The Role of Human Factors in Home Health Care Workshop Summary (2010) / Chapter Skim
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4 The Environments of Home Health Care
4 The Environments of Home Health Care
Pages 47-66
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From page 47... ...
This information about abilities, activities, and attributes then needs to be analyzed and translated into appropriate interventions. 1 This section is based on the presentation by Jon Sanford, director and senior research scientist in the Center for Assistive Technology and Environmental Access at the Georgia Institute of Technology.
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From page 48... ...
And safe transfers and greater independence can involve modified toilets, sinks, and baths; grab bars and other devices in bathrooms and kitchens; and other modifications designed to facilitate daily activities. A wide variety of organizations and individuals support and provide these modifications, including government agencies, nongovernmental organizations, private contractors, remodelers, builders, occupational therapists, home health nurses, and social service providers, some of whom are trained and certified for their jobs and others of whom are not.
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From page 49... ...
. Universal design differs from either accessible design or assistive technology.
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Design features are easier to use and learn by both health care recipients and providers. Universal design can also eliminate the need for many assistive technologies and home modifications.
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The home has to support all of the other health care interventions that we do." • Certifying environmental service providers in the same way that other professionals are certified. To affect legislation and regula tory policy, the efficacy and effectiveness of interventions need to be demonstrated for care recipients, for providers, and for society as a whole.
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The high initial cost of environmental interventions makes randomized controlled trials very difficult. Crossover designs are less expensive, but the disruption of installing interventions is burdensome to the subjects.
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Our community environments are less than accessible." Furthermore, the Americans with Disabilities Act exerts little control over the community environment. Many of the issues affecting people with physical disabilities apply with even greater force to people with cognitive disabilities.
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This decision may be informed by a strong filial obligation, social traditions of home care, or an expansive cultural definition of "home." All of these factors can affect the choice to adapt the home for intensive medical care. Similarly, a family decision to disrupt family relations may depend on a supportive division of labor within the family, family networks that allow appropriate information gathering, the willingness to include home health care staff as family, or perhaps modification of a home.
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Social and Family Relationships Familism -- the subordination of individual interests to family concerns -- can affect decisions about home health care in many different ways. It may reinforce individual cultural expectations for home care.
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From page 56... ...
to include not only greater control over hiring and sched uling but also greater control over the adoption of in-home medical technologies. • Establishing cultural competence training and certification for allied health home care providers.
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Such studies may lead to better tools for assessment of cultural expectations for home care. • Cross-level investigations of the choices people make to modify homes, use home care paraprofessionals, adopt advanced home care technologies, or some combination of the three.
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From page 58... ...
An important issue is deciding which types of care are done better by a human and which are more appropriate for technologies. Home caregivers provide social support and forms of monitoring that cannot be achieved with technology.
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From page 59... ...
These numbers are expected to grow dramatically as the baby boom generation starts to reach retirement age. Home Care Silos Home health care, which represented about 4 percent of the $484 billion Medicare budget in fiscal year 2009, is broken into a variety of separately funded categories -- called "silos" in the field of health care financing -- based partly on payment sources and regulations.
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Long-Term Care The U.S. health care system needs reform both in the area of communitybased long-term care and in the area of chronic illness care for seriously ill people, said Boling.
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Largely missing from health care services for seriously ill people is long-term ADL support, unless a recipient is poor, on Medicaid, or has an advanced chronic illness. ADL care may be provided only for short, predetermined periods.
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Based on this observation, Boling has been working on a piece of health care legislation, called Independence at Home,6 that calls for interdisciplinary teams that would use house calls, electronic health records, other forms of technology, and their own expertise to deliver care where and when people need it. Any net savings would flow both to Medicare and to the Independence at Home program.
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From page 63... ...
process has been so enormously complicated." The parts of the Independence at Home legislation that he views as most important are attracting talented people to the field, creating teams that can go to care recipients, and aligning financial incentives with objectives. "If the objective is comprehensive care with less dependence on hospitals and nursing homes, you need to structure the financial parameters in such a way that you are paying to obtain those results." In addition, research has shown that home visits yield marked improvements in detection of and intervention in significant health problems.
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From page 64... ...
The Visiting Nurse Service has also done considerable work on aging in place programs to help residents stay in their homes and communities. The service becomes part of the fabric of communities, performing screenings, assessments, and group health education and providing certified home care services if needed.
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From page 65... ...
"I am not at all a fan of people having to come to a hospital or to a medical center for chronic illness care, because I don't think that for the majority of those folks we are doing them any good by making them do that." David Wegman emphasized the importance of human factors research in the discussion, to which Sanford responded that occupational therapists could be trained and encouraged to be part of home health care teams. They could bring new attention to the influence of the built environment, even as physicians, nurse practitioners, and other clinicians are trained to be more observant of that environment.
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From page 66... ...
This issue, he said, "needs to be explored more carefully." In response to a question about the logistics of home visits, Boling observed that traveling to care recipients has advantages over recipients traveling to care providers because most recipients are always at home, so people can be added to a schedule at the last minute. "I could see them within hours of the time that they need to be seen, not days or weeks.
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