Smart Homecare Research Translation into Broader Practice: Enablers, Barriers and Directions

Smart homecare utilises advanced technologies to support, improve and promote remote healthcare in homes and communities through collecting and analysing health data and sharing this knowledge with carers and clinicians. With the continuous growth in the world’s older population, smart homecare becomes increasingly crucial in providing in-home care for older adults, allowing the vital healthcare dollars to go further into other critical care needs. In addition, with the rise in the development and utilisation of innovative technologies in healthcare settings, it is vital to ensure that these technologies are guided and approved by the corresponding regulatory bodies such as FDA (Foods and Drug Administration) in the USA and TGA (Therapeutic Good Administration) in Australia. With this premise, this paper identifies four dimensions for researchers to consider when developing smart homecare solutions for in-home remote care: Technology, Data, People, and Operational Environment. The essential interplays amongst these four dimensions are discussed to identify the various enablers and barriers in the successful delivery of smart homecare solutions. As the primary output of this paper, it proposes a conceptual framework to achieve practical in-home care for the older population living independently with the support of technology, while addressing the challenges such as security and privacy of patient data. Secondly, a comprehensive and practical guide featuring seven phases is presented to support and direct researchers in implementing smart homecare solutions for remote care. The proposed framework and the guide aim to make smart homecare research practical and truly translational into broader practice. Author

Novel in-home COVID-19 vaccination program for vulnerable populations using public-private collaboration.

Background: The continued emergence of new COVID-19 variants highlights the importance of vaccination in the effort to reduce disease transmission and burden. The objective of this study is to evaluate the processes and outcomes associated with a novel in-home COVID-19 vaccination program aimed at vaccinating high-risk populations in New York, USA. Methods: To evaluate program processes, we described the program itself and reflected on some key lessons learned. To evaluate program outcomes, we analyzed data reported by vaccine recipients. These outcomes included the percentage of vaccine recipients that successfully received the full course of vaccinations, and the demographic and health characteristics of vaccine recipients. We additionally assessed demographic differences in motivations for receiving in-home care, using chi-squared tests to assess statistical significance. Data were collected and reported via dynamic online intake forms. Results: The median age of vaccine recipients was 79 ± SD 9.0 years. The oldest vaccine recipient was 107 years old. Of those with non-missing data, more than half of vaccine recipients were female (63%), identified as part of a racial/ethnic minority (66%), reported an annual income of < $25,000 (58%), and received a high school degree or less (68%). Most vaccine recipients reported having one or more health conditions associated with increased risk of severe COVID-19 disease (72%). Vaccine recipients were most likely to report receiving in-home vaccination because they were home-bound due to disability. Motivations for receiving in-home vaccination differed by demographic subgroup. Conclusion: The population receiving vaccinations from this in-home care delivery program comprised seniors who were mostly female and non-white, indicated socioeconomic vulnerability, and reported one or more COVID-related health conditions; this signified that the program met its goal of vaccinating those most at risk for severe COVID-19 disease.

Caring for Homebound Veterans during COVID-19 in the U.S. Department of Veterans Affairs Medical Foster Home Program.

The onset of the COVID-19 pandemic made older, homebound adults with multiple chronic conditions increasingly vulnerable to contracting the virus. The United States (US) Department of Veterans Affairs (VA) Medical Foster Home (MFH) program cares for such medically complex veterans residing in the private homes of non-VA caregivers rather than institutional care settings like nursing homes. In this qualitative descriptive study, we assessed adaptations to delivering safe and effective health care during the early stages of the pandemic for veterans living in rural MFHs. From December 2020 to February 2021, we interviewed 37 VA MFH care providers by phone at 16 rural MFH programs across the US, including caregivers, program coordinators, and VA health care providers. Using both inductive and deductive approaches to thematic analysis, we identified themes reflecting adaptations to caring for rural MFH veterans, including care providers rapidly increased communication and education to MFH caregivers while prioritizing veteran safety. Telehealth visits also increased, MFH veterans were prioritized for in-home COVID-19 vaccinations, and strategies were applied to mitigate the social isolation of veterans and caregivers. The study findings illustrate the importance of clear, regular communication and intentional care coordination to ensure high-quality care for vulnerable, homebound populations during crises like the COVID-19 pandemic.