Understanding the Workflow of Home Health Care for Patients with Heart Failure: Challenges and Opportunities

Abstract

BACKGROUND: Readmission rates are high among heart failure (HF) patients who require home health care (HHC) after hospitalization. Although HF patients who require HHC are often sicker than those who do not, HHC delivery itself may also be suboptimal. OBJECTIVE: We aimed to describe the workflow of HHC among adults discharged home after a HF hospitalization, including the roles of various stakeholders, and to determine where along these workflow challenges and opportunities for improvement exist. DESIGN AND PARTICIPANTS: In this qualitative study, we used purposeful sampling to approach and recruit a variety of key stakeholders including home health aides, nurses, HF patients, family caregivers, physicians, social workers, home care agency leaders, and policy experts. The study took place in New York, NY, from March to October 2018. APPROACH: Using a semi-structured topic guide, we elicited participants' experiences with HHC in HF through a combination of one-on-one interviews and focus groups. Data were recorded, transcribed, and analyzed thematically. We also asked selected participants to depict in a drawing their understanding of HHC workflow after hospitalization for HF patients. We synthesized the drawings into a final image. KEY RESULTS: Study participants (N = 80) described HHC for HF patients occurring in 6 steps, with home health aides playing a main role: (1) transitioning from hospital to home; (2) recognizing clinical changes; (3) making decisions; (4) managing symptoms; (5) asking for help; and (6) calling 911. Participants identified challenges and opportunities for improvement for each step. CONCLUSIONS: Our findings suggest that HHC for HF patients occurs in discrete steps, each with different challenges. Rather than a one-size-fits-all approach, various interventions may be required to optimize HHC delivery for HF patients in the post-discharge period.

Family Caregiver Perspectives on Benefits and Challenges of Caring for Older Adults With Paid Caregivers

“…Intervention to address these training needs could, in turn, alleviate caregivers' sense of discomfort or lack of preparation with certain tasks (for example, as reported by our study participants, physical tasks such as assisting with bathing). Clinicians and clinicians-in-training may also benefit from education regarding the challenges that family and paid home care workers face since many medical professionals are unaware of the intricacies of caregiving and its effect on patient care (Sterling et al, 2020).…”

Home care workers caring for adults with heart failure need better access to training and technology: A role for implementation science

“…Compounding this, our prior research suggests that HCWs often have trouble reaching other members of the healthcare team by phone when their patients are sick [6]. As a result, HCWs may dial 9-1-1, which can lead to trips to the hospital [7]. While some trips are clinically necessary, others could be avoided if HCWs were better supported in the field [7].…”

“…As a result, HCWs may dial 9-1-1, which can lead to trips to the hospital [7]. While some trips are clinically necessary, others could be avoided if HCWs were better supported in the field [7].…”

Understanding the Technological Landscape of Home Health Aides: Scoping Literature Review and a Landscape Analysis of Existing mHealth Apps

“…(5) facilitated communication between an HHA and their patient; (6) provided resources such as training courses, information, and so on for HHAs; (7) helped with electronic visit verification; and (8) assisted HHAs with clocking in and out. After applying these criteria to the 67 apps, 48 (72%) remained that performed one or more of the 8 core functions (Figure 2).…”