부산대학교 도서관

Background and Objectives: Despite the importance of provider continuity across healthcare settings, continuity among home care workers who provide hands-on long-term care is understudied. This project describes home care worker continuity, identifies factors associated with increased continuity, and examines associations between continuity and client outcomes. Research Design and Methods: We conducted a retrospective cohort study of clients receiving Medicaid-funded home- based long-term care (n = 3,864) using insurance plan and home care agency data from a large nonprofit organization. We estimated home care worker continuity for clients between 6-month clinical assessments using Bice-Boxerman scores. We then used generalized estimating equations to model associations between home care worker continuity and (1) client characteristics (e.g., cognitive impairment), and (2) client functional, health, and psychosocial outcomes. Results: While home care worker continuity was lowest for clients receiving the most weekly care hours, a range of continuity existed across all levels of care need. Those who were male, older, Asian/Pacific Islander/Native American, cognitively impaired, and functionally impaired had lower continuity. Higher home care worker continuity was significantly associated (p < .05) with fewer falls, a higher likelihood of functional improvement/stabilization, and fewer depressive symptoms. Discussion and Implications: The finding that home care worker continuity is associated with the health and well- being of home-based long-term care clients underscores the importance of building high-quality relationships in long-term care. Continued efforts are necessary to understand and advance home care worker continuity and to identify other aspects of the home care experience that benefit those receiving long-term care at home. Translational Significance: While home care workers play an essential role keeping older adults living safely at home, home care workers are rarely examined in relation to their clients. We find that continuity in the individual home care worker providing home-based long-term care is associated with important client outcomes including fewer falls, a higher likelihood of functional improvement/stabilization, and fewer depressive symptoms. These findings provide foundational evidence of how aspects of the home care experience matter for clients and point to home care worker continuity as an important marker of home care quality. Keywords: Caregiving, Home- and community-based services, Home health aide, Long-term care
Background and Objectives Seeing the same provider over time (i.e., "provider continuity") has known benefits across healthcare settings including inpatient hospital, primary care, and skilled home healthcare (Amjad et al., [...]