U.S. home health care leaders and geriatrics experts have established the first national framework to define home care excellence and shape the future of home health services for older people.
The Framework Initiative, spearheaded by the Visiting Nurse Service of New York (VNSNY) Center for Home Care Policy & Research (Center) with funding from The John A. Hartford Foundation, forged a ground-breaking consensus on key values, critical practice areas, and core strategies for achieving maximally effective, efficient home health care that responds to the preferences, needs and values of older people and their families.
"Research on geriatrics -the care of older persons -is critical for providing the most responsive and effective home health services to older people," said Penny H. Feldman, Ph.D., Director of the Center and Vice President for Research and Evaluation at VNSNY.
"The Framework Initiative is the first comprehensive effort to synthesize a large body of geriatric and chronic care research and distill its application to the home health setting. Building on this evidence base, we drew on the knowledge and experience of experts in home care and geriatrics to chart the first national course toward home care quality improvement for older adults."
The Framework Initiative calls for the recognition by home care providers that truly outstanding home care must focus on older people and their well being not simply on their problem or disease. Home care providers must embrace foundational values that:
- Maximize older persons' quality of life
- Honor their preferences and provide genuine choices
- Optimize their health and ability to function
- Help them cope both physically and emotionally with decline and end of life
The study identified six critical practice areas in which home care providers should focus their efforts to improve quality of care and quality of life: Care Coordination, Management and Transitions; Medication Management; Cognitive Function; Physical Function; Chronic Pain Management; and Palliative Care and Advanced Illness Management. An "evidence brief" for each practice area was prepared in which a large body of geriatric and chronic care research was synthesized and applied to the home health setting - an innovation for the field.
Dr. Feldman explained, "There is still a dearth of research conducted specifically in home care so the evidence that underpins the best way to practice home care must be adapted from research conducted in hospitals, nursing facilities, or out-patient settings." Each evidence brief explains why each practice area was selected as a priority for home care for older adults, contains a summary of evidence on effective practice and describes the implications for current home care practice.
The Framework Initiative also established a set of important principles for achieving excellence in home care for older adults that cut across all six practice areas. These cross-cutting principles are common to all the best practices and provide a vision to spur home care providers' quality improvement efforts. They state that home care providers should offer services that are:
- Relationship-centered, engaging the older person, and emphasizing familial, social, helping and caring relationships
- Team-based, interdisciplinary, and collaborative
- Based on the best available evidence from the fields of aging and home care
- Individualized for each patient and culturally sensitive
- Focused on communication among all individuals involved in care
- Organized to facilitate monitoring, evaluation and revision of care as needed over time
To assist home care providers in implementing best practices, the Framework Initiative provided an outline of four core strategies to be followed to adopt to support organizational change:
1. Engage older adults and their caregivers
2. Manage organizational change
3. Promote systems change
4. Recruit, retain and support an effective work force
The Framework Initiative also presented policy, practice and research recommendations specific to the critical practice areas. The policy recommendations describe changes needed at the state and federal level to allow, encourage and sustain key practice changes; the practice recommendations provide direction for providers to advance home care excellence; the research recommendations highlight the knowledge and understanding that is lacking but needed to improve care for older home care patients.
"The Framework Initiative is just a start that will inspire collaboration and innovation and provide a structure for advancing excellence in home care for older people," said Dr. Feldman. "'Optimal' geriatric home health care has been defined to give the home care industry and individual providers the information they need to tackle quality improvement one area at a time."
A National Advisory Council comprised of experts in home care and geriatrics from nursing, medicine, social work, pharmacy, paraprofessional services, as well as consumer and family caregiver organizations helped steer the Framework Initiative. A national conference held in July 2008 gave one hundred stakeholders an opportunity to participate in the process of developing recommendations for geriatric home care practice innovation, future research, and policy changes. The collective efforts also led to four articles in the Journal for Healthcare Quality special issue on home care (March/April 2009).
More information is available at champ-program/framework/.
The Center for Home Care Policy and Research (Center) conducts scientifically rigorous research to promote the delivery of high quality, cost-effective care in the home and community and support informed decision making by policy makers, payers, managers, practitioners, and consumers of home and community based services. The Center is part of the Visiting Nurse Service of New York (VNSNY) and conducts research that is broadly applicable to real-world home care settings. VNSNY is the largest not-for-profit home care agency in the United States.
Source
Center for Home Care Policy and Research
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