Consistency is important in the care of people with dementia, but just how important? Well, according to a new study, having the same home health nurse for every home visit may even go so far as to help people with dementia stay out of the hospital.
The study, conducted by researchers at NYU Rory Meyers College of Nursing and published in the journal Medical Care (a journal of the American Public Health Association), states that dementia patients receiving regular home health care visits are less likely to be readmitted to the hospital when they have consistency in their nursing staff.
Home health care is a popular way to care for people living with dementia and other conditions which don’t require hospitalization but affect an individual’s ability to live on their own. Health providers, usually nurses, visit patients’ homes to help them manage chronic conditions, take their medications, and perform the activities of daily living.
This care typically begins after a patient has had a hospital stay and family and friends have realized that they may need extra care at home. At that point, home health care is brought in to help the individual be able to function properly in their own home and hopefully prevent them from returning to the hospital.
“Nurses play a pivotal role in providing home health care,” says Chenjuan Ma, PhD, MSN, assistant professor at NYU Meyers and the study’s lead author. “As the population ages and older adults choose to ‘age in place’ as long as possible, the demand for home health care for people with dementia is expected to grow rapidly.”
The study used data from 23,886 older patients with dementia who received home health care from a large not-for-profit home health agency. The researchers noted the number of visits and number of nurses each person had and scored each person’s overall continuity of care based on those factors. A wide range of continuity of care was found among in-home health visits for people with dementia.
Eight percent of the participants had no continuity of care, meaning they had a different nurse for each visit. 26 percent had all their visits with the same nurse, the highest level of continuity of care available. Greater visit “intensity,” meaning the number of hours of care provided per week, was associated with lower continuity of care.
“This may suggest that it is hard to achieve continuity of care when a patient requires more care, though we cannot exclude the possibility that high continuity of care results in more efficient care delivery and thus fewer hours of care,” explains Ma.
During the study, roughly a quarter (24 percent) of the dementia patients were hospitalized after receiving home health care for reasons like infections, respiratory problems, and heart disease.
The researchers discovered that greater continuity of home health care was associated with a lower risk for rehospitalization, even after the researchers controlled for other clinical risk factors and intensity of home health care. Those who received a low or moderate continuity of care were 30 to 33 percent more likely to be hospitalized than those who received a high continuity of care.
“Continuity of nursing care is valuable for home health care because of its decentralized and intermittent care model,” says Ma. “While continuity of nursing care may benefit every home health care patient, it may be particularly critical for people with dementia. Having the same person delivering care can increase familiarity, instill trust, and reduce confusion for patients and their families.”
The researchers are not recommending that the shortage of home health care nurses be addressed and care coordination improved so that continuity of care can be increased for people with dementia. They also recommend an increase in telehealth home care where possible.
“Multiple structural factors present challenges for continuity of care for home health nurses and other staff. These can include long commute times, few full- or part-time staff, agencies relying mostly on per diem staff, and organizational cultures that do not foster retention of home health care staff,” says Allison Squires, PhD, RN, FAAN, associate professor at NYU Meyers and the study’s senior author. “Proposed legislation in Congress that seeks to increase nursing and home health care frontline staff salaries will pay for itself because agencies can improve continuity of care, and therefore reduce penalties associated with hospital readmissions.”
Hopefully, this research will prompt home health care companies to do a better job of delivering continuity of care to their clients. In the meantime, if you have a loved one who receives home health care visits, it may be a good idea to ask if they can have the same nurse most or all of the time to improve their continuity of care and reduce their chances of hospitalization.Whizzco