According to a new study by researchers at NYU Rory Meyers College of Nursing, people with dementia who get home health care visits are less likely to be readmitted to the hospital when nursing personnel is consistent. The findings were published in the American Public Health Association journal Medical Care.
Consistency In Nursing Care Can Help People With Dementia
Home health care, in which health workers, usually nurses, visit patients’ homes to offer care, has emerged as a major source of home- and community-based services for individuals living with dementia. These people frequently have numerous chronic illnesses, take multiple medications, and require assistance with everyday tasks. More than 5 million Medicare beneficiaries got home health care in 2018, including 1.2 million with Alzheimer’s disease and other dementias.
According to Chenjuan Ma, Ph.D., MSN, associate professor at NYU Meyers and the study’s primary author, nurses play a critical role in delivering home health care. As the population ages and more older persons want to age in place for as long as possible, the need for home health care for those with dementia is projected to rise dramatically.
Most patients’ home health care begins after they are released from the hospital. Given that hospital readmissions are a big quality, safety, and cost concern in healthcare, Ma and her colleagues sought to know if having continuity of care, or having the same nurse come to each home visit, may help patients avoid being readmitted.
The researchers investigated 23,886 older individuals with dementia who got home health care following a hospitalization using data from a major, not-for-profit home health service spanning many years. The number of nurses and visits during home health care were used to calculate continuity of care, with a higher score indicating better continuity of care.
One-quarter (24%) of the older individuals with dementia in the research were rehospitalized after being discharged from home health care. Infections, respiratory issues, and heart disease were the three most prevalent reasons for hospital readmission.
The researchers discovered substantial differences in nurse care continuity in-home health visits for patients with dementia. Only 8% got no continuity of care, with a new nurse attending each time, while 26% received all visits from the same nurse. They also discovered that the higher the intensity of the visit, or the number of hours of care delivered each week, the lower the continuity of care.
This may imply that it is difficult to establish continuity of care when a patient requires more care, but they cannot rule out the potential that high continuity of care results in more efficient care delivery and hence fewer hours of care, according to Ma.
Notably, even after the researchers accounted for other clinical risk variables and the intensity of home health care, higher continuity of home health care was associated with a reduced risk of rehospitalization (the average hours of care per week). People with dementia who received low or moderate continuity of nursing care were 30 to 33 percent more likely to be rehospitalized than those who received high continuity of nursing care.
Because of its decentralized and intermittent care style, Ma believes that continuity of nursing care is important for home health care. While continuity of nursing care may help all home health care patients, it may be especially important for those suffering from dementia. Having the same individual provide treatment can enhance familiarity, trust, and decrease misunderstanding for patients and their families.
The researchers propose addressing the lack of home health care nurses, increasing care coordination, and adopting telehealth in-home health care to enhance nursing care continuity.
According to the researchers, a hybrid care approach combining in-person and telehealth sessions might assist achieve more continuity of treatment. They urge governments to explore extending coverage for home health care telehealth visits.
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