Testing the chronic care model for depression in homebound older adults.

Homebound older adults are a unique population of older adults with many chronic illnesses and complex care needs (Qui et al., 2010). Depression is highly prevalent in homebound older adults (Qui et al., 2010). Many Chronic Care Models (CCMs) have been developed to provide a better system of care to those with chronic health conditions (Bodenheimer, Wagner, & Grumbach, 2002; Wagner et al., 2001; Wagner, Austin, & Von Korff, 1996a, 1996b). The Chronic Care Model for Depressed Homebound Older Adults is a model that was specifically designed for the depressed homebound elderly. It addresses many areas for improvement of care including delivery system design, communication/collaboration, education of patients and caregivers, technology, training/education of providers, and specialist involvement. This dissertation examined aspects of this model in the current home health care system to test model-predicted relationships between home health system characteristics and outcomes. Outcomes of interest were hospitalizations, nursing home admissions, and emergency room visits. CCM model relevant independent variables examined include the number of services provided by each agency, the number of visits provided to each client, and caregiver involvement. This study also examined whether home health patients who are admitted from a short-term hospital stay are more likely to be depressed than those who are admitted from any other location. A five percent sample of the Home Health Outcome and Assessment Information Set (OASIS), a national database containing assessments of each Medicare home health recipient, was used. Results showed that the number of home health visits were related to an increased likelihood of ER visits, hospitalizations, and skilled nursing facility (SNF) admissions, providing support for the part of the proposed model that emphasizes communication between patients/caregivers and providers. Increased number of home health services was related to decreased ER visits, providing support for the importance of the delivery system design piece of the model. Discharge from an acute hospital stay was related to diagnosis of depression, and those with caregivers were less likely to be depressed. This provided support for caregiver involvement. Implications of these findings are discussed

Family Caregiving to the Older Population: Background, Federal Programs, and Issues for Congress

[Excerpt] Family caregiving to older individuals in need of long-term care encompasses a wide range of activities, services, and supports. Caregiving can include assistance with personal care needs, such as bathing, dressing, and eating, as well as other activities necessary for independent living, such as shopping, medication management, and meal preparation. In addition, family caregivers may arrange, supervise, or pay for formal or paid care to be provided to the care recipient. Family caregivers fulfill the majority of the need for long-term care by older persons with chronic disabilities in the United States. As a result of increases in life expectancy, as well as the aging of the baby-boom generation, demand for family caregiving to the older population is likely to increase. However, demographic trends such as reduced fertility, increased divorce rates, and greater labor force participation among women may limit the number of available caregivers to older individuals, as well as the capacity for caregivers to provide needed care. Although many family caregivers find caregiving for an older family member a rewarding experience, other life circumstances, in addition to caregiving, may increase caregiver stress. For example, family members may not live in close proximity to the care recipient, they may face the competing demands of child care and elder care, and they may have to manage work with caregiving responsibilities. As a result, family caregiving can lead to emotional and physical strain and financial hardship. These effects are more likely to be felt among those caring for persons with high levels of disability or cognitive impairment. Caregiver stress has been linked to nursing home admission for the care recipient, thus interventions that can reduce stress may also reduce nursing home placement. Recognizing family caregivers as an important part of the nation\u27s long-term care delivery system, the federal government has established programs and initiatives that provide direct supports to caregivers, such as respite care, education and training, tax relief, and cash assistance. These benefits are targeted at family caregivers to reduce stress and financial hardship, and to improve caregiving skills, among other things. Other federal programs and initiatives provide home- and community-based long-term care services and supports to the care recipient. These programs can indirectly benefit caregivers in relieving caregiver burden by either supplementing the informal care they are providing or substituting with paid support. Three sets of policies that would provide direct assistance to family caregivers to older adults are briefly discussed in the last section of this report. These policy issues, which have been the subject of discussion among federal policymakers and other interested stakeholders, include the following: caregiver services and supports, flexible workplace accommodations and income security, and additional tax credits. This report will be updated as warranted

The Need for National Training Standards and Guidelines for Privately Paid Geriatric Home Caregivers

Contrary to public opinion, America's institution-centered long-term care (LTC) system does not serve the majority of older adults. Currently, nursing homes serve less than 20% of older adults needing care, and thus do not provide a viable solution for future caregiving needs. While these LTC institutions will continue to play an important role in providing care for our most frail older adults who need skilled nursing and/or medical care, they will not be necessary for the vast majority of older adults who simply need nonmedical caregiving, that is, help with activities of daily living. There is, and will continue to be, an urgent need for a large cadre of trained caregivers for older adults who live at home. This issue brief calls for the development of national training standards and a caregiver certifying organization that provides national oversight

Collaborating to Create Elder Friendly Communities in New Hampshire: A Scan of the Current Landscape

The fact that the population of the United States is aging is no surprise; the demographic projections are well documented. There have never been as many older adults living as there are today, and this number will only increase. Northern New England is aging more rapidly than the rest of the country, with Vermont, Maine, and New Hampshire having the oldest populations in term of median age (U.S. Census, 2014). New Hampshire is expected to be the fastest aging state in New England through 2030, with nearly one-third of its population being over the age of 65 (Norton, 2011). This phenomenon is anticipated to place substantial pressure on publicly-funded health programs and long-term services and supports in the Granite State. But the story of the aging of the population is not only about increased numbers. As longevity increases, the average age of the older population will see a dramatic increase. The number of persons over the age of 85 in the United States is expected to increase five-fold by 2040. As the possibility for functional limitations and disability increases with age, the need for long-term, formal, and informal supports is expected to increase as the number of older adults, particularly those over the age of 85 increases. In addition, women continue to live longer than men; on average, life expectancy for women is three years longer than for men. These factors create a complex picture of aging, which includes a growing population of older adults, a majority of whom will be women; and a growing number of those over the age of 85, who are more likely to require some type of assistance as they age. It is a mistake to look at our aging population in a singular way. Although we tend to make generalizations about older adults, as a group, they are more physiologically and socially diverse than any other age group (Brummel-Smith & Mosqueda, 2003). As we age, we become more and more diverse, as there are no two people who have had the same life experiences, shaping who we are over our lifetimes. The baby boomers (those born between 1946 and 1964) are likely to be the most diverse cohort of older adults we have seen to date, and it is likely that they will redefine our conception of age and aging. Older adults bring a diverse set of skills, talents, and knowledge that should be tapped as a significant natural resource to support a new and exciting vision of aging

An Educational Pathway for Geriatric Home Caregivers

The establishment of a multi-tiered educational pathway for geriatric home caregivers would support efforts to meet the needs of an increasing number of community dwelling older adults who require assistance with activities of daily living, while generating a cadre of qualified employees for an expanding non-medical private home care market. An educational pathway for geriatric home caregivers would also standardize the training of home care assistants while providing these individuals access to routine, high quality continuing education opportunities and the potential for career advancement. This issue brief provides two model educational pathways toward becoming a Geriatric Home Caregiver

Developing National In-Home Caregiver Training Standards

This report incorporates discussion by experts on topics of paid in-home caregiver training standards, including curricula, accreditation, certification, career ladder, and caregiver support

Public Health Model Identifies Recruitment Barriers among Older Adults with Delirium and Dementia

Recruiting older adults and their family caregivers into research studies presents challenges. Although the literature notes some general recruitment challenges, no studies specifically address the unique challenges of recruiting older adults who have Alzheimer\u27s Disease (AD) and their family caregivers in studies about delirium or suggest using a framework to identify barriers to recruiting this population. In conducting a pilot study about preparing family caregivers to detect delirium symptoms in older adults with (AD) the researchers used the Public Health Model for identifying barriers to recruitment. The goals of this methodological article are to: (1) briefly describe the methodology of the pilot study to illustrate how the Public Health Model was applied in the context of the present study and (2) discuss the benefits of the Public Health Model for identifying the barriers to recruitment in a study that prepared family caregivers to detect delirium symptoms in older adults with AD. The Public Health Model helped us to identify four specific barriers to recruitment (lack of knowledge about delirium, desire to maintain normalcy, protective caregiving behaviors, and older adult\u27s fears) and ways to overcome them. The Public Health Model might also help other researchers address similar issues

Caregiver Integration During Discharge Planning for Older Adults to Reduce Resource Use: A Metaanalysis

Objectives To determine the effect of integrating informal caregivers into discharge planning on postdischarge cost and resource use in older adults. Design A systematic review and metaanalysis of randomized controlled trials that examine the effect of discharge planning with caregiver integration begun before discharge on healthcare cost and resource use outcomes. MEDLINE, EMBASE, and the Cochrane Library databases were searched for all English‐language articles published between 1990 and April 2016. Setting Hospital or skilled nursing facility. Participants Older adults with informal caregivers discharged to a community setting. Measurements Readmission rates, length of and time to post‐discharge rehospitalizations, costs of postdischarge care. Results Of 10,715 abstracts identified, 15 studies met the inclusion criteria. Eleven studies provided sufficient detail to calculate readmission rates for treatment and control participants. Discharge planning interventions with caregiver integration were associated with a 25% fewer readmissions at 90 days (relative risk (RR) = 0.75, 95% confidence interval (CI) = 0.62–0.91) and 24% fewer readmissions at 180 days (RR = 0.76, 95% CI = 0.64–0.90). The majority of studies reported statistically significant shorter time to readmission, shorter rehospitalization, and lower costs of postdischarge care among discharge planning interventions with caregiver integration. Conclusion For older adults discharged to a community setting, the integration of caregivers into the discharge planning process reduces the risk of hospital readmission

Caregiver Integration During Discharge Planning for Older Adults to Reduce Resource Use: A Metaanalysis

Objectives To determine the effect of integrating informal caregivers into discharge planning on postdischarge cost and resource use in older adults. Design A systematic review and metaanalysis of randomized controlled trials that examine the effect of discharge planning with caregiver integration begun before discharge on healthcare cost and resource use outcomes. MEDLINE, EMBASE, and the Cochrane Library databases were searched for all English‐language articles published between 1990 and April 2016. Setting Hospital or skilled nursing facility. Participants Older adults with informal caregivers discharged to a community setting. Measurements Readmission rates, length of and time to post‐discharge rehospitalizations, costs of postdischarge care. Results Of 10,715 abstracts identified, 15 studies met the inclusion criteria. Eleven studies provided sufficient detail to calculate readmission rates for treatment and control participants. Discharge planning interventions with caregiver integration were associated with a 25% fewer readmissions at 90 days (relative risk (RR) = 0.75, 95% confidence interval (CI) = 0.62–0.91) and 24% fewer readmissions at 180 days (RR = 0.76, 95% CI = 0.64–0.90). The majority of studies reported statistically significant shorter time to readmission, shorter rehospitalization, and lower costs of postdischarge care among discharge planning interventions with caregiver integration. Conclusion For older adults discharged to a community setting, the integration of caregivers into the discharge planning process reduces the risk of hospital readmission