'Social environmental factors' affect rehospitalization risk in home healthcare patients

November 12, 2012, Wolters Kluwer Health

For elderly patients receiving home healthcare after a hospital stay, "social environmental factors"—particularly care provided by a family member or other informal caregiver—have a significant impact on the risk of repeated hospital admissions, reports a study in the October-December issue of Advances in Nursing Science.

"Understanding how social contribute to home healthcare patients being rehospitalized would be assist in improving care for patients and in helping agencies deliver more cost-effective care while at the same time managing spending," according to the report by Hong Tao, RN, PhD, of University of Wisconsin Milwaukee and colleagues.

Social Environmental Factors Affect Functional Abilities…

The study looked at factors affecting the risk of repeated among 1,268 receiving home healthcare. Using data from routine, Medicare-required assessments, the researchers focused on the importance of social environmental factors: such as whether the patient lived alone or with others, whether he or she had a primary informal caregiver, and the type and frequency of informal care provided.

Overall, nearly 21 percent of patients in the study were rehospitalized, most within the first 20 days of being discharged from the hospital to home healthcare. Rehospitalizations—defined as to the hospital within 60 days after being released from the hospital to home care—are an important indicator of the quality of care.

The study found some significant associations between social environmental factors, and suggested some pathways by which these effects occur. Patients' functional ability—their ability to take care of themselves—was influenced by their living arrangements and by the type and frequency of informal care they received.

The greater the difference between the patients' clinical condition and functional status, the greater the risk of rehospitalization. Social environmental factors contributed to the risk of repeated hospital admission by altering the balance between the patient's need for and ability to provide self-care.

…With 'Self-Care Deficit' Leading to Repeat Hospitalizations

Changes in clinical condition placed increased demands on the patient's ability to care for himself or herself, while at the same time making it more difficult to provide self-care. Consistent with a central nursing theory, the resulting "self-care deficit" was linked to an increased risk of rehospitalization.

The amount of care and assistance received from informal caregivers had an important impact on self-care ability and rehospitalization risk. Other patient characteristics linked to self-care deficit included obesity and cognitive (intellectual) ability. Patients living alone were less likely to be rehospitalized—perhaps because those choosing to live alone were better able to functional independently and care for themselves.

Few previous studies have looked at how social environmental factors in general, and informal caregivers in particular, affect patient outcomes. Rehospitalization is considered a "major adverse event" in home care. "Rehospitalizations are costly and in many cases preventable," Dr Tao and colleagues explain. One recent study found that 20 percent of hospitalized Medicare beneficiaries are readmitted within 30 days, with costs accounting for one-sixth of the total Medicare budget.

Dr Tao and colleagues believe their study has implications for strategies to reduce unnecessary rehospitalizations and improve the quality of home healthcare. "[Our] findings may help home healthcare nurses to recognize those patients who are in need of certain services that may reduce hospitalization, such as those that lack the support of the patient's family or assistance from paid informal caregivers," they write. Patients with good social environmental support are "more likely to have a higher and thus remain in their homes, the first choice of most patients."

The study also reaffirms the important role of informal caregivers in maintaining home healthcare . The authors add, "Informal caregivers are part of the solution in preventing unnecessary hospitalizations and more attention needs to be given to how these caregivers are supported in their roles."

Explore further: Predictors identified for rehospitalization among post-acute stroke patients

Related Stories

Predictors identified for rehospitalization among post-acute stroke patients

April 6, 2012
Stroke patients receiving in-patient rehabilitation are more likely to land back in the hospital within three months if they are functioning poorly, show signs of depression and lack social support according to researchers ...

Medicare patients at risk of long-term institutionalization after hospital stay

October 3, 2011
Confirming many elderly patients' worst fears, a national study has shown that being hospitalized for an acute event, such as a stroke or hip fracture, can lead to long-term institutionalization in a nursing home. Equally ...

Discharge summaries play key role in keeping nursing home patients safe

December 22, 2011
(Medical Xpress) -- Sending thorough and timely reports to nursing homes when a patient is discharged from the hospital could help promote patient safety during the early days after a hospitalization.   Yet, these reports ...

Reducing avoidable rehospitalizations among seniors

June 13, 2011
The rehospitalization of senior patients within 30 days of discharge from a skilled nursing facility (SNF) has risen dramatically in recent years, at an estimated annual cost of more than $17 billion. A new study from Hebrew ...

High rates of disability and health care use for older Americans with cirrhosis

January 10, 2012
New research shows that older Americans with cirrhosis have significantly worse health status and greater functional disability compared to those without this potentially deadly disease. In fact, findings now published in ...

Recommended for you

Women run faster after taking newly developed supplement, study finds

January 19, 2018
A new study found that women who took a specially prepared blend of minerals and nutrients for a month saw their 3-mile run times drop by almost a minute.

Americans are getting more sleep

January 19, 2018
Although more than one in three Americans still don't get enough sleep, a new analysis shows first signs of success in the fight for more shut eye. According to data from 181,335 respondents aged 15 and older who participated ...

Wine is good for you—to a point

January 18, 2018
The Mediterranean diet has become synonymous with healthy eating, but there's one thing in it that stands out: It's cool to drink wine.

Sleep better, lose weight?

January 17, 2018
(HealthDay)—Sleeplessness could cost you when it's time to stand on your bathroom scale, a new British study suggests.

Who uses phone apps to track sleep habits? Mostly the healthy and wealthy in US

January 16, 2018
The profile of most Americans who use popular mobile phone apps that track sleep habits is that they are relatively affluent, claim to eat well, and say they are in good health, even if some of them tend to smoke.

Improvements in mortality rates are slowed by rise in obesity in the United States

January 15, 2018
With countless medical advances and efforts to curb smoking, one might expect that life expectancy in the United States would improve. Yet according to recent studies, there's been a reduction in the rate of improvement in ...

0 comments

Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.