Effects of Family Caregiver Availability and Capacity on Home Health Care for Older Adults with Alzheimer's Disease and Related Dementias

家庭护理人员的可用性和能力对患有阿尔茨海默病和相关痴呆症的老年人的家庭保健的影响

• 批准号: 10571079
• 负责人: Julia Burgdorf
• 金额: $ 9.04万
• 依托单位: VISITING NURSE SERVICE OF NEW YORK
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-04-15 至 2025-03-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10571079
• 关键词: Accident and Emergency department; Acute; Address; Adverse event; Advocacy; Affect; Aging; Alzheimer' s disease diagnosis; Alzheimer' s disease patient; Alzheimer' s disease related dementia; Ambulatory Care; Caregiver support; Caregivers; Caring; Characteristics; Communities; Complex; Data; Data Sources; Dementia; Dementia caregivers; Development; Discipline; Discipline of Nursing; Elderly; Equipment; Family; Family Caregiver; Family Study; Funding; Future; Goals; Health; Healthcare; Home; Home Care Services; Home Health Agency; Hospitalization; Household; Impaired cognition; Individual; Institution; Institutionalization; Intensive Care; Interdisciplinary Study; Intervention; Knowledge; Length of Stay; Link; Logistic Regressions; Measures; Medical; Medicare; Medicare claim; Modeling; Needs Assessment; Nurses; Occupational Therapy; Outcome; Outcome Measure; Ownership; Patient Care; Patient-Focused Outcomes; Patients; Persons; Physical therapy; Procedures; Reporting; Research; Research Personnel; Resources; Role; Sample Size; Sampling; Self Care; Services; Severities; Site; Source; Standardization; Structure; Supervision; Training; United States Centers for Medicare and Medicaid Services; Visit; Visiting Nurse; Work; adverse outcome; beneficiary; care delivery; care outcomes; career; caregiver education; caregiving; community living; dementia caregiving; effective intervention; experience; family support; functional disability; functional improvement; health care delivery; health care quality; health plan; high risk; hospital readmission; human old age (65+); improved; improved outcome; interest; medication administration; meetings; novel; nursing skill; patient population; payment; readmission rates; readmission risk; satisfaction; skills; tool; trend; willingness

PROJECT SUMMARY/ABSTRACT Of an estimated 5.4 million older adults with Alzheimer’s Disease and Related Dementias (ADRD) in the US, 67% reside in the community with unique and significant care needs. Medicare-funded Home Health (HH) delivers skilled nursing, therapy, and personal care aide services in the patient’s home and is one of few affordable and accessible options for home-based care among those with ADRD. Of the 3.4 million Medicare beneficiaries who access HH each year, 31% have ADRD. HH patients with ADRD receive more intensive care, yet are more likely to experience adverse outcomes including institutionalization and hospitalization. Thus, there is critical need to develop tailored HH interventions to improve outcomes for patients with ADRD. In 87% of HH episodes, clinicians report needing family caregiver assistance to implement the plan of care and engaging/supporting family caregivers during HH contributes to improved care outcomes—including reduced readmission risk and greater patient and family satisfaction. Family caregivers are a crucial resource for those with ADRD, including during HH. However, there is currently a dearth of information regarding ADRD family caregivers’ specific roles and support needs during HH. Analyses of ADRD caregiver involvement in care delivery have focused on the ambulatory setting and hold limited applicability for HH due to this setting’s unique payment and care delivery structures. Prior work examining caregiver activities and training needs during HH did not specifically examine those with ADRD. HH patients with ADRD (and their caregivers) merit targeted study given: the unique challenges of ADRD caregiving, ADRD patients’ higher risk for adverse HH outcomes, and prior work indicating that caregivers are more likely to need training during HH if assisting a patient with cognitive impairment. The goal of this project is to describe ADRD caregivers’ role and training needs during HH, and to determine how caregiver availability and capacity impact HH care delivery and outcomes for patients with ADRD. Availability refers to caregivers’ willingness to assist and how often they are present in the home. Capacity refers to caregivers’ identified training needs related to specific caregiving activities. We will use a national sample of Medicare beneficiaries with diagnosed ADRD (determined via Medicare claims) who received HH in 2018. We will analyze linked HH patient assessment, Medicare claims, and HH agency administrative data for this sample to 1) characterize caregiver involvement (including types of assistance provided, availability, and capacity) during HH; 2) determine the impact of caregiver availability and capacity on HH care delivery for patients with ADRD; and 3) assess the impact of caregiver availability and capacity on HH outcomes for patients with ADRD. Findings will provide novel foundational evidence regarding ADRD caregivers’ role and support needs during HH, informing the development of targeted interventions to improve care for HH patients with ADRD by better engaging and supporting their family caregivers.

项目摘要/摘要 在估计的540万老年人中，阿尔茨海默病和相关痴呆症（ADRD） 在美国，67%的人居住在有独特和重大护理需求的社区。医疗保险资助的家庭健康（HH） 在病人家中提供熟练的护理、治疗和个人护理助理服务，是为数不多的 为ADRD患者提供负担得起和可获得的家庭护理选择。在340万医疗保险中， 每年获得HH的受益人中，31%患有ADRD。HH型ADRD患者接受的强化治疗 护理，但更有可能经历不利的结果，包括机构化和住院。 因此，迫切需要开发定制的HH干预措施，以改善ADRD患者的结局。 在87%的HH发作中，临床医生报告需要家庭护理人员协助实施护理计划 并在HH期间参与/支持家庭护理人员有助于改善护理结果，包括 降低再入院风险，提高患者和家属满意度。家庭照顾者是一个重要的资源 对于ADRD患者，包括HH期间。然而，目前缺乏关于ADRD的信息 家庭照顾者在HH期间的具体角色和支持需求。ADRD照顾者参与的分析 护理提供集中在门诊环境，由于这种环境的 独特的支付和护理提供结构。检查护理人员活动和培训需求的先前工作 HH没有专门检查ADRD患者。HH ADRD患者（及其护理人员）值得 针对性研究：ADRD治疗的独特挑战，ADRD患者不良HH的风险较高 结果，以及先前的工作表明，如果帮助护理人员， 认知障碍患者。 本项目的目标是描述ADRD护理人员在HH期间的角色和培训需求，并确定 护理人员的可用性和能力如何影响HH护理服务和ADRD患者的结局。 可用性是指照顾者是否愿意提供帮助以及他们在家中出现的频率。能力 是指照顾者确定的与具体照顾活动有关的培训需求。我们将使用一个国家 患有ADRD的Medicare受益人样本（通过Medicare索赔确定）， 2018.我们将分析关联的HH患者评估、Medicare索赔和HH机构管理数据， 该样本用于1）表征护理人员参与（包括提供的帮助类型、可用性，以及 2）确定护理人员的可用性和能力对HH护理提供的影响， ADRD患者;和3）评估护理人员可用性和能力对HH结局的影响， ADRD患者研究结果将提供关于ADRD照顾者角色的新的基础证据， HH期间的支持需求，为制定有针对性的干预措施提供信息，以改善HH患者的护理 更好地参与和支持他们的家庭照顾者。