Academic literature on the topic 'Hospital admission and home and community care program clients'

The purpose of this study was to describe and evaluate the Unassigned Geriatric Evaluation and Management (UGEM) program recently developed at Bundoora Extended Care Centre (BECC). The UGEM program resembles a bed substitution service and aims to prevent hospital admissions by providing community case management services to clients who would otherwise require inpatient admission.Data was collected on 36 clients who had received UGEM services. Twenty-six clients/carers also took part in a follow-up telephone satisfaction interview.Overall, the evaluation indicates that the UGEM program is a flexible, valuable and effective service. Most UGEM clients could be maintained at home with services, and this suggests that the program succeeds in assisting many clients to avoid hospitalisation in crisis situations. Further, clients and carers displayed a very high level of satisfaction with the service. The ongoing funding of such programs is crucial in order to maintain the reduction in hospital admissions and hence the high costs associated with inpatient care.

ABSTRACTClients who were either admitted to a long-term care program (N = 7251) or assessed but not admitted to the program (N = 1680) were evaluated for their utilization of health care services in 1981–82. Mean utilization values were calculated and analyses of variance were performed in order to respond to: a) whether utilization patterns of clients admitted to the program differed from patterns of clients who were not admitted; b) whether clients admitted to institutions were different from clients admitted to the program who stayed at home. The data show that among clients who were not admitted to the program utilization levels nearly tripled during the year following assessments. Among clients who were admitted to the program, hospital use decreased for facility dwellers only. The findings suggest that admission to the program can reduce health care utilization particularly if medical surveillance is provided in institutions.

ABSTRACTThis study compared the changes in some bio-psychosocial variables (functional independence, nutritional risk, pain, balance and walking, grip strength, general well-being, psychiatric profile, perception of social support, leisure satisfaction, and caregivers' feeling of burden) in four categories of clients during their program at a geriatric day hospital (GDH). The study also evaluated whether or not improvements, if any, were maintained 3 months after discharge. One-hundred-and-fifty-one people, categorized by primary reason for admission, were assessed at the GDH with reliable and valid tools, at admission and at discharge. Three months after discharge, they were reassessed with the same tools. Overall, two categories of clients, stroke / neurological diseases and musculoskeletal disorders / amputations, improved the most. For the gait disorders and falls group, only the functional independence score improved, but not at a clinically significant level. Finally, clients in the cognitive function disorders / psychopathologies group improved the most on their well-being scores and caregivers' burden decreased the most. All gains were maintained up to 3 months after discharge, except for leisure satisfaction. With the exception of clients who attended the GDH because of gait disorders and falls, the improvements and maintenance achieved in each category occurred in the domains where improvement had been hoped for, because of the particular disabilities in question and because of the nature of the GDH services offered.

Chronic obstructive pulmonary disease (COPD) represents one of the main causes of morbidity and mortality in the western world. Acute exacerbations of COPD were a major cause of hospital admissions and emergency department attendances and represented a considerable economic burden on health resources in the Northern Sydney Area Health Service of Sydney, NSW. To redress deficits in access and equity in health care delivery and to align with best practice, the Area Health Service implemented a comprehensive, interagency, multidisciplinary model of care for chronic respiratory disease in the community setting. The BREATHE program provides nursing, physiotherapy, occupational therapy, clinical psychology, pharmacy and community care aid services in a client's home at a flexible level according to their acuity and complexity of health care needs. This program works in collaboration with primary care providers to provide specialty respiratory services not previously available. Since commencement of client intake in 2001, the program has observed reductions in health care utilisation and improvement in health outcomes.

Purpose As part of a pilot studyassessing the feasibility of record-linking health and social care data, the purpose of this paper is to examine patterns of non-delivery of home care among older clients (>65 years) of a social home care provider in Glasgow, Scotland. The paper also assesses whether non-delivery is associated with subsequent emergency hospital admission. Design/methodology/approach After obtaining appropriate permissions, the electronic records of all home care clients were linked to a hospital inpatient database and anonymised. Data on home care plans were collated for 4,815 older non-hospitalised clients, and non-delivered visits were examined. Using case-control methodology, those who had an emergency hospital admission in the next calendar month were identified (n=586), along with age and sex-matched controls, to determine whether non-delivery was a risk factor for hospital admission. Findings There were 4,170 instances of “No Access” non-delivery among 1,411 people, and 960 instances of “Service Refusal” non-delivery among 427 people. The median number of undelivered visits was two among the one-third of clients who did not receive all their planned care. There were independent associations between being male and living alone, and non-delivery, while increasing age was associated with a decreased likelihood of non-delivery. Having any undelivered home care was associated with an increased risk of emergency hospital admission, but this could be due to uncontrolled confounding. Research limitations/implications This study demonstrates untapped potential for innovative research into the quality of social care and effects on health outcomes. Originality/value Non-delivery of planned home care, for whatever reason, is associated with emergency hospital admission; this could be a useful indicator of vulnerable clients needing increased surveillance.

ABSTRACTOn January 1, 1978, a new Long Term Care Program was introduced in British Columbia. Five levels of care are offered, any one of which may be provided at home or in a facility. This paper presents data from a longitudinal study of Program clients (N = 3516) in two health unit areas, one urban, one semi-rural. The period of analysis is five years from admission. By the end of the five years, 40.2 percent of clients had died; 35.0 percent were still in the Program; 24.7 percent had been discharged alive and were still alive. This paper focuses on the decedents.It was established that approximately half of the males and half of those aged 75 or over at admission were deceased within five years of admission. Regardless of level of care at admission, at least one-third had died in the five year period. More than one-third of decedents did not change level or location of service prior to death.While these data may assist care providers in identifying high risk clients, probably the most provocative finding was the similarity in the proportion and pattern of deaths among new clients admitted to care at home and those admitted to facility.

ABSTRACTThe objective of this study was to compare enhanced access to geriatric assessment and case management to usual home care service provision for the frail elderly. This was a demonstration project, with randomized allocation to control or intervention groups of frail elderly persons who had been referred to the Home Care service in Winnipeg. Of the 164 persons who were randomized, 78 intervention and 74 control patients were evaluated. Intervention subjects received a multidimensional assessment as soon as possible by a specially trained coordinator, who had enhanced access to geriatric medical and day-hospital services; intervention patients were case managed for a 3-month period. Control cases received usual care from home care coordinators. The intervention group received significantly faster assessment and deployment of home services, as well as greater utilization of the geriatric day-hospital services. Utilization of emergency room and hospital services was similar for both groups. Control subjects experienced more prolonged hospital stays and a significantly higher proportion (23%) were designated for long-term care than of intervention clients (9%). We conclude that the SWING program, which facilitated access to geriatric services and case management, reduced or delayed the need for long-term care.

<p>This paper describes the development and implementation of a community-based palliative care program in Six Nations of the Grand River Territory, Ontario. Six Nations innovative program is grounded in their vision to provide access to quality palliative care at home and incorporate Haudenosaunee Traditional teachings. A community Project Advisory Committee led the development process, and a Leadership Team of local and regional palliative care partners led implementation. Using participatory action research, academic researchers supported activities and facilitated data collection and evaluation. Outcomes included: creation of a Palliative Shared Care Outreach Team, including a First Nation’s physician, nurse and social worker; development of a detailed care pathway for clients who need palliative care; increased home deaths (55) as compared to hospital (22) or hospice deaths (6); access to palliative care education and mentorship for local health care providers; incorporation of Traditional teachings to support clients and staff around death, dying, grief and loss; and creation of a palliative care program booklet for Six Nations Health Services. This unique initiative reduces disparities in access to quality palliative home care and demonstrates that First Nations communities can successfully undertake a process of community capacity development to create unique and culturally responsive palliative care programs. Challenges included overcoming federal and provincial jurisdictional issues in provision of health services through collaborative partnerships at the local and regional level. </p>

AbstractThis study evaluates a local health promotion project that may be widely adaptable to assist frail elderly persons to live longer at home. Subjects, enrolled in New Westminster, B.C., were men and women aged 65 and over living in their own homes but assessed and newly admitted to “personal care at home” by the Long Term Care (LTC) program of the B.C. Ministry of Health. About 90 per cent of eligible clients consented to participate. Randomized to Treatment or Control, they were followed for three years. Controls (n = 86) received standard LTC services, which included screening and pre-admission assessment, arrangement/purchase of needed services and review at three months and at least yearly thereafter. The Treatment group (n = 81) received standard LTC services plus visits from the project nurse who helped each subject to devise a personal health plan based on his or her needs in the areas of health care, substance use, exercise, nutrition, stress management, emotional functioning, social support and participation, housing, finances and transportation. The visits concentrated on setting goals and developing personal health skills, with referral to appropriate community services. An additional group of LTC clients (n = 81) from the adjacent community of Coquitlam was also followed. Success or “survival” was defined as “alive and still assessed for care at home”. After three years the “survival rate” for the Treatment group was 75.3 per cent, compared with 59.3 per cent for the Control group and 58.0 per cent for the Coquitlam group. Standard Kaplan-Meier “survival” graphs show that Treatment subjects were more likely to be alive and living at home at every time point during the three years. Differences between the Treatment and Control groups were statistically significant (p ≤ 0.05) both for simple cross-tabulations of care status at 24 and 36 months and in tests comparing “survival” curves. The results are especially striking because Control subjects received LTC services in a geographic area that offers universal access to health care and community resources and because the Control data were concurrent, not historical.

Objectives. To identify characteristics associated with the likelihood of a client receiving a referral to the Home and Community Care (HACC) program from various sources. Methods. Data were collected from 73 809 home care clients during 2007–08. Binary logistic and multinomial logistic regression were used to investigate the likelihood of a client being referred by health workers v. non-health workers. Results. Females and clients cared for by their parents were less likely to receive referrals from health workers than non-health workers after confounding variables were controlled for. While poorer functional ability of clients increased the probability of receiving a referral from a health worker, the opposite was true for those with behavioural problems. Over 43% of the sample either self-referred or was referred by family or friends. Conclusions. Eligible individuals may miss out on services unless they or their family take the initiative to refer. There is a need for improved methods and incentives to support and encourage health workers to refer eligible individuals to the program. What is known about the topic? The absence or inappropriate referral to a suitable home care program can place pressure on formalised institutions and increase burdens on family members and the community. Factors largely unrelated to healthcare needs carry significant weight in determining hospital discharge decisions and home care referrals by practitioners. What does this paper add? The effectiveness of the HACC program is dependent on the referrer who acts to inform and facilitate individuals to the program. The purpose of this study is to identify the characteristics associated with the likelihood of individuals receiving a referral to the HACC program from various sources. What are the implications for practitioners? This study will assist policy makers and practitioners in developing effective strategies that transition individuals to suitable home care services in a timely manner. An effective referral process would provide opportunities for implementing preventative strategies that reduce disability rates among individuals and the burden of care for the community. For instance, individuals with unmet needs may be at higher risk from injury at home through inadequate monitoring of nutrient and medication intake and inappropriate home surroundings. Improving knowledge about care options and providing appropriate incentives that encourage health workers to refer individuals would be an effective start in improving the health outcomes of an ageing population.

The focus of this thesis is on the impact that a hospital admission can have on the continuing ability of Home and Community Care¹ (HACC) clients (older people and people with disability) to remain living in their home. Of concern to HACC service providers were their clients' readmissions to hospital and/or unnecessary institutionalisation after hospitalisation. Both events were considered poor outcomes by HACC service providers. The desire to improve these poor outcomes and to alleviate discontinuous care led the HACC program to fund a project in Adelaide, which I undertook as action research. In this thesis I investigated how poor outcomes could be avoided and continuity of care improved in the South Australian hospital and HACC systems. A literature review revealed that population ageing, the demand and resource pressures on acute hospitals and community services and the paucity of discharge planning were factors leading to discontinuity of care of older people and people with disability, as well as impacting on their carers. Theoretical perspectives first look at the divisions between the biomedical and social models of health, as well as the critiques of medical care and the role of bureaucracy put forward by iatrogenesis and medicalisation. Next, the theoretical lens turns to the lives of people, where the centrality of 'care' and interdependence are considered, along with the need to improve our understanding of the nature of vulnerability and the importance of resilience to moving beyond the dominant 'problem-based' discourse of ageing and disability. Processes in the action research included two cyclical phases of making plans, embarking on actions and observing the results of the actions. Methods for collecting data included surveys (n=16 older patients and 10 carers), an evaluation (n=28), face-to-face interviews (n=52), one focus group (n=8), three Reference Groups (n=46), a workshop (n=14) and a nominal group (n=14). The interviews and surveys provided the opportunity to analyse the admission, hospitalisation and discharge issues for HACC clients and their carers from the perspectives of hospital nurses (n=19) and 33 community care providers. The latter participants were clinicians and case managers from domiciliary care² (n=23) and community nurses³ (n=10). These interviews were analysed thematically. Results from the action research project yielded valuable research insights and successful actions which were reflexively planned, implemented and evaluated. The actions increased local linkages between the hospital and community service providers, collaboration, communication and access to information about the HACC program. Despite this, the action research project appeared to have little or no direct effect on avoiding poor outcomes or improving discontinuity of care. Such effects were more complex and beyond the scope of a project of this size. Achieving the necessary systems and structural changes to address these problems would have required more time, resources, capacity and leadership to be committed by government departments and the agencies. The descriptive statistics of surveys with patients and carers and the key issues identified by the Reference Group supported triangulation of the interviews with domiciliary, community nursing and hospital participants. Findings from the interviews with domiciliary, community nursing and hospital participants point to uncertainty and complexity before, during and after hospitalisation of older people, people with disability, their carer/family, and also for service providers. Before admission to hospital there are four 'dimensions of uncertainty', and during hospitalisation, there were four categories which contributed to 'complexity in discharge planning'. When leaving hospital, 'adjustment and adaptation' highlights individual patients' and carer/families' adjustments. In addition, it points to the need/potential for service adaptation to support people's ability to return home. Putting these dimensions together, the main themes to emerge in this context are ‘systemic uncertainty and complexity'. In building upon these themes, I have developed a model of systemic uncertainty and complexity before, during and after hospital. Given this new knowledge about the context of uncertainty and complexity on the one hand, and adjustment and adaptation on the other, I conclude by considering the implications of these understandings for theory, policy and practice. ¹ The HACC program, funded jointly by the Australian, State and Territory governments, targets community-dwelling frail aged people, people with disability, and their carers, who in the absence of basic maintenance and support services are at risk of premature or inappropriate long-term residential care. ² Domiciliary care services are provided to older people (aged 65 years and over) and younger people with disability whose ability to care for themselves is reduced. Domiciliary care assists them to stay living in their own homes, by providing physical assistance, rehabilitation and personal care, as well as respite and support for carers. By promoting independence and improving quality of life for clients, domiciliary care services aim to prevent unnecessary admission into hospital or residential care. ³ Community nursing services provide community based health and care services, including rehabilitation, therapy and nursing care.
Thesis (Ph.D.) -- University of Adelaide, School of Population Health and Clinical Practice, 2010

Home First is an Ontario transition management approach that attempts to reduce the pressure on hospital and Long Term Care (LTC) beds through early discharge planning, the provision of timely and appropriate home care, and the delay of LTC placement. The purpose of this qualitative descriptive study was to obtain descriptions from South Eastern Ontario Home First clients and their family caregivers of their experiences with and thoughts about care transitions, the provision of care, and the Home First approach. The goal was to enable insight into the Home First approach, care transitions, and the provision of care through access to the perspectives of study participants. Nine semi structured interviews (and one or more follow-up calls for each interview) with Home First clients discharged from hospitals in South East Ontario and their family caregivers were conducted and their content analyzed. All participating Home First clients were pleased to be home from hospital and did not consider LTC placement a positive option. All had family involved with their care and used a mix of formal and informal services to meet their care needs. Four general themes were identified: (a) maintaining independence while responding (or not) to risks, (b) constraints on care provision, (c) communication is key, and (d) relationship matters. Although all Home First clients participating in the study were discharged home successfully, a sense of partnership between health care providers, families, and clients was often lacking. The Home First approach may be successfully addressing hospital alternative level of care issues and getting people home where they want to be, but it is also putting increasing demands on formal and informal community caregivers. There is room for improvement in how well their needs and those of care recipients are being met. Health professionals and policy makers must ask caregivers and recipients about their concerns and provide them with appropriate resources and information if they want them to become true partners on the care team.
Thesis (Master, Rehabilitation Science) -- Queen's University, 2013-05-23 16:10:53.323