Home health

2012.11.8Home health1OutlineIntroductionHistory (USA & Taiwan)Personal qualities of the practitionerTeam membersOTs workResearch Study Evaluate the long-term mortality effect of a home-based interventionHome environment v.s. day hospital settingsMaintenance of Effects of the Home Environmental Skill-Building Program for Family Caregivers

2IntroductionHomePart of a persons identityPotential as a therapeutic environment

OT rolereturn people to functional independentReclaim their identity

3

HistorySocial Security Act(Medicare & Medicaid)Diagnosis-related groups(DRGs)Deinstitutionalization

4 (2007)6555645064IADLs2007245,5112010270,3252015327,1852020398,130

5()1.25IADLs50902.1803.()221,300()1,0001()1010()IADLs50()14211,0005.1,0004()4(8)190()1.51.518,6006Unique aspects of home-based care7Personal qualities of the practitioner8FlexibilityIndependenceCultural sensitivityAbility to relate and communication

8Safety9Personal safety Infection control precautions

9Family as the caregiverSpouse / femaleThe loss of role fulfillment by the client Personal sacrifices

10Team membersClient1112ADL, IADL13RESEARCH Study

14Long-Term Effect on Mortality of a Home Intervention that Reduces Functional Difficulties in Older Adults: Results from a Randomized TrialLaura N. Gitlin, WalterW. Hauck,w Marie P. Dennis, EdM, LaraineWinter, Nancy Hodgson, and Sandy SchinfeldJournal of the American Geriatrics Society. 57:476481, 2009PurposeTo evaluate the long-term mortality effect of a home-based intervention previously shown to reduce functional difficulties and whether survivorship benefits differ according to initial mortality risk level.15MethodParticipants: 319 adults aged 70 and with difficulties performing daily activities.Two-group randomized trial with survivorship followed up to 4 yearsControl group (n=159)Intervention group (n=160)

Intervention (first 6 months)Maintain phase(6-12 months)OT & PT: compensatory strategies, home modifications, home safety, fall recovery techniques, and balance and muscle strength exercises.

Telephone calls to reinforce strategy use and help generalize use to newly identified problems.16Result

ConclusionThe intervention extended survivorship up to 3.5 years and maintained statistically significant differences for 2 years. Subjects at moderate mortality risk derived the most intervention benefit. The intervention could be a low-cost clinical tool to delay functional decline and mortality

At 2 yearsIntervention group(n=160)Control group(n=159)5.6% mortality rate (n=9 deaths)Participants with moderate mortality risk had a 16.7% mortality rate (n=16 deaths)Mortality rates remained lower for intervention participants up to 3.5 years from study entry13.2% mortality rate (n=21 deaths)Participants with moderate mortality risk had a 28.2% mortality rate (n=24 deaths)By 3 years, mortality rates were not statistically significantlydifferent between the intervention and control groups.Comparing the experience of outpatient therapy in home and day hospital settings after traumatic brain injury: patient, significant other and therapist perspectivesEMMAH DOIG, JENNIFER FLEMING, PETREA CORNWELL & PIM KUIPERSDisability and Rehabilitation, 2011; 33(1314): 12031214PurposeTo explore how therapy in a home and day hospital setting impacts on rehabilitation processes and outcomes Method14 severe traumatic brain injuryA one-to-one, goal-directed, client-centred outpatient occupational therapy program (a) in their home for 6 weeks (b) in a day hospital clinic for 6 weeks. (1 hr/week, random assigned)Use semi-structured interviews with the participants, their significant others and their treating occupational therapists.17ResultHome-based therapy perceived as more relaxing, normal, satisfying and effective

ConclusionThe experience of home-based therapy was perceived as more convenient, positive and preferred by patients and their family members. Therapists described more therapeutic benefits and the ability to work more effectively on activity and participation level goals in the clients real-life environment.HomeDay hospital real-lifesimulation of real life tasksremedial exercisesFriendshipTherapist as visitorPatients v.s. bosses or teachers1819 19(3)135-145, 2012(ADLPSTRSF-36 )20111120111231(n=165)20

(SF-36)8

(n=13083.3%)51.92 10.53

(n=79, 50.6%)73.76 14.58

(ADL 61-90)6(3.8%)(ADL 21-60)84(53.8%)(ADL 0-20)66(42.3%))))20212 31

22Maintenance of Effects of the Home EnvironmentalSkill-Building Program for Family Caregivers andIndividuals With Alzheimers Disease and Related Disorders

Laura N. Gitlin, Walter W. Hauck, Marie P. Dennis, and Laraine WinterJournal of Gerontology: MEDICAL SCIENCES 2005, Vol. 60A, No. 3, 368374PurposeThis article examines whether treatment effects found at 6 months following active treatment were sustained at 12 months for family caregivers who participated in an occupational therapy intervention

23MethodParticipant: caregiverTo Caregive for at least 6 months, and provide at least 4 hours of daily care to person with one or more activity limitations and MMSE