People frequently do things “the way Mom (or Dad) did—it worked for them.” And, of course, sometimes things do work out. But in many cases, the ways that seemed to work once upon a time either don’t work now, or didn’t work then.
The search for best practices is simply the search for techniques, in each setting, which consistently shows superior results. Home health care providers, whether agencies providing professional senior care for family members helping their loved ones, should follow the best practices which have emerged in the field. Doing so will ensure a better life for all concerned.
Care Management Programs
Care management programs coordinate the activities of caregivers and patients. The goal of this management is to improve health, reduce hospitalization and emergency visits, and lower other costs. Care managers, usually social works or nurses, assess health needs and risks, promoting self-care as much as possible.
Research into these programs shows that quality of care improves, but that cost reduction does not necessarily follow, especially for people 85 and up. Transition programs from hospital to home seem to be the most effective for both goals. The key component of these programs is follow-up contact between patient and nurses in the period immediately following release from the hospital.
Best Practices in Care Management Programs
Care management programs work for people who remain in the home or live in facilities. The successful programs provide:
- Integration with the primary care health care providers – the care manager is either in the same office or visits frequently.
- The targeting of high-risk patients is imperative.
- Included consistent face-to-face interaction for the patient with the care manager
- Patient coaching—the care manager makes sure patients can care for themselves, manage medicines and know what to look for if conditions worsen.
- Managed transitions from hospital-to-home—these periods present great cost-savings opportunities; patients may also be the most open to innovative ideas for doing things.
The PACE Program
The Program of All-Inclusive Care for the Elderly (or PACE) under Medicaid provides both significant cost savings and care quality improvements. PACE does require attendance at elderly day care, as well as using specific physicians. Attempts to increase the flexibility in arrangements do not seem to result in significant savings or improvements.
A visit to the PACE program in Baton Rouge, Louisiana, provides anecdotal evidence supporting the benefits of this practice in eldercare. The availability for medical, social and fun all under one roof provides a healthy supportive atmosphere which combines the best of home and traditional facility.
The PACE program can help keep people in their own homes for the evening, but expand possible horizons during the day.
Interventions for Medication
Best practices in home care recognize the home is the patient’s domain. This control presents challenges for medication administration. In a facility, medications can be administered at the set time, while in the home, if the patient is self-medicating, the timings may deviate significantly from the prescribed times.
Research indicates that intervention in one or more methods increases the likelihood of proper self-medication. The interventions tested included patient education with follow-up, individually tailored interventions and medical review and collaboration among providers. Unnecessary and duplicate medications were reduced.
Thirty percent of people aged 65 and over living at home fall each year. While few studies have focused on falling in the home, creating a fall-prevention program with the patient should be followed.
Muscle strengthening, balance retraining, risk factor screening and home assessment all seem indicated for the home health care setting. They are already included in assisted living and skilled nursing settings.
The National Council on Aging provides a variety of evidence-based fall-prevention programs, which can serve as a model. The programs include group activity, individual intervention, fall-awareness training, strength and balance exercises and tai chi.
Home Health Caregivers
Some best practices focus on the caregivers themselves. The research indicates that in an institutional setting, the quality of the work environment and the quality of patient care are related. Health caregivers in a positive work environment tend to provide better outcomes.
Less research has been done into the relationship between the work environment and quality in-home health care. While some connection between a positive, supportive working environment and the quality of outcomes is indicated, more research is required into which factors do, in fact, play a role.
One way in which home health care workers can increase health care workers’ quality of care is the use of tablets. Tablets allow connection with full health records on the spot. They also allow home health caregivers to take notes immediately, rather than after their shifts are over.
Providing both the professional and family caregivers knowledge-based interventions seems to improve pain management, quality of life issues, care satisfaction and other matters. Use of email reminders and other enhanced communication added to these benefits.
More research is needed to establish true best practices in many areas of home health care. While useful and positive indications are present in the current research, much of it is based on best practices from the institutional model.