July 23, 2021
When people with Alzheimer’s disease who require hospital care are discharged from the hospital, they typically receive follow-up care at home by a visiting nurse. Having the same nurse return for follow-up visits greatly increases the chances that they will not have to be readmitted to the hospital, according to a new report. The findings suggest that consistency in home nursing staff is not just good for the patient and their family in the short term but also in the longer term, and it may also save costs in the long run.
People with Alzheimer’s disease, who tend to be older, typically have multiple chronic health conditions that require monitoring and a variety of medications. After a hospital stay, medical demands may be particularly acute. More than five million Americans on Medicare, the government health insurance program for people 65 and older, receive home care visits from nurses and other health providers every year, including 1.2 million with Alzheimer’s disease or another form of dementia.
“Nurses play a pivotal role in providing home health care,” said Chenjuan Ma, assistant professor at NYU Rory Meyers College of Nursing and the lead author of the study, published in Medical Care, a journal from the American Public Health Association. “As the population ages and older adults choose to ‘age in place’ as long as possible, the demand for home health care for people with dementia is expected to grow rapidly.”
Home health care usually begins after a patient is discharged from the hospital. The goal of home health care, typically provided by nurses, is to help the patient safely heal at home. One measure of success is that with good home care, the patient does not need to return for another costly and disorienting visit to the hospital.
For the study, Dr. Ma and her colleagues analyzed many years of patient data from a large, not-for-profit home health agency. They looked at records from nearly 24,000 older men and women with dementia who received home health care visits after a hospitalization.
They also assessed each patient’s continuity of care, or how often the same nurse returned to provide home care. The more often the same nurse visited, the higher the patient’s continuity of care. About 8 percent of the patients had no continuity of care, or a different nurse at each home visit; 26 percent had excellent continuity of care, or the same nurse visiting each time.
The researchers found that about one in four of the patients in the study needed to be rehospitalized. Most often it was because they had developed infections or respiratory problems, or because of problems related to heart disease.
The researchers found that having a regular nurse lowered the risk that someone with dementia needed to return to the hospital. Compared to those with a high continuity of nursing care, people with dementia receiving low or moderate continuity of nursing care were 30 to 33 percent more likely to be rehospitalized.
“Continuity of nursing care is valuable for home health care because of its decentralized and intermittent care model,” said Dr. Ma. “While continuity of nursing care may benefit every home health care patient, it may be particularly critical for people with dementia. Having the same person delivering care can increase familiarity, instill trust, and reduce confusion for patients and their families.”
The researchers say that more needs to be done to address the shortage of home health care nurses. Long commutes, limited pay and other stresses of the job need to be addressed.
“Proposed legislation in Congress that seeks to increase nursing and home health care frontline staff salaries will pay for itself, because agencies can improve continuity of care, and therefore reduce penalties associated with hospital readmissions,” said Allison Squires, associate professor at NYU Meyers and the study’s senior author.
A hybrid care model of in-person visits and telehealth, or using the video chats and Zoom calls that became increasingly popular during the Covid pandemic, could also help to provide better continuity of care, the researchers note. They encourage policymakers to consider expanding coverage for telehealth visits in home health care.
By ALZinfo.org, The Alzheimer’s Information Site. Reviewed by Marc Flajolet, Ph.D., Fisher Center for Alzheimer’s Research Foundation at The Rockefeller University.
Source: Chenjuan Ma, PhD; Margaret V. McDonald, MSW; Penny Feldman, PHD; et al: “Continuity of Nursing Care in Home Health: Impact on Rehospitalization Among Older Adults With Dementia.” Medical Care, June 23, 2021