Health Care Comes Home The Human Factors (2011) / Chapter Skim
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2 People Involved in Health Care in the Home
2 People Involved in Health Care in the Home
Pages 19-60
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From page 19... ...
However, the population of people who receive and provide care is very diverse and possesses variable skills, resources, knowledge, and experiences. They also differ on a number of other characteristics, such as age, cultural and ethnic backgrounds, education, and living arrangements.
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. One distinction between informal and formal caregivers is that informal caregivers are typically not paid for the care provided.
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The population of people involved in health care in the home also includes persons with physical, sensory/perceptual, cognitive, and emotional disabilities. According to the U.S.
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From page 22... ...
. Individuals with disabilities represent a significant population of people who engage in or receive care at home.
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From page 23... ...
Informal caregivers are also referred to as family caregivers, lay caregivers, or simply family and friends who provide assistance by virtue of kinship, friendship, or altruism.1 In contrast, formal caregivers (sometimes referred to as professional caregivers2) have often had formal health care training and have some level of service delivery skill and education.
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From page 24... ...
Performance of health care tasks places a variety of physical, cognitive, sensory/perceptual and emotional demands on people, whether they are caring for themselves BOX 2-1 The Lopez Family Ricardo Lopez, an 82-year-old retired teacher of Cuban descent, takes care of his wife Dolores, who in her mid-70s was diagnosed with Alzheimer's disease, approximately 7 years ago. The couple lives in a small one-bedroom apartment in Florida, within walking distance of a small local grocery store and pharmacy.
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Health care tasks may also involve some type of equipment or technology, which presents its own set of demands, and may be performed in various environments that generate additional demands. (The family vignette in Box 2-1 illustrates some of this complexity.)
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In addition, cognitive abilities may wax and wane over time due to the effects of fatigue, pain, drugs, or disease progression. Care recipients (and even caregivers to the extent that fatigue and their own health challenges affect them)
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From page 27... ...
It is estimated that 93 million U.S. adults have English literacy skills that are categorized as "basic" and "below basic." Rates of low literacy are higher among populations of lower socioeconomic status, older adults, and minorities (Kutner et al., 2006)
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In addi tion, older adults experience increased activity limitations as they age as a result of chronic health conditions (see Figure 2-3)
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Attitudinal variables also affect a person's performance of health care tasks. General attitudes toward health and health care have a strong influence on willingness to seek care and adherence to treatment protocols.
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Many racial/ethnic minorities and individuals of lower socioeconomic status are less likely than whites and persons of higher socioeconomic status to have a usual source of care, to have access to quality care, and to engage in preventive health practices. These groups also tend to experience disproportionately some chronic illnesses and conditions, such as obesity, hypertension, and diabetes.
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. Informal caregivers respond differently to the caregiving experience depending on their ethnic/cultural background.
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. INFORMAL CAREGIVERS Rosalyn Carter is often quoted for her observation that there are only four types of people in the world: "those who have been caregivers; those
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. Informal caregivers span the spectrum of age and are heterogeneous across multiple dimensions that include their relationship to and geographical proximity to the people for whom they provide care and the nature, duration, and intensity of the assistance they provide.
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. Roles and Responsibilities Informal caregivers are involved in a wide range of household, personal care, and medically oriented tasks.
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. Data from the National Long Term Care Survey and its Informal Caregivers Survey indicate that caregivers commonly assist with the full range of these tasks.
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The geographic proximity of informal caregivers to the person for whom they provide care is another important consideration. One study of living arrangements found that 24 percent of caregivers lived in the same house, 42 percent lived within 20 minutes, 19 percent lived between 20 and 60 minutes away, 5 percent lived 1 to 2 hours away, and 10 percent lived more than 2 hours away from the individual's home (National Alliance for Caregiving and American Association of Retired Persons, 2004)
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; however, support for informal caregivers who themselves need assistance and support in order to continue to care for impaired family members is not reimbursed. Detrimental Effects of Caregiving Caregiving can be challenging for both people who provide care and people who receive it.
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. The most recent survey of caregivers by the NAC and AARP found that more than 6 in 10 informal caregivers with other jobs had made work accommodations that increased in proportion to the level of care needed by the person for whom they provided care (see Table 2-2)
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From page 39... ...
. FORMAL CAREGIVERS Health professionals are defined here as individuals who receive compensation to provide health-related technical and supportive services.
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Estimated Quantity Type of Provider 2008 2018 in Homes (000s) Overall In-Home Care Home health aide 920 1,400 Most 9.84/hour 9.70/hour Home aide/personal attendant 820 1,200 Most 9.22/hour 7.94/hour Registered nurse 2,600 3,200 130 62,450/year 58,740/year Licensed practical nurse 750 900 40 39,000/year 39,000/year Social service assistant 352 432 Many 27,280/year ?
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About 88 percent of home care aides are women, which is even higher than their prevalence among informal caregivers (Yamada, 2002)
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Supervised by RNs or other home care professionals. Home aide/ Assist with personal care No high school diploma personal activities (e.g., bathing, required; no certification attendant dressing, negotiating daily tasks)
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From page 43... ...
certification from American Few physicians practice in Board of Medical Specialists the home but they are most often responsible for initiation of health care services, prescription medications, and health care procedures. Home health care is initiated with physician prescription; home health care recipients must be under care of a physician.
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Social worker Help care recipients cope Bachelor degree; state licensure (medical/public with and solve life issues by varies but typically includes health) providing psychosocial support supervised experience or assessing, coordinating, and monitoring services.
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Personal and home care aides are typically employed and supervised by individuals and families who are also responsible for deciding whether the worker adequately demonstrates basic competencies; they are not typically supervised by licensed health care professionals (e.g., nurses or therapists)
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From page 46... ...
Registered nurses, in an effort to ensure quality of clinical care, record medical histories and symptoms, perform diagnostic tests and analyze results, operate medical equipment, administer treatments and medications, and help establish treatment plans. Registered nurses also supervise licensed practical nurses and other direct-care workers and play an important educational role by instructing care recipients and families how to perform self-care tasks.
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From page 47... ...
A number of factors challenge retention and recruitment of directcare workers. As shown in Table 2-3, the mean hourly wage of home health aides and personal and home care aides in 2008 was $9.70/hour and $7.94/hour, respectively (Bureau of Labor Statistics, 2010a)
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From page 48... ...
. There is a well-documented shortage of nurses, and evidence suggests that home care nurses are among the least satisfied with their profession (Sochalski, 2004)
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From page 49... ...
found that insufficient time with and access to front-line managers was a significant contributor to stress and job dissatisfaction in home care nurses. Professional Practice Issues Relative to health professionals employed in traditional clinical environments, those who practice in the home have greater independence and autonomy.
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From page 50... ...
Consequently, tasks may be performed in awkward positions or involve more strain and exertion -- and may thereby result in injury. Formal caregivers whose jobs involve substantial time on personal care tasks, such as transferring, bathing, and dressing, have been found to incur among the highest rates of musculoskeletal injuries (Orr, 1997; Pohjonen, Punakallio, and Louhevaara, 1998; Galinsky, Waters, and Malit, 2001)
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From page 51... ...
Teaching is such an important aspect of providing home care that Medicare considers teaching as a skilled service -- one that can be done only by a licensed health care professional. Despite the practical importance of establishing a productive partnership with care recipients and their informal caregivers, most formal caregivers are exposed to limited, if any, formal educational curriculum addressing effective strategies to include families in
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From page 52... ...
. Nearly 40 percent of these informal caregivers reported learning that the home care services would end around the time of the last visit by the formal caregiver (Levine et al., 2006)
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From page 53... ...
. Ergonomics for home care providers.
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. Challenged to care: Informal caregivers in a changing health system.
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. Home care nurses' descriptions of important agency at tributes.
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. Advanced practice nurses in home care: Is there a role?
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From page 57... ...
. Correlates of physical health of informal caregivers: A meta-analysis.
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. Informal caregivers in the United States: Prevalence, characteristics, and ability to provide care.
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. Exercise of autonomous home care practice: The relationship with nurse characteristics.
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From page 60... ...
. Profile of home care aides, nursing home aides, and hospital aides: Histori cal changes and data recommendations.
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