Citation
Perspectives on assistance in home health care

Material Information

Title:
Perspectives on assistance in home health care
Creator:
Schroeder, Shara L.
Place of Publication:
Denver, CO
Publisher:
University of Colorado Denver
Publication Date:
Language:
English

Thesis/Dissertation Information

Degree:
Master's ( Master of arts)
Degree Grantor:
University of Colorado Denver
Degree Divisions:
Department of Sociology, CU Denver
Degree Disciplines:
Sociology
Committee Chair:
Bosick, Stacey J.
Committee Members:
Jones, Christine D.
Reich, Jennifer A.

Notes

Abstract:
Patients, caregivers, and home health care (HHC) clinicians resolve obstacles in healing by using rational or relational responses. By interviewing within two weeks after leaving the hospital, this research examined how interviewees sometimes tried unsuccessfully to fill basic aftercare needs such as transportation, home and personal care, as well as food and medication access making these chores into obstacles for healing and caregiving. To resolve these obstacles the interviewees responded with either rational reactions of independence and helplessness or relational interactions of encouragement and assistance. Studying rational and relational solutions compares the options available for individuals within the healing experience as well as other individuals facing obstacles in post-crisis experiences.
General Note:
IRB Approval #17-0553

Record Information

Source Institution:
University of Colorado Denver
Holding Location:
Auraria Library
Rights Management:
Copyright Shara L. Schroeder. Permission granted to University of Colorado Denver to digitize and display this item for non-profit research and educational purposes. Any reuse of this item in excess of fair use or other copyright exemptions requires permission of the copyright holder.

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iii This thesis for the Master of Arts degree by Shara L. Schroeder has been approved for the Sociology Program by Stacey J. Bosick, Chair Christine D. Jones Jennifer A. Reich Date: July 28 , 20 18

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iv transportation, home and personal care, as well as food and medication access

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vi ................................ ................................ ................................ .......... ................................ ................................ ............................... ................................ ................................ ................................ .......................... ................................ ................................ ................................ ....................... ................................ ................................ ................................ .................. ................................ ................................ ................................ .... ................................ ................................ ................................ ................. ................................ ................................ ................................ ......................... ................................ ................................ ................................ ................. ................................ ................................ ................................ ...... ................................ ................................ .................. ................................ ................................ ............... ................................ ................................ .................... ................................ ................................ ............ ................................ ......... ................................ ...... ................................ .................... ................................ ............. ................................ ................................ ................................ ........................ ................................ ................................ ......................

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1 L eaving the hospital after a medical crisis , patients often anticipate the reprieve of sleeping in their own bed and eating in their own kitchen, surrounde d by the familiarity of home . To the patient, i t may represent an end to the medical episode which took them to the hospital . However, patients seldom experience their ideal ized homecoming . While hospitalized, a patient receives assistance with movement, medications, food preparation , and care . D octors, nurses, physical therapists, and other specialists surround the patient as knowledgeable individuals who work to heal them by attend ing to the medical crisis using treatment s and medication . Upon l eaving the hospital, a patient needs aftercare which includes transportation, home and personal care, as well as food and medication access . H owever, accessing aftercare sometimes proves difficult. D riving home from the hospital may include painful bumps and jolts . Getting food may requ ire grocery shopping (Blair, Volpe, & Aggarwal, 2014) . Doing laundry may require walking stairs to the basement . Taki ng a shower may requi re balance on a slippery floor. Getting the medications may require a trip to the pharmacy . For each of these aftercare chores , the patient often turns to the assistance of a caregiver (Coleman & Roman, 2015; Linton, Ing, Vento, & Nakagawa, 2015) . If the patient and caregiver do not accomplish the aftercare chores involved in transportation, home and personal care, as well as food and medication access , t hes e unattended chores can result in obstacles to healing potentially causing a rel apse of illness and readmission to the hospital (Ursan et al., 2016)

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2 Sometimes the patients receive care givin g from family and friends. Lacking payment and often lacking caregivers (Levine, Halper, Peist, & Gould, 2010) . In addition to informal caregive rs, doctors may prescribe formal skilled care, from a home health care (HHC) agency . HHC orders can include a nurse , physical therapist , and/or occupational therapist . To receive HHC services the doctor certifies the patient is homebound, meaning the patient cannot leave home without (Sender, 2004) . interaction experience By analyzing the se interviews , this research examines how people solve obstacles with rational reactions like helplessness or independence during healing . Then , this research compares the rational solutions with relational solutions like encouragement or assistance.

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10 lder than 50 , had 3 or m ore comorbidities (chr onic diseases or conditions a patient experiences at the same time), lived in the community before admission , were discharged back to a community setting without hospice, and had a caregiver who also met the criteria for the study . Eligible patients spoke English and were co gnitively capable of consenting to participation in an interview . The patient must also have received a referral for HHC and participated in the HHC services offered, f ollowing discharge . Eligible caregivers were over 18 , had provided care for the patient at least one hour/week before admission and provided care for the patient at least one hour/week after discharge .

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28 transportation, home and personal care, as well as food and medication access.

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35 Banerjee, A., Armstrong, P., Daly, T., Armstrong, H., & Journal of Aging Studies, 33 (Supplement C), 28 36. doi: https://doi.org/10.101 6/j.jaging.2015.02.005 Blair, J., Volpe, M., & Aggarwal, B. (2014). Challenges, Needs, and Experiences of Recently Hospitalized Cardiac Patients and Their Informal Caregivers. Journal of Cardiovascular Nursing, 29 (1), 29 37. doi:10.1097/JCN.0b013e31827841 23 Bookchin, M. (1982). An Open Letter to the Ecological Movement. Social Alternatives, 2 (3), 13 16. Cancian, F. M. (2000). Paid emotional care: organizinational forms that encourage nurturance. In M. Harrington Meyer (Ed.), Care work : gender, class, and the welfare state (pp. 136 148). New York: Routledge. Coleman, E. A., & Roman, S. P. (2015). Family caregivers' experiences during transitions out of hospital. Journal for Healthcare Quality, 37 (1), 12 21. doi: https://dx.doi.org/10.1097/01.JHQ.0000460117.83437.b3 Cornelius White, J. H. D., & Cornelius White, C. F. (2005). Reminiscing and Predicting: Rogers's Beyond Word Speech and Commentarty. Journal of Humanistic Psychology, 45 (3), 383 396. doi:10.1177/0022167804274363 Follett, M. P. (1942). Business as an Integrative Unity. In M. Godwyn & J. H. Gittell (Eds.), Sociology of Organizations: Structures and Relationships (pp. 7 13). Thousand Oaks, CA: Sage Publictions, Ltd. Godwyn, M., & Gittell, J. (Eds.). (2012). Sociology of Organizations: Structures and Relationships . Thousand Oaks, CA: Pine Forge Press: An Imprint of SAGE Publications, Inc. Hannan, M. T., & Freem an, J. (1984). Structural Inertia and Organizational Change. American Sociological Review, 49 (2), 149 164. doi:10.2307/2095567 Hochschild, A. R. (2012). The outsourced self : intimate life in market times (1st U.S. ed.). New York: Metropolitan Books. Jen kins, T. M. (2014). Clothing norms as markers of status in a hospital setting: A Bourdieusian analysis. Health, 18 (5), 526 541. doi:10.1177/1363459314524800 Joynt, K. E., & Jha, A. K. (2012). Thirty day readmissions -truth and consequences. The New Englan d journal of medicine, 366 (15), 1366 1369. doi:10.1056/NEJMp1201598

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36 Levine, C., Halper, D., Peist, A., & Gould, D. A. (2010). Bridging Troubled Waters: Family Caregivers, Transitions, And Long Term Care. Health Affairs, 29 (1), 116 124. doi:10.1377/hlthaff. 2009.0520 Linton, K. F., Ing, M. M., Vento, M. A., & Nakagawa, K. (2015). From Discharge Planner to "Concierge": Recommendations for Hospital Social Work by Clients with Intracerebral Hemorrhage. Social Work in Public Health, 30 (6), 486 495. doi:10.1080/1 9371918.2015.1058730 Liu, W., Manias, E., & Gerdtz, M. (2012). Medication communication during ward rounds on medical wards: Power relations and spatial practices. Health, 17 (2), 113 134. doi:10.1177/1363459312447257 Lupton, D. (2012). Medicine as Cultur e : Illness, Disease and the Body . London, UNKNOWN: SAGE Publications. Marx, K. (1867). Capital: A Critique of Political Economy. In M. Godwyn & J. Gittell (Eds.), Sociology of Organizations: Structures and Relationships (pp. 415 416). Thousand Oaks, C A: Pine Forge Press: An Imprint of SAGE Publications, Inc. Poteat, T., German, D., & Kerrigan, D. (2013). Managing uncertainty: A grounded theory of stigma in transgender health care encounters. Social Science & Medicine, 84 (Supplement C), 22 29. doi: https://doi.org/10.1016/j.socscimed.2013.02.019 Putnam, R. D. (2000). Bowling Alone: The Collapse and Revival of American Community . New York, NY: Simon and Schuster. Rittman, M., Faircloth, C., Boylstein, C., Gubrium, J. F., Williams, C., Van Puymbroeck, M., & Ellis, C. (2004). The experience of time in the transition from hospital to home following stroke. Journal of Rehabilitation Research & Development, 41 (3A), 259 268. Rogers, C. R. (1945). Chapter V: Counseling. Review of Educational Research, 15 (2), 155 163. doi:10.3102/00346543015002155 Rogers, C. R. (1965). Client centered therapy: its current practice, implications, and theory . Boston: Houghton Mifflin Compa ny. Sender, S. (2004). Defining, Assessing, and Documenting Homebound Status for Medicare Patients. Journal of Health Care Compliance, 6 (2), 13. Silva Smith, A. L. (2007). Restructuring life: preparing for and beginning a new caregiving role. Journal of Family Nursing, 13 (1), 99 116. doi: https://dx.doi.org/10.1177/1074840706297425

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37 Stacey, C. L. (2011). The caring self : the work experiences of home care aides . Ithaca: ILR Press. Stewart, M. (2 003). Patient centered medicine: transforming the clinical method : Radcliffe Publishing. Taylor, F. W. (1911). The Principles of Scientific Management. In M. J. Handel (Ed.), The Sociology of Organizations: Classic, Contemporary, and Critical Readings (p p. 24 31). Thousand Oaks, CA: Sage Publications. Ursan, I. D. P. M. S., Krishnan, J. A. M. D. P., Pickard, A. S. P., Calhoun, E. P., DiDomenico, R. P., Prieto Centurion, V. M. D., . . . Joo, M. M. D. M. P. H. (2016). Engaging Patients and Caregivers to De sign Transitional Care Management Services at a Minority Serving Institution. Journal of Health Care for the Poor and Underserved, 27 (1), 352 365. Weber, M. (1924). Bureaucracy and Legitimate Authority. In M. J. Handel (Ed.), The Sociology of Organizatio ns: Classic, contemporary and Critical Readings (pp. 17 23). Thousand Oaks, California: Sage Puglications.

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38 Principal Investigator: Christine D. Jones COMIRB No: 17 0553 Version Date: 6/22/17 Interview Guide for Patients Table 1: Interview Guide for Patients, by AHRQ Care Coordination Activities and Coleman Domains General Opening Question Could you tell me about your experience with having ( home health nurse/PT name ) visit after hospital discharge? Probe: What were you hoping they would help with? Probe: Tell me about your experience interacting with ( HHC name )? Patient Preparation Did you feel that you were prepared to come home with home health care? Probe: In other words, were you prepared to receive home health care? Probe: How were you prepared to know what to expect from home health care? Probe: Did you have a clear understanding of your role in taking care of yourself? Probe: Were there any surprises with what hom e health care could/could not do? After leaving the hospital, did you feel fearful or anxious? Probe: What would have reduced your fears? Self Management Support What did you need to meet your health care needs after discharge from the hospital? Probe: How did the home health provider help/not help to address these care needs? Probe: Did the home health provider describe what you needed to do or did you practice what you needed to do together? Probe: Was there special equipment that you needed help with? If so, can you give an example? Probe: Were there additional needs that you had that the home health provider was not able to address? If so, what were they?

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39 Medication Management Did you have any questions or concerns about medications after discharge? Probe: If so, how did the home health provider address your concerns? Probe: Could you walk me through how you got your medications after discharge? Did you notice differences when you compared medication lists from the hospital, from home health, and the primary care provider with the medications you actually take? Probe: Can you tell me about those differences and how it affected taking the medications? Assess Needs/Goals, Proactive Plan of Care Tell me how having ( HHC name ) visit did/did not meet your expectations. Probe: For example, when ( HHC name ) visited you after you were discharged from the hospital, was it what you thought it would be? Were you ever worried that you would need to go back to the hospital after you were discharged? Probe: If so, why? Probe: If so, how did the home health provider address your concerns? Care Coordination Give me an example of a time that ( HHC name ) was/was not able to clarify a question with the hospital doctor or primary care clinician. Probe: How did that affect your ability to manage your health? Probe(s): What do you think the role is for ( HHC name ) to communicate with other clinic ians, such as the hospital or primary care provider? Probe: What do you think your role is to communicate with other clinicians? Sub probe: For example have you been in contact with any of your clinicians since discharge?

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40 Interpersonal Communication, Accountability In your opinion, which clinicians should ( HHC name ) talk to with questions about your health your hospital clinician, your primary care clinician, or somebody else? Probe: If there was only one other healt h professional ( HHC name ) should talk with, who would that be? Probe: In an ideal world, how would ( HHC name ) work with the other clinicians on your team? Probe: How did ( HHC name ) involve ( ) in your care and treatment? Tell me more Information Transfer, Facilitate Transitions In general, what should (HHC name ) know about you and your conditions? Probe: How much of this did ( HHC name ) know at the first visit with you? Did ( HHC name ) ask you about advance directives, CPR or other parts of advance care planning? Probe: If so, what did you discuss? (could be healthcare decision maker, medical power of attorney form, Colorado MOST form, etc) Probe: After your recent hospital stay did your treatment preferences change? If so did you discuss this with ( HHC name )?

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