Discharge Planning and Home Care Needs Assessment for Older Patients in a Nursing Hospital.

Background and objectives: Following the accumulation of a sufficient amount of scientific evidence, it is now possible to appeal for changes in the organization of nursing services. Our aims are to assess the health status of patients discharged from nursing hospitals and to identify their home care needs by applying the international InterRAI Home Care (HC) assessment form. Material and methods: 152 geriatric patients (older than 65 years of age) discharged after a 90-120-day stay at a nursing hospital were examined using face-to-face interviews. The data from the medical records were also assessed. The capacities of patients were discussed with the patients themselves, nursing personnel, and relatives of the patients. Results: The analysis revealed that 45.4% of the respondents had severely impaired cognitive skills, while 27.6% had moderately impaired cognitive skills for decision making in daily living. People with greater cognitive difficulties were more dependent during daily instrumental activities and ordinary daily activities. The strongest relationship was established among the cognitive skills and management of medications, management of finances, and ordinary housework. For the greater part of respondents, a special need for permanent nursing (57.9%) or assistance (25.7%) was determined, i.e., official, state-funded nursing at home was appointed. The remaining respondents (16.4%) were not appointed further state-funded nursing or assistance at home, but an assessment of the independence of these patients based on the InterRai Activities of Daily Living Hierarchy Scale indicated that these skills varied from moderate independence (decision making was difficult only in new situations) to severely impaired skills (made no independent decisions or they were scarce). Despite the low independence of respondents, the majority of them would prefer nursing services at home to institutional nursing. Conclusions: The low independence observed in all participants, as well as their limited capacities, prove the need for nursing services at home and the necessity of their continuity. Despite the low independence of respondents, the majority of them would prefer nursing services at home to institutional nursing.

Convergent validity of the interRAI-HC for societal costs estimates in comparison with the RUD Lite instrument in community dwelling older adults.

BACKGROUND: The interRAI-Home Care (interRAI-HC) instrument is commonly used in routine care to assess care and service needs, resource utilisation and health outcomes of community dwelling home care clients. Potentially, the interRAI-HC can also be used to calculate societal costs in economic evaluations. The purpose of this study was to assess the convergent validity of the interRAI-HC instrument in comparison with the RUD Lite instrument for the calculation of societal costs among care-dependent community dwelling older adults. METHODS: A within-subject design was used. Participants were 65 years and older and received professional community care in five countries. The RUD Lite was administered by trained (research) nurses or self-reports within 4 weeks after the interRAI-HC assessment. Agreement between the interRAI-HC and RUD Lite estimates was assessed using Spearman's correlation coefficients. We hypothesised that there was strong correlation (Spearman's ρ > 0.5) between resource utilisation estimates, costs of care estimates and total societal cost estimates derived from both instruments. RESULTS: Strong correlation was found between RUD Lite and interRAI-HC resource utilisation assessments for eight out of ten resource utilisation items. Total societal costs according to the RUD Lite were statistically significantly lower than according to the interRAI-HC (mean difference €-804, 95 % CI -1340; -269). The correlation between the instruments for total societal costs and all six cost categories was strong. CONCLUSIONS: The interRAI-HC has good convergent validity as compared with the RUD-Lite instrument to estimate societal cost of resource utilisation in community dwelling older adults. Since interRAI-HC assessments are part of routine care in many community care organisations and countries already, this finding may increase the feasibility of performing economic evaluations among community dwelling older adults.

Developing the Patient Falls Risk Report: A Mixed-Methods Study on Sharing Falls-Related Clinical Information from Home Care with Primary Care Providers.

If interRAI home care information were shared with primary care providers, care provision and integration could be enhanced. The objective of this study was to co-develop an interRAI-based clinical information sharing tool (i.e., the Patient Falls Risk Report) with a sample of primary care providers. This mixed-methods study employed semi-structured interviews to inform the development of the Patient Falls Risk Report and online surveys based on the System Usability Scale instrument to test its usability. Most of the interview sample (n = 9) believed that the report could support patient care by sharing relevant and actionable falls-related information. However, criticisms were identified, including insufficient detail, clarity, and support for shared care planning. After incorporating suggestions for improvement, the survey sample (n = 27) determined that the report had excellent usability with an overall usability score of 83.4 (95% CI = 78.7-88.2). By prioritizing the needs of end-users, sustainable interRAI interventions can be developed to support primary care.

Predictors of Frailty Change in Home and Community-Based Services Populations.

OBJECTIVES: With unprecedented demand for Medicaid long-term services and supports, states are seeking to allocate resources in the most efficient way. Understanding the prevalence of frailty and how it varies across home and community-based services (HCBS) populations can assist states with more precise identification of individuals most in need of services. Early identification of individuals more likely to experience frailty changes could allow for enhanced care planning to prevent or slow the progression of decline. DESIGN: Longitudinal study. SETTING AND PARTICIPANTS: Data from Connecticut's assessment tool (based on interRAI-HC) were analyzed at 2 time points for 16,309 individuals receiving HCBS. The sample included assessments completed between November 1, 2017 and July 15, 2020 across 4 groups: older adults 65+ years old meeting nursing facility level of care (NF LOC), older adults 65+ years old not meeting NF LOC, individuals with acquired brain injury, and individuals <65 years old with physical disability. METHODS: We measured frailty using the Frailty Index (FI) and examined change in FI between baseline and follow-up. A change in FI score of at least ±0.03 was classified as a clinically meaningful change. We compared predictors of clinically meaningful decline or improvement using multivariate logistic regression. RESULTS: In our sample, 54% of individuals experienced a clinically meaningful change: 42% declined and 12% improved. Individuals receiving in-home care services had lower odds of improvement across all HCBS groups and multiple frailty categories with odds ratios ranging from 0.35 to 0.68. Frail older adults 65+ years old meeting nursing facility level of care receiving physical therapy were 21% less likely to experience decline and 1.4 times more likely to improve. CONCLUSIONS AND IMPLICATIONS: The nature of HCBS support provided can impact changes in frailty status. More reactive services such as in-home care may contribute to frailty decline while rehabilitative services such as physical therapy may protect against decline.

Tooling nurses to assess complexity in routine home care practice: Derivation of a complexity index from the interRAI-HC.

AIM: Home care nurses often use the Resident Assessment Instrument-Home Care (interRAI-HC) to assess health needs. However, this tool does not assess complexity. This study proposes to derive a complexity index (CI) from the interRAI-HC using the operational definition of the dedicated COMID checklist (COmplexité Multidimensionnelle des prises en soins Infirmières à Domicile). DESIGN: Data were collected at the baseline assessment of the fraXity study (N = 231, aged ≥ 65), which relied on an observational longitudinal design. METHODS: Measures were the interRAI-HC, from which the CI binary variables were computed and the COMID, used as a reference. RESULTS: Twenty-six CI variables were computed from the interRAI-HC, and all but three correlations were significant. The correlation between the CI score and the COMID score was ρ = 0.730 (p < .001). CONCLUSIONS: The study demonstrates that complexity can be assessed directly from the interRAI-HC by deriving a CI.

Using Standardized Tools to Characterize Adult Day Program Populations: Implications for Future Research and Clinical Practice.

OBJECTIVES: To demonstrate the usefulness of primary data collection using clinician-rated and self-rated standardized measures to describe adult day program (ADP) populations and address programming issues such as identifying members at risk of dropping out. SETTING AND PARTICIPANTS: One ADP in London, Ontario, and 2 ADPs in Toronto, Ontario, Canada. A total of 223 community-dwelling older adults were recruited across the 3 different programs. METHODS: The interRAI Community Health or Home Care Assessment and self-rated psychosocial assessments were collected on program enrollment. Data analyses included descriptive statistics, comparison of the populations between ADPs, and multinomial regression models to assess reasons for program withdrawal. RESULTS: Mean ages across the 3 programs ranged from 78.3 to 83.8 years and the proportion of women ranged from 49.3% to 56.6%. Compared with one of the ADPs, members from 2 other ADPs exhibited higher use of mobility aids (P < .001), higher levels of cognitive impairment (P < .05), increased risk for institutionalization (P < .001), lower levels of depression (P < .01), and greater need for supervision for basic and instrumental activities of daily living (P < .01). Members assessed to be at higher risk for institutionalization and have increased medical complexity showed possible association with program withdrawal at one ADP. CONCLUSIONS AND IMPLICATIONS: The tools were useful in identifying differences in physical and psychosocial characteristics of members across the 3 ADPs. Information collected from interRAI and self-rated psychosocial assessments may be helpful in the development of individualized care plans, program services, and recommendations that target transitional care. By understanding member profiles and reasons for withdrawal, ADPs may be able to develop strategies to help members stay in the program and live in the community longer.

Hospitalization Trajectories in Home- and Community-Based Services Recipients: The Influence of Physician and Social Care Density.

OBJECTIVES: Repeated hospitalizations among older adults receiving Home- and Community-Based Services (HCBS) may indicate unmet medical and social needs. This study examined all-cause hospitalization trajectories and the association between area-level resource density for medical and social care and the trajectory group membership. METHODS: The study participants included 11,223 adults aged 60 years or older who were enrolled in public HCBS programs in Michigan between 2008 and 2012. Data sources included the Michigan interRAI-Home Care, Dartmouth Atlas of Health Care Data, the American Community Survey, and the County Business Patterns from the Census Bureau. The group-based trajectory modeling was used to identify trajectories of hospitalization over 15 months. Correlates of the trajectories were examined using multinomial logistic regression. RESULTS: Four distinct hospitalization trajectory groups emerged: "never" (43.1%)-individuals who were rarely hospitalized during the study period, "increasing" (19.9%)-individuals who experienced an increased risk of hospitalization, "decreasing" (21.6%)-individuals with a decreased risk, and "frequent" (15.8%)-individuals with frequent hospitalizations. Older adults living in areas with a higher number of social service organizations for older adults and persons with disability were less likely to be on the "frequent" trajectory relative to the "decreasing" trajectory. The density of primary care physicians was not associated with the trajectory group membership. DISCUSSION: Area-level social care resource density contributes to changes in 15-month hospitalization risks among older adult recipients of HCBS.