The Role of Human Factors in Home Health Care Workshop Summary (2010) / Chapter Skim
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2 The People Who Receive and Provide Home Health Care
2 The People Who Receive and Provide Home Health Care
Pages 9-28
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From page 9... ...
. The percentage of people with chronic conditions increases with age, to the point that more than 90 percent of people older than 85 have one or more chronic conditions.2 The bulk of health care expenditures is spent on hospital care and physician services, Charness observed.
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In analyzing home health care technologies and practices, Charness and his colleagues often assess the fit of capabilities and demand. Health care devices, technologies, and practices can make many demands on a person's capabilities.
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Similarly, medical devices, such as oxygen concentrators, may need both visual and auditory warnings to alert older users to potential hazards when the equipment is failing. The learning rate slows with age, so that it can take an older adult between 50 and 100 percent longer to learn new material.
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More impaired care recipients are more willing to cede some degree of privacy and confidentiality regarding such issues as toileting, medications, movement in the home, cognitive abilities, and driving. But they often are unwilling to share that information with insurance companies or government agencies.
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Charness pointed out that virtual groups, even if they include large numbers of people living alone, can be large and geographically extended. INFORMAL CAREGIVERS: FAMILY, FRIENDS, OTHERS Many of the people who provide home health care are not paid professionals but family members, friends, and other lay providers, said Richard Schulz.
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This group overlaps with the other two, but they have different kinds of needs for home health care. After hospitalization, needs tend to be more acute, and informal caregivers can be required to provide highly specialized and technical assistance.
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All of the tasks undertaken by informal caregivers are amenable to training. A small industry has taken shape in the United States focused on how to teach caregivers to provide home care services.
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Caregiving tends to evolve over time, from assistance with instrumental activities of daily living to more intensive forms of caregiving. For elderly caregiving, the progression can continue into some kind of institutional placement and then death.
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Sociodemographic factors also play into the effects of home health care on caregivers. Informal caregivers tend to have lower socioeconomic status, and this status might be affected by the caregiving experience itself.
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adults expect to be a caregiver in the future, but most admit to being unprepared. "We need campaigns to educate adults about the likelihood of their becoming caregivers, the likelihood of their being care recipients, and how to plan for those eventualities," said Schulz.
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But the current system is clearly not sustainable." FORMAL CAREGIVERS5 Paula Milone-Nuzzo defined formal caregivers as clinicians and trained individuals who receive compensation to provide intermittent or continuous in-home services. These services can be provided by a traditional home care agency, a community or social service agency, or for-profit providers.
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Typically, formal providers work in interdisciplinary teams of professionals and direct-care workers to assist care recipients to achieve their health and daily living goals. While physicians generally have the formal responsibility for ordering home care services, home care nurses or physical therapists often develop the plan of care, based on their knowledge and expertise, and send it to the physician for approval.
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In addition, only a few research programs have looked at the use of advanced-practice nurses in home care. Direct-care workers, who represent a large proportion of the home care workforce, include home health aides, companions, homemakers, and personal-care attendants.
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Direct-care workers, even those in formal home care agencies, often receive little formal training before beginning employment. Home health aides who work in Medicare- and Medicaid-certified home care agencies are required to have a minimum of 75 hours of training, including classroom content and clinical experience, and they are required to pass a test.
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According to Humphrey, "There is no financial incentive, surely not by insurance companies and not by the federal government, to have that kind of qualification." Likewise, the American Physical Therapy Association and the Occupational Therapy Association have special interest groups for home care, but they are small work committees that look at specific home care issues. The American Speech-Language-Hearing Association does not have such a group.
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• Involvement by the Occupational Safety and Health Administra tion in issuing home care guidelines. • Raising consciousness of human factors issues in the home health care community and among the recipients of care.
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Home caregiving disproportionately affects women, racial and ethnic minorities, and those with low incomes, often at the peak of their own ability to earn wages outside the home. There also are significant psychological and health impacts on informal caregivers, such as musculoskeletal strains caused by lifting and ambulation.
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• Adopt a standard definition of home caregivers, especially for informal caregiving. Regarding research, she suggested the following: • Identify the full range of human factors stressors for care recipients and informal and formal caregivers.
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• Encourage efforts to provide improved social support for informal caregivers. • Preserve and enhance meaningful, dignified, caring relationships.
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From page 28... ...
Milone-Nuzzo agreed that there is a great deal of overlap between formal and informal caregivers, especially in terms of the relationships that develop, the physical tasks involved, and the use of medical equipment. Yet distinguishing between these two groups does offer a "lens to begin the conversation." Schulz added that informal caregivers also rely on formal caregivers for various services, creating a back-and-forth dynamic between the two groups.
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