Informal, Family Care in Home Healthcare Impacts
Risk of Return to Hospital
Amount of care and assistance from informal
caregivers had an important impact on self-care ability and
Nov. 12, 2012 – Elderly patients being treated in
home healthcare after a stay in the hospital are much less likely to
return to the hospital if they experience strong “social environmental
factors,” especially if this care is provided by a family member or
other informal caregiver.
"Understanding how social environmental factors
contribute to home healthcare patients being rehospitalized would be
assist in improving care for patients and in helping agencies deliver
more cost-effective care while at the same time managing Medicare
spending," according to the report by Hong Tao, RN, PhD, of University
of Wisconsin Milwaukee and colleagues.
The study in the October-December issue of
Advances in Nursing
Science looked at factors affecting the risk of repeated
hospital admissions among 1,268 elderly patients receiving home
Using data from routine, Medicare-required
assessments, the researchers focused on the importance of social
environmental factors: such as whether the patient lived alone or with
others, whether he or she had a primary informal caregiver, and the type
and frequency of informal care provided.
Overall, nearly 21 percent of patients in the study
were rehospitalized, most within the first 20 days of being discharged
from the hospital to home healthcare.
Rehospitalizations - defined as readmission to the
hospital within 60 days after being released from the hospital to home
care - are an important indicator of the quality of care.
The study found some significant associations
between social environmental factors, and suggested some pathways by
which these effects occur.
Patients' functional ability - their ability to
take care of themselves - was influenced by their living arrangements
and by the type and frequency of informal care they received.
The greater the difference between the patients'
clinical condition and functional status, the greater the risk of
rehospitalization. Social environmental factors contributed to the risk
of repeated hospital admission by altering the balance between the
patient's need for and ability to provide self-care.
…With 'Self-Care Deficit' Leading to Repeat
Changes in clinical condition placed increased
demands on the patient's ability to care for himself or herself, while
at the same time making it more difficult to provide self-care.
Consistent with a central nursing theory, the resulting "self-care
deficit" was linked to an increased risk of rehospitalization.
The amount of care and assistance received from
informal caregivers had an important impact on self-care ability and
Other patient characteristics linked to self-care
deficit included obesity and cognitive (intellectual) ability. Patients
living alone were less likely to be rehospitalized—perhaps because those
choosing to live alone were better able to functional independently and
care for themselves.
Few previous studies have looked at how social
environmental factors in general, and informal caregivers in particular,
affect patient outcomes. Rehospitalization is considered a "major
adverse event" in home care. "Rehospitalizations are costly and in many
cases preventable," Dr Tao and colleagues explain.
One recent study found that 20 percent of
hospitalized Medicare beneficiaries are readmitted within 30 days, with
costs accounting for one-sixth of the total Medicare budget.
Dr Tao and colleagues believe their study has
implications for strategies to reduce unnecessary rehospitalizations and
improve the quality of home healthcare.
"[Our] findings may help home healthcare nurses to
recognize those patients who are in need of certain services that may
reduce hospitalization, such as those that lack the support of the
patient's family or assistance from paid informal caregivers," they
write. Patients with good social environmental support are "more likely
to have a higher functional ability and thus remain in their homes, the
first choice of most patients."
The study also reaffirms the important role of
informal caregivers in maintaining home healthcare patients. The authors
add, "Informal caregivers are part of the solution in preventing
unnecessary hospitalizations and more attention needs to be given to how
these caregivers are supported in their roles."
Advances in Nursing
Science is published by
Lippincott Williams &
Wilkins, a part of
Wolters Kluwer Health.
• Nursing Home Abuse,
• Medical Malpractice -
• Experienced Legal Help
Janicek Law attorneys are working every day to help senior citizens and others harmed by failure of care in nursing homes and the healthcare system.
you or a loved one have suffered due to the neglect or inadequate care of others, call us today. We offer the skill and knowledge gained in more than twenty years of success.
Free Consultation - Call toll free 1-877-795-3425