost to the taxpayer. In addition, millions of families have received the benefit of the lower out-of-pocket costs for health services and medications. They have benefited from the broader definition of health which made simple, continuous support services such as homemaking and personal care available at no charge. The question of hospice cost-effectiveness would seem to be a question of the past. Other questions offer even more substantial challenges to continuing hospice care as it is now offered and into the future. There are no data to allow a critique of the current structure of hospice services, or to support the link between individual components of service and outcomes. This leaves the hospice concept open to considerable manipulation.(ABSTRACT TRUNCATED)

Cost-Benefit Analysis↗
PubMedDate not supplied

How much is too much? A study of pregnant women in service industry jobs.

This qualitative study explored the broad aspects of stress and coping in the work and home experiences of pregnant women who worked in the service industry. The participants described home roles of mother, spouse/partner, and homemaker that were particularly valued and significant. Work provided income and a cultural setting for socialization, personal growth, and social support. The participants coped with the additional demands of pregnancy by adopting health promotion measures and scheduling routines at work and home in different ways. However, pregnant working women often are pulled in many directions at once, and their health eventually may be affected.

Adaptation, Psychological↗
PubMed2003

Rural nonphysician providers' perspectives on palliative care services in northwestern Ontario, Canada.

Most palliative care in rural remote areas is provided by nonphysicians. This paper reports a survey of interdisciplinary rural health service providers (not including physicians) to identify the strengths and weaknesses in palliative care service delivery in a rural and remote region in northwestern Ontario, Canada. Questionnaires were sent to 156 nurses, homemakers, social workers, and pastoral care workers who care for terminally ill persons and their families, and 122 were completed and returned (response rate 78%). Consistent with practice in most rural areas, 90% of respondents were generalists. Respondents identified several problems with palliative care services, including inadequate training for caregivers, inadequate support services for family and professional caregivers, inadequate human resources, and lack of organized volunteer programs. Suggestions for improvements included better education for service providers; better availability of palliative care services; more counseling and support services for patients, family members, and professionals; and greater availability of respite beds. Overall, respondents rated clients' needs as being better met than their own. The most frequently reported problems for care providers were related to the lack of supports for care provision.

Adult↗
PubMed2004

Home health care utilization: a review of the research for social work.

The author reviewed the literature to identify the variables associated with home health care utilization using the Andersen-Newman model as a framework for analysis. Sixty-four studies published between 1985 and 2000 were identified through PUBMED, Sociofile, and PsycINFO databases. Home health care was defined as in-home skilled nursing, homemaker, mobile meals, home health aide, physical therapy, occupational therapy, or social work services. The review indicates that the client most likely to use home health care is elderly, has a high number of ADL/IADL impairments, lives alone, has a low level of informal support, and has Medicaid coverage. In the presence of informal support or when care recipients live with others, the initiation of formal services may be delayed until physical impairment of the care recipient is severe or caregiver burden is high. Implications for social work practice and research are discussed.

Activities of Daily Living↗
PubMed1995

Occupation and cervical cancer.

Data collected for a multicenter case-control study of invasive cervical cancer and carcinoma in situ of the cervix were analyzed with regard to occupation. Odds ratios comparing 481 invasive cases and 293 carcinoma in situ cases to 801 controls were calculated and adjusted for potential confounding factors. Working women and homemakers had a similar risk of invasive cervical cancer, with several groups of service and industrial workers showing elevated risks (particularly maids, cleaners, and cooks). Risk of carcinoma in situ was slightly increased for working women, but no occupational groups had notable associations. The principal strengths of this analysis were the ability to address both invasive cervical cancer and carcinoma in situ and to control for multiple potential confounding factors. However, occupational information was limited and risk estimates for women in specific occupations were imprecise.

Adult↗
PubMed1994

Structural barriers to the use of formal in-home services by elderly Latinos.

We examined data on elderly Latinos to identify structural barriers that influence the use of a visiting nurse, home health aide, and/or homemaker, and to investigate possible cultural influence on use. Data are from the 1988 Commonwealth Fund Commission's national survey of 2,299 Latinos age 65 and over. Logistic equations are estimated for all elderly Latinos, those with a hospitalization in the past year, and those without a hospitalization. Need factors consistently increase the odds of using services. The significance of Medicaid and poverty income demonstrates income barriers to community-based care. Living arrangements improve our models only for those with a hospitalization in the past year. Acculturation has no independent effect, although some other findings can be interpreted as cultural preferences. We conclude that a universal, public long-term care program would substantially reduce barriers faced by elderly Latinos, but that nonfinancial barriers are likely to continue.

Aged↗
PubMed1998

A typology of service patterns in end-stage AIDS care: relationships to the transprofessional model.

OBJECTIVE: To determine the relationship among 11 types of home health care services for patients with HIV/AIDS and to develop a terminal-care, service-usage profile of persons receiving such services. Services include the number of psychiatric nurse visits, Medical Social Work (MSW) visits, evaluation visits, physical therapy visits, occupational therapy visits, homemaker visits, home health aide visits, public health nurse visits, registered nurse (RN) visits, Licensed Vocational Nurse (LVN) visits, and Intravenous (i.v.) nurse visits. DATA SOURCES AND STUDY SETTING: Data were collected on 549 AIDS patients admitted for medical/surgical home-care services to the Visiting Nurse Association of Los Angeles (VNA-LA). The service utilization data were collected from the VNA-LA's computerized data system. STUDY DESIGN: The relationship among the service types was evaluated with principal component analysis. A service-usage profile was developed for patients using cluster analysis. To control for the variability in the amount of time that patients were on service, the number of days that patients were in the VNA-LA program and were actually receiving services was included as a factor that yielded a variable reflecting the number of each type of service that a patient received per day. PRINCIPAL FINDINGS: Five components were found to best describe the relationships among the service-type variables. These were identified as being: the Number of Evaluation Visits, the Number of Intensive Nursing Visits, the Number of Physical Therapy Visits, the Number of Psychosocial Visits, and the Number of Attendant Visits. Patients were found to cluster into 1 of 5 groups based on the type of service utilization profile that they received. The variables that appeared to have the most influence on this profile were the number of home health aide visits per day that the patient received, the number of RN visits that were made, the number of i.v. nurse visits that were provided, and the number of LVN visits that were made. CONCLUSIONS: Terminally ill AIDS patients receiving home health care services can be identified as having a service utilization profile. This profile can be used to evaluate more precisely the service areas in which costs for patient services differ. Individually assigned to an experimental Transprofessional Model of care had a different service utilization profile than those assigned to a Traditional Model of care.

Acquired Immunodeficiency Syndrome↗
PubMed1987

The hierarchical relationship between activities of daily living and instrumental activities of daily living.

A three-level hierarchical scale including IADL (shopping and transportation) and ADL (bathing, dressing, transferring, and feeding) was tested and validated based on secondary analysis of three studies of elders in the community: a population-based sample, the Cleveland-GAO, and two service-based samples, the Alternative Health Services Project, a study of Medicaid-eligible elders in Georgia, and the Section 222 Homemaker-Day Care study, a sample of Medicare-eligible elders. Scalability analysis included evaluation of Kronbach's alpha, Guttman analysis, and analysis of the pairwise association of individual items using phi/phi max. Validation included discriminant validity and predictive validity. With respect to discriminant validity, the negative association between functional ability (as measured by the scale) and age was observed. With respect to predictive validity, the negative relationship between functional ability (as measured by the scale) and risk of decline to ADL, death, and hospitalization in a year was observed. A six-level scale similar in structure and detail to the Katz Index of ADL was examined with the three studies. This scale can be used to described a broader range of needs of elders in the community and will be particularly useful to health services planners, practitioners, and researchers.

Activities of Daily Living↗