The Role of Human Factors in Home Health Care Workshop Summary (2010) / Chapter Skim
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11 Impact of Cultural, Social, and Community Environments on Home Care--Steven M. Albert
11 Impact of Cultural, Social, and Community Environments on Home Care--Steven M. Albert
Pages 247-274
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From page 247... ...
Access to appropriate supportive care technologies and home health care services depends in part on where homes are located, what sorts of spaces are available for care in the home, and whether basic services (such as utilities) are reliable.
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From page 248... ...
Perceived usefulness depends in part on contact with providers, which is affected by features of a patient's community. Perceived ease of use depends on social support from families, whether families will help maintain technologies, and how receptive they are to instruction from home health care providers.
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From page 249... ...
Progressively expanding circles radiate outward that first include social relationships and then community environments. Beyond the community sphere is a larger circle encompassing public policies and laws that regulate provision of home care.
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From page 250... ...
At the level of family social relations, family consensus, a supportive division of labor, and appropriate information gathering respond to the challenge of potential disruption of family relations. Similarly, community factors, such as neighborhood resources to support medical technology in homes, may lessen the impact of low availability of home health care agency services.
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From page 251... ...
Likewise, a consistent relationship with service providers at the level of the neighborhood may reinforce proadaptation resources at the level of the family, such as willingness to include home health care staff as "family," and a reasonable division of labor with home care providers. These in turn will support cultural expectations for adapting homes to provide care.
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From page 252... ...
• What changes in your household would you need to make in order to provide quality care for a family member receiving home health care services? • What aspects of a home make it hard or easy for a home health care worker to do his or her job?
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From page 253... ...
African Americans are more likely than whites to endorse the primacy of family care (Dilworth-Anderson et al., 2005) and accordingly are less likely to make use of formal long-term care, including respite, home care, adult day programs, skilled nursing facilities, and hospice.
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From page 254... ...
. Similarly, African American caregivers report lower anxiety, greater well-being, and more perceived benefits of caregiving than white caregivers (Haley et al., 2004)
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From page 255... ...
In urban centers, such as New York City, it is very common for home health care providers and patients to speak different languages, come from different neighborhoods, and have very different expectations for care. Yet home care paraprofessionals are expected to work in patient homes, to serve to some extent as surrogate family, and to help disabled or critically ill patients function on their own terms.
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From page 256... ...
. For ethnic and cultural communities that wish to maintain traditions yet participate in effective disease prevention or home care, it is important that they mobilize community resources, perhaps in partnership with service providers, to develop appropriate delivery of information in culturally acceptable ways.
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From page 257... ...
Families and Receptivity to use of Home Care Services and Medical Technologies Whether minority groups use home care services and home-based medical technologies more or less than nonminorities use them depends in part on how these services are defined, how available they are in particular localities (and often what kind of state Medicaid waiver policy is in play) , and whether differences in SES are adequately controlled.
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From page 258... ...
One study found higher use of physical and occupational therapy among whites and Asians relative to black and Hispanic home health recipients, but this difference was no longer significant with adjustment for case mix (Peng, Navaie-Waliser, and Feldman, 2003)
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From page 259... ...
Trust may also be relevant for adoption of home care technologies, but little research is available in this area. If informal sources of health information are more important for some cultural groups for the adoption of home health care technologies, then it will be important to work through these informal networks for changing social norms regarding acceptability.
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From page 260... ...
For example, in a neighborhood with a high crime rate, it may be difficult to attract agency care, and home care paraprofessionals may be reluctant to make home visits. Home care equipment and technologies brought into a home may make it a target for theft or attract attention a family may not want.
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From page 261... ...
The difference, Klinenberg argues, was in their community social capital, that is, health resources related to social ties. South Lawndale's predominantly Latino community was economically vibrant, less crime-ridden, more densely populated, with active civic organizations.
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From page 262... ...
The potential for other forms of violence outside the hospital and skilled nursing home setting is likely to be much higher. For example, in the New York City study of home attendants providing personal assistance care, many reported thefts, pressure if not overt threats from family members, and great concern for personal safety (Albert, 2002)
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From page 263... ...
Access to Home Health Care Workers and Technologies: A Social Capital Perspective Access to home care may be affected by more subtle community effects, apart from the environmental limitations of homes and barriers posed by the low SES of communities. Weak neighborhoods mean weak social ties, with fewer neighbors to check in on elders, absence of common safe areas (such as stores or parks)
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From page 264... ...
Thus, the flow of information is more efficient in high-income communities and allows greater efficiencies in service delivery. GAPS AND DIRECTIONS FOR RESEARCH The social-ecological approach suggests that improvement in home care outcomes will depend on adequate recognition of the role of culture, family and social relationships, and communities in the delivery of care.
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From page 265... ...
My research with home care in New York City suggests that differences in language are quite common -- not surprising when one notes that New York City's fastest growing populations include Mandarin, Russian, and Spanish speakers. One home health care agency director suggested that 80 percent of her agency's clients and home attendants differed in culture.
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From page 266... ...
, we found that family caregivers provided about three-quarters of the weekly care (32 of 43 total hours) while families received weekly insurance-based home health care services, regardless of type of insurance coverage.
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From page 267... ...
As mentioned earlier, many home health care agencies have begun such efforts. The Cash and Counseling
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From page 268... ...
HYPOTHESES FOR FuTuRE RESEARCH This inquiry suggests a number of hypotheses for future research, some of which were mentioned earlier, all drawing on the social-ecological framework developed for home care. I conclude with a list of hypotheses relevant to the adaptation of homes to accommodate advanced medical technologies.
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From page 269... ...
Interventions in which families exert greater control over vendors and providers, like the Cash and Counseling Demonstration and Evaluation, may promote more effective home use of emerging medical technologies. How to Enhance Home Health Care with What Is Known Now This review suggests that successful adoption of home care technologies depends on individual human factors but also the context in which individuals live, including the social, cultural, and community resources available to them.
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From page 270... ...
These groups invite vendors or therapists to demonstrate equipment and often introduce new patients to patients who have already adopted it. These efforts represent important enhancements to home health care that emerge from a socialecological perspective.
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From page 271... ...
. Can culture help explain the physical health effects of caregiving over time among African American caregivers?
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From page 272... ...
. "This case is closed": The transition in family caregiving when home health care services end.
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From page 273... ...
. Cultural assessment in home healthcare.
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From page 274... ...
. Optimizing patient and family involvement in geriatric home care.
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