Academic journal article Health and Social Work

Post-Acute Home Care and Hospital Readmission of Elderly Patients with Congestive Heart Failure

Academic journal article Health and Social Work

Post-Acute Home Care and Hospital Readmission of Elderly Patients with Congestive Heart Failure

Article excerpt

Elderly patients often receive home care from formal service providers after inpatient hospitalization (Caro & Blank, 1988; Kane, 1994; Kane & Kane, 1987). Elderly patients use of home care services has grown at an unprecedented rate. Between 1988 and 1994 the proportion of Medicare beneficiaries receiving home care services nearly doubled, and the average number of visits per user almost tripled (Moon, 1996). However, elderly patients receive most of the needed care from family members, relatives, or friends. These informal caregivers help elderly patients with functional needs and participate in the elderly patients' medical care (Kane & Kane). Despite the involvement of informal caregivers and formal service providers, researchers have not paid sufficient attention to the effects of informal and formal home care services on elderly patients' outcomes during the post-acute period (Kane, 1996).

The purpose of this study was to examine the independent and joint effects of informal and formal service use on hospital readmission. This study is important because few researchers have tested the effects of informal and formal home care services on hospital readmission, especially during the post-acute period. The findings will expand our understanding of the interface of informal and formal services and their effects on elderly patient outcomes in post-acute care. The findings may also help policymakers and service providers develop policies and programs that are more responsive to the needs of elderly patients and that may reduce hospital readmission.

LITERATURE REVIEW

Although they vary depending on sample criteria and length of observation, hospital readmission rates for elderly patients with congestive heart failure (CHF) are high (Burns & Nichols, 1991; Kane, 1994). After reviewing more than 17,000 CHF patients' Medicare records, Krumholz and colleagues (1997) noted that over a six-month period 44 percent of patients experienced at least one readmission. Vinson and colleagues (1990) found that the readmission rate for a group of patients ages 70 or older was 47 percent over 90 days. Kane (1994) reported a 24 percent readmission rate in six weeks.

Researchers have suggested that hospital readmission is related to alterable factors such as compliance with medical treatment, seeking medical attention, adequate discharge plans, or well-designed and implemented home health care services (Benack, 1964; Berkman & Abrams, 1986; Proctor, Morrow-Howell, Li, & Dore, 2000; Vinson, Rich, Sperry, Shah, & McNamara, 1990). Through these measures, it has been estimated that 6 percent to 53 percent of hospital readmissions may have been preventable (Proctor et al., 2000; Rich et al., 1995; Vinson et al., 1990). Home care services during the post-acute period are a recognized strategy for delaying or preventing hospital readmission for CHF patients (Berkman & Abrams, 1986; Martens & Mellor, 1997). Medical home health services may stabilize the recovery process, and supportive services may compensate for functional dependency (Kane & Kane, 1987).

Post-acute home care is often shared among informal caregivers and formal service providers. A study showed that up to 93 percent and 63 percent of elderly patients received informal and formal services, respectively (Kane, 1994). Informal caregivers help elderly people with activities of daily living (ADLs), such as feeding, bathing, dressing, toileting, and getting in or out of bed, as well as instrumental activities of daily living (IADLs), such as housekeeping, shopping, transportation, administering medication, or handling finances. Informal caregivers are also actively involved in patients' medical care (Kane, 1996; Lough, 1996; Silliman, Shelah, & Amina, 1996). A qualitative study on post-acute home care for elderly patients with CHF revealed that informal caregivers contacted physicians, verified medication regimens, helped with grocery shopping, and incorporated prescribed diets into family meals (Lough). …

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