8 CFR 204.311 - Convention adoption home study requirements.

Code of Federal Regulations, 2012 CFR

2012-01-01

... 8 Aliens and Nationality 1 2012-01-01 2012-01-01 false Convention adoption home study requirements... IMMIGRANT PETITIONS Intercountry Adoption of a Convention Adoptee § 204.311 Convention adoption home study requirements. (a) Purpose. For immigration purposes, a home study is a process for screening and preparing an...

8 CFR 204.311 - Convention adoption home study requirements.

Code of Federal Regulations, 2013 CFR

2013-01-01

... 8 Aliens and Nationality 1 2013-01-01 2013-01-01 false Convention adoption home study requirements... IMMIGRANT PETITIONS Intercountry Adoption of a Convention Adoptee § 204.311 Convention adoption home study requirements. (a) Purpose. For immigration purposes, a home study is a process for screening and preparing an...

8 CFR 204.311 - Convention adoption home study requirements.

Code of Federal Regulations, 2014 CFR

2014-01-01

... 8 Aliens and Nationality 1 2014-01-01 2014-01-01 false Convention adoption home study requirements... IMMIGRANT PETITIONS Intercountry Adoption of a Convention Adoptee § 204.311 Convention adoption home study requirements. (a) Purpose. For immigration purposes, a home study is a process for screening and preparing an...

Home Study Course Development Handbook. Second Edition.

ERIC Educational Resources Information Center

Lambert, Michael P., Ed.; Welch, Sally R., Ed.

Intended to help developers of home study courses and their directors of education create good correspondence courses, this document updates the 1980 edition and was developed by members of the National Home Study Council's Research and Educational Standards Committee. The document begins with photographs and biographies of its authors. The…

Medicare-certified home health services: national and regional supply in the 1980s.

PubMed Central

Scalzi, C C; Zinn, J S; Guilfoyle, M J; Perdue, S T

1994-01-01

The number of Medicare-certified home health agencies nearly doubled from 1980 to 1990. Using Health Care Financing Administration data, this study documented national and regional patterns of entry and exist by Medicare home health providers from 1980 to 1990. Nationally, agency origination rates accelerated during the early 1980s and then dropped abruptly in the second half of the decade. The proprietary sector, accounting for approximately 42% of agencies in existence during the period of the study, exhibited the greatest volatility. Regional differences are also evident. Both expansion and contraction in Medicare home health services appear to be a response to the incentives of legislation implemented during this period. PMID:7943487

American Healthy Homes Survey: A National Study of Residential Pesticides Measured from Floor Wipes.

EPA Science Inventory

The U.S. Department of Housing and Urban Development in collaboration with the United States Environmental Protection Agency conducted a survey measuring lead, allergens, and insecticides in a randomly selected nationally representative sample of resodential homes. Multistage sa...

Training of Home Health Aides and Nurse Aides: Findings from National Data

ERIC Educational Resources Information Center

Sengupta, Manisha; Ejaz, Farida K.; Harris-Kojetin, Lauren D.

2012-01-01

Training and satisfaction with training were examined using data from nationally representative samples of 2,897 certified nursing assistants (CNAs) from the National Nursing Assistant Survey and 3,377 home health aides (HHAs) from the National Home Health Aide Survey conducted in 2004 and 2007, respectively. This article focuses on the…

Directory of Accredited Private Home Study Schools, 1971.

ERIC Educational Resources Information Center

National Home Study Council, Washington, DC.

This directory of accredited private home study schools lists 152 schools which have met the following standards set by the National Home Study Council: competent faculty; educationally sound and up-to-date courses; careful screening of students for admission; satisfactory educational services; demonstration of ample student success and…

Directory of Accredited Private Home Study Schools, 1970.

ERIC Educational Resources Information Center

National Home Study Council, Washington, DC.

This directory of accredited private home study schools lists 137 schools which have met the following standards set by the National Home Study Council: competent faculty; educationally sound and up-to-date courses; careful screening of students for admission; satisfactory educational services; demonstration of ample student success and…

32 CFR 553.16 - Persons eligible for burial in Soldiers' Home National Cemetery.

Code of Federal Regulations, 2010 CFR

2010-07-01

... 32 National Defense 3 2010-07-01 2010-07-01 true Persons eligible for burial in Soldiers' Home National Cemetery. 553.16 Section 553.16 National Defense Department of Defense (Continued) DEPARTMENT OF... eligible for burial in Soldiers' Home National Cemetery. The Board of Commissioners of the US Soldiers' and...

Turnover, staffing, skill mix, and resident outcomes in a national sample of US nursing homes.

PubMed

Trinkoff, Alison M; Han, Kihye; Storr, Carla L; Lerner, Nancy; Johantgen, Meg; Gartrell, Kyungsook

2013-12-01

The authors examined the relationship of staff turnover to selected nursing home quality outcomes, in the context of staffing and skill mix. Staff turnover is a serious concern in nursing homes as it has been found to adversely affect care. When employee turnover is minimized, better care quality is more likely in nursing homes. Data from the National Nursing Home Survey, a nationally representative sample of US nursing homes, were linked to Nursing Home Compare quality outcomes and analyzed using logistic regression. Nursing homes with high certified nursing assistant turnover had significantly higher odds of pressure ulcers, pain, and urinary tract infections even after controlling for staffing, skill mix, bed size, and ownership. Nurse turnover was associated with twice the odds of pressure ulcers, although this was attenuated when staffing was controlled. This study suggests turnover may be more important in explaining nursing home (NH) outcomes than staffing and skill mix and should therefore be given greater emphasis.

Elephant (Loxodonta africana) home ranges in Sabi Sand Reserve and Kruger National Park: a five-year satellite tracking study.

PubMed

Thomas, Bindi; Holland, John D; Minot, Edward O

2008-01-01

During a five-year GPS satellite tracking study in Sabi Sand Reserve (SSR) and Kruger National Park (KNP) we monitored the daily movements of an elephant cow (Loxodonta africana) from September 2003 to August 2008. The study animal was confirmed to be part of a group of seven elephants therefore her position is representative of the matriarchal group. We found that the study animal did not use habitat randomly and confirmed strong seasonal fidelity to its summer and winter five-year home ranges. The cow's summer home range was in KNP in an area more than four times that of her SSR winter home range. She exhibited clear park habitation with up to three visits per year travelling via a well-defined northern or southern corridor. There was a positive correlation between the daily distance the elephant walked and minimum daily temperature and the elephant was significantly closer to rivers and artificial waterholes than would be expected if it were moving randomly in KNP and SSR. Transect lines established through the home ranges were surveyed to further understand the fine scale of the landscape and vegetation representative of the home ranges.

Design and operation of the national home health aide survey: 2007-2008.

PubMed

Bercovitz, Anita; Moss, Abigail J; Sengupta, Manisha; Harris-Kojetin, Lauren D; Squillace, Marie R; Emily, Rosenoff; Branden, Laura

2010-03-01

This report provides an overview of the National Home Health Aide Survey (NHHAS), the first national probability survey of home health aides. NHHAS was designed to provide national estimates of home health aides who provided assistance in activities of daily living (ADLs) and were directly employed by agencies that provide home health and/or hospice care. This report discusses the need for and objectives of the survey, the design process, the survey methods, and data availability. METHODS NHHAS, a multistage probability sample survey, was conducted as a supplement to the 2007 National Home and Hospice Care Survey (NHHCS). Agencies providing home health and/or hospice care were sampled, and then aides employed by these agencies were sampled and interviewed by telephone. Survey topics included recruitment, training, job history, family life, client relations, work-related injuries, and demographics. NHHAS was virtually identical to the 2004 National Nursing Assistant Survey of certified nursing assistants employed in sampled nursing homes with minor changes to account for differences in workplace environment and responsibilities. RESULTS From September 2007 to April 2008, interviews were completed with 3,416 aides. A public-use data file that contains the interview responses, sampling weights, and design variables is available. The NHHAS overall response rate weighted by the inverse of the probability of selection was 41 percent. This rate is the product of the weighted first-stage agency response rate of 57 percent (i.e., weighted response rate of 59 percent for agency participation in NHHCS times the weighted response rate of 97 percent for agencies participating in NHHCS that also participated in NHHAS) and the weighted second-stage aide response rate of 72 percent to NHHAS.

A Nation-Wide Study of Prevalence and Risk Factors for Fecal Impaction in Nursing Homes

PubMed Central

Rey, Enrique; Barcelo, Marta; Jiménez Cebrián, Maria Jose; Alvarez-Sanchez, Angel; Diaz-Rubio, Manuel; Rocha, Alberto Lopez

2014-01-01

Background There are no existing studies that provide data regarding the epidemiology of, and risk factors for, fecal impaction, either in the general population or in any sub-group of people. Objective Estimate the prevalence of and factors associated with fecal impaction on a representative sample of the institutionalized elderly population. Design Two-phase study. Phase 1: pilot study validating the methodology in which all residents of a single nursing home participated. Phase 2: national multi-center cross-sectional study. Setting 34 randomly selected nursing homes. Measurements The presence of fecal impaction and associated factors were evaluated using three different tools: data collected from medical records; a self-completion questionnaire filled out by the subjects or a proxy; and a rectal examination. Subjects Older subjects living in nursing homes. Results The prevalence of chronic constipation was 70.7% (95%CI: 67.3–74.1%), of which 95.9% of patients were properly diagnosed and 43.1% were properly controlled. The prevalence of FI according to patient history was 47.3% (43.6–51.0%) and 6.6% (4.7–8.5%) according to rectal examination. Controlled constipation (OR: 9.8 [5.2–18.4]) and uncontrolled constipation (OR: 37.21 [19.7–70.1]), the number of medications (OR: 1.2 [1.1–1.3]), reduced functional capacity (OR: 0.98 [0.97–0.99]) and the occasional use of NSAIDs were independent risk factors for fecal impaction. Conclusions Constipation affects more than 70% of people living in nursing homes. Although it is properly diagnosed in more than 95% of cases, the disease is only controlled in less than 50%. Constipation, especially when not controlled, is the most significant risk factor leading to fecal impaction, which is prevalent in almost 50% of this population. PMID:25148393

Testing Home Study Advertising. NHSC Occasional Paper Number 4.

ERIC Educational Resources Information Center

Thompson, Jack

This document, which is intended for individuals responsible for advertising at National Home Study Council (NHSC) schools, explains how to test home study advertising. Presented first are the success stories of four NHSC schools that experienced significant enrollment increases and/or cost savings by testing their advertisements. Discussed next…

Actualizing Concepts in Home Management: Proceedings of a National Conference.

ERIC Educational Resources Information Center

American Home Economics Association, Washington, DC.

The booklet prints the following papers delivered at a national conference: Actualizing Concepts in Home Management: Decision Making, Dorothy Z. Price; Innovations in Teaching: Ergonomics, Fern E. Hunt; Relevant Concepts of Home Management: Innovations in Teaching, Kay P. Edwards; Standards in a Managerial Context, Florence S. Walker; Organizing:…

Mothers Working Outside the Home: What Do National Assessment Results Tell Us?

ERIC Educational Resources Information Center

Anderson, Bernice; And Others

National Assessment of Educational Progress (NAEP) data show that children in grades 4, 8, and 11 whose mothers work outside the home read better than children whose mothers do not work outside the home--but the difference is small. This conclusion represents one segment of the findings of the 1983-84 National Assessment, which focused on reading…

Predictors of Intent to Leave the Job Among Home Health Workers: Analysis of the National Home Health Aide Survey.

PubMed

Stone, Robyn; Wilhelm, Jess; Bishop, Christine E; Bryant, Natasha S; Hermer, Linda; Squillace, Marie R

2017-10-01

To identify agency policies and workplace characteristics that are associated with intent to leave the job among home health workers employed by certified agencies. Data are from the 2007 National Home and Hospice Care Survey/National Home Health Aide Survey, a nationally representative, linked data set of home health and hospice agencies and their workers. Logistic regression with survey weights was conducted to identify agency and workplace factors associated with intent to leave the job, controlling for worker, agency, and labor market characteristics. Job satisfaction, consistent patient assignment, and provision of health insurance were associated with lower intent to leave the job. By contrast, being assigned insufficient work hours and on-the-job injuries were associated with greater intent to leave the job after controlling for fixed worker, agency, and labor market characteristics. African American workers and workers with a higher household income also expressed greater intent to leave the job. This is the first analysis to use a weighted, nationally representative sample of home health workers linked with agency-level data. The findings suggest that intention to leave the job may be reduced through policies that prevent injuries, improve consistency of client assignment, improve experiences among African American workers, and offer sufficient hours to workers who want them. © The Author 2016. Published by Oxford University Press on behalf of The Gerontological Society of America. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

Rurality and nursing home quality: evidence from the 2004 National Nursing Home Survey.

PubMed

Kang, Yu; Meng, Hongdao; Miller, Nancy A

2011-12-01

To evaluate the impact of rural geographic location on nursing home quality of care in the United States. The study used cross-sectional observational design. We obtained resident- and facility-level data from 12,507 residents in 1,174 nursing homes from the 2004 National Nursing Home Survey. We used multilevel regression models to predict risk-adjusted rates of hospitalization, influenza and pneumococcal vaccination, and moderate to severe pain while controlling for resident and facility characteristics. Adjusting for covariates, residents in rural facilities were more likely to experience hospitalization (odds ratio [OR] = 1.50, 95% confidence interval [CI] = 1.16-1.94) and moderate to severe pain (OR = 1.68, 95% CI = 1.35-2.09). Significant facility-level predictors of higher quality included higher percentage of Medicaid beneficiaries, accreditation status, and special care programs. Medicare payment findings were mixed. Significant resident-level predictors included dementia diagnosis and being a "long-stay" resident. Rural residents were more likely to reside in facilities without accreditations or special care programs, factors that increased their odds of receiving poorer quality of care. Policy efforts to enhance Medicare payment approaches as well as increase rural facilities' accreditation status and provision of special care programs will likely reduce quality of care disparities in facilities.

Perspective view of east entrance from northeast National Home ...

Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

Perspective view of east entrance from northeast - National Home for Disabled Volunteer Soldiers, Pacific Branch, Mental Health Building, 11301 Wilshire Boulevard, West Los Angeles, Los Angeles County, CA

Perspective view of south facade from southeast National Home ...

Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

Perspective view of south facade from southeast - National Home for Disabled Volunteer Soldiers, Pacific Branch, Mental Health Buildings, 11301 Wilshire Boulevard, West Los Angeles, Los Angeles County, CA

Home ranges and habitat use of sloth bears Melursus ursinus inornatus in Wasgomuwa National Park, Sri Lanka

USGS Publications Warehouse

Ratnayeke, S.; Van Manen, F.T.; Padmalal, U.K.G.K.

2007-01-01

We studied home ranges and habitat selection of 10 adult sloth bears Melursus ursinus inornatus at Wasgomuwa National Park, Sri Lanka during 2002-2003. Very little is known about the ecology and behaviour of M. u. inornatus, which is a subspecies found in Sri Lanka. Our study was undertaken to assess space and habitat requirements typical of a viable population of M. u. inornatus to facilitate future conservation efforts. We captured and radio-collared 10 adult sloth bears and used the telemetry data to assess home-range size and habitat use. Mean 95% fixed kernel home ranges were 2.2 km2 (SE = 0.61) and 3.8 km2 (SE = 1.01) for adult females and males, respectively. Although areas outside the national park were accessible to bears, home ranges were almost exclusively situated within the national park boundaries. Within the home ranges, high forests were used more and abandoned agricultural fields (chenas) were used less than expected based on availability. Our estimates of home-range size are among the smallest reported for any species of bear. Thus, despite its relatively small size, Wasgomuwa National Park may support a sizeable population of sloth bears. The restriction of human activity within protected areas may be necessary for long-term viability of sloth bear populations in Sri Lanka as is maintenance of forest or scrub cover in areas with existing sloth bear populations and along potential travel corridors. ?? Wildlife Biology 2007.

Perspective view of east facade from northeast National Home ...

Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

Perspective view of east facade from northeast - National Home for Disabled Volunteer Soldiers, Pacific Branch, Main Mental Health Building, 11301 Wilshire Boulevard, West Los Angeles, Los Angeles County, CA

Americans Needing Home Care, United States. Data from the National Health Survey.

ERIC Educational Resources Information Center

Feller, Barbara A.

1986-01-01

This report presents information from the Home Care Supplement to the National Health Interview Survey (NHIS) on the types of help needed by adults with chronic health problems who live outside of institutions. Home care items discussed include: (1) assistance in basic physical activities; (2) assistance in home management activities; (3) adults…

Contraindications in planned home birth in Iceland: A retrospective cohort study.

PubMed

Halfdansdottir, Berglind; Hildingsson, Ingegerd; Smarason, Alexander Kr; Sveinsdottir, Herdis; Olafsdottir, Olof A

2018-03-01

Icelandic national guidelines on place of birth list contraindications for home birth. Few studies have examined the effect of contraindication on home birth, and none have done so in Iceland. The aim of this study was to examine whether contraindications affect the outcome of planned home birth or have a different effect at home than in hospital. The study is a retrospective cohort study on the effect of contraindications for home birth on the outcome of planned home (n = 307) and hospital (n = 921) birth in 2005-2009. Outcomes were described for four different groups of women, by exposure to contraindications (unexposed vs. exposed) and planned place of birth (hospital vs. home). Linear and logistic regression analysis was used to evaluate the effect of the contraindications under study and to detect interactions between contraindications and planned place of birth. The key findings of the study were that contraindications were related to higher rates of adverse maternal and neonatal outcomes, regardless of place of birth; women exposed to contraindications had higher rates of adverse outcomes in planned home birth; and healthy, unexposed women had higher rates of adverse outcomes in planned hospital birth. Contraindications significantly increased the risk of transfer in labour and postpartum haemorrhage in planned home births. The defined contraindications for home birth had a negative effect on maternal and neonatal outcomes in Iceland, regardless of place of birth. The study results do not contradict the current national guidelines on place of birth. Copyright © 2017 Elsevier B.V. All rights reserved.

National Trends and Geographic Variation in Availability of Home Health Care: 2002-2015.

PubMed

Wang, Yun; Leifheit-Limson, Erica C; Fine, Jonathan; Pandolfi, Michelle M; Gao, Yan; Liu, Fanglin; Eckenrode, Sheila; Lichtman, Judith H

2017-07-01

To evaluate national trends and geographic variation in the availability of home health care from 2002 to 2015 and identify county-specific characteristics associated with home health care. Observational study. All counties in the United States. All Medicare-certified home health agencies included in the Centers for Medicare & Medicaid Services Home Health Compare system. County-specific availability of home health care, defined as the number of available home health agencies that provided services to a given county per 100,000 population aged ≥18 years. The study included 15,184 Medicare-certified home health agencies that served 97% of U.S. ZIP codes. Between 2002-2003 and 2014-2015, the county-specific number of available home health agencies per 100,000 population aged ≥18 years increased from 14.7 to 21.8 and the median (inter-quartile range) population that was serviced by at least one home health agency increased from 403,605 (890,329) to 455,488 (1,039,328). Considerable geographic variation in the availability of home health care was observed. The West, North East, and South Atlantic regions had lower home health care availability than the Central regions, and this pattern persisted over the study period. Counties with higher median income, a larger senior population, higher rates of households without a car and low access to stores, more obesity, greater inactivity, and higher proportions of non-Hispanic white, non-Hispanic black, and Hispanic populations were more likely to have higher availability of home health care. The availability of home health care increased nationwide during the study period, but there was much geographic variation. © 2017, Copyright the Authors Journal compilation © 2017, The American Geriatrics Society.

Diabetes risk evaluation and microalbuminuria (DREAM) studies: ten years of participatory research with a First Nation's home and community model for type 2 diabetes care in Northern Saskatchewan.

PubMed

Pylypchuk, George; Vincent, Lloyd; Wentworth, Joan; Kiss, Alexander; Perkins, Nancy; Hartman, Susan; Ironstand, Laurie; Hoppe, Jacqueline; Tobe, Sheldon W

2008-06-01

To review the DREAM studies and the role of participatory research using a Home and Community Care model in treating First Nations diabetes. Population survey, pilot and prospective randomized trial Review documented history of these studies since inception. Collation of all data from the DREAM studies from 1998 to the present, including interviews with all providers and many of the participants. The DREAM studies were a participatory process providing a needs assessment and became the foundation for this First Nation's Home and Community Care team involvement in providing community-based chronic-disease management. The findings motivated the community to find a process that would lead to needed changes. This participatory research enabled a culturally tailored algorithm of evidence-based management of hypertension and disease management strategies for people with diabetes. These studies demonstrated that in this community the Home and Community Care team could work together with primary care physicians and specialists to prevent the complications of diabetes. The DREAM studies demonstrated in the first controlled trial that with participatory research a systems change is possible; a chronic-disease management model utilizing a trained multidisciplinary Home and Community Care team and informed patients can lead to lower blood pressure in a Canadian First Nations population with diabetes.

National Trends and Geographic Variation in Availability of Home Health Care: 2002–2015

PubMed Central

Wang, Yun; Leifheit-Limson, Erica C; Fine, Jonathan; Pandolfi, Michelle M; Gao, Yan; Liu, Fanglin; Eckenrode, Sheila; Lichtman, Judith H

2017-01-01

Objectives To evaluate national trends and geographic variation in the availability of home health care from 2002–2015 and identify county-specific characteristics associated with home health care. Design Observational study Setting All counties in the United States Participants All Medicare-certified home health agencies included in the Centers for Medicare & Medicaid Services Home Health Compare system. Measurements County-specific availability of home health care, defined as the number of available home health agencies that provided services to a given county per 100,000 population aged ≥18 years. Results The study included 15,184 Medicare-certified home health agencies that served 97% of U.S. ZIP codes. Between 2002–2003 and 2014–2015, the county-specific number of available home health agencies per 100,000 population aged ≥18 years increased from 14.7 to 21.8 and the median (inter-quartile range) population that was serviced by at least one home health agency increased from 403,605 (890,329) to 455,488 (1,039,328). Considerable geographic variation in the availability of home health care was observed. The West, North-East, and South Atlantic regions had lower home health care availability than the Central regions, and this pattern persisted over the study period. Counties with higher median income, a larger senior population, higher rates of households without a car and low access to stores, more obesity, greater inactivity, and higher proportions of non-Hispanic white, non-Hispanic black, and Hispanic populations were more likely to have higher availability of home health care. Conclusion The availability of home health care increased nationwide during the study period, but there was much geographic variation. PMID:28322441

Does litigation increase or decrease health care quality?: a national study of negligence claims against nursing homes.

PubMed

Stevenson, David G; Spittal, Matthew J; Studdert, David M

2013-05-01

The tort system is supposed to help improve the quality and safety of health care, but whether it actually does so is controversial. Most previous studies modeling the effect of negligence litigation on quality of care are ecologic. To assess whether the experience of being sued and incurring litigation costs affects the quality of care subsequently delivered in nursing homes. We linked information on 6471 negligence claims brought against 1514 nursing homes between 1998 and 2010 to indicators of nursing home quality drawn from 2 US national datasets (Online Survey, Certification, and Reporting system; Minimum Data Set Quality Measure/Indicator Reports). At the facility level, we tested for associations between 9 quality measures and 3 variables indicating the nursing homes' litigation experience in the preceding 12-18 months (total indemnity payments; total indemnity payments plus administrative costs; ≥ 1 paid claims vs. none). The analyses adjusted for quality at baseline, case-mix, ownership, occupancy, year, and facility and state random effects. Nearly all combinations of the 3 litigation exposure measures and 9 quality measures--27 models in all--showed an inverse relationship between litigation costs and quality. However, only a few of these associations were statistically significant, and the effect sizes were very small. For example, a doubling of indemnity payments was associated with a 1.1% increase in the number of deficiencies and a 2.2% increase in pressure ulcer rates. Tort litigation does not increase the quality performance of nursing homes, and may decrease it slightly.

In-home firearm access among US adolescents and the role of religious subculture: Results from a nationally representative study.

PubMed

Stroope, Samuel; Tom, Joshua C

2017-09-01

Religious participation is linked to numerous positive safety outcomes for adolescents. Scant attention, however, has been paid to associations between religious participation and safety risks among adolescents. Using data from Add Health (N = 18,449), a nationally representative school-based sample of US adolescents, this study examines the relationship between adolescents' religious affiliation and easy access to firearms at home. Regression analyses adjust for complex sampling design and compare easy firearm access at home among conservative Protestant adolescents to adolescent firearm access in other religious traditions. Conservative Protestant adolescents have a substantially greater likelihood of easy access to a gun at home compared to adolescents of all other major religious traditions in the United States. Recognizing differences in adolescent firearm access between subcultural groups can help public health interventions more effectively identify and address the needs of vulnerable populations. The paper's conclusion considers suggestions for effective policy and programmatic initiatives. Copyright © 2017 Elsevier Inc. All rights reserved.

Activities of daily living in nursing home and home care settings: a retrospective 1-year cohort study.

PubMed

Lee, Tae Wha; Cho, Eunhee; Yim, Eun Shil; Lee, Hye Sun; Ko, Yu Kyung; Kim, Bok Nam; Kim, Sinhye

2015-02-01

Korea introduced universal long-term care insurance (LTCI) for physically dependent older adults in 2008. Older adults, their family members, and policy makers in Korea want to know patient outcomes in different care modalities because older adults who have a similar functional status and LTC needs can choose either nursing home care or home care. The aim of this study was to compare activities of daily living (ADLs) in nursing home care and home care settings for physically dependent older adults in Korea. A retrospective 1-year cohort study using national LTCI data. This study used the LTCI dataset from the National Health Insurance Service in Korea. Participants were identified from among those in the LTCI dataset who enrolled from July 2008 to June 2010. We extracted a sample consisting of 22,557 older adults who consistently received either nursing home care (n = 11,678) or home care (n = 10,879) for 1 year. The outcome variable was change in ADLs after 1 year. Covariates were an older adult's home geographical region, LTC level, age, sex, primary caregiver, Medicaid beneficiary status, bedridden status, medical diagnosis, baseline ADLs, cognitive function, behavioral problems, nursing and special treatment, and rehabilitation needs. Multiple regression analysis of all participants unmatched and a paired t-test with a propensity-score-matched cohort were performed to explain the association of changes in ADLs with the types of LTC. Multiple regression analysis with all participants (n = 22,557) unmatched showed that compared with older adults who received home care, those who received nursing home care had deteriorated further in terms of ADLs after 1 year (β = 0.44108, P < .0001). After propensity-score matching, paired t-test analysis also found that the ADLs of older adults had deteriorated less in the home care group compared with the nursing home group after 1 year (P < .0001). The ADLs of older adults who received home care showed significantly less

National Home Start Evaluation Interim Report VII. Twenty-Month Program Analysis and Findings.

ERIC Educational Resources Information Center

Love, John M.; And Others

This interim evaluation report focuses on process (formative) and outcome (summative) data collected in spring 1975 on the National Home Start Program. Home Start, a federally-funded 3-year (1972-1975) home-based demonstration program for low-income families with 3- to 5-year-old children was designed to enhance a mother's skills in dealing with…

32 CFR 553.16 - Persons eligible for burial in Soldiers' Home National Cemetery.

Code of Federal Regulations, 2014 CFR

2014-07-01

... 32 National Defense 3 2014-07-01 2014-07-01 false Persons eligible for burial in Soldiers' Home National Cemetery. 553.16 Section 553.16 National Defense Department of Defense (Continued) DEPARTMENT OF THE ARMY MILITARY RESERVATIONS AND NATIONAL CEMETERIES ARMY NATIONAL CEMETERIES § 553.16 Persons...

Whole-Home Dehumidifiers: Field-Monitoring Study

DOE Office of Scientific and Technical Information (OSTI.GOV)

Burke, Tom; Willem, Henry; Ni, Chun Chun

2014-09-23

Lawrence Berkeley National Laboratory (LBNL) initiated a WHD field-metering study to expand current knowledge of and obtain data on WHD operation and energy consumption in real-world applications. The field study collected real-time data on WHD energy consumption, along with information regarding housing characteristics, consumer behavior, and various outdoor conditions expected to affect WHD performance and efficiency. Although the metering study collected similar data regarding air conditioner operation, this report discusses only WHDs. The primary objectives of the LBNL field-metering study are to (1) expand knowledge of the configurations, energy consumption profiles, consumer patterns of use (e.g., relative humidity [RH] settings),more » and environmental parameters of whole-home dehumidification systems; and (2) develop distributions of hours of dehumidifier operation in four operating modes: off, standby, fan-only, and compressor (also called dehumidification mode). Profiling energy consumption entails documenting the power consumption, duration of power consumption in different modes, condensate generation, and properties of output air of an installed system under field conditions of varying inlet air temperature and RH, as well as system configuration. This profiling provides a more detailed and deeper understanding of WHD operation and its complexities. This report describes LBNL’s whole-home dehumidification field-metering study conducted at four homes in Wisconsin and Florida. The initial phase of the WHD field-metering study was conducted on one home in Madison, Wisconsin, from June to December of 2013. During a second phase, three Florida homes were metered from June to October of 2014. This report presents and examines data from the Wisconsin site and from the three Florida sites.« less

Disadvantaged Parents' Engagement with a National Secondhand Smoke in the Home Mass Media Campaign: A Qualitative Study.

PubMed

Rowa-Dewar, Neneh; Amos, Amanda

2016-09-09

Mass media campaigns can be effective in tobacco control but may widen health inequalities if they fail to engage disadvantaged smokers. This qualitative study explored how parents with young children living in disadvantaged circumstances engaged with a national campaign which aimed to raise awareness of the importance of smokefree homes. Individual semi-structured interviews were carried out with 17 parents before and after the Scottish 2014 "Right Outside" mass media campaign. A conceptual framework exploring meaningful exposure (recall and understanding), motivational responses (protecting children from secondhand smoke (SHS)) and opportunities to act (barriers) was used to thematically analyse the findings. Campaign recall and engagement, and motivation to protect children were high. Parents identified with the dramatized scenario and visual impact of SHS harm to children in the TV advertisement. Some reported changed smoking practices. However, supervising young children in limited accommodation when caring alone constrained opportunities to smoke outside. Instead, parents described actions other than smoking outside that they had taken or were planning to take to create smokefree homes. Mass media campaigns using emotive, real-life circumstances can be effective in engaging parents about SHS. However, the behavioural impact may be limited because of difficult home environments and circumstances.

Sociocultural determinants of home delivery in Ethiopia: a qualitative study.

PubMed

Kaba, Mirgissa; Bulto, Tesfaye; Tafesse, Zergu; Lingerh, Wassie; Ali, Ismael

2016-01-01

Maternal health remains a major public health problem in Ethiopia. Despite the government's measures to ensure institutional delivery assisted by skilled attendants, home delivery remains high, estimated at over 80% of all pregnant women. The study aims to identify determinants that sustain home delivery in Ethiopia. A total of 48 women who delivered their most recent child at home, 56 women who delivered their most recent child in a health facility, 55 husbands of women who delivered within 1 year preceding the study, and 23 opinion leaders in selected districts of Amhara, Oromia, Southern Nations, Nationalities, and Peoples' Region, and Tigray regions were involved in the study. Key informant interview, in-depth interviews, and focus group discussions were conducted to collect data using checklists developed for this purpose. Data reduction and analysis were facilitated by Maxqda qualitative data analysis software version 11. Findings show that pregnancy and delivery is a normal and natural life event. Research participants unanimously argue that such a life event should not be linked with health problems. Home is considered a natural space for delivery and most women aspire to deliver at home where rituals during labor and after delivery are considered enjoyable. Even those who delivered in health facilities appreciate events in connection to home delivery. Efforts are underway to create home-like environments in health facilities, but health facilities are not yet recognized as a natural place of delivery. The positive tendency to deliver at home is further facilitated by poor service delivery at the facility level. Perceived poor competence of providers and limited availability of supplies and equipment were found to maintain the preference to deliver at home. The government's endeavor to improve maternal health has generated positive results with more women now attending antenatal care. Yet over 80% of women deliver at home and this was found to be the

Business Solutions Case Study: Marketing Zero Energy Homes: LifeStyle Homes, Melbourne, Florida

DOE Office of Scientific and Technical Information (OSTI.GOV)

None

Building America research has shown that high-performance homes can potentially give builders an edge in the marketplace and can boost sales. But it doesn't happen automatically. It requires a tailored, easy to understand marketing campaign and sometimes a little flair. This case study highlights LifeStyle Homes’ successful marketing approach for their SunSmart home package, which has helped to boost sales for the company. SunSmart marketing includes a modified logo, weekly blog, social media, traditional advertising, website, and sales staff training. Marketing focuses on quality, durability, healthy indoor air, and energy efficiency with an emphasis on the surety of third-party verificationmore » and the scientific approach to developing the SunSmart package. With the introduction of SunSmart, LifeStyle began an early recovery, nearly doubling sales in 2010; SunSmart sales now exceed 300 homes, including more than 20 zero energy homes. Completed homes in 2014 far outpaced the national (19%) and southern census region (27%) recovery rates for the same period. As technology improves and evolves, this builder will continue to collaborate with Building America.« less

Does litigation increase or decrease health care quality? A national study of negligence claims against nursing homes

PubMed Central

Stevenson, David G.; Spittal, Matthew J.; Studdert, David M.

2016-01-01

Background The tort system is supposed to help improve the quality and safety of health care, but whether it actually does so is controversial. Most previous studies modeling the effect of negligence litigation on quality of care are ecologic. Objective To assess whether the experience of being sued and incurring litigation costs affects the quality of care subsequently delivered in nursing homes. Research Design, Subjects, Measures We linked information on 6,471 negligence claims brought against 1,514 nursing homes between 1998 and 2010 to indicators of nursing home quality drawn from two U.S. national datasets (Online Survey, Certification, and Reporting system; Minimum Data Set Quality Measure/Indicator Reports). At the facility level, we tested for associations between 9 quality measures and 3 variables indicating the nursing homes’ litigation experience in the preceding 12–18 months (total indemnity payments; total indemnity payments plus administrative costs; ≥1 paid claims vs. none). The analyses adjusted for quality at baseline, case-mix, ownership, occupancy, year, and facility and state random effects. Results Nearly all combinations of the 3 litigation exposure measures and 9 quality measures—27 models in all—showed an inverse relationship between litigation costs and quality. However only a few of these associations were statistically significant, and the effect sizes were very small. For example, a doubling of indemnity payments was associated with a 1.1% increase in the number of deficiencies and a 2.2% increase in pressure ulcer rates. Conclusions Tort litigation does not increase the quality performance of nursing homes, and may decrease it slightly. PMID:23552438

Effectiveness of Home Study.

ERIC Educational Resources Information Center

Diehl, Grover E.; And Others

Home study has enjoyed a slow but steady growth in popularity and acceptance. The growth of independent home study may be attributed to both the realities of the present educational environment and the consistently positive results of the home study method. At least one researcher has suggested that the initially slow growth of home study may have…

Exploring correlates of turnover among nursing assistants in the National Nursing Home Survey.

PubMed

Temple, April; Dobbs, Debra; Andel, Ross

2011-01-01

High turnover of nursing assistants (NAs) has implications for the quality of nursing home care. Greater understanding of correlates of NA turnover is needed to provide insight into possible retention strategies. This study examined nursing home organizational characteristics and specific job characteristics of staff in relation to turnover of NAs. Cross-sectional data on 944 nationally representative nursing homes were derived from the 2004 National Nursing Home Survey. Using a 3-month turnover rate, 25% of the facilities with the lowest turnover rates were classified as low turnover, 25% of the facilities with the highest turnover were classified as high turnover, and the remaining 50% of the facilities were classified as moderate turnover. Multinomial logistic regression was used to examine organizational and job characteristics associated with low and high turnover compared with moderate turnover. One organizational characteristic, staffing levels at or greater than 4.0 hours per patient day, was associated with greater odds of low NA turnover and reduced odds of high NA turnover. Job characteristics including higher wages and union membership were associated with greater odds of low NA turnover, whereas wages, fully paid health insurance, employee assistance benefits, and involvement in resident care planning were associated with reduced odds of high NA turnover. The results of this study suggest that job characteristics of NA staff may be particularly important for turnover. Specifically, the provision of competitive wages and benefits (particularly health insurance) and involvement of NAs in resident care planning could potentially reduce NA turnover, as could maintaining high levels of nurse staffing.

Exploring correlates of turnover among nursing assistants in the National Nursing Home Survey.

PubMed

Temple, April; Dobbs, Debra; Andel, Ross

2009-01-01

High turnover of nursing assistants (NAs) has implications for the quality of nursing home care. Greater understanding of correlates of NA turnover is needed to provide insight into possible retention strategies. This study examined nursing home organizational characteristics and specific job characteristics of staff in relation to turnover of NAs. Cross-sectional data on 944 nationally representative nursing homes were derived from the 2004 National Nursing Home Survey. Using a 3-month turnover rate, 25% of the facilities with the lowest turnover rates were classified as low turnover, 25% of the facilities with the highest turnover were classified as high turnover, and the remaining 50% of the facilities were classified as moderate turnover. Multinomial logistic regression was used to examine organizational and job characteristics associated with low and high turnover compared with moderate turnover. One organizational characteristic, staffing levels at or greater than 4.0 hours per patient day, was associated with greater odds of low NA turnover and reduced odds of high NA turnover. Job characteristics including higher wages and union membership were associated with greater odds of low NA turnover, whereas wages, fully paid health insurance, employee assistance benefits, and involvement in resident care planning were associated with reduced odds of high NA turnover. The results of this study suggest that job characteristics of NA staff may be particularly important for turnover. Specifically, the provision of competitive wages and benefits (particularly health insurance) and involvement of NAs in resident care planning could potentially reduce NA turnover, as could maintaining high levels of nurse staffing.

National Newspaper Portrayal of U.S. Nursing Homes: Periodic Treatment of Topic and Tone

PubMed Central

Miller, Edward Alan; Tyler, Denise A; Rozanova, Julia; Mor, Vincent

2012-01-01

Context Although observers have long highlighted the relationship of public distrust, government regulation, and media depictions of nursing-home scandals, no study has systematically analyzed the way in which nursing homes have been portrayed in the national media. This study examines how nursing homes were depicted in four leading national newspapers—the New York Times, Washington Post, Chicago Tribune, and Los Angeles Times—from 1999 to 2008. Methods We used keyword searches of the LexisNexis database to identify 1,704 articles pertaining to nursing homes. We then analyzed the content of each article and assessed its tone, themes, prominence, and central actor. We used basic frequencies and descriptive statistics to examine the articles’ content, both cross-sectionally and over time. Findings Approximately one-third of the articles were published in 1999/2000, and a comparatively high percentage (12.4%) appeared in 2005. Most were news stories (89.8%), and about one-quarter were on the front page of the newspaper or section. Most focused on government (42.3%) or industry (39.2%) interests, with very few on residents/family (13.3%) and community (5.3%) concerns. Most were negative (45.1%) or neutral (37.0%) in tone, and very few were positive (9.6%) or mixed (8.3%). Common themes were quality (57.0%), financing (33.4%), and negligence/fraud (28.1%). Both tone and themes varied across newspapers and years. Conclusions Overall, our findings highlight the longitudinal variation in the four widely read newspapers’ framing of nursing-home coverage, regarding not only tone but also shifts in media attention from one aspect of this complex policy area to another. The predominantly negative media reports contribute to the poor public opinion of nursing homes and, in turn, of the people who live and work in them. These reports also place nursing homes at a competitive disadvantage and may pose challenges to health delivery reform, including care integration across

National newspaper portrayal of U.S. nursing homes: periodic treatment of topic and tone.

PubMed

Miller, Edward Alan; Tyler, Denise A; Rozanova, Julia; Mor, Vincent

2012-12-01

Although observers have long highlighted the relationship of public distrust, government regulation, and media depictions of nursing-home scandals, no study has systematically analyzed the way in which nursing homes have been portrayed in the national media. This study examines how nursing homes were depicted in four leading national newspapers-the New York Times, Washington Post, Chicago Tribune, and Los Angeles Times-from 1999 to 2008. We used keyword searches of the LexisNexis database to identify 1,704 articles pertaining to nursing homes. We then analyzed the content of each article and assessed its tone, themes, prominence, and central actor. We used basic frequencies and descriptive statistics to examine the articles' content, both cross-sectionally and over time. Approximately one-third of the articles were published in 1999/2000, and a comparatively high percentage (12.4%) appeared in 2005. Most were news stories (89.8%), and about one-quarter were on the front page of the newspaper or section. Most focused on government (42.3%) or industry (39.2%) interests, with very few on residents/family (13.3%) and community (5.3%) concerns. Most were negative (45.1%) or neutral (37.0%) in tone, and very few were positive (9.6%) or mixed (8.3%). Common themes were quality (57.0%), financing (33.4%), and negligence/fraud (28.1%). Both tone and themes varied across newspapers and years. Overall, our findings highlight the longitudinal variation in the four widely read newspapers' framing of nursing-home coverage, regarding not only tone but also shifts in media attention from one aspect of this complex policy area to another. The predominantly negative media reports contribute to the poor public opinion of nursing homes and, in turn, of the people who live and work in them. These reports also place nursing homes at a competitive disadvantage and may pose challenges to health delivery reform, including care integration across settings. © 2012 Milbank Memorial Fund.

Personal Empowerment in the Study of Home Internet Use by Low-Income Families.

ERIC Educational Resources Information Center

Bier, Melinda; Gallo, Michael; Nucklos, Eddy; Sherblom, Stephen; Pennick, Michael

1997-01-01

Describes a United States Department of Commerce (National Telecommunications and Information Administrations, NTIA, 1995) study of home Internet use by Low-income families. The study investigated the barriers, benefits (empowerment), and perceived worth of the Internet and concluded that home Internet access enabled powerful emotional and…

Nonresident Suicides in England: A National Study

ERIC Educational Resources Information Center

Windfuhr, Kirsten; Bickley, Harriet; While, David; Williams, Alyson; Hunt, Isabelle M.; Appleby, Louis; Kapur, Navneet

2010-01-01

Little is known about the numbers and characteristics of people who travel away from home before dying by suicide. Therefore, this studied attempts to identify the sociodemographic characteristics, location, and method of suicide in people who died distant from home, in a national sample. Data were collected on all English suicides and a patient…

Sociocultural determinants of home delivery in Ethiopia: a qualitative study

PubMed Central

Kaba, Mirgissa; Bulto, Tesfaye; Tafesse, Zergu; Lingerh, Wassie; Ali, Ismael

2016-01-01

Background Maternal health remains a major public health problem in Ethiopia. Despite the government’s measures to ensure institutional delivery assisted by skilled attendants, home delivery remains high, estimated at over 80% of all pregnant women. Objective The study aims to identify determinants that sustain home delivery in Ethiopia. Methods A total of 48 women who delivered their most recent child at home, 56 women who delivered their most recent child in a health facility, 55 husbands of women who delivered within 1 year preceding the study, and 23 opinion leaders in selected districts of Amhara, Oromia, Southern Nations, Nationalities, and Peoples’ Region, and Tigray regions were involved in the study. Key informant interview, in-depth interviews, and focus group discussions were conducted to collect data using checklists developed for this purpose. Data reduction and analysis were facilitated by Maxqda qualitative data analysis software version 11. Results Findings show that pregnancy and delivery is a normal and natural life event. Research participants unanimously argue that such a life event should not be linked with health problems. Home is considered a natural space for delivery and most women aspire to deliver at home where rituals during labor and after delivery are considered enjoyable. Even those who delivered in health facilities appreciate events in connection to home delivery. Efforts are underway to create home-like environments in health facilities, but health facilities are not yet recognized as a natural place of delivery. The positive tendency to deliver at home is further facilitated by poor service delivery at the facility level. Perceived poor competence of providers and limited availability of supplies and equipment were found to maintain the preference to deliver at home. Conclusion The government’s endeavor to improve maternal health has generated positive results with more women now attending antenatal care. Yet over 80% of

Family Day Care in the United States: Family Day Care Systems. Final Report of the National Day Care Home Study. Volume 5.

ERIC Educational Resources Information Center

Grasso, Janet; Fosburg, Steven

Fifth in a series of seven volumes reporting the design, methodology, and findings of the 4-year National Day Care Home Study (NDCHS), this volume presents a descriptive and statistical analysis of the day care institutions that administer day care systems. These systems, such as Learning Unlimited in Los Angeles and the family day care program of…

Achievement in Large-Scale National Numeracy Assessment: An Ecological Study of Motivation and Student, Home, and School Predictors

ERIC Educational Resources Information Center

Martin, Andrew J.; Lazendic, Goran

2018-01-01

With the rise of large-scale academic assessment programs around the world, there is a need to better understand the factors predicting students' achievement in these assessment exercises. This investigation into national numeracy assessment drew on ecological and transactional conceptualizing involving student, student/home, and school factors.…

Association between home visiting interventions and First Nations families’ health and social outcomes in Manitoba, Canada: protocol for a study of linked population-based administrative data

PubMed Central

Brownell, Marni D; Nickel, Nathan C; Enns, Jennifer E; Chartier, Mariette; Campbell, Rhonda; Phillips-Beck, Wanda; Chateau, Dan; Burland, Elaine; Santos, Rob; Katz, Alan

2017-01-01

Introduction First Nations people are descendants of Canada’s original inhabitants. In consequence of historical and ongoing structural injustices, many First Nations families struggle with challenging living conditions, including high rates of poverty, poor housing conditions, mental illness and social isolation. These risk factors impede caregivers’ abilities to meet their children’s basic physical and psychosocial needs. Home visiting programmes were developed to support child developmental health in families facing parenting challenges. However, whether home visiting is an effective intervention for First Nations families has not been examined. We are evaluating two home visiting programmes in Manitoba, Canada, to determine whether they promote nurturing family environments for First Nations children. Methods and analysis This research builds on new and established relationships among academic researchers, government decision-makers and First Nations stakeholders. We will link health, education and social services data from the Manitoba Population Research Data Repository to data from two home visiting programmes in Manitoba. Logistic regression modelling will be used to assess whether programme participation is associated with improved child developmental health, better connections between families and social services, reduced instances of child maltreatment and being taken into out-of-home care by child welfare and reduced inequities for First Nations families. Non-participating individuals with similar sociodemographic characteristics will serve as comparators. We will use an interrupted time series approach to test for differences in outcomes before and after programme implementation and a propensity score analysis to compare differences between participants and non-participants. Ethics and dissemination Approvals were granted by the Health Information Research Governance Committee of the First Nations Health and Social Secretariat of Manitoba and the

The nursing home as a home: a field study of residents' daily life in the common living rooms.

PubMed

Hauge, Solveig; Kristin, Heggen

2008-02-01

This Norwegian-based study investigates how and to what extent the idea of the nursing home as a home has been realized. For the last two decades, Norway, as other Western Country has had an explicit national policy that nursing homes should become more like homes. The research literature indicates that residents in nursing home seem to lack the opportunities to maintain a private sphere. A field study design was conducted. Data were collected in 1999 in two long-term units in a traditional nursing home by using participant observation and interviewing the residents. A phenomenological hermeneutic analysis strategy was used to get an impression of the residents' everyday life. The residents spend most of their time in the common living room. The common living room has an ambiguous boundary between the public and private spheres, unlike the clear boundaries characterizing a home. The relationship among the residents is fragile, and the residents who can, withdraw from the common living room. Despite having single rooms and more home-like interior decoration, the residents in nursing home still have reduced opportunity to develop a private everyday lifestyle. The long-term unit examined in this research had a forced relationship between the residents, and the residents with best health resources systematically withdraw from the common area to control both where and with whom they wish to spend their time. This study lays the foundation for rethinking daily routines in long-term units in nursing homes. One way to realize the idea of the nursing home as a home could be to define the living room as a clear public area and to give the residents a chance to develop a more private lifestyle by alternating between their private rooms and a public common living room.

Home literacy experiences and early childhood disability: a descriptive study using the National Household Education Surveys (NHES) program database.

PubMed

Breit-Smith, Allison; Cabell, Sonia Q; Justice, Laura M

2010-01-01

The present article illustrates how the National Household Education Surveys (NHES; U.S. Department of Education, 2009) database might be used to address questions of relevance to researchers who are concerned with literacy development among young children. Following a general description of the NHES database, a study is provided that examines the extent to which parent-reported home literacy activities and child emergent literacy skills differ for children with (a) developmental disabilities versus those who are developing typically, (b) single disability versus multiple disabilities, and (c) speech-language disability only versus other types of disabilities. Four hundred and seventy-eight preschool-age children with disabilities and a typically developing matched sample (based on parent report) were identified in the 2005 administration of the Early Childhood Program Participation (ECPP) Survey in the NHES database. Parent responses to survey items were then compared between groups. After controlling for age and socioeconomic status, no significant differences were found in the frequency of home literacy activities for children with and without disabilities. Parents reported higher levels of emergent literacy skills for typically developing children relative to children with disabilities. These findings suggest the importance of considering the home literacy experiences and emergent literacy skills of young children with disabilities when making clinical recommendations.

24 CFR 203.43i - Eligibility of mortgages on Hawaiian Home Lands insured pursuant to section 247 of the National...

Code of Federal Regulations, 2010 CFR

2010-04-01

... Hawaiian Home Lands insured pursuant to section 247 of the National Housing Act. 203.43i Section 203.43i... Eligibility of mortgages on Hawaiian Home Lands insured pursuant to section 247 of the National Housing Act. (a) Eligibility. A mortgage on a homestead lease granted by the Department of Hawaiian Home Lands...

Association between home visiting interventions and First Nations families' health and social outcomes in Manitoba, Canada: protocol for a study of linked population-based administrative data.

PubMed

Brownell, Marni D; Nickel, Nathan C; Enns, Jennifer E; Chartier, Mariette; Campbell, Rhonda; Phillips-Beck, Wanda; Chateau, Dan; Burland, Elaine; Santos, Rob; Katz, Alan

2017-10-10

First Nations people are descendants of Canada's original inhabitants. In consequence of historical and ongoing structural injustices, many First Nations families struggle with challenging living conditions, including high rates of poverty, poor housing conditions, mental illness and social isolation. These risk factors impede caregivers' abilities to meet their children's basic physical and psychosocial needs. Home visiting programmes were developed to support child developmental health in families facing parenting challenges. However, whether home visiting is an effective intervention for First Nations families has not been examined. We are evaluating two home visiting programmes in Manitoba, Canada, to determine whether they promote nurturing family environments for First Nations children. This research builds on new and established relationships among academic researchers, government decision-makers and First Nations stakeholders. We will link health, education and social services data from the Manitoba Population Research Data Repository to data from two home visiting programmes in Manitoba. Logistic regression modelling will be used to assess whether programme participation is associated with improved child developmental health, better connections between families and social services, reduced instances of child maltreatment and being taken into out-of-home care by child welfare and reduced inequities for First Nations families. Non-participating individuals with similar sociodemographic characteristics will serve as comparators. We will use an interrupted time series approach to test for differences in outcomes before and after programme implementation and a propensity score analysis to compare differences between participants and non-participants. Approvals were granted by the Health Information Research Governance Committee of the First Nations Health and Social Secretariat of Manitoba and the University of Manitoba Health Research Ethics Board. Our

Organizational characteristics influencing nursing home social service directors' qualifications: a national study.

PubMed

Simons, Kelsey V

2006-11-01

This research sought to identify organizational characteristics associated with the amount of professional qualifications among a nationally representative sample of nursing home social service directors. A self-administered survey was sent to directors in 675 facilities randomly sampled from a federal database, excluding facilities with fewer than 120 beds that are not required to staff a full-time social worker. The response rate was 45 percent (N = 299). Univariate results showed that most respondents possessed a social work degree, most lacked licensure, and few were clinically supervised. A multiple regression analysis found that nonprofit, independently owned facilities in rural areas staffed social service directors who were significantly more qualified than directors in for-profit, chain-affiliated facilities in urban and suburban areas. Facilities with fewer psychosocial deficiencies and higher occupancy rates employed social service directors with greater qualifications. The implications of these findings for social work education, practice, policy, and research are discussed.

Factors predicting a home death among home palliative care recipients

PubMed Central

Ko, Ming-Chung; Huang, Sheng-Jean; Chen, Chu-Chieh; Chang, Yu-Ping; Lien, Hsin-Yi; Lin, Jia-Yi; Woung, Lin-Chung; Chan, Shang-Yih

2017-01-01

Abstract Awareness of factors affecting the place of death could improve communication between healthcare providers and patients and their families regarding patient preferences and the feasibility of dying in the preferred place. This study aimed to evaluate factors predicting home death among home palliative care recipients. This is a population-based study using a national representative sample retrieved from the National Health Insurance Research Database. Subjects receiving home palliative care, from 2010 to 2012, were analyzed to evaluate the association between a home death and various characteristics related to illness, individual, and health care utilization. A multiple-logistic regression model was used to assess the independent effect of various characteristics on the likelihood of a home death. The overall rate of a home death for home palliative care recipients was 43.6%. Age; gender; urbanization of the area where the patients lived; illness; the total number of home visits by all health care professionals; the number of home visits by nurses; utilization of nasogastric tube, endotracheal tube, or indwelling urinary catheter; the number of emergency department visits; and admission to intensive care unit in previous 1 year were not significantly associated with the risk of a home death. Physician home visits increased the likelihood of a home death. Compared with subjects without physician home visits (31.4%) those with 1 physician home visit (53.0%, adjusted odds ratio [AOR]: 3.23, 95% confidence interval [CI]: 1.93–5.42) and those with ≥2 physician home visits (43.9%, AOR: 2.23, 95% CI: 1.06–4.70) had higher likelihood of a home death. Compared with subjects with hospitalization 0 to 6 times in previous 1 year, those with hospitalization ≥7 times in previous 1 year (AOR: 0.57, 95% CI: 0.34–0.95) had lower likelihood of a home death. Among home palliative care recipients, physician home visits increased the likelihood of a home death

The Medical Home Model and Pediatric Asthma Symptom Severity: Evidence from a National Health Survey.

PubMed

Rojanasarot, Sirikan; Carlson, Angeline M

2018-04-01

The objective was to investigate the association between receiving care under the medical home model and parental assessment of the severity of asthma symptoms. It was hypothesized that parents of children who received care under the medical home model reported less severe asthma symptoms compared with their counterparts, whose care did not meet the medical home criteria. Secondary analyses were conducted using cross-sectional data from the 2011-2012 National Survey of Children's Health. Children with asthma aged 0-17 years were included and classified as receiving care from the medical home if their care contained 5 components: a personal doctor, a usual source of sick care, family-centered care, no problems getting referrals, and effective care coordination. Ordinal logistic regression was used to examine the relationship between parent-rated severity of asthma symptoms (mild, moderate, and severe symptoms) and the medical home. Approximately 52% of 8229 children who reported having asthma received care from the medical home. Only 30.8% of children with severe asthma symptoms received care that met the medical home criteria, compared to 55.7% of children with mild symptoms. After accounting for confounding factors, obtaining care under the medical home model decreased the odds of parent-reported severe asthma symptoms by 31% (adjusted odds ratio 0.69; 95% CI, 0.56-0.85). Study results suggest that the medical home model can reduce parent-rated severity of asthma symptoms. The findings highlight the importance of providing medical home care to children with asthma to improve the outcomes that matter most to children and their families.

Teachers' Value Internalization and Commitment to Implementation of National Junior Secondary School Home Economics Curriculum in South-Western States of Nigeria

ERIC Educational Resources Information Center

Badmus, Medinat

2007-01-01

This study investigated the level of degree to which the home Economics teachers developed value internalization and commitment for the implementation of the National Junior Secondary School Home Economics Curriculum (NJSSHEC). It also determined the state and qualification influence on the level of degree of value internalization and commitment…

From prevention to nursing home care: a comprehensive national audit of stroke care.

PubMed

Horgan, Frances; McGee, Hannah; Hickey, Anne; Whitford, David L; Murphy, Sean; Royston, Maeve; Cowman, Seamus; Shelley, Emer; Conroy, Ronan M; Wiley, Miriam; O'Neill, Desmond

2011-01-01

Many countries are developing national audits of stroke care. However, these typically focus on stroke care from acute event to hospital discharge rather than the full spectrum from prevention to long-term care. We report on a comprehensive national audit of stroke care in the community and hospitals in the Republic of Ireland. The findings provide insights into the wider needs of people with stroke and their families, a basis for developing stroke-appropriate health strategies, and a global model for the evaluation of stroke services. Six national surveys were completed: general practitioners (prevention and primary care), hospital organisational and clinical audit of 2,570 consecutive stroke admissions (acute and hospital care), allied health professionals and public health nurses (discharge to community care), nursing homes (needs of patients discharged to long-term care), and patient and carers (post-hospital phase of rehabilitation and ongoing care). The audit identified substantial deficits in a number of areas including primary prevention, emergency assessment/investigation and treatment in hospital, discharge planning, rehabilitation and ongoing secondary prevention, and communication with patients and families. There was a lack of coordination and communication between the acute and community services, with a dearth of therapy services in both home and nursing home settings. This multi-faceted national stroke audit facilitated multiple perspectives on the continuum of stroke prevention and care. An overall synthesis of surveys supports the development of a multidisciplinary perspective in planning the development of comprehensive stroke services at the national level, and may assist in regional and global development of stroke strategies. Copyright © 2011 S. Karger AG, Basel.

Pediatric Hospital Discharges to Home Health and Postacute Facility Care: A National Study.

PubMed

Berry, Jay G; Hall, Matt; Dumas, Helene; Simpser, Edwin; Whitford, Kathleen; Wilson, Karen M; O'Neill, Margaret; Mittal, Vineeta; Agrawal, Rishi; Dribbon, Michael; Haines, Christopher J; Traul, Christine; Marks, Michelle; O'Brien, Jane

2016-04-01

Acute care hospitals are challenged to provide efficient, high-quality care to children who have medically complex conditions and may require weeks or months for recovery. Although the use of home health care (HHC) and facility-based postacute care (PAC) after discharge is well documented for adults, to our knowledge, little is known for children. To assess the national prevalence of, characteristics of children discharged to, and variation in use across states of HHC and PAC for children. Retrospective analysis of 2,423,031 US acute care hospital discharges in 2012 for patients ages 0 to 21 years from the nationally representative Agency for Healthcare Research and Quality Kids' Inpatient Database. Discharges to HHC (eg, visiting or private-duty home nursing) and PAC (eg, rehabilitation facility) were identified from Centers for Medicare and Medicaid Services Discharge Status Codes. We compared children's characteristics (eg, race/ethnicity and number of chronic conditions) by discharge type using generalized linear regression. The median age of participants was 3 years (interquartile range, 0-13 years), and 45.6% were female. Of 2,423,031 US acute care hospital discharges in 2012 for patients ages 0 to 21 years, 122,673 discharges (5.1%) were to HHC and 26,282 (1.1%) were to PAC facilities. Neonatal care was the most common reason (44.5%, n = 54,589) for acute care hospitalization with discharge to HHC. Nonneonatal respiratory, musculoskeletal, and trauma-related problems, collectively, were the most common reasons for discharge to PAC (42.9%, n = 11,275). When compared with PAC, more discharges to HHC had no chronic condition (34.4% vs 18.0%, P < .001) and fewer discharges to HHC had 4 or more chronic conditions (22.5% vs 37.7%, P < .001). In multivariable analysis, Hispanic children were less likely to use PAC (0.8% vs 1.1%; odds ratio [OR], 0.9 [95% CI, 0.8-0.9]) or HHC (3.3% vs 5.5%; OR, 0.8 [95% CI, 0.7-0.8]) compared with other children. Children with 4 or

Trends in US home food preparation and consumption: analysis of national nutrition surveys and time use studies from 1965-1966 to 2007-2008.

PubMed

Smith, Lindsey P; Ng, Shu Wen; Popkin, Barry M

2013-04-11

It has been well-documented that Americans have shifted towards eating out more and cooking at home less. However, little is known about whether these trends have continued into the 21st century, and whether these trends are consistent amongst low-income individuals, who are increasingly the target of public health programs that promote home cooking. The objective of this study is to examine how patterns of home cooking and home food consumption have changed from 1965 to 2008 by socio-demographic groups. This is a cross-sectional analysis of data from 6 nationally representative US dietary surveys and 6 US time-use studies conducted between 1965 and 2008. Subjects are adults aged 19 to 60 years (n= 38,565 for dietary surveys and n=55,424 for time-use surveys). Weighted means of daily energy intake by food source, proportion who cooked, and time spent cooking were analyzed for trends from 1965-1966 to 2007-2008 by gender and income. T-tests were conducted to determine statistical differences over time. The percentage of daily energy consumed from home food sources and time spent in food preparation decreased significantly for all socioeconomic groups between 1965-1966 and 2007-2008 (p ≤ 0.001), with the largest declines occurring between 1965 and 1992. In 2007-2008, foods from the home supply accounted for 65 to 72% of total daily energy, with 54 to 57% reporting cooking activities. The low income group showed the greatest decline in the proportion cooking, but consumed more daily energy from home sources and spent more time cooking than high income individuals in 2007-2008 (p ≤ 0.001). US adults have decreased consumption of foods from the home supply and reduced time spent cooking since 1965, but this trend appears to have leveled off, with no substantial decrease occurring after the mid-1990's. Across socioeconomic groups, people consume the majority of daily energy from the home food supply, yet only slightly more than half spend any time cooking on a given

Factors associated with delivery at home in Bhutan: findings from the National Health Survey 2012.

PubMed

Gurung, Mongal Singh; Pelzom, Dorji; Wangdi, Sonam; Tshomo, Tashi; Lethro, Pema; Dema, Tashi

2018-04-01

Despite Bhutan's remarkable progress in the area of maternal and child health during the era of the Millennium Development Goals, a large proportion of pregnant women are still delivering at home with no skilled attendant. Limited empirical studies have been carried out to understand the factors associated with delivery at home in Bhutan. This cross-sectional analytical study used secondary data collected in the nationally representative National Health Survey 2012. The survey included a total of 2213 women aged 15-49 years who had a live birth in the 2 years preceding the survey and were selected using multistage stratified cluster sampling. Weighted analysis was done to evaluate determinants for the place of delivery. Unadjusted and adjusted prevalence ratios with 95% confidence intervals (CIs) were calculated to assess the possible association of factors with home delivery. Out of 2213 women aged 15-49 years who had a live birth in the 2 years preceding the survey, 73.7% had an institutional delivery. Coverage of institutional delivery ranged from 49.4% in Zhemgang district to 96.1% in Paro district. Women in the poorest wealth quintile were 7.35 times more likely to have a birth at home compared to women in the richest quintile (adjusted prevalence ratio [aPR]: 7.35, 95% CI: 2.59-20.9). The older mothers aged 30-49 years were 0.79 times (aPR: 0.79, 95% CI: 0.70-0.88) less likely to have a home delivery than mothers aged 15-19 years. Women who had fewer than four antenatal care visits were 1.50 times (aPR: 1.50, 95% CI: 1.35-1.66) more likely to give birth at home compared to those who had four or more visits. The mothers giving birth for a third or more time were 1.88 times (aPR: 1.88, 95% CI: 1.60-2.22) more likely to give birth at home compared to those giving birth for the first time. Women living in rural areas were 2.87 times (aPR: 2.87, 95% CI: 1.42-5.77) more likely to deliver at home compared to those living in urban areas and women living in the

Home-based anthropometric, blood pressure and pulse measurements in young children by trained data collectors in the National Children's Study.

PubMed

Zimowski, Michele; Moye, Jack; Dugoni, Bernard; Heim Viox, Melissa; Cohen, Hildie; Winfrey, Krishna

2017-02-01

The current study assessed whether home-based data collection by trained data collectors can produce high-quality physical measurement data in young children. The study assessed the quality of intra-examiner measurements of blood pressure, pulse rate and anthropometric dimensions using intra-examiner reliability and intra-examiner technical error of measurement (TEM). Non-clinical, primarily private homes of National Children's Study participants in twenty-two study locations across the USA. Children in four age groups: 5-7 months (n 91), 11-16 months (n 393), 23-28 months (n 1410) and 35-40 months (n 800). Absolute TEM ranged in value from 0·09 to 16·21, varying widely by age group and measure, as expected. Relative TEM spanned from 0·27 to 13·71 across age groups and physical measures. Reliabilities for anthropometric measurements by age group and measure ranged from 0·46 to >0·99 with most exceeding 0·90, suggesting that the large majority of anthropometric measures can be collected in a home-based setting on young children by trained data collectors. Reliabilities for blood pressure and pulse rate measurements by age group ranged from 0·21 to 0·74, implying these are less reliably measured with young children when taken in the data collection context described here. Reliability estimates >0·95 for weight, length, height, and thigh, waist and head circumference, and >0·90 for triceps and subscapular skinfolds, indicate that these measures can be collected in the field by trained data collectors without compromising data quality. These estimates can be used for interim evaluations of data collector training and measurement protocols.

Home visits in primary care: contents and organisation in daily practice. Study protocol of a cross-sectional study.

PubMed

Voigt, Karen; Bojanowski, Stefan; Taché, Stephanie; Voigt, Roger; Bergmann, Antje

2016-02-26

Medical care of homebound patients by home visits is an integral part of primary care in Germany and other industrialised countries. Owing to the sociodemography and changes in the health system, the need for home visits is projected to increase rather than decrease. Our study will provide information on content and organisation of home visits. This evidence is needed to assure sufficient medical care for homebound patients. Germany is one of the European nations with highest proportions of elderly age groups, so that our results will be indicative for other European countries with comparable organisation of primary care. This cross-sectional study is conducted over a period of 12 months. All home visits of each participating family practice are documented within a 1-week time period. The anonymous documentation of home visits is carried out by the family practitioner or medical assistant conducting the home visit. All Saxon Family practitioners received study information and were personally invited to participate in our study. Almost 303 (of 2677) family practitioners expressed their interest to participate to generate data on the content and organisational characteristics of home visits. Data analysis of more than 4000 home visits will take into account several patient-related and system-related parameters. Descriptive and multivariate analysis will be carried out by using non-parametric methods. Regarding expected cluster structure of the data, a multilevel analysis will be necessary. The study received ethical approval by the Ethical Commission of the TU Dresden and adheres to the Declaration of Helsinki. Considering that the results of our project will be indicative for ageing societies with comparable organisation of primary care, we will publish them in international open access journals concerned with healthcare and primary care research and disseminate them by a final symposium and at national/international scientific events. Published by the BMJ

Suicide among nursing home residents in Australia: A national population-based retrospective analysis of medico-legal death investigation information.

PubMed

Murphy, Briony J; Bugeja, Lyndal C; Pilgrim, Jennifer L; Ibrahim, Joseph E

2018-05-01

Suicide among nursing home residents is a growing public health concern, currently lacking in empirical research. This study aims to describe the frequency and nature of suicide among nursing home residents in Australia. This research comprised a national population-based retrospective analysis of suicide deaths among nursing home residents in Australia reported to the Coroner between July 2000 and December 2013. Cases were identified using the National Coronial Information System, and data collected from paper-based coroners' records on individual, incident, and organizational factors, as well as details of the medico-legal death investigation. Data analysis comprised univariate and bivariate descriptive statistical techniques; ecological analysis of incidence rates using population denominators; and comparison of age and sex of suicide cases to deaths from other causes using logistic regression. The study identified 141 suicides among nursing home residents, occurring at a rate of 0.02 deaths per 100 000 resident bed days. The ratio of deaths from suicide to deaths from any other cause was higher in males than females (OR = 3.56, 95%CI = 2.48-5.12, P = <0.001). Over half of the residents who died from suicide had a diagnosis of depression (n = 93, 66.0%) and had resided in the nursing home for less than 12 months (n = 71, 50.3%). Common major life stressors identified in suicide cases included the following: health deterioration (n = 112, 79.4%); isolation and loneliness (n = 60, 42.6%); and maladjustment to nursing home life (n = 42, 29.8%). This research provides a foundational understanding of suicide among nursing home residents in Australia and contributes important new information to the international knowledge base. Copyright © 2018 John Wiley & Sons, Ltd.

Nursing Home Administrators' Opinions of the Nursing Home Compare Web Site

ERIC Educational Resources Information Center

Castle, Nicholas G.

2005-01-01

Purpose: In November of 2002 the Centers for Medicare and Medicaid Services publicly reported on a national basis the quality of nursing homes on the Nursing Home Compare (NHC) Web site. This study examines administrators' opinions of this initiative and whether it has fostered quality improvement. Design and Methods: Data used in this…

Associations of Special Care Units and Outcomes of Residents with Dementia: 2004 National Nursing Home Survey

ERIC Educational Resources Information Center

Luo, Huabin; Fang, Xiangming; Liao, Youlian; Elliott, Amanda; Zhang, Xinzhi

2010-01-01

Purpose: We compared the rates of specialized care for residents with Alzheimer's disease or dementia in special care units (SCUs) and other nursing home (NH) units and examined the associations of SCU residence with process of care and resident outcomes. Design and Methods: Data came from the 2004 National Nursing Home Survey. The indicators of…

Home Country National Intelligence and Self-Employment Rates among Immigrants in Norway

ERIC Educational Resources Information Center

Vinogradov, Evgueni; Kolvereid, Lars

2010-01-01

The level of self-employment varies significantly among immigrants from different countries of origin. The objective of this research is to examine the relationship between home-country national intelligence and self-employment rates among first generation immigrants in Norway. Empirical secondary data on self-employment among immigrants from 117…

Making the transition from lead poisoning prevention to healthy homes: a qualitative study.

PubMed

Maring, Elisabeth F; Singer, Barbara Jones; Shenassa, Edmond D

2010-01-01

The goal of this study was to create a guide for programs considering transition from Lead Poisoning Prevention to Healthy Homes. Healthy Homes programs are comprehensive, focusing on multiple residential housing hazards. This study focused on the Baltimore City Healthy Homes Division, which was selected by the Centers for Disease Control and Prevention to pilot the transition process. For this qualitative study, data were collected through interviews with program staff from the Baltimore City Healthy Homes Division and followed up by focus groups with community members who received its services. Grounded theory procedures were used for data analysis. Interviews and focus groups were conducted in Baltimore City near the Health Department. Seventeen interviews were conducted with Baltimore City Healthy Homes Division staff. Three focus groups were held with 3 to 6 community participants in each group. Findings for the study are arranged around an organizational framework for which transition from Lead Poisoning Prevention to Healthy Homes is the central phenomenon. Three general themes emerged: (1) programmatic changes; (2) policy changes; and (3) partnerships. Quotations from participating staff and community members provide supporting evidence for the results. Findings provide insight into the strengths and challenges of transition for 1 program. The study has implications for change on a national level as programs around the country transition to provide families with comprehensive Healthy Homes services.

National Structural Survey of Veterans Affairs Home-Based Primary Care Programs.

PubMed

Karuza, Jurgis; Gillespie, Suzanne M; Olsan, Tobie; Cai, Xeuya; Dang, Stuti; Intrator, Orna; Li, Jiejin; Gao, Shan; Kinosian, Bruce; Edes, Thomas

2017-12-01

To describe the current structural and practice characteristics of the Department of Veterans Affairs (VA) Home-Based Primary Care (HBPC) program. We designed a national survey and surveyed HBPC program directors on-line using REDCap. We received 236 surveys from 394 identified HBPC sites (60% response rate). HBPC site characteristics were quantified using closed-ended formats. HBPC program directors were most often registered nurses, and HBPC programs primarily served veterans with complex chronic illnesses that were at high risk of hospitalization and nursing home care. Primary care was delivered using interdisciplinary teams, with nurses, social workers, and registered dietitians as team members in more than 90% of the sites. Most often, nurse practitioners were the principal primary care providers (PCPs), typically working with nurse case managers. Nearly 60% of the sites reported dual PCPs involving VA and community-based physicians. Nearly all sites provided access to a core set of comprehensive services and programs (e.g., case management, supportive home health care). At the same time, there were variations according to site (e.g., size, location (urban, rural), use of non-VA hospitals, primary care models used). HBPC sites reflected the rationale and mission of HBPC by focusing on complex chronic illness of home-based veterans and providing comprehensive primary care using interdisciplinary teams. Our next series of studies will examine how HBPC site structural characteristics and care models are related to the processes and outcomes of care to determine whether there are best practice standards that define an optimal HBPC structure and care model or whether multiple approaches to HBPC better serve the needs of veterans. Published 2017. This article is a U.S. Government work and is in the public domain in the USA.

Listen to the Voices of Unwed Teenage Mothers in Malaysian Shelter Homes: An Explorative Study

PubMed Central

Saim, Nor Jana; Dufåker, Mona; Eriksson, Malin; Ghazinour, Mehdi

2013-01-01

This qualitative research aims to explore the daily life experiences of Malaysian unwed teenage mothers in shelter homes. The research is based on the thematic analysis of interviews with seventeen respondents aged from 12 to 18 years. Eight sub-themes described the experience of the unwed teenage mothers in the shelter home and led to three overall themes: rules and regulations, relationship with the staff and relationship with the other girls at the shelter home. The findings indicated that the shelter homes involved were not fulfilling the standard of the Malaysian national laws and United Nations Convention on the Rights of the Child. We strongly suggest that the authorities provide a clear guideline concerning the implementation of Malaysian national laws and United Nations Convention on the Rights of the Child. PMID:23985103

Dustborne Alternaria alternata antigens in U.S. homes: Results from the National Survey of Lead and Allergens in Housing

PubMed Central

Salo, Päivi M.; Yin, Ming; Arbes, Samuel J.; Cohn, Richard D.; Sever, Michelle; Muilenberg, Michael; Burge, Harriet A.; London, Stephanie J.; Zeldin, Darryl C.

2005-01-01

Background: Alternaria alternata is one of the most common fungi associated with allergic disease. However, Alternaria exposure in indoor environments is not well characterized. Objective: The primary goals of this study were to examine the prevalence of Alternaria exposure and identify independent predictors of Alternaria antigen concentrations in U.S. homes. Methods: Data for this cross-sectional study were obtained from the National Survey of Lead and Allergens in Housing. A nationally representative sample of 831 housing units in 75 different locations throughout the U.S. completed the survey. Information on housing and household characteristics was obtained by questionnaire and environmental assessments. Concentrations of Alternaria antigens in dust collected from various indoor sites were assessed with a polyclonal anti-Alternaria antibody assay. Results: Alternaria antigens were detected in most (95-99%) of the dust samples. The geometric mean concentration, reflecting the average Alternaria concentration in homes, was 4.88 μg/g (SE=0.13 μg/g). In the multivariable linear regression analysis, the age of the housing unit, geographic region, urbanization, poverty, family race, observed mold and moisture problems, use of dehumidifier, and presence of cats and dogs were independent predictors of Alternaria antigen concentrations. Less frequent cleaning and smoking indoors also contributed to higher Alternaria antigen levels in homes. Conclusion: Exposure to Alternaria alternata antigens in U.S. homes is common. Antigen levels in homes are not only influenced by regional factors but also by residential characteristics. Preventing mold and moisture problems, avoiding smoking indoors, and regular household cleaning may help reduce exposure to Alternaria antigens indoors. PMID:16159634

Adherence of pain assessment to the German national standard for pain management in 12 nursing homes.

PubMed

Osterbrink, Jürgen; Bauer, Zsuzsa; Mitterlehner, Barbara; Gnass, Irmela; Kutschar, Patrick

2014-01-01

Pain is very common among nursing home residents. The assessment of pain is a prerequisite for effective multiprofessional pain management. Within the framework of the German health services research project, 'Action Alliance Pain-Free City Muenster', the authors investigated pain assessment adherence according to the German national Expert Standard for Pain Management in Nursing, which is a general standard applicable to all chronic⁄acute pain-affected persons and highly recommended for practice. To evaluate the state of pain assessment and to identify need for improvement in 12 nursing homes in a German city. In the present study, the authors used an ex-post-facto design (survey methodology). Available written policies for routine pain assessment in residents ≥65 years of age were reviewed and a standardized online survey completed by 151 of 349 nurses in 12 nursing home facilities was conducted between September 2010 and April 2011. Most of the included nursing homes provided written policies for pain assessment, and the majority of nurses reported that they assess and regularly reassess pain. However, observational tools for residents with severe cognitive impairment and written reassessment schedules were lacking in many facilities or were inconsistent. Essentially, pain assessment appeared to be feasible in the majority of the German nursing homes studied. However, the absence or inconsistency of reassessment schedules indicate that pain management guidelines should include a detailed and explicit reassessment schedule for the heterogenic needs of nursing home residents. For residents with severe cognitive impairment, assessment tools are needed that are simple to use and clearly indicate the presence or absence of pain.

Delivery of a national home safety equipment scheme in England: a survey of local scheme leaders.

PubMed

Mulvaney, C A; Watson, M C; Hamilton, T; Errington, G

2013-11-01

Unintentional home injuries sustained by preschool children are a major cause of morbidity in the UK. Home safety equipment schemes may reduce home injury rates. In 2009, the Royal Society for the Prevention of Accidents was appointed as central coordinator of a two-year, £18m national home safety equipment scheme in England. This paper reports the findings from a national survey of all scheme leaders responsible for local scheme delivery. A questionnaire mailed to all local scheme leaders sought details of how the schemes were operated locally; barriers and facilitators to scheme implementation; evaluation of the local scheme and its sustainability. A response rate of 73% was achieved. Health visitors and family support workers played a key role in both the identification of eligible families and performing home safety checks. The majority of local scheme leaders (94.6%) reported that they thought their local scheme had been successful in including those families considered 'harder to engage'. Many scheme leaders (72.4%) reported that they had evaluated the provision of safety equipment in their scheme and over half (56.6%) stated that they would not be able to continue the scheme once funding ceased. Local schemes need support to effectively evaluate their scheme and to seek sustainability funding to ensure the future of the scheme. There remains a lack of evidence of whether the provision of home safety equipment reduces injuries in preschool children.

Nursing Home Nomads: A Study of Transfers.

ERIC Educational Resources Information Center

Retsinas, Joan

Researchers have divided nursing home residents into long-stayers and short-stayers. While long-stayers rarely return home, they do not necessarily stay long in one institution. Instead, they may transfer from nursing home to nursing home. Although many studies have examined the impact of relocation on nursing home residents, few studies have…

38 CFR 21.129 - Home study course.

Code of Federal Regulations, 2012 CFR

2012-07-01

... 38 Pensions, Bonuses, and Veterans' Relief 2 2012-07-01 2012-07-01 false Home study course. 21.129... Educational and Vocational Training Services § 21.129 Home study course. (a) Definition. A home study course... inclusion of home study courses, in rehabilitation plans. A veteran and his or her case manager may include...

38 CFR 21.129 - Home study course.

Code of Federal Regulations, 2014 CFR

2014-07-01

... 38 Pensions, Bonuses, and Veterans' Relief 2 2014-07-01 2014-07-01 false Home study course. 21.129... Educational and Vocational Training Services § 21.129 Home study course. (a) Definition. A home study course... inclusion of home study courses, in rehabilitation plans. A veteran and his or her case manager may include...

38 CFR 21.129 - Home study course.

Code of Federal Regulations, 2013 CFR

2013-07-01

... 38 Pensions, Bonuses, and Veterans' Relief 2 2013-07-01 2013-07-01 false Home study course. 21.129... Educational and Vocational Training Services § 21.129 Home study course. (a) Definition. A home study course... inclusion of home study courses, in rehabilitation plans. A veteran and his or her case manager may include...

A mixed methods study of the work patterns of full-time nurse practitioners in nursing homes.

PubMed

Martin-Misener, Ruth; Donald, Faith; Wickson-Griffiths, Abigail; Akhtar-Danesh, Noori; Ploeg, Jenny; Brazil, Kevin; Kaasalainen, Sharon; McAiney, Carrie; Carter, Nancy; Schindel Martin, Lori; Sangster-Gormley, Esther; Taniguchi, Alan

2015-05-01

The aim of this study was to explore the integration of the nurse practitioner role in Canadian nursing homes to enable its full potential to be realised for resident and family care. The objective was to determine nurse practitioners' patterns of work activities. Nurse practitioners were introduced in Canadian nursing homes a decade ago on a pilot basis. In recent years, government and nursing home sector interest in the role has grown along with the need for data to inform planning efforts. The study used a sequential mixed methods design using a national survey followed by case studies. A national survey of nurse practitioners included demographic items and the EverCare Nurse Practitioner Role and Activity Scale. Following the survey, case studies were conducted in four nursing homes. Data were collected using individual and focus group interviews, document reviews and field notes. Twenty-three of a target population of 26 nurse practitioners responded to the survey, two-thirds of whom provided services in nursing homes with one site and the remainder in nursing homes with as many as four sites. On average, nurse practitioners performed activities in communicator, clinician, care manager/coordinator and coach/educator subscales at least three to four times per week and activities in the collaborator subscale once a week. Of the 43 activities, nurse practitioners performed daily, most were in the clinician and communicator subscales. Case study interviews involved 150 participants. Findings complemented those of the survey and identified additional leadership activities. Nurse practitioners undertake a range of primary health care and advanced practice activities which they adapt to meet the unique needs of nursing homes. Knowledge of work patterns enables nursing homes to implement the full range of nurse practitioner roles and activities to enhance resident and family care. © 2014 John Wiley & Sons Ltd.

76 FR 44573 - Child and Adult Care Food Program: National Average Payment Rates, Day Care Home Food Service...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-07-26

... DEPARTMENT OF AGRICULTURE Food and Nutrition Service Child and Adult Care Food Program: National Average Payment Rates, Day Care Home Food Service Payment Rates, and Administrative Reimbursement Rates for Sponsoring Organizations of Day Care Homes for the Period July 1, 2011 Through June 30, 2012...

78 FR 45176 - Child and Adult Care Food Program: National Average Payment Rates, Day Care Home Food Service...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-07-26

... DEPARTMENT OF AGRICULTURE Food and Nutrition Service Child and Adult Care Food Program: National Average Payment Rates, Day Care Home Food Service Payment Rates, and Administrative Reimbursement Rates for Sponsoring Organizations of Day Care Homes for the Period July 1, 2013 Through June 30, 2014...

76 FR 43254 - Child and Adult Care Food Program: National Average Payment Rates, Day Care Home Food Service...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-07-20

... DEPARTMENT OF AGRICULTURE Food and Nutrition Service Child and Adult Care Food Program: National Average Payment Rates, Day Care Home Food Service Payment Rates, and Administrative Reimbursement Rates for Sponsoring Organizations of Day Care Homes for the Period July 1, 2011 Through June 30, 2012...

Use of physical restraints and antipsychotic medications in nursing homes: a cross-national study

PubMed Central

Feng, Zhanlian; Hirdes, John P.; Smith, Trevor F.; Finne-Soveri, Harriet; Chi, Iris; Pasquier, Jean-Noel Du; Gilgen, Ruedi; Ikegami, Naoki; Mor, Vincent

2013-01-01

SUMMARY Objectives This study compares inter- and intra-country differences in the prevalence of physical restraints and antipsychotic medications in nursing homes, and examines aggregated resident conditions and organizational characteristics correlated with these treatments. Methods Population-based, cross-sectional data were collected using a standardized Resident Assessment Instrument (RAI) from 14,504 long-term care facilities providing nursing home level services in five countries participating in the interRAI consortium, including Canada, Finland, Hong Kong (Special Administrative Region, China), Switzerland, and the United States. Facility-level prevalence rates of physical restraints and antipsychotic use were examined both between and within the study countries. Results The prevalence of physical restraint use varied more than five-fold across the study countries, from an average 6% in Switzerland, 9% in the US, 20% in Hong Kong, 28% in Finland, and over 31% in Canada. The prevalence of antipsychotic use ranged from 11% in Hong Kong, between 26–27% in Canada and the US, 34% in Switzerland, and nearly 38% in Finland. Within each country, substantial variations existed across facilities in both physical restraint and antipsychotic use rates. In all countries, neither facility case mix nor organizational characteristics were particularly predictive of the prevalence of either treatment. Conclusions There exists large, unexplained variability in the prevalence of physical restraint and antipsychotic use in nursing home facilities both between and within countries. Since restraints and antipsychotics are associated with adverse outcomes, it is important to understand the idiosyncratic factors specific to each country that contribute to variation in use rates. PMID:19280680

Use of physical restraints and antipsychotic medications in nursing homes: a cross-national study.

PubMed

Feng, Zhanlian; Hirdes, John P; Smith, Trevor F; Finne-Soveri, Harriet; Chi, Iris; Du Pasquier, Jean-Noel; Gilgen, Ruedi; Ikegami, Naoki; Mor, Vincent

2009-10-01

This study compares inter- and intra-country differences in the prevalence of physical restraints and antipsychotic medications in nursing homes, and examines aggregated resident conditions and organizational characteristics correlated with these treatments. Population-based, cross-sectional data were collected using a standardized Resident Assessment Instrument (RAI) from 14,504 long-term care facilities providing nursing home level services in five countries participating in the interRAI consortium, including Canada, Finland, Hong Kong (Special Administrative Region, China), Switzerland, and the United States. Facility-level prevalence rates of physical restraints and antipsychotic use were examined both between and within the study countries. The prevalence of physical restraint use varied more than five-fold across the study countries, from an average 6% in Switzerland, 9% in the US, 20% in Hong Kong, 28% in Finland, and over 31% in Canada. The prevalence of antipsychotic use ranged from 11% in Hong Kong, between 26-27% in Canada and the US, 34% in Switzerland, and nearly 38% in Finland. Within each country, substantial variations existed across facilities in both physical restraint and antipsychotic use rates. In all countries, neither facility case mix nor organizational characteristics were particularly predictive of the prevalence of either treatment. There exists large, unexplained variability in the prevalence of physical restraint and antipsychotic use in nursing home facilities both between and within countries. Since restraints and antipsychotics are associated with adverse outcomes, it is important to understand the idiosyncratic factors specific to each country that contribute to variation in use rates. Copyright (c) 2009 John Wiley & Sons, Ltd.

Introduction: shifting meanings of home.

PubMed

Hart, Mechthild; Ben-Yoseph, Miriam

2005-01-01

The studies and narratives collected in this special volume acknowledge "home" as a complex, ambiguous notion and reality. The contributors pay tribute to different ways of experiencing home, and to multiple connections to place and time. They illustrate how home is a social edifice, how it embodies different meanings and values, how it demarcates individual and social or national identities, and how a longing for home permeates experiences of homelessness as well as cultural, spatial, linguistic, and economic transitions.

Case Study of Home-School Visits

ERIC Educational Resources Information Center

Aguerrebere, Yolanda

2009-01-01

This case study evaluated one site of a California teacher home visit program. Home visits have been an important means of connecting families and schooling. In 1999, California inaugurated a statewide home visit program to promote effective partnership between home and school for low-achieving schools. At this site, families in 3 kindergarten…

DOE Challenge Home Case Study: e2 Homes – Winter Park, Florida

DOE Office of Scientific and Technical Information (OSTI.GOV)

none,

2013-01-01

This Challenge Home case study describes the first certified DOE Challenge Home as constructed by e2 Homes. Completed in May 2012, the “Wilson Residence” in Winter Park, Florida, is a 4,305-ft2 custom home that scores a HERS 57 without solar and a better than zero net-energy HERS -7 with solar.

Comparing unplanned and potentially planned home deaths: a population-based cross-sectional study.

PubMed

Kjellstadli, Camilla; Husebø, Bettina Sandgathe; Sandvik, Hogne; Flo, Elisabeth; Hunskaar, Steinar

2018-05-02

There is little research on number of planned home deaths. We need information about factors associated with home deaths, but also differences between planned and unplanned home deaths to improve end-of-life-care at home and make home deaths a feasible alternative. Our aim was to investigate factors associated with home deaths, estimate number of potentially planned home deaths, and differences in individual characteristics between people with and without a potentially planned home death. A cross-sectional study of all decedents in Norway in 2012 and 2013, using data from the Norwegian Cause of Death Registry and National registry for statistics on municipal health and care services. We defined planned home death by an indirect algorithm-based method using domiciliary care and diagnosis. We used logistic regressions models to evaluate factors associated with home death compared with nursing home and hospital; and to compare unplanned home deaths and potentially planned home deaths. Among 80,908 deaths, 12,156 (15.0%) were home deaths. A home death was most frequent in 'Circulatory diseases' and 'Cancer', and associated with male sex, younger age, receiving domiciliary care and living alone. Only 2.3% of home deaths were from 'Dementia'. In total, 41.9% of home deaths and 6.3% of all deaths were potentially planned home deaths. Potentially planned home deaths were associated with higher age, but declined in ages above 80 years for people who had municipal care. Living together with someone was associated with more potentially planned home deaths for people with municipal care. There are few home deaths in Norway. Our estimations indicate that even fewer people than anticipated have a potentially planned home death.

Adherence of pain assessment to the German national standard for pain management in 12 nursing homes

PubMed Central

Osterbrink, Jürgen; Bauer, Zsuzsa; Mitterlehner, Barbara; Gnass, Irmela; Kutschar, Patrick

2014-01-01

BACKGROUND: Pain is very common among nursing home residents. The assessment of pain is a prerequisite for effective multiprofessional pain management. Within the framework of the German health services research project, ‘Action Alliance Pain-Free City Muenster’, the authors investigated pain assessment adherence according to the German national Expert Standard for Pain Management in Nursing, which is a general standard applicable to all chronic/acute pain-affected persons and highly recommended for practice. OBJECTIVES: To evaluate the state of pain assessment and to identify need for improvement in 12 nursing homes in a German city. METHODS: In the present study, the authors used an ex-post-facto design (survey methodology). Available written policies for routine pain assessment in residents ≥65 years of age were reviewed and a standardized online survey completed by 151 of 349 nurses in 12 nursing home facilities was conducted between September 2010 and April 2011. RESULTS: Most of the included nursing homes provided written policies for pain assessment, and the majority of nurses reported that they assess and regularly reassess pain. However, observational tools for residents with severe cognitive impairment and written reassessment schedules were lacking in many facilities or were inconsistent. CONCLUSIONS: Essentially, pain assessment appeared to be feasible in the majority of the German nursing homes studied. However, the absence or inconsistency of reassessment schedules indicate that pain management guidelines should include a detailed and explicit reassessment schedule for the heterogenic needs of nursing home residents. For residents with severe cognitive impairment, assessment tools are needed that are simple to use and clearly indicate the presence or absence of pain. PMID:24851238

Home Study Course Development Handbook.

ERIC Educational Resources Information Center

Lambert, Michael P., Ed.; Welch, Sally R., Ed.

Intended for independent study directors, course authors, and directors of home based or distance learning projects, this collection of current, practical guides on correspondence course development contains fourteen chapters authored by practicing home study educators and experts in their field. From Theory to Practice lists steps in course…

Trends in US home food preparation and consumption: analysis of national nutrition surveys and time use studies from 1965–1966 to 2007–2008

PubMed Central

2013-01-01

Background It has been well-documented that Americans have shifted towards eating out more and cooking at home less. However, little is known about whether these trends have continued into the 21st century, and whether these trends are consistent amongst low-income individuals, who are increasingly the target of public health programs that promote home cooking. The objective of this study is to examine how patterns of home cooking and home food consumption have changed from 1965 to 2008 by socio-demographic groups. Methods This is a cross-sectional analysis of data from 6 nationally representative US dietary surveys and 6 US time-use studies conducted between 1965 and 2008. Subjects are adults aged 19 to 60 years (n= 38,565 for dietary surveys and n=55,424 for time-use surveys). Weighted means of daily energy intake by food source, proportion who cooked, and time spent cooking were analyzed for trends from 1965–1966 to 2007–2008 by gender and income. T-tests were conducted to determine statistical differences over time. Results The percentage of daily energy consumed from home food sources and time spent in food preparation decreased significantly for all socioeconomic groups between 1965–1966 and 2007–2008 (p ≤ 0.001), with the largest declines occurring between 1965 and 1992. In 2007–2008, foods from the home supply accounted for 65 to 72% of total daily energy, with 54 to 57% reporting cooking activities. The low income group showed the greatest decline in the proportion cooking, but consumed more daily energy from home sources and spent more time cooking than high income individuals in 2007–2008 (p ≤ 0.001). Conclusions US adults have decreased consumption of foods from the home supply and reduced time spent cooking since 1965, but this trend appears to have leveled off, with no substantial decrease occurring after the mid-1990’s. Across socioeconomic groups, people consume the majority of daily energy from the home food supply, yet only

Business Metrics for High-Performance Homes: A Colorado Springs Case Study

DOE Office of Scientific and Technical Information (OSTI.GOV)

Beach, R.; Jones, A.

This report explores the correlation between energy efficiency and the business success of home builders by examining a data set of builders and homes in the Colorado Springs, Colorado, market between 2006 and 2014. During this time, the Great Recession of 2007 to 2009 occurred, and new-home sales plummeted both nationally and in Colorado Springs. What is evident from an analysis of builders and homes in Colorado Springs is that builders who had Home Energy Rating System (HERS) ratings performed on some or all of their homes during the Recession remained in business during this challenging economic period. Many buildersmore » who did not have HERS ratings performed on their homes at that time went out of business or left the area. From the analysis presented in this report, it is evident that a correlation exists between energy efficiency and the business success of home builders, although the reasons for this correlation remain largely anecdotal and not yet clearly understood.« less

Comparison of stool collection on site versus at home in a population-based study : feasibility and participants' preference in Pretest 2 of the German National Cohort.

PubMed

Schultze, A; Akmatov, M K; Andrzejak, M; Karras, N; Kemmling, Y; Maulhardt, A; Wieghold, S; Ahrens, W; Günther, K; Schlenz, H; Krause, G; Pessler, F

2014-11-01

For certain laboratory investigations it is necessary to obtain native stool samples and process them within a narrow time window at the point of contact or a nearby laboratory. However, it is not known whether it is feasible to obtain stool samples from asymptomatic individuals during an appointment in a study center (SC). We therefore compared participants' preference, feasibility and acceptance of stool sample collection during the appointment at the study center (on-site sampling) to collection at home after the appointment. The study was conducted at two sites in Northern Germany (Bremen, n = 156; Hannover, n = 147) during the Pretest 2 phase of the German National Cohort (GNC), drawing upon a randomly selected population supplemented by a small convenience sample. In the study center, the participants were given the choice to provide a stool sample during the appointment or to collect a sample later at home and return it by mail. In all, 303 of the 351 participants (86 %) of Pretest 2 at these sites participated in this feasibility study. Only 7.9 % (24/303) of the participants chose on-site collection, whereas 92 % (279/303) chose at-home collection. There were significant differences between the two study sites in that 14 % (21/147) of participants in Hannover and 2 % (3/156) of participants in Bremen chose on-site collection. Compliance was high in both groups, as 100 % (24/24) and 98 % (272/279) of participants in the on-site and at-home groups, respectively, provided complete samples. Both methods were highly accepted, as 92 % of the participants in each group (22/24 and 227/248) stated that stool collection at the respective site was acceptable. When given a choice, most participants in this population-based study preferred home collection of stool samples to collection in the study center. Thus, native stool samples for immediate processing in the study center may potentially be obtained only from a subpopulation of

Improving quality and safety in nursing homes and home care: the study protocol of a mixed-methods research design to implement a leadership intervention

PubMed Central

Wiig, Siri; Ree, Eline; Johannessen, Terese; Strømme, Torunn; Storm, Marianne; Aase, Ingunn; Ullebust, Berit; Holen-Rabbersvik, Elisabeth; Hurup Thomsen, Line; Sandvik Pedersen, Anne Torhild; van de Bovenkamp, Hester; Bal, Roland; Aase, Karina

2018-01-01

Introduction Nursing homes and home care face challenges across different countries as people are living longer, often with chronic conditions. There is a lack of knowledge regarding implementation and impact of quality and safety interventions as most research evidence so far is generated in hospitals. Additionally, there is a lack of effective leadership tools for quality and safety improvement work in this context. Methods and analysis The aim of the ‘Improving Quality and Safety in Primary Care—Implementing a Leadership Intervention in Nursing Homes and Homecare’ (SAFE-LEAD) study is to develop and evaluate a research-based leadership guide for managers to increase quality and safety competence. The project applies a mixed-methods design and explores the implications of the leadership guide on managers’ and staffs’ knowledge, attitudes and practices. Four nursing homes and four home care services from different Norwegian municipalities will participate in the intervention. Surveys, process evaluation (interviews, observations) and document analyses will be conducted to evaluate the implementation and impact of the leadership intervention. A comparative study of Norway and the Netherlands will establish knowledge of the context dependency of the intervention. Ethics and dissemination The study is approved by the Norwegian Centre for Research Data (2017/52324 and 54855). The results will be disseminated through scientific articles, two PhD dissertations, an anthology, presentations at national and international conferences, and in social media, newsletters and in the press. The results will generate knowledge to inform leadership practices in nursing homes and home care. Moreover, the study will build new theory on leadership interventions and the role of contextual factors in nursing homes and home care. PMID:29599394

National newspaper portrayal of nursing homes: tone of coverage and its correlates.

PubMed

Miller, Edward A; Tyler, Denise A; Mor, Vincent

2013-01-01

The mass media can exert considerable influence over the relative saliency of different public policy concerns. Because emotional resonance can have a strong impact on how the general public and policy makers perceive specific issues, the purpose of this study is to characterize the tone of nursing home coverage in the national media. Keyword searches of LexisNexis were used to identify 1562 articles published in 4 national newspapers from 1999 to 2008. The content of each article was analyzed and tone, themes, prominence, focal entity, and geographic focus assessed. Multinomial logit was used to examine the correlates of tone. Most articles were negative (49.2%) or neutral (40.3%); few were positive (10.5%). Both positive and negative articles were considerably more likely than neutral articles (>10 times) to be an opinion piece. Negative articles were three quarters more likely to be on the front page and two thirds more likely to focus on industry actors. Positive articles were 10 times more likely to be about community actors and two and three quarters more likely to be about local issues. Positive articles were considerably more likely to be about quality; negative articles about negligence/fraud and natural disasters. Findings suggest that negative reporting predominates and its impact on public perceptions and government decision making may be reinforced by its prominence and focus on industry interests/behavior. The adverse impact of media coverage on the industry's reputation has likely influenced consumer care choices, particularly in light of growing competition from the home-based and community-based and assisted living sectors.

A National Study of the Relationship between Home Access to a Computer and Academic Performance Scores of Grade 12 U.S. Science Students: An Analysis of the 2009 NAEP Data

NASA Astrophysics Data System (ADS)

Coffman, Mitchell Ward

The purpose of this dissertation was to examine the relationship between student access to a computer at home and academic achievement. The 2009 National Assessment of Educational Progress (NAEP) dataset was probed using the National Data Explorer (NDE) to investigate correlations in the subsets of SES, Parental Education, Race, and Gender as it relates to access of a home computer and improved performance scores for U.S. public school grade 12 science students. A causal-comparative approach was employed seeking clarity on the relationship between home access and performance scores. The influence of home access cannot overcome the challenges students of lower SES face. The achievement gap, or a second digital divide, for underprivileged classes of students, including minorities does not appear to contract via student access to a home computer. Nonetheless, in tests for significance, statistically significant improvement in science performance scores was reported for those having access to a computer at home compared to those not having access. Additionally, regression models reported evidence of correlations between and among subsets of controls for the demographic factors gender, race, and socioeconomic status. Variability in these correlations was high; suggesting influence from unobserved factors may have more impact upon the dependent variable. Having access to a computer at home increases performance scores for grade 12 general science students of all races, genders and socioeconomic levels. However, the performance gap is roughly equivalent to the existing performance gap of the national average for science scores, suggesting little influence from access to a computer on academic achievement. The variability of scores reported in the regression analysis models reflects a moderate to low effect, suggesting an absence of causation. These statistical results are accurate and confirm the literature review, whereby having access to a computer at home and the

Home Study Course Development Handbook. Third Edition.

ERIC Educational Resources Information Center

Lambert, Michael P., Ed.; Welch, Sally R., Ed.

This handbook is intended to assist new home study directors of education, course writers, instructors, and others interested in home study course development. It contains 13 guides that were each written by practicing home study educators and experts in the correspondence study field and that together cover the complete course development…

38 CFR 21.129 - Home study course.

Code of Federal Regulations, 2010 CFR

2010-07-01

... 38 Pensions, Bonuses, and Veterans' Relief 2 2010-07-01 2010-07-01 false Home study course. 21.129... Educational and Vocational Training Services § 21.129 Home study course. (a) Definition. A home study course... school to the student for study and preparation of written answers, solutions to problems, and work...

38 CFR 21.129 - Home study course.

Code of Federal Regulations, 2011 CFR

2011-07-01

... 38 Pensions, Bonuses, and Veterans' Relief 2 2011-07-01 2011-07-01 false Home study course. 21.129... Educational and Vocational Training Services § 21.129 Home study course. (a) Definition. A home study course... school to the student for study and preparation of written answers, solutions to problems, and work...

Improving quality and safety in nursing homes and home care: the study protocol of a mixed-methods research design to implement a leadership intervention.

PubMed

Wiig, Siri; Ree, Eline; Johannessen, Terese; Strømme, Torunn; Storm, Marianne; Aase, Ingunn; Ullebust, Berit; Holen-Rabbersvik, Elisabeth; Hurup Thomsen, Line; Sandvik Pedersen, Anne Torhild; van de Bovenkamp, Hester; Bal, Roland; Aase, Karina

2018-03-28

Nursing homes and home care face challenges across different countries as people are living longer, often with chronic conditions. There is a lack of knowledge regarding implementation and impact of quality and safety interventions as most research evidence so far is generated in hospitals. Additionally, there is a lack of effective leadership tools for quality and safety improvement work in this context. The aim of the 'Improving Quality and Safety in Primary Care-Implementing a Leadership Intervention in Nursing Homes and Homecare' (SAFE-LEAD) study is to develop and evaluate a research-based leadership guide for managers to increase quality and safety competence. The project applies a mixed-methods design and explores the implications of the leadership guide on managers' and staffs' knowledge, attitudes and practices. Four nursing homes and four home care services from different Norwegian municipalities will participate in the intervention. Surveys, process evaluation (interviews, observations) and document analyses will be conducted to evaluate the implementation and impact of the leadership intervention. A comparative study of Norway and the Netherlands will establish knowledge of the context dependency of the intervention. The study is approved by the Norwegian Centre for Research Data (2017/52324 and 54855). The results will be disseminated through scientific articles, two PhD dissertations, an anthology, presentations at national and international conferences, and in social media, newsletters and in the press. The results will generate knowledge to inform leadership practices in nursing homes and home care. Moreover, the study will build new theory on leadership interventions and the role of contextual factors in nursing homes and home care. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

Food in Relation to Sustainable Development Expressed in Swedish Syllabuses of Home and Consumer Studies: At Present and Past

ERIC Educational Resources Information Center

Gisslevik, Emmalee; Wernersson, Inga; Åberg, Helena; Larsson, Christel

2016-01-01

Little is known what the term sustainable development entails in relation to the school subject of home and consumer studies and the subject's knowledge area of food. The aim is to illustrate how food is expressed in national syllabuses of home and consumer studies at present and in the past, and its operationalization into sustainable…

Home Start Followup Study: A Study of Long-Term Impact of Home Start on Program Participants. Final Report.

ERIC Educational Resources Information Center

Bache, William; And Others

This Home Start followup study was designed to determine the long-term impact of Home Start on program participants in sixteen states within the USA. Home Start was a three-year demonstration program which provided Head Start-type comprehensive services to young children (3- to 5-year-olds) and their families in their homes. In Chapter 1…

Burns in mobile home fires--descriptive study at a regional burn center.

PubMed

Mullins, Robert F; Alarm, Badrul; Huq Mian, Mohammad Anwarul; Samples, Jancie M; Friedman, Bruce C; Shaver, Joseph R; Brandigi, Claus; Hassan, Zaheed

2009-01-01

causes. About 40% of burns took place between December and February. Among the studied cohorts, 32% were unemployed, 15% were disabled, and 14% did not have any information about their employment status. One in every four patients had a family history of a burn. Eight (12%) died in the hospital during treatment. There was a higher prevalence of inhalation injury and higher case fatality among the burn patients in mobile home fires compared with the statistics of the Burn Center. Observation showed a higher number of smokers and alcoholics among the burn patients. The main sources of fire were from home appliances. Fewer people had health insurance coverage than the national standard and more people suffered from some sort of chronic illness compared with the national morbidity data.

Is There Evidence of Cream Skimming among Nursing Homes following the Publication of the Nursing Home Compare Report Card?

ERIC Educational Resources Information Center

Mukamel, Dana B.; Ladd, Heather; Weimer, David L.; Spector, William D.; Zinn, Jacqueline S.

2009-01-01

Purpose: A national quality report card for nursing homes, Nursing Home Compare, has been published since 2002. It has been shown to have some, albeit limited, positive impact on quality of care. The objective of this study was to test empirically the hypothesis that nursing homes have responded to the publication of the report by adopting cream…

Evaluation of the association between Nursing Home Survey on Patient Safety culture (NHSOPS) measures and catheter-associated urinary tract infections: results of a national collaborative.

PubMed

Smith, Shawna N; Greene, M Todd; Mody, Lona; Banaszak-Holl, Jane; Petersen, Laura D; Meddings, Jennifer

2018-06-01

Recent efforts to reduce patient infection rates emphasise the importance of safety culture. However, little evidence exists linking measures of safety culture and infection rates, in part because of the difficulty of collecting both safety culture and infection data from a large number of nursing homes. To examine the association between nursing home safety culture, measured with the Nursing Home Survey on Patient Safety Culture (NHSOPS), and catheter-associated urinary tract infection rates (CAUTI) using data from a recent national collaborative for preventing healthcare-associated infections in nursing homes. In this prospective cohort study of nursing homes, facility staff completed the NHSOPS at intervention start and 11 months later. National Healthcare Safety Network-defined CAUTI rates were collected monthly for 1 year. Negative binomial models examined CAUTI rates as a function of both initial and time-varying facility-aggregated NHSOPS components, adjusted for facility characteristics. Staff from 196 participating nursing homes completed the NHSOPS and reported CAUTI rates monthly. Nursing homes saw a 52% reduction in CAUTI rates over the intervention period. Seven of 13 NHSOPS measures saw improvements, with the largest improvements for 'Management Support for Resident Safety' (3.7 percentage point increase in facility-level per cent positive response, on average) and 'Communication Openness' (2.5 percentage points). However, these increases were statistically insignificant, and multivariate models did not find significant association between CAUTI rates and initial or over-time NHSOPS domains. This large national collaborative of nursing homes saw declining CAUTI rates as well as improvements in several NHSOPS domains. However, no association was found between initial or over-time NHSOPS scores and CAUTI rates. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is

Association of Individual and Neighborhood Factors with Home Food Availability: Evidence from the National Health and Nutrition Examination Survey.

PubMed

Chai, Weiwen; Fan, Jessie X; Wen, Ming

2018-05-01

Accumulating evidence suggests the important role of the home food environment in an individual's dietary intake. This study examined the associations of individual and neighborhood-level factors with the availability of healthy and unhealthy foods in the home using a nationally representative sample from the 2007 to 2008 and 2009 to 2010 National Health and Nutrition Examination Surveys (NHANES). A cross-sectional study design was used with NHANES merged with the 2000 census data. Food availability was measured through self-report questionnaire regarding the frequency of foods or drinks available in the home. The analysis included 8,975 participants aged 19 to 65 years. Associations of individual and neighborhood factors with home food availability (always or most of the time available) were assessed using logistic regression modeling accounting for NHANES' complex survey design and weights. Individual-level and neighborhood-level factors were simultaneously included in the analysis. Family income-to-needs ratio was positively associated with the availability of dark green vegetables (odds ratio [OR]=1.07; 95% CI=1.00 to 1.13), fat-free or low-fat milk (OR=1.16; 95% CI=1.07 to 1.25), and salty snacks (OR=1.12; 95% CI=1.04 to 1.20) in the home. College graduates were more likely to have fruits (OR=1.96, 95% CI=1.48 to 2.60), vegetables (OR=1.48; 95% CI=1.16 to 1.88), and fat-free or low-fat milk (OR=1.81; 95% CI=1.55 to 2.12) and less likely to have salty snacks (OR=0.77; 95% CI=0.63 to 0.95) and sugary drinks (OR=0.46, 95% CI=0.37 to 0.57) available compared with non-college graduates. Tract socioeconomic status (SES) scores were positively associated with fruit (OR=1.15; 95% CI=1.02 to 1.29), vegetable (OR=1.14; 95% CI=1.03 to 1.26), and fat-free or low-fat milk (OR=1.25; 95% CI=1.10 to 1.42) availability. Urban residents were associated with greater availability of fruits (OR=1.47; 95% CI=1.05 to 2.08) and fat-free or low-fat milk (OR=1.33; 95% CI=1.02 to 1

Insights from a national study.

PubMed

Kulig, Judith C; Stewart, Norma J; Morgan, Debra; Andrews, Mary Ellen; MacLeod, Martha L P; Pitblado, J Roger

2006-04-01

Aboriginal registered nurses have been identified as an essential group in the delivery of health services in First Nations communities. Despite this, there is a lack of information about this group of nurses in Canada. This article presents information about this group taken from two components of a national study, The Nature of Nursing Practice in Rural and Remote Canada: documentary analysis and a national survey of nurses. The aboriginal nurse participants were predominantly female, between the ages of 40 and 49, diploma prepared and with licensure for less than 10 years. The survey data showed 41.4 per cent returned to their home communities to work. The participants noted how they enjoyed the challenges of rural and remote nursing and wanted to raise their families in these small communities. They have been able to create supportive work environments, particularly with their nursing colleagues. The nurses are committed to working in rural and remote communities.

The effect of Channeling on in-home utilization and subsequent nursing home care: a simultaneous equation perspective.

PubMed Central

Rabiner, D J; Stearns, S C; Mutran, E

1994-01-01

OBJECTIVE. This study explored the relationship between participation in a home/community-based long-term care case management intervention (known as the Channeling demonstration), use of formal in-home care, and subsequent nursing home utilization. STUDY DESIGN. Structural analysis of the randomized Channeling intervention was conducted to decompose the total effects of Channeling on nursing home use into direct and indirect effects. DATA COLLECTION METHOD. Secondary data analysis of the National Long-Term Care Data Set. PRINCIPAL FINDINGS. The use of formal in-home care, which was increased by the Channeling intervention, was positively associated with nursing home utilization at 12 months. However, the negative direct effect of Channeling on nursing home use was of sufficient magnitude to offset this positive indirect effect, so that a small but significant negative total effect of Channeling on subsequent nursing home utilization was found. CONCLUSIONS. This study shows why Channeling did not have a large total impact on nursing home utilization. The analysis did not provide evidence of direct substitution of in-home care for nursing home care because the direct reductions in nursing home utilization due to other aspects of Channeling (including, but not limited to case management) were substantially offset by the indirect increases in nursing home utilization associated with additional home care use. PMID:8002352

The Future of Home Health Care

PubMed Central

Landers, Steven; Madigan, Elizabeth; Leff, Bruce; Rosati, Robert J.; McCann, Barbara A.; Hornbake, Rodney; MacMillan, Richard; Jones, Kate; Bowles, Kathryn; Dowding, Dawn; Lee, Teresa; Moorhead, Tracey; Rodriguez, Sally; Breese, Erica

2016-01-01

The Future of Home Health project sought to support transformation of home health and home-based care to meet the needs of patients in the evolving U.S. health care system. Interviews with key thought leaders and stakeholders resulted in key themes about the future of home health care. By synthesizing this qualitative research, a literature review, case studies, and the themes from a 2014 Institute of Medicine and National Research Council workshop on “The Future of Home Health Care,” the authors articulate a vision for home-based care and recommend a bold framework for the Medicare-certified home health agency of the future. The authors also identify challenges and recommendations for achievement of this framework. PMID:27746670

Home advantage and player nationality in international club football.

PubMed

Poulter, Damian R

2009-06-01

The home advantage effect was investigated at a team and player level in Union of European Football Associations (UEFA) Champions League football using in-depth performance and disciplinary variables. Performance analysis revealed that the home team scored more goals, had more shots on and off target, had a greater share of possession, and won more corners than the away team. There was an opposite trend for disciplinary variables, with the home team committing less fouls than the away team, and receiving less yellow and red cards. There were home advantage effects at player level for goals, total shots, shots on target, assists, and yellow cards, as found in the team analysis. In addition, foreign players demonstrated a home advantage effect for goals scored, whereas domestic players scored an equivalent number of goals at home and away venues. Results are discussed in relation to the home advantage literature and wider implications for the sport.

Rationales for home safety promotion in the Iranian primary healthcare system: results from a pilot study.

PubMed

Mohammadi, R; Ekman, R; Svanström, L; Gooya, M M

2006-01-01

To analyse the prerequisites for a nationwide primary healthcare (PHC) home safety promotion programme in Iran. Injury is a major public health problem throughout the world, currently accounting for one-seventh of all premature deaths and disabilities. Within 20 years, it is estimated that the proportion will increase to one-fifth. The present healthcare system in Iran was started in 1979, with a major focus on easy access to services and prevention. The system is based on the 'health house', which is run by community health workers. A survey shows that 36% of injuries occur in the home environment. A pilot phase of the Home Safety Promotion Programme was initiated in 1994, and included safety checking at home for fences, kitchens, drugs and poisons, heaters, electricity, and stairs and ladders. The pilot study covered 478,551 households out of the 12 million (approximately) in Iran. Sixty-nine supervisors were involved individually, assembled into eight focus groups. Household safety increased by 10-20% over the 4 years of the study. The frequency of home visits changed from annual to seasonal, since all participants agreed that there were seasonal differences in safety problems. The supervisors showed a high level of knowledge of injury as a public health problem, and also positive attitudes towards doing something about safety on the basis of a PHC scheme. The role of a surveillance system was highlighted, and it was suggested that such a system should be added to the programme. Based on our preliminary findings, there were reasons to obtain a policy decision concerning a national programme for safety promotion before extending the pilot scheme to the whole country. A national safety programme was decided upon following completion of the pilot study. It includes a home-related-injury surveillance system that is mandatory in rural areas and voluntary in some cities.

Randomized trial of the ForeseeHome monitoring device for early detection of neovascular age-related macular degeneration. The HOme Monitoring of the Eye (HOME) study design - HOME Study report number 1.

PubMed

Chew, Emily Y; Clemons, Traci E; Bressler, Susan B; Elman, Michael J; Danis, Ronald P; Domalpally, Amitha; Heier, Jeffrey S; Kim, Judy E; Garfinkel, Richard A

2014-03-01

To evaluate the effects of a home-monitoring device with tele-monitoring compared with standard care in detection of progression to choroidal neovascularization (CNV) associated with age-related macular degeneration (AMD), the leading cause of blindness in the US. Participants, aged 55 to 90 years, at high risk of developing CNV associated with AMD were recruited to the HOme Monitoring of Eye (HOME) Study, an unmasked, multi-center, randomized trial of the ForeseeHome (FH) device plus standard care vs. standard care alone. The FH device utilizes preferential hyperacuity perimetry and tele-monitoring to detect changes in vision function associated with development of CNV, potentially prior to symptom and visual acuity loss. After establishing baseline measurements, subsequent changes on follow-up are detected by the device, causing the monitoring center to alert the clinical center to recall participants for an exam. Standard care consists of instructions for self-monitoring visual changes with subsequent self-report to the clinical center. The primary objective of this study is to determine whether home monitoring plus standard care in comparison with standard care alone, results in earlier detection of incident CNV with better present visual acuity. The primary outcome is the decline in visual acuity at CNV diagnosis from baseline. Detection of CNV prior to substantial vision loss is critical as vision outcome following anti-angiogenic therapy is dependent on the visual acuity at initiation of treatment. HOME Study is the first large scale study to test the use of home tele-monitoring system in the management of AMD patients. Published by Elsevier Inc.

Insights into the factors associated with achieving the preference of home death in terminal cancer: A national population-based study.

PubMed

Bannon, Finian; Cairnduff, Victoria; Fitzpatrick, Deirdre; Blaney, Janine; Gomes, Barbara; Gavin, Anna; Donnelly, Conan

2017-11-23

Most terminally ill cancer patients prefer to die at home, yet only a minority are able to achieve this. Our aim was to investigate the factors associated with cancer patients achieving their preference to die at home. This study took the form of a mortality followback, population-based, observational survey of the relatives of deceased cancer patients in Northern Ireland. Individuals who registered the death of a friend or relative (aged ≥ 18 years) between 1 December 2011 and 31 May 2012, where the primary cause of death was cancer (ICD10: C00-D48), who were invited to take part. Preferred and actual place of death, and patient, service, and clinical data were collected using the QUALYCARE postal questionnaire. Multivariable logistic regression was employed to investigate the factors associated with achieving a home death when preferred. Some 467 of 1,493 invited informants completed the survey. The 362 (77.5%) who expressed a preference for dying at home and spent time at home in their final 3 months were included in our analysis. Of these, 53.4% achieved their preference of a home death. Factors positively associated with achieving a home death were: living in an affluent area, receipt of good and satisfactory district nurse care, discussing place of death with health professionals, and the caregiver's preference for a home death. Being older than 80 years of age, being a Presbyterian, and being unconscious most of the time during their final week were negatively associated with achieving a home death. Communication, care satisfaction, and caregiver preferences were all associated with home death. Our findings will help inform the design of future interventions aimed at increasing the proportion of patients achieving their preferred place of death at home, for example, by targeting interventions toward older patients and those from the most deprived communities.

Home advantage in the Winter Paralympic Games 1976-2014.

PubMed

Wilson, Darryl; Ramchandani, Girish

2017-01-01

There is a limited amount of home advantage research concerned with winter sports. There is also a distinct lack of studies that investigate home advantage in the context of para sport events. This paper addresses this gap in the knowledge by examining home advantage in the Winter Paralympic Games. Using a standardised measure of success, we compared the performances of host nations at home with their own performances away from home between 1976 and 2014. Both country level and individual sport level analysis is conducted for this time period. Comparisons are also drawn with the Winter Olympic Games since 1992, the point from which both the Winter Olympic Games and the Winter Paralympic Games have been hosted by the same nations and in the same years. Clear evidence of a home advantage effect in the Winter Paralympic Games was found at country level. When examining individual sports, only alpine skiing and cross country skiing returned a significant home advantage effect. When comparing home advantage in the Winter Paralympic Games with the Winter Olympic Games for the last seven host nations (1992-2014), we found that home advantage was generally more pronounced (although not a statistically significant difference) in the case of the former. The causes of home advantage in the Winter Paralympic Games are unclear and should be investigated further.

The U.S. home infusion market.

PubMed

Monk-Tutor, M R

1998-10-01

Medicare legislation stimulated the development of home care services but also resulted in fragmentation of service components. In the 1980s, prospective pricing and diagnosis-related groups, and resulting pressures to reduce inpatient length of stay, prompted additional growth of the industry. Even so, in 1995 home care represented only 3% of total national expenditures on health care. The annual growth rate of the home infusion industry dropped from 64% in 1982-86 to 24% in 1986-93. While revenue per patient for home infusion is expected to decrease under managed care, an increasing number of patients will support continued market growth. The home infusion market is highly competitive, with only a few large national providers and many small local providers. In 1996, 29% of acute care hospitals provided or were developing a home care program. Community pharmacists' options in the home infusion area include independent services, partnerships, joint ventures, contracts with hospitals, and franchises. The home infusion market is being integrated into alternative sites, such as ambulatory infusion centers (AICs), as providers attempt to diversify to maintain managed care contracts. AICs provide infusion therapy and nursing to noninstitutionalized, nonhome-bound patients. Untapped sources for future growth of the infusion market include long-term-care facilities. More consistent studies of the home care market are needed. Despite slowed growth in recent years, home care has a strong market in the United States.

Child Injury Prevention in the Home: A National Survey of Safety Practices and Use of Safety Equipment in Deprived Families

ERIC Educational Resources Information Center

Mulvaney, C. A.; Watson, M. C.; Smith, S.; Coupland, C.; Kendrick, D.

2014-01-01

Objective: To determine the prevalence of home safety practices and use of safety equipment by disadvantaged families participating in a national home safety equipment scheme in England. Design: Cross-sectional postal survey sent to a random sample of 1,000 families. Setting: England, United Kingdom. Results: Half the families (51%) returned a…

Medicare and Medicaid Programs; CY 2017 Home Health Prospective Payment System Rate Update; Home Health Value-Based Purchasing Model; and Home Health Quality Reporting Requirements. Final rule.

PubMed

2016-11-03

This final rule updates the Home Health Prospective Payment System (HH PPS) payment rates, including the national, standardized 60-day episode payment rates, the national per-visit rates, and the non-routine medical supply (NRS) conversion factor; effective for home health episodes of care ending on or after January 1, 2017. This rule also: Implements the last year of the 4-year phase-in of the rebasing adjustments to the HH PPS payment rates; updates the HH PPS case-mix weights using the most current, complete data available at the time of rulemaking; implements the 2nd-year of a 3-year phase-in of a reduction to the national, standardized 60-day episode payment to account for estimated case-mix growth unrelated to increases in patient acuity (that is, nominal case-mix growth) between CY 2012 and CY 2014; finalizes changes to the methodology used to calculate payments made under the HH PPS for high-cost "outlier" episodes of care; implements changes in payment for furnishing Negative Pressure Wound Therapy (NPWT) using a disposable device for patients under a home health plan of care; discusses our efforts to monitor the potential impacts of the rebasing adjustments; includes an update on subsequent research and analysis as a result of the findings from the home health study; and finalizes changes to the Home Health Value-Based Purchasing (HHVBP) Model, which was implemented on January 1, 2016; and updates to the Home Health Quality Reporting Program (HH QRP).

Study Of Lampungnese Traditional Home Garden Design

NASA Astrophysics Data System (ADS)

Pratiwi, R. A.; Gunawan

2017-10-01

Lampung is one area in Indonesia which has a traditional culture that comes from two groups of descents, they are ulun Lampung Pepadun and ulun Lampung Saibatin. Lampungnese traditional culture has been well-known by Indonesian people for its traditional dances, traditional clothing, or traditional home architecture. However, Lampungnese traditional home garden recently may not yet been described. Information related to Lampungnese traditional home garden is still very limited and it does not yet represented the culture based design concept. This research was directed to identify the elements of the home garden and map it into design concept of the Lampungnese traditional home garden based on information of Lampungnese traditional culture. The study was conducted by using descriptive approach through literature review, interviews and cultural exploration, as well as field observation. The study was able to identify the elements forming the Lampungnese traditional home garden, namely gakhang hadap, walai, outdoor kitchenette, firewood place, outdoor kitchen, livestock barns, as well as plants. Space layout of the home garden comprises front yard (tengahbah/terambah/beruan), side yard (kebik/kakebik), and backyard (kudan/juyu/kebon). Each element of the garden is located in the right place of the space layout.

A Comprehensive National Plan for New Initiatives in Home Economics Research, Extension, and Higher Education.

ERIC Educational Resources Information Center

Science and Education Administration (USDA), Hyattsville, MD.

New initiatives in home economics research, extension, and higher education are proposed in order to influence national goals for family well-being measurably within five to ten years. The proposals are for work to be conducted cooperatively by the U.S. Department of Agriculture, the land-grant colleges and universities, cooperative extension…

Connecting to the Art Market from Home: An Exploration of First Nations Artists in Alert Bay, British Columbia

ERIC Educational Resources Information Center

Neufeld, Margaret R. M.

2009-01-01

Historically, Northwest Coast First Nations artists have been active participants in local and external economic markets. In Alert Bay, British Columbia, home of the 'Namgis People of the Kwakwaka'wakw Nation, artists have sold their work in urban centers since the 1950s. Now they are more rigorously involved in selling their work to local shops…

Technology Solutions Case Study: Southern Energy Homes, First DOE Zero Energy Ready Manufactured Home

DOE Office of Scientific and Technical Information (OSTI.GOV)

None

The country’s first Zero Energy Ready manufactured home that is certified by the U.S. Department of Energy (DOE) is up and running in Russellville, Alabama. The manufactured home was built by a partnership between Southern Energy Homes and the Advanced Residential Integrated Energy Solutions Collaborative (ARIES), which is a DOE Building America team. The effort was part of a three-home study including a standard-code manufactured home and an ENERGY STAR® manufactured home. Cooling-season results showed that the building used half the space-conditioning energy of a manufactured home built to the U.S. Department of Housing and Urban Development’s (HUD’s) Manufactured Homemore » Construction and Safety Standards. These standards are known collectively as the HUD Code, which is the building standard for all U.S. manufactured housing.« less

Home Schooling Goes Mainstream

ERIC Educational Resources Information Center

Gaither, Milton

2009-01-01

This article reports that while home schooling may have particular appeal to celebrities, over the last decade families of all kinds have embraced the practice for widely varying reasons: no longer is home schooling exclusive to Christian fundamentalism and the countercultural Left. Along with growing acceptance of home schooling nationally has…

Implementing the patient-centered medical home: observation and description of the national demonstration project.

PubMed

Stewart, Elizabeth E; Nutting, Paul A; Crabtree, Benjamin F; Stange, Kurt C; Miller, William L; Jaén, Carlos Roberto

2010-01-01

We provide an overall description of the National Demonstration Project (NDP) intervention to transform family practices into patient-centered medical homes. An independent evaluation team used multiple data sources and methods to describe the design and implementation of the NDP. These included direct observation of the implementation team and project meetings, site visits to practices, depth interviews with practice members and implementation team members, access to practice communications (eg, telephone calls, e-mails), and public domain materials (eg, the NDP Web site). The American Academy of Family Physicians created a new division called TransforMED, which launched the 24-month NDP in June 2006. From 337 family medicine practices completing an extensive online application, 36 were selected and randomized to a facilitated group, which received tailored, intensive assistance and services from TransforMED, or a self-directed group, which received very limited assistance. Three facilitators from diverse backgrounds in finance, practice management, and organizational psychology used multiple practice change strategies including site visits, e-mails, metrics, and learning sessions. The self-directed practices worked primarily on their own, but self-organized a retreat midway through the project. The intervention model for the project evolved to be consistent with the emerging national consensus principles of the patient-centered medical home. The independent evaluation team studied the NDP and provided ongoing feedback to inform the implementation process. The NDP illustrates that complex practice change interventions must combine flexibility in the intervention model, implementation strategy, and the evaluation, in order to maximize ongoing learning.

Implementing the Patient-Centered Medical Home: Observation and Description of the National Demonstration Project

PubMed Central

Stewart, Elizabeth E.; Nutting, Paul A.; Crabtree, Benjamin F.; Stange, Kurt C.; Miller, William L.; Jaén, Carlos Roberto

2010-01-01

PURPOSE We provide an overall description of the National Demonstration Project (NDP) intervention to transform family practices into patient-centered medical homes. METHODS An independent evaluation team used multiple data sources and methods to describe the design and implementation of the NDP. These included direct observation of the implementation team and project meetings, site visits to practices, depth interviews with practice members and implementation team members, access to practice communications (eg, telephone calls, e-mails), and public domain materials (eg, the NDP Web site). RESULTS The American Academy of Family Physicians created a new division called TransforMED, which launched the 24-month NDP in June 2006. From 337 family medicine practices completing an extensive online application, 36 were selected and randomized to a facilitated group, which received tailored, intensive assistance and services from TransforMED, or a self-directed group, which received very limited assistance. Three facilitators from diverse backgrounds in finance, practice management, and organizational psychology used multiple practice change strategies including site visits, e-mails, metrics, and learning sessions. The self-directed practices worked primarily on their own, but self-organized a retreat midway through the project. The intervention model for the project evolved to be consistent with the emerging national consensus principles of the patient-centered medical home. The independent evaluation team studied the NDP and provided ongoing feedback to inform the implementation process. CONCLUSIONS The NDP illustrates that complex practice change interventions must combine flexibility in the intervention model, implementation strategy, and the evaluation, in order to maximize ongoing learning. PMID:20530392

A Study of the Association Between Multidisciplinary Home Care and Home Death Among Thai Palliative Care Patients.

PubMed

Nagaviroj, Kittiphon; Anothaisintawee, Thunyarat

2017-06-01

Many terminally ill patients would prefer to stay and die in their own homes, but unfortunately, some may not be able to do so. Although there are many factors associated with successful home deaths, receiving palliative home visits from the multidisciplinary care teams is one of the key factors that enable patients to die at home. Our study was aimed to find whether there was any association between our palliative home care program and home death. A retrospective study was conducted in the Department of Family Medicine at Ramathibodi Hospital between January 2012 and May 2014. All of the patients who were referred to multidisciplinary palliative care teams were included. The data set comprised of patient's profile, disease status, functional status, patient's symptoms, preferred place of death, frequency of home visits, types of team interventions, and patient's actual place of death. Multiple logistic regression was applied in order to determine the association between the variables and the probability of dying at home. A total of 142 patients were included into the study. At the end of the study, 50 (35.2%) patients died at home and 92 (64.8%) patients died in the hospital. The multivariate logistic regression analysis demonstrated a strong association between multidisciplinary home care and home death (odds ratio 6.57, 95% confidence interval [CI] 2.48-17.38). Palliative home care was a significant factor enabling patients who want to die at home. We encourage health policy makers to promote the development of community-based palliative care programs in Thailand.

Factors affecting death at home in Japan.

PubMed

Sauvaget, C; Tsuji, I; Li, J H; Hosokawa, T; Fukao, A; Hisamichi, S

1996-10-01

Despite the wish of the Japanese people to spend their final moments at home, the percentage of deaths at home among elderly is decreasing. Moreover, large variations in this rate were observed over the country. The present ecological study analyzed the relationship between the percentage of deaths at home for decedents aged 70 and over, and demographic, medical and socioeconomic characteristics. The data published in 1990 by the Japanese National Government were analyzed by correlation, principal-component, and multiple linear regression analyses. The results showed that the percentage of deaths at home for decedents aged 70 and over was positively associated with the number of persons per household, and the area of floor space per house. The divorce rate, the national tax per capita, and the mean length of hospitalization for stroke showed a negative association with the percentage of deaths at home. In the prefectures where the crude death rates of stroke and senility were high, elderly were more likely to die at home. These results suggested the importance of the number of family caregivers, and the housing conditions for terminal care at home. This research may lead to improve home medical assistance which is still underdeveloped in Japan.

A study of home deaths in Japan from 1951 to 2002

PubMed Central

Yang, Limin; Sakamoto, Naoko; Marui, Eiji

2006-01-01

Background Several surveys in Japan have indicated that most terminally ill Japanese patients would prefer to die at home or in a homelike setting. However, there is a great disparity between this stated preference and the reality, since most Japanese die in hospital. We report here national changes in home deaths in Japan over the last 5 decades. Using prefecture data, we also examined the factors in the medical service associated with home death in Japan. Methods Published data on place of death was obtained from the vital statistics compiled by the Ministry of Health, Labor and Welfare of Japan. We analyzed trends of home deaths from 1951 to 2002, and describe the changes in the proportion of home deaths by region, sex, age, and cause of death. Joinpoint regression analysis was used for trend analysis. Logistic regression analysis was performed to identify secular trends in home deaths, and the impact of age, sex, year of deaths and cause of deaths on home death. We also examined the association between home death and medical service factors by multiple regression analysis, using home death rate by prefectures in 2002 as a dependent variable. Results A significant decrease in the percentage of patients dying at home was observed in the results of joinpoint regression analysis. Older patients and males were more likely to die at home. Patients who died from cancer were less likely to die at home. The results of multiple regression analysis indicated that home death was related to the number of beds in hospital, ratio of daily occupied beds in general hospital, the number of families in which the elderly were living alone, and dwelling rooms. Conclusion The pattern of the place of death has not only been determined by social and demographic characteristics of the decedent, but also associated with the medical service in the community. PMID:16524485

Place of death of children with complex chronic conditions: cross-national study of 11 countries.

PubMed

Håkanson, Cecilia; Öhlén, Joakim; Kreicbergs, Ulrika; Cardenas-Turanzas, Marylou; Wilson, Donna M; Loucka, Martin; Frache, Sandra; Giovannetti, Lucia; Naylor, Wayne; Rhee, YongJoo; Ramos, Miguel Ruiz; Teno, Joan; Beernaert, Kim; Deliens, Luc; Houttekier, Dirk; Cohen, Joachim

2017-03-01

Cross-national understanding of place of death is crucial for health service systems for their provision of efficient and equal access to paediatric palliative care. The objectives of this population-level study were to examine where children with complex chronic conditions (CCC) die and to investigate associations between places of death and sex, cause of death and country. The study used death certificate data of all deceased 1- to 17-year-old children (n = 40,624) who died in 2008, in 11 European and non-European countries. Multivariable logistic regression was performed to determine associations between place of death and other factors. Between 24.4 and 75.3% of all children 1-17 years in the countries died of CCC. Of these, between 6.7 and 42.4% died at home. In Belgium and the USA, all deaths caused by CCC other than malignancies were less likely to occur at home, whereas in Mexico and South Korea, deaths caused by neuromuscular diseases were more likely to occur at home than malignancies. In Mexico (OR = 0.91, 95% CI: 0.83-1.00) and Sweden (OR = 0.35, 95% CI: 0.15-0.83), girls had a significantly lower chance of dying at home than boys. This study shows large cross-national variations in place of death. These variations may relate to health system-related infrastructures and policies, and differences in cultural values related to place of death, although this needs further investigation. The patterns found in this study can inform the development of paediatric palliative care programs internationally. What is known: • There is a scarcity of population-level studies investigating where children with CCC die in different countries. • Cross-national understanding of place of death provides information to health care systems for providing efficient and equal access to paediatric palliative care. What is new : • There are large cross-national variations in the place of death of children with CCC, with few deathsoccuring at home in some countries

Institutional and Cultural Perspectives on Home Birth in Israel

PubMed Central

Meroz, Michal (Rosie); Gesser-Edelsburg, Anat

2015-01-01

ABSTRACT This study exposes doctors’ and midwives’ perceptions and misperceptions regarding home birth by examining their views on childbirth in general and on risk associated with home births in particular. It relies on an approach of risk communication and an anthropological framework. In a qualitative-constructive study, 19 in-depth interviews were conducted with hospital doctors, hospital midwives, home-birth midwives, and a home-birth obstetrician. Our findings reveal that hospital midwives and doctors suffer from lack of exposure to home births, leading to disagreement regarding norms and risk; it also revealed sexist or patriarchal worldviews. Recommendations include improving communication between home-birth midwives and hospital counterparts; increased exposure of hospital doctors to home birth, creating new protocols in collaboration with home-birth midwives; and establishing a national database of home births. PMID:26937159

Why Do They Stay? Job Tenure among Certified Nursing Assistants in Nursing Homes

ERIC Educational Resources Information Center

Wiener, Joshua M.; Squillace, Marie R.; Anderson, Wayne L.; Khatutsky, Galina

2009-01-01

Purpose: This study identifies factors related to job tenure among certified nursing assistants (CNAs) working in nursing homes. Design and Methods: The study uses 2004 data from the National Nursing Home Survey, the National Nursing Assistant Survey, and the Area Resource File. Ordinary least squares regression analyses were conducted with length…

Smart homes, private homes? An empirical study of technology researchers' perceptions of ethical issues in developing smart-home health technologies.

PubMed

Birchley, Giles; Huxtable, Richard; Murtagh, Madeleine; Ter Meulen, Ruud; Flach, Peter; Gooberman-Hill, Rachael

2017-04-04

Smart-home technologies, comprising environmental sensors, wearables and video are attracting interest in home healthcare delivery. Development of such technology is usually justified on the basis of the technology's potential to increase the autonomy of people living with long-term conditions. Studies of the ethics of smart-homes raise concerns about privacy, consent, social isolation and equity of access. Few studies have investigated the ethical perspectives of smart-home engineers themselves. By exploring the views of engineering researchers in a large smart-home project, we sought to contribute to dialogue between ethics and the engineering community. Either face-to-face or using Skype, we conducted in-depth qualitative interviews with 20 early- and mid-career smart-home researchers from a multi-centre smart-home project, who were asked to describe their own experience and to reflect more broadly about ethical considerations that relate to smart-home design. With participants' consent, interviews were audio-recorded, transcribed and analysed using a thematic approach. Two overarching themes emerged: in 'Privacy', researchers indicated that they paid close attention to negative consequences of potential unauthorised information sharing in their current work. However, when discussing broader issues in smart-home design beyond the confines of their immediate project, researchers considered physical privacy to a lesser extent, even though physical privacy may manifest in emotive concerns about being watched or monitored. In 'Choice', researchers indicated they often saw provision of choice to end-users as a solution to ethical dilemmas. While researchers indicated that choices of end-users may need to be restricted for technological reasons, ethical standpoints that restrict choice were usually assumed and embedded in design. The tractability of informational privacy may explain the greater attention that is paid to it. However, concerns about physical privacy may

Dog allergen (Can f 1) and cat allergen (Fel d 1) in US homes: Results from the National Survey of Lead and Allergens in Housing

PubMed Central

Arbes, Samuel J.; Cohn, Richard D.; Yin, Ming; Muilenberg, Michael L.; Friedman, Warren; Zeldin, Darryl C.

2017-01-01

Background Exposures to dog and cat allergens are believed to play important roles in the etiology of asthma; however, the levels of these allergens have never been assessed in a representative sample of US homes. Objective The objective of this study was to estimate and characterize exposures to Can f 1 (dog allergen) and Fel d 1 (cat allergen) in US homes. Methods Data were obtained from the National Survey of Lead and Allergens in Housing, a nationally representative survey of 831 US homes. Vacuumed-collected dust samples from the bed, bedroom floor, living room floor, and living room sofa were analyzed for concentrations of Can f 1 and Fel d 1 (micrograms of allergen per gram of dust). Results Although a dog or cat had lived in only 49.1% of homes in the previous 6 months, Can f 1 and Fel d 1 were detected in 100% and 99.9% of homes, respectively. Averaged over the sampled sites, geometric mean concentrations (µg/g) were 4.69 for Can f 1 and 4.73 for Fel d 1. Among homes with an indoor dog and cat, respectively, geometric mean concentrations were 69 for Can f 1 and 200 for Fel d 1. Among homes without the indoor pet, geometric mean concentrations were above 1.0. The independent predictors of elevated concentrations in homes without pets were all demographic variables that were also linked to a higher prevalence of pet ownership. Conclusions Can f 1 and Fel d 1 are universally present in US homes. Levels that have been associated with an increased risk of allergic sensitization were found even in homes without pets. Because of the transportability of these allergens on clothing, elevated levels in homes without pets, particularly among demographic groups in which pet ownership is more prevalent, implicate the community as an important source of these pet allergens. PMID:19055206

Incidence of pneumonia in nursing home residents with dementia in the Netherlands: an estimation based on three differently designed studies.

PubMed

Zomer, T P; VAN DER Maaden, T; VAN Gageldonk-Lafeber, A B; DE Greeff, S C; VAN DER Steen, J T; Verhoef, L

2017-08-01

Pneumonia leads to considerable morbidity and mortality in nursing home residents with dementia. We assessed pneumonia incidence based on data from three different studies: (1) real-time national surveillance of healthcare-associated infections in nursing home residents in 2009-2015; (2) a randomized controlled trial in 2012-2015 to assess effects of a practical guideline in nursing home residents with dementia and pneumonia; and (3) a study in 2007-2010 to assess quality of dying in newly admitted nursing home residents with dementia. In national surveillance data, pneumonia incidence was calculated separately for psychogeriatric and somatic beds, as a proxy for residents with and without dementia. Weekly pneumonia incidence was significantly lower per 1000 psychogeriatric beds (3·9; 95% confidence interval (CI) 3·2-4·6) compared with 1000 somatic beds (5·7; 95% CI 5·1-6·3). Annual incidence per 1000 psychogeriatric beds was similar in national surveillance (range 78·9-117·1) and the trial (range 71·0-94·3), and significantly higher in newly admitted dementia residents (range 267·3-363·2). The incidence was highest during the first months after admission when compared with residents with longer stay. In conclusion, follow-up of pneumonia in newly admitted dementia residents may result in higher incidence, possibly due to higher risk in this population.

An investigation of home advantage in the Summer Paralympic Games.

PubMed

Wilson, Darryl; Ramchandani, Girish

2017-01-01

There is a paucity of home advantage research set in the context of para-sport events. It is this gap in the knowledge that this paper addresses by investigating the prevalence and size of home advantage in the Summer Paralympic Games. Using a standardised measure of success, we compared the performances of nations when competing at home with their own performances away from home in the competition between 1960 and 2016. Both country-level and individual sport-level analyses were conducted for this time frame. A Wilcoxon signed rank test was used to determine whether there was a genuine difference in nations' performance under host and non-host conditions. Spearman's rank-order correlation was run to assess the relationship between nation quality and home advantage. Strong evidence of a home advantage effect in the Summer Paralympic Games was found at country level ( p  < 0.01). When examining individual sports, only athletics, table tennis, and wheelchair fencing returned a significant home advantage effect ( p  < 0.05). Possible explanations for these findings are discussed. The size of the home advantage effect was not significantly correlated with the quality or strength of the host nation ( p  > 0.10). While our results confirm that home advantage is prevalent in the Summer Paralympic Games at an overall country level and within specific sports, they do not explain fully why such an effect does exist. Future studies should investigate the causes of home advantage in the competition and also draw comparisons with the Summer Olympic Games to explore any differences between para-sport events and able-bodied events.

Substituting physicians with nurse practitioners, physician assistants or nurses in nursing homes: protocol for a realist evaluation case study

PubMed Central

Lovink, Marleen Hermien; Persoon, Anke; van Vught, Anneke JAH; Schoonhoven, Lisette; Koopmans, Raymond TCM; Laurant, Miranda GH

2017-01-01

Introduction In developed countries, substituting physicians with nurse practitioners, physician assistants and nurses (physician substitution) occurs in nursing homes as an answer to the challenges related to the ageing population and the shortage of staff, as well as to guarantee the quality of nursing home care. However, there is great diversity in how physician substitution in nursing homes is modelled and it is unknown how it can best contribute to the quality of healthcare. This study aims to gain insight into how physician substitution is modelled and whether it contributes to perceived quality of healthcare. Second, this study aims to provide insight into the elements of physician substitution that contribute to quality of healthcare. Methods and analysis This study will use a multiple-case study design that draws upon realist evaluation principles. The realist evaluation is based on four concepts for explaining and understanding interventions: context, mechanism, outcome and context–mechanism–outcome configuration. The following steps will be taken: (1) developing a theory, (2) conducting seven case studies, (3) analysing outcome patterns after each case and a cross-case analysis at the end and (4) revising the initial theory. Ethics and dissemination The research ethics committee of the region Arnhem Nijmegen in the Netherlands concluded that this study does not fall within the scope of the Dutch Medical Research Involving Human Subjects Act (WMO) (registration number 2015/1914). Before the start of the study, the Board of Directors of the nursing home organisations will be informed verbally and by letter and will also be asked for informed consent. In addition, all participants will be informed verbally and by letter and will be asked for informed consent. Findings will be disseminated by publication in a peer-reviewed journal, international and national conferences, national professional associations and policy partners in national government. PMID

Rehospitalization in a national population of home health care patients with heart failure.

PubMed

Madigan, Elizabeth A; Gordon, Nahida H; Fortinsky, Richard H; Koroukian, Siran M; Piña, Ileana; Riggs, Jennifer S

2012-12-01

Patients with heart failure (HF) have high rates of rehospitalization. Home health care (HHC) patients with HF are not well studied in this regard. The objectives of this study were to determine patient, HHC agency, and geographic (i.e., area variation) factors related to 30-day rehospitalization in a national population of HHC patients with HF, and to describe the extent to which rehospitalizations were potentially avoidable. Chronic Condition Warehouse data from the Centers for Medicare & Medicaid Services. Retrospective cohort design. The 2005 national population of HHC patients was matched with hospital and HHC claims, the Provider of Service file, and the Area Resource File. The 30-day rehospitalization rate was 26 percent with 42 percent of patients having cardiac-related diagnoses for the rehospitalization. Factors with the strongest association with rehospitalization were consistent between the multilevel model and Cox proportional hazard models: number of prior hospital stays, higher HHC visit intensity category, and dyspnea severity at HHC admission. Substantial numbers of rehospitalizations were judged to be potentially avoidable. The persistently high rates of rehospitalization have been difficult to address. There are health care-specific actions and policy implications that are worth examining to improve rehospitalization rates. © Health Research and Educational Trust.

DOE Zero Energy Ready Home Case Study: Thrive Home Builders, Lowry Plan

DOE Office of Scientific and Technical Information (OSTI.GOV)

Pacific Northwest National Laboratory

Thrive Home Builders built this 4,119-ft2 home at the Lowry development in Denver, Colorado, to the high-performance criteria of the U.S. Department of Energy’s Zero Energy Ready Home Program. Despite the dense positioning of the homes, mono-plane roof designs afforded plenty of space for the 8.68 kW of photovoltaic panels. With the PV, the home achieves a Home Energy Rating System (HERS) score of 4 and the home owners should enjoy energy bills of about $-11 a year. Without the PV, the home would score a HERS 38 (far lower than the HERS 80 to 100 of typical new homes).

Bringing central line-associated bloodstream infection prevention home: CLABSI definitions and prevention policies in home health care agencies.

PubMed

Rinke, Michael L; Bundy, David G; Milstone, Aaron M; Deuber, Kristin; Chen, Allen R; Colantuoni, Elizabeth; Miller, Marlene R

2013-08-01

A study was conducted to investigate health care agency central line-associated bloodstream infection (CLABSI) definitions and prevention policies and pare them to the Joint Commission National Patient Safety Goal (NPSG.07.04.01), the Centers for Disease Control and Prevention (CDC) CLABSI prevention recommendations, and a best-practice central line care bundle for inpatients. A telephone-based survey was conducted in 2011 of a convenience sample of home health care agencies associated with children's hematology/oncology centers. Of the 97 eligible home health care agencies, 57 (59%) completed the survey. No agency reported using all five aspects of the National Healthcare and Safety Network/Association for Professionals in Infection Control and Epidemiology CLABSI definition and adjudication process, and of the 50 agencies that reported tracking CLABSI rates, 20 (40%) reported using none. Only 10 agencies (18%) had policies consistent with all elements of the inpatient-focused NPSG.07.04.01, 10 agencies (18%) were consistent with all elements of the home care targeted CDC CLABSI prevention recommendations, and no agencies were consistent with all elements of the central line care bundle. Only 14 agencies (25%) knew their overall CLABSI rate: mean 0.40 CLABSIs per 1,000 central line days (95% confidence interval [CI], 0.18 to 0.61). Six agencies (11%) knew their agency's pediatric CLABSI rate: mean 0.54 CLABSIs per 1,000 central line days (95% CI, 0.06 to 1.01). The policies of a national sample of home health care agencies varied significantly from national inpatient and home health care agency targeted standards for CLABSI definitions and prevention. Future research should assess strategies for standardizing home health care practices consistent with evidence-based recommendations.

Low-cost measurement techniques to characterize the influence of home heating fuel on carbon monoxide in Navajo homes.

PubMed

Casey, Joanna Gordon; Ortega, John; Coffey, Evan; Hannigan, Michael

2018-06-01

A large fraction of the global population relies on the inefficient combustion of solid fuels for cooking and home heating, resulting in household exposure to combustion byproducts. In the southwestern United States, unhealthy air quality has been observed in some homes that use solid fuels as a primary source of heat on the Navajo Nation. In order to better understand how home heating fuel choice can influence indoor air quality in this region, we used recently developed low-cost electrochemical sensors to measure carbon monoxide (CO) air mole fractions continuously inside and outside 41 homes in two communities on the Navajo Nation. Using low-cost sensors in this study, which don't require extensive training to operate, enabled collaboration with local Diné College students and faculty in the planning and implementation of home deployments. Households used natural gas, propane, pellets, wood, and/or coal for heating. We developed quantification methods that included uncertainty estimation for Alphasense CO-B4 sensors, for measurements both inside and outside homes. CO concentrations elevated above background were observed in homes in each heating fuel group, but the highest hourly concentrations were observed in wood and coal burning homes, some of which exceeded World Health Organization Guidelines on both an hourly and eight-hourly basis. In order to probe the many factors that can influence indoor pollutant concentrations, we developed and implemented methods that employ CO emission and decay time periods observed in homes during everyday activities to estimate air exchange rates as well as CO emission rates on the basis of a given well-mixed volume of air. The air quality measurement tools and methods demonstrated in this study can be readily extended to indoor air quality studies in other communities around the world to inform how home heating and cooking practices are influencing indoor air quality during normal daily activities. Copyright © 2018 Elsevier

1983 Home Study Survey. A Report on Current Course Structure and Educational Practices in NHSC Member Institutions.

ERIC Educational Resources Information Center

National Home Study Council, Washington, DC.

A study examined the course structure and educational practices used by National Home Study Council (NHSC) member institutions. To gather data for the study, researchers mailed questionnaires to 60 members of the NHSC. Based on data from the 51 usable responses, the researchers determined that the average age of students enrolled in programs…

Smart Home Test Bed: Examining How Smart Homes Interact with the Power Grid

DOE Office of Scientific and Technical Information (OSTI.GOV)

This fact sheet highlights the Smart Home Test Bed capability at the Energy Systems Integration Facility. The National Renewable Energy Laboratory (NREL) is working on one of the new frontiers of smart home research: finding ways for smart home technologies and systems to enhance grid operations in the presence of distributed, clean energy technologies such as photovoltaics (PV). To help advance this research, NREL has developed a controllable, flexible, and fully integrated Smart Home Test Bed.

Home-Schooled Students Rise in Supply and Demand

ERIC Educational Resources Information Center

Wasley, Paula

2007-01-01

The home-school movement, a once-marginalized segment of the educational community, is all grown up and going off to college. As colleges across the nation report increasing numbers of applications from home-schooled students, policies have been developed to evaluate these candidates. Translating years of independent study into something that…

Home versus office blood pressure: longitudinal relations with left ventricular hypertrophy: the Finn-Home study.

PubMed

Sivén, Sam S E; Niiranen, Teemu J; Langén, Ville L J; Puukka, Pauli J; Kantola, Ilkka M; Jula, Antti M

2017-02-01

Electrocardiographically assessed left-ventricular hypertrophy (ECG-LVH) is a particularly high-risk phenomenon that is a part of every hypertensive patient's initial work-up. Several cross-sectional studies have demonstrated that home blood pressure (BP) has a stronger relation to LVH than office BP. However, longitudinal evidence on the association between home BP and target organ damage is scarce to nonexistent. We studied in a sample of 615 community-dwelling participants (mean age at baseline 53.7 ± 7.2, 58% women) whether change in home BP is more strongly associated with change in ECG-LVH than change in office BP over an 11-year follow-up. Pearson's correlation coefficients between changes in home/office SBP and changes in Sokolow-Lyon index, Cornell voltage, Cornell product and R wave amplitude in aVL were 0.21/0.18, 0.28/0.17, 0.25/0.16, and 0.32/0.20, respectively (asterisk indicates P < 0.05 for between-method difference in correlations with Steiger's z test). For change in home/office DBP and change in the aforementioned ECG-LVH indexes, the correlations were 0.12/0.12, 0.20/0.15, 0.16/0.12, and 0.28/0.19. Multivariable-adjusted regression modelling provided similar results. No clinically significant increase in correlations between home BP and ECG-LVH indexes occurred after the fourth day of home BP measurement. Our study demonstrates for the first time the superiority of home BP over office BP in the follow-up of left ventricular mass. The results of this and previous studies underline the importance of using out-of-office BP measurements as the primary method for assessing blood pressure levels.

At-home and away-from-home dietary patterns and BMI z-scores in Brazilian adolescents.

PubMed

Cunha, Diana Barbosa; Bezerra, Ilana Nogueira; Pereira, Rosangela Alves; Sichieri, Rosely

2018-01-01

Away-from-home food intake has been associated with high rates of overweight among children and adolescents. However, there are no studies comparing at-home and away-from-home eating patterns among adolescents. The objective of this paper was to identify at-home and away-from-home dietary patterns among adolescents in Brazil, and to evaluate the relationship between these patterns and body mass index (BMI) z-scores. Data from the Brazilian National Dietary Survey 2008-2009 were analyzed in this cross-sectional study. Dietary intake was assessed by completion of written food records on two non-consecutive days. Five thousand two hundred sixty-six adolescents 10-19 years of age living in urban areas of Brazil were included in the analysis. Thirty-two food groups were examined by factor analysis, stratified by at-home and away-from-home eating. The associations between the food patterns and BMI z-scores were ascertained using linear regression analysis. In general, mean at-home food intake was greater than away-from-home food intake, but the ratio of away-from-home/at-home was greater than 30% for baked and deep-fried snacks, soft drinks, sandwiches, pizza, and desserts, and was lower than 10% for rice and beans. Three main similar dietary patterns were identified both at-home and away-from-home: the "Traditional pattern", the "Bread and Butter pattern" and the "Western pattern"; however, away-from-home patterns encompassed more overall food items. Only the at-home "Western pattern" was positively associated with BMI z-scores (β = 0.0006; p < 0.001). Our results indicate that unhealthy dietary pattern consumed at home is associated to BMI z-score, while away-from-home food consumption is not associated. Copyright © 2017 Elsevier Ltd. All rights reserved.

Parenthood and Leaving Home in Young Adulthood

PubMed Central

Hofferth, Sandra L.; Curtin, Sally C.

2014-01-01

With increases in nonmarital fertility, the sequencing of transitions in early adulthood has become even more complex. Once the primary transition out of the parental home, marriage was first replaced by nonfamily living and cohabitation; more recently, many young adults have become parents before entering a coresidential union. Studies of leaving home, however, have not examined the role of early parenthood. Using the Young Adult Study of the 1979 National Longitudinal Survey of Youth (n = 4,674), we use logistic regression to analyze parenthood both as a correlate of leaving home and as a route from the home. We find that even in mid-adolescence, becoming a parent is linked with leaving home. Coming from a more affluent family is linked with leaving home via routes that do not involve children rather than those that do, and having a warm relationship with either a mother or a father retards leaving home, particularly to nonfamily living, but is not related to parental routes out of the home. PMID:25544790

An evaluation of venous thromboembolic risk in acutely ill medical patients immobilized at home: the AT-HOME Study.

PubMed

Haas, Sylvia K; Hach-Wunderle, Viola; Mader, Frank H; Ruster, Katherine; Paar, Wilhelm D

2007-01-01

Many risk factors for venous thromboembolism (VTE) in hospitalized medical patients are also present in medical outpatients. VTE prevention represents an important challenge for physicians treating patients at home. The AT-HOME study was a prospective cross-sectional observational study designed to assess awareness of the risk of VTE in immobilized acutely ill medical outpatients among German physicians, many of whom were participating in a national Continuing Medical Education (CME) program designed to raise awareness of VTE. The study involved 1210 medical patients who were acutely confined to bed at home. Physicians performed a subjective assessment of VTE risk, which was rated on a 10-point scale (1 = very low risk; 10 = very high risk). The risk of VTE was also assessed retrospectively by using a scorecard developed for use in hospitalized medical patients. Of the 1210 patients, 198 (16%) had risk scores of 0-4, 319 (26%) had scores of 5 or 6, and 693 (57%) had scores > or =7. Overall, 966 patients (80%) received thromboprophylaxis. The proportion of patients receiving thromboprophylaxis was 0% to 47% in risk score groups 0-4, 76% to 85% in groups 5 and 6, and 90% to 100% in risk score groups 7-10. In the retrospective assessment of VTE risk, 74% of patients were at high risk, 15% were at intermediate risk, and 11% were at low risk. The proportions of patients receiving thromboprophylaxis in these groups were 87%, 61%, and 55%, respectively. The involvement of physicians in educational activities focusing on VTE awareness appeared to create awareness of the risks of VTE in acutely ill medical outpatients.

Recruiting a U.S. national sample of HIV-negative gay and bisexual men to complete at-home self-administered HIV/STI testing and surveys: Challenges and Opportunities

PubMed Central

Grov, Christian; Cain, Demetria; Whitfield, Thomas H. F.; Rendina, H. Jonathon; Pawson, Mark; Ventuneac, Ana; Parsons, Jeffrey T.

2015-01-01

We describe enrollment for the One Thousand Strong panel, present characteristics of the panel relative to other large U.S. national studies of gay and bisexual men (GBM), and examine demographic and behavioral characteristics that were associated with passing enrollment milestones. A U.S. national sample of HIV-negative men were enrolled via an established online panel of over 22,000 GBM. Participants (n = 1071) passed three milestones to join our panel. Milestone 1 was screening eligible and providing informed consent. Milestone 2 involved completing an hour-long at-home computer-assisted self-interview (CASI) survey. Milestone 3 involved completing at-home self-administered rapid HIV testing and collecting/returning urine and rectal samples for gonorrhea and chlamydia testing. Compared to those who completed milestones: those not passing milestone 1 were more likely to be non-White and older; those not passing milestone 2 were less likely to have insurance or a primary care physician; and those not passing milestone 3 were less educated, more likely to be bisexual as opposed to gay, more likely to live in the Midwest, had fewer male partners in the past year, and less likely to have tested for HIV in the past year. Effect sizes for significant findings were small. We successfully enrolled a national sample of HIV-negative GBM who completed at-home CASI assessments and at-home self-administered HIV and urine and rectal STI testing. This indicates high feasibility and acceptability of incorporating self-administered biological assays into otherwise fully online studies. Differences in completion of study milestones indicate a need for further investigation into the reasons for lower engagement by certain groups. PMID:26858776

Medicaid payment policies for nursing home care: A national survey

PubMed Central

Buchanan, Robert J.; Madel, R. Peter; Persons, Dan

1991-01-01

This research gives a comprehensive overview of the nursing home payment methodologies used by each State Medicaid program. To present this comprehensive overview, 1988 data were collected by survey from 49 States and the District of Columbia. The literature was reviewed and integrated into the study to provide a theoretical framework to analyze the collected data. The data are organized and presented as follows: payment levels, payment methods, payment of capital-related costs, and incentives in nursing home payment. We conclude with a discussion of the impact these different methodologies have on program cost containment, quality, and recipient access. PMID:10114935

A National Study of Community Living: Impact of Type of Residence and Hours of In-Home Support

ERIC Educational Resources Information Center

Kim, Rah Kyung; Dymond, Stacy K.

2012-01-01

This study investigated the frequency of community participation and level of assistance needed to perform domestic and safety skills for individuals with severe disabilities who live successfully in the community, based on type of residence and hours of in-home support provided. Participants included residential specialists from small community…

Home sleep studies in the assessment of sleep apnea/hypopnea syndrome.

PubMed

Golpe, Rafael; Jiménez, Antonio; Carpizo, Rosario

2002-10-01

To determine the clinical utility of a limited sleep-recording device used unsupervised in the patient's home, compared with in-laboratory, fully supervised polysomnography for the diagnosis of sleep apnea/hypopnea syndrome (SAHS), and to assess its impact on costs. Prospective case study. The sleep-disorders unit of a tertiary referral university hospital. Fifty-five patients suspected of having SAHS and living within 30 km of our laboratory. Patients were studied first in their homes with the limited sleep-recording device. Polysomnography was performed within 30 days of the first study. Both studies were read by independent investigators blinded to the results of the other study. Diagnoses and therapeutic decisions regarding the use of continuous positive airway pressure obtained from the home and laboratory studies were compared. Agreement between the home and laboratory study recordings was also assessed using receiver operating characteristic (ROC) curves and Bland-Altman analysis. One half of the home studies were randomly assigned to be performed with a sleep technician's set up of the equipment in the patient's home (group 1), and the other half with the patient's own setup of the sleep-recording device (group 2), after an instruction period in the hospital. An economic analysis was performed, considering the cost of repeating studies in cases with faulty or inconclusive home studies (these patients should undergo polysomnography as a second step). Seven percent of the home studies in group 1, and 33% in group 2 produced no interpretable data because of artifacts (p < 0.05). Sixteen percent of the home study findings were inconclusive. The diagnosis obtained from the limited sleep-recording device and polysomnography agreed in 75% of the interpretable home studies (89%, if inconclusive home studies were excluded). The area under the ROC curve for the home study-derived parameters was between 0.84 and 0.89, compared with polysomnography. There was no bias

Food Stamp Participation is Associated with Fewer Meals Away From Home, yet Higher Body Mass Index and Waist Circumference in a Nationally Representative Sample

ERIC Educational Resources Information Center

Jilcott, Stephanie B.; Liu, Haiyong; DuBose, Katrina D.; Chen, Susan; Kranz, Sibylle

2011-01-01

Objective: To examine associations between Food Stamp (FS) participation, meals away from home (MAFH), body mass index (BMI), and waist circumference (WC). Design: Cross-sectional study. Setting: Nationally representative. Participants: Data from low-income, FS-eligible individuals (N = 945) ages 20-65 years, responding to the 2005-2006 National…

DOE Zero Energy Ready Home Case Study: Palo Duro Homes — Palo Duro Homes, Albuquerque, NM

DOE Office of Scientific and Technical Information (OSTI.GOV)

none,

2014-09-01

This builder was honored for Most DOE Zero Energy Ready Homes Built in the 2014 Housing Innovation Awards. By July 2014, Palo Duro had completed 152 homes since the program began in 2013 (under the original program title DOE Challenge Home), all of them certified to the stringent efficiency requirements of DOE’s Zero Energy Ready Home program.

World Wide Web home page for the South Platte NAWQA

USGS Publications Warehouse

Qi, Sharon L.; Dennehy, Kevin F.

1997-01-01

A World Wide Web home page for the U.S. Geological Survey's (USGS) National Water-Quality Assessment (NAWQA) Program, South Platte River Basin study is now online. The home page includes information about the basinwide investigation and provides viewing and downloading access to physical, chemical, and biological data collected by the study team.

Using comprehensive geriatric assessment for quality improvements in healthcare of older people in UK care homes: protocol for realist review within Proactive Healthcare of Older People in Care Homes (PEACH) study.

PubMed

Zubair, Maria; Chadborn, Neil H; Gladman, John R F; Dening, Tom; Gordon, Adam L; Goodman, Claire

2017-10-10

Care home residents are relatively high users of healthcare resources and may have complex needs. Comprehensive geriatric assessment (CGA) may benefit care home residents and improve efficiency of care delivery. This is an approach to care in which there is a thorough multidisciplinary assessment (physical and mental health, functioning and physical and social environments) and a care plan based on this assessment, usually delivered by a multidisciplinary team. The CGA process is known to improve outcomes for community-dwelling older people and those in receipt of hospital care, but less is known about its efficacy in care home residents. Realist review was selected as the most appropriate method to explore the complex nature of the care home setting and multidisciplinary delivery of care. The aim of the realist review is to identify and characterise a programme theory that underpins the CGA intervention. The realist review will extract data from research articles which describe the causal mechanisms through which the practice of CGA generates outcomes. The focus of the intervention is care homes, and the outcomes of interest are health-related quality of life and satisfaction with services; for both residents and staff. Further outcomes may include appropriate use of National Health Service services and resources of older care home residents. The review will proceed through three stages: (1) identifying the candidate programme theories that underpin CGA through interviews with key stakeholders, systematic search of the peer-reviewed and non-peer-reviewed evidence, (2) identifying the evidence relevant to CGA in UK care homes and refining the programme theories through refining and iterating the systematic search, lateral searches and seeking further information from study authors and (3) analysis and synthesis of evidence, involving the testing of the programme theories. The PEACH project was identified as service development following submission to the UK Health

Safety Risks Among Home Infusion Nurses and Other Home Health Care Providers

PubMed Central

Galligan, Catherine; Quinn, Margaret

2017-01-01

In the United States, home health care (HHC) is a rapidly growing industry and home infusion therapy is a rapidly growing market. HHC can present substantial occupational safety and health (OSH) risks. This article summarizes major OSH risks relevant to home infusion therapy by illustrating them through real-life scenarios collected systematically using qualitative research methods by the National Institute for Occupational Safety and Health-funded research projects at the University of Massachusetts Lowell. The need for home infusion therapy will continue to grow in the future, and safety interventions to prevent or minimize OSH risks are essential. PMID:28683000

Nursing Home Work Practices and Nursing Assistants' Job Satisfaction

ERIC Educational Resources Information Center

Bishop, Christine E.; Squillace, Marie R.; Meagher, Jennifer; Anderson, Wayne L.; Wiener, Joshua M.

2009-01-01

Purpose: To estimate the impact of nursing home work practices, specifically compensation and working conditions, on job satisfaction of nursing assistants employed in nursing homes. Design and Methods: Data are from the 2004 National Nursing Assistant Survey, responses by the nursing assistants' employers to the 2004 National Nursing Home Survey,…

A National Implementation Project to Prevent Catheter-Associated Urinary Tract Infection in Nursing Home Residents.

PubMed

Mody, Lona; Greene, M Todd; Meddings, Jennifer; Krein, Sarah L; McNamara, Sara E; Trautner, Barbara W; Ratz, David; Stone, Nimalie D; Min, Lillian; Schweon, Steven J; Rolle, Andrew J; Olmsted, Russell N; Burwen, Dale R; Battles, James; Edson, Barbara; Saint, Sanjay

2017-08-01

Catheter-associated urinary tract infection (UTI) in nursing home residents is a common cause of sepsis, hospital admission, and antimicrobial use leading to colonization with multidrug-resistant organisms. To develop, implement, and evaluate an intervention to reduce catheter-associated UTI. A large-scale prospective implementation project was conducted in community-based nursing homes participating in the Agency for Healthcare Research and Quality Safety Program for Long-Term Care. Nursing homes across 48 states, Washington DC, and Puerto Rico participated. Implementation of the project was conducted between March 1, 2014, and August 31, 2016. The project was implemented over 12-month cohorts and included a technical bundle: catheter removal, aseptic insertion, using regular assessments, training for catheter care, and incontinence care planning, as well as a socioadaptive bundle emphasizing leadership, resident and family engagement, and effective communication. Urinary catheter use and catheter-associated UTI rates using National Healthcare Safety Network definitions were collected. Facility-level urine culture order rates were also obtained. Random-effects negative binomial regression models were used to examine changes in catheter-associated UTI, catheter utilization, and urine cultures and adjusted for covariates including ownership, bed size, provision of subacute care, 5-star rating, presence of an infection control committee, and an infection preventionist. In 4 cohorts over 30 months, 568 community-based nursing homes were recruited; 404 met inclusion criteria for analysis. The unadjusted catheter-associated UTI rates decreased from 6.78 to 2.63 infections per 1000 catheter-days. With use of the regression model and adjustment for facility characteristics, the rates decreased from 6.42 to 3.33 (incidence rate ratio [IRR], 0.46; 95% CI, 0.36-0.58; P < .001). Catheter utilization was 4.5% at baseline and 4.9% at the end of the project. Catheter

A National Analysis of Medicaid Home and Community Based Services Waivers for People With Intellectual and Developmental Disabilities: FY 2015.

PubMed

Friedman, Carli

2017-10-01

Medicaid Home and Community Based Services (HCBS) 1915(c) waivers are the largest source of funding for the long term services and supports of people with intellectual and developmental disabilities (IDD). National-level analyses of HCBS IDD waivers are crucial because of the large variance across states, the recent CMS rule and regulation changes (CMS 2249-F/2296-F), and the ever changing economic and political landscape. Therefore, the aim of this study was to examine state waiver priorities for people with IDD. In FY 2015, 111 waivers projected spending $25.6 billion for approximately 630,000 people with IDD. The services with the most funding were residential habilitation, supports to live in one's own home, and day habilitation. However, our analysis revealed large discrepancies across states and services.

LONGITUDINAL STUDY OF YOUNG CHILDREN'S EXPOSURES IN THEIR HOMES TO SELECTED PESTICIDES, PHTHALATES, BROMINATED FLAME RETARDANTS, AND PERFLUORINATED CHEMICALS (A CHILDREN'S ENVIRONMENTAL EXPOSURE RESEARCH STUDY - CHEERS)

EPA Science Inventory

The U.S. Environmental Protection Agency's (EPA) National Exposure Research Laboratory (NERL) is conducting a study of young children's exposures to chemicals in the home. The American Chemistry Council (ACC) is partnering with the EPA to enhance an existing EPA study of childre...

Success Begins at Home.

ERIC Educational Resources Information Center

Lombard, Avima D.

Israel's Home Instruction Program for Preschool Youngsters, a nationally administered home-based program of early childhood education, is discussed in this book. In addition to presenting information regarding the social conditions that necessitated development of the program, this book describes the theory and planning behind the program, its…

Facilitating home birth.

PubMed

Finigan, Valerie; Chadderton, Diane

2015-06-01

The birth of a baby is a family experience. However, in the United Kingdom birth often occurs outside the family environment, in hospital. Both home and hospital births have risks and benefits, but research shows that, for most women, it is as safe to give birth at home as it is in hospital. Women report home-birth to be satisfying with lowered risks of intervention and less likelihood of being separated from their family. It is also more cost effective for the National Health Service. Yet, whilst midwives are working hard to promote home birth as an option, it remains controversial. The aim of this paper is to raise awareness of the safety of home birth and the needs of women and midwives when a home birth is chosen. It provides an overview of care required and the role of the midwife in the ensuring care is woman-centred and personalised.

American Healthy Homes Survey (AHHS)

EPA Pesticide Factsheets

A nationally representative sample of homes was selected for this survey. AHHS measured levels of lead, lead hazards, and allergens in homes nationwide. AHHS also surveyed additional potential health hazards such as arsenic, pesticides, and molds. The lead

Substituting physicians with nurse practitioners, physician assistants or nurses in nursing homes: protocol for a realist evaluation case study.

PubMed

Lovink, Marleen Hermien; Persoon, Anke; van Vught, Anneke J A H; Schoonhoven, Lisette; Koopmans, Raymond T C M; Laurant, Miranda G H

2017-06-08

In developed countries, substituting physicians with nurse practitioners, physician assistants and nurses (physician substitution) occurs in nursing homes as an answer to the challenges related to the ageing population and the shortage of staff, as well as to guarantee the quality of nursing home care. However, there is great diversity in how physician substitution in nursing homes is modelled and it is unknown how it can best contribute to the quality of healthcare. This study aims to gain insight into how physician substitution is modelled and whether it contributes to perceived quality of healthcare. Second, this study aims to provide insight into the elements of physician substitution that contribute to quality of healthcare. This study will use a multiple-case study design that draws upon realist evaluation principles. The realist evaluation is based on four concepts for explaining and understanding interventions: context, mechanism, outcome and context-mechanism-outcome configuration. The following steps will be taken: (1) developing a theory, (2) conducting seven case studies, (3) analysing outcome patterns after each case and a cross-case analysis at the end and (4) revising the initial theory. The research ethics committee of the region Arnhem Nijmegen in the Netherlands concluded that this study does not fall within the scope of the Dutch Medical Research Involving Human Subjects Act (WMO) (registration number 2015/1914). Before the start of the study, the Board of Directors of the nursing home organisations will be informed verbally and by letter and will also be asked for informed consent. In addition, all participants will be informed verbally and by letter and will be asked for informed consent. Findings will be disseminated by publication in a peer-reviewed journal, international and national conferences, national professional associations and policy partners in national government. © Article author(s) (or their employer(s) unless otherwise stated

Agricultural Products | National Agricultural Library

Science.gov Websites

Skip to main content Home National Agricultural Library United States Department of Agriculture Ag News Contact Us Search  Log inRegister Home Home Agricultural Products NEWT: National Extension Web , tables, graphs), Agricultural Products html National Animal Nutrition Program (NANP) Feed Composition

The National Home Visiting Coalition: A History of Collaboration

ERIC Educational Resources Information Center

Callahan, Jane; Gavaghan, Bridget; Howard, Karen; Kelley, Melissa L.; Schwartz, Marvin; Walzer, Sarah

2010-01-01

The Home Visiting Coalition represents more than 75 organizations working together to articulate the effectiveness of home visiting to a range of policymakers and stakeholders in the early childhood field. Despite varying program goals and service delivery strategies, the Coalition participants share a commitment to expanding access to…

32 CFR 728.76 - Naval Home residents.

Code of Federal Regulations, 2011 CFR

2011-07-01

... 32 National Defense 5 2011-07-01 2011-07-01 false Naval Home residents. 728.76 Section 728.76 National Defense Department of Defense (Continued) DEPARTMENT OF THE NAVY PERSONNEL MEDICAL AND DENTAL CARE.... Provide necessary medical and dental care, both inpatient and outpatient, to residents of the Naval Home...

32 CFR 728.76 - Naval Home residents.

Code of Federal Regulations, 2012 CFR

2012-07-01

... 32 National Defense 5 2012-07-01 2012-07-01 false Naval Home residents. 728.76 Section 728.76 National Defense Department of Defense (Continued) DEPARTMENT OF THE NAVY PERSONNEL MEDICAL AND DENTAL CARE.... Provide necessary medical and dental care, both inpatient and outpatient, to residents of the Naval Home...

32 CFR 728.76 - Naval Home residents.

Code of Federal Regulations, 2013 CFR

2013-07-01

... 32 National Defense 5 2013-07-01 2013-07-01 false Naval Home residents. 728.76 Section 728.76 National Defense Department of Defense (Continued) DEPARTMENT OF THE NAVY PERSONNEL MEDICAL AND DENTAL CARE.... Provide necessary medical and dental care, both inpatient and outpatient, to residents of the Naval Home...

32 CFR 728.76 - Naval Home residents.

Code of Federal Regulations, 2010 CFR

2010-07-01

... 32 National Defense 5 2010-07-01 2010-07-01 false Naval Home residents. 728.76 Section 728.76 National Defense Department of Defense (Continued) DEPARTMENT OF THE NAVY PERSONNEL MEDICAL AND DENTAL CARE.... Provide necessary medical and dental care, both inpatient and outpatient, to residents of the Naval Home...

Pilot study of methods and equipment for in-home noise level measurements.

PubMed

Neitzel, Richard L; Heikkinen, Maire S A; Williams, Christopher C; Viet, Susan Marie; Dellarco, Michael

2015-01-15

Knowledge of the auditory and non-auditory effects of noise has increased dramatically over the past decade, but indoor noise exposure measurement methods have not advanced appreciably, despite the introduction of applicable new technologies. This study evaluated various conventional and smart devices for exposure assessment in the National Children's Study. Three devices were tested: a sound level meter (SLM), a dosimeter, and a smart device with a noise measurement application installed. Instrument performance was evaluated in a series of semi-controlled tests in office environments over 96-hour periods, followed by measurements made continuously in two rooms (a child's bedroom and a most used room) in nine participating homes over a 7-day period with subsequent computation of a range of noise metrics. The SLMs and dosimeters yielded similar A-weighted average noise levels. Levels measured by the smart devices often differed substantially (showing both positive and negative bias, depending on the metric) from those measured via SLM and dosimeter, and demonstrated attenuation in some frequency bands in spectral analysis compared to SLM results. Virtually all measurements exceeded the Environmental Protection Agency's 45 dBA day-night limit for indoor residential exposures. The measurement protocol developed here can be employed in homes, demonstrates the possibility of measuring long-term noise exposures in homes with technologies beyond traditional SLMs, and highlights potential pitfalls associated with measurements made by smart devices.

Nutritional and health status among nursing home residents in Lebanon: comparison across gender in a national cross sectional study.

PubMed

Doumit, Jacqueline H; Nasser, Ramzi N; Hanna, Dimitri R

2014-06-20

This study described the differences between elderly men and women living in Lebanese long-term care nursing homes on socio-economic, health and nutritional status. This study used a cross-sectional design. Field researchers obtained data from 221 residents; 148 (67%) women and 73 (33%) men, living in 36 nursing homes. Data on health conditions; nutritional, psychological, and functional status; socio-demographic characteristics, as well as social relations were collected. The analysis used both chi-square and t-test tests. The majority of elderly had low socio-economic and poor health status. In comparison to men, women were significantly less educated, had lower occupational status, had no partner, relied financially on their children and relatives, and enjoyed better social relations and health behaviours. Furthermore, the prevalence of both; malnutrition, and at risk of malnutrition, were at 3.2% and 27.6% respectively. There was no statistically significant difference between women and men on Mini Nutritional Assessment, Activities of Daily Living, Geriatric Depression Scale, Body Mass Index, and chronic diseases. While women reported "good" health status compared to men, they continued to have higher prevalence of diseases and chronic pain. This study explored the socio-demographic, health, and nutritional status of elderly residing in Lebanese nursing homes and compared these characteristics across gender. The results indicated the need of health support and institutional interventions for elderly women residents.

Health and Care Related Risk Factors for Suicide Among Nursing Home Residents: A Data Linkage Study.

PubMed

Murphy, Briony; Kennedy, Briohny; Martin, Catherine; Bugeja, Lyndal; Willoughby, Melissa; Ibrahim, Joseph E

2018-04-17

This study aimed to examine associations between health status and care needs of nursing home residents and risk of death from suicide compared to other causes through a retrospective data linkage cohort study examining nursing home resident deaths in Australia between 2000 and 2013. Data linkage was performed between aged care assessment tools-Resident Classification System and Aged Care Funding Instrument-and the National Coronial Information System. A competing risks survival analysis was performed to determine the association between care assessment variables (activities of daily living (ADL), behavior, and complex health care) and the risk of death from suicide and any other cause. Of the 146 nursing home residents who died from suicide, 130 (89%) were matched to their assessment data, with comparable information available for 95 residents (65%). Residents who required high levels of care with ADL, physical health care, and cognitive and behavioral issues had a higher risk of dying from all other causes, yet lower risk of dying from suicide. The study findings demonstrate the feasibility and value of linking these two data sets; highlight a need for improved data collection processes; and support a person-centered care approach for prevention of suicide among nursing home residents. © 2018 The American Association of Suicidology.

Early Childhood Home Visiting.

PubMed

Duffee, James H; Mendelsohn, Alan L; Kuo, Alice A; Legano, Lori A; Earls, Marian F

2017-09-01

High-quality home-visiting services for infants and young children can improve family relationships, advance school readiness, reduce child maltreatment, improve maternal-infant health outcomes, and increase family economic self-sufficiency. The American Academy of Pediatrics supports unwavering federal funding of state home-visiting initiatives, the expansion of evidence-based programs, and a robust, coordinated national evaluation designed to confirm best practices and cost-efficiency. Community home visiting is most effective as a component of a comprehensive early childhood system that actively includes and enhances a family-centered medical home. Copyright © 2017 by the American Academy of Pediatrics.

American Healthy Homes Survey: A National Study of Residential Phthalates Measured from Floor Wipes

EPA Science Inventory

The United States Environmental Protection Agency (U.S. EPA), in collaboration with the U.S. Department of Housing and Urban Development (HUD), conducted a survey measuring phthalates in randomly selected residential homes throughout the U.S. Multistage sampling with clustering w...

AMERICAN HEALTHY HOMES SURVEY: A NATIONAL STUDY OF RESIDENTIAL PESTICIDES MEASURED FROM FLOOR WIPES

EPA Science Inventory

The US Environmental Protection Agency and the US Department of Housing and Urban Development conducted the American Healthy Homes Survey (AHHS) in 2006 to assess environmental concentrations of lead, allergens, mold, pesticides, and arsenic in and around U.S. residences.

The Canadian Birth Place Study: describing maternity practice and providers' exposure to home birth.

PubMed

Vedam, Saraswathi; Schummers, Laura; Stoll, Kathrin; Rogers, Judy; Klein, Michael C; Fairbrother, Nichole; Dharamsi, Shafik; Liston, Robert; Chong, Gua Khee; Kaczorowski, Janusz

2012-10-01

(1) to describe educational, practice, and personal experiences related to home birth practice among Canadian obstetricians, family physicians, and registered midwives; (2) to identify barriers to provision of planned home birth services, and (3) to examine inter-professional differences in attitudes towards planned home birth. the first phase of a mixed-methods study, a quantitative survey, comprised of 38 items eliciting demographic, education and practice data, and 48 items about attitudes towards planned home birth, was distributed electronically to all registered midwives (N=759) and obstetricians who provide maternity care (N=800), and a random sample of family physicians (n=3,000). Canada. This national investigation was funded by the Canadian Institutes for Health Research. Canadian registered midwives (n=451), obstetricians (n=245), and family physicians (n=139). almost all registered midwives had extensive educational and practice experiences with planned home birth, and most obstetricians and family physicians had minimal exposure. Attitudes among midwives and physicians towards home birth safety and advisability were significantly different. Physicians believed that home births are less safe than hospital births, while midwives did not agree. Both groups believed that their views were evidence-based. Midwives were the most comfortable with including planned home birth as an option when discussing choice of birth place with pregnant women. Both midwives and physicians expressed discomfort with inter-professional consultation related to planned home births. In addition, both family physicians and obstetricians reported discomfort with discussing home birth with their patients. A significant proportion of family physicians and obstetricians would have liked to attend a home birth as part of their education. the amount and type of education and exposure to planned home birth practice among maternity care providers were associated with attitudes towards home

Haemodialysis: hospital or home?

PubMed

Power, Albert; Ashby, Damien

2014-02-01

Healthcare costs associated with the provision of dialysis therapy are escalating globally as the number of patients developing end-stage renal disease increases. In this setting, there has been heightened interest in the application and potential benefit of home haemodialysis therapies compared with the conventional approach of thrice weekly, incentre treatments. Increasingly, national healthcare systems are financially incentivising the expansion of home haemodialysis programmes with observational studies demonstrating better patient survival, superior control of circulating volume and blood pressure, greater patient satisfaction and lower running costs compared with incentre dialysis. Nonetheless, increasing the prevalence of home haemodialysis is challenged by the technological complexity of conventional dialysis systems, the need for significant adaptations to the home as well as suboptimal clinician and patient education about the feasibility and availability of this modality. In addition, enthusiasm about frequent as well as nocturnal (extended-hours) haemodialysis has been tempered by results from the recent Frequent Haemodialysis Network randomised controlled trials comparing these schedules with a conventional incentre regime. An increasing emphasis on empowering patient choice and promoting self-management of chronic illness is a powerful driver for the expansion of home haemodialysis programmes in the UK and internationally.

Impact of national smoke-free legislation on home smoking bans: findings from the International Tobacco Control Policy Evaluation Project Europe Surveys.

PubMed

Mons, Ute; Nagelhout, Gera E; Allwright, Shane; Guignard, Romain; van den Putte, Bas; Willemsen, Marc C; Fong, Geoffrey T; Brenner, Hermann; Pötschke-Langer, Martina; Breitling, Lutz P

2013-05-01

To measure changes in prevalence and predictors of home smoking bans (HSBs) among smokers in four European countries after the implementation of national smoke-free legislation. Two waves of the International Tobacco Control Policy Evaluation Project Europe Surveys, which is a prospective panel study. Pre- and post-legislation data were used from Ireland, France, Germany and the Netherlands. Two pre-legislation waves from the UK were used as control. 4634 respondents from the intervention countries and 1080 from the control country completed both baseline and follow-up and were included in the present analyses. Multiple logistic regression models to identify predictors of having or of adopting a total HSB, and Generalised Estimating Equation models to compare patterns of change after implementation of smoke-free legislation to a control country without such legislation. Most smokers had at least partial smoking restrictions in their home, but the proportions varied significantly between countries. After implementation of national smoke-free legislation, the proportion of smokers with a total HSB increased significantly in all four countries. Among continuing smokers, the number of cigarettes smoked per day either remained stable or decreased significantly. Multiple logistic regression models indicated that having a young child in the household and supporting smoking bans in bars were important correlates of having a pre-legislation HSB. Prospective predictors of imposing a HSB between survey waves were planning to quit smoking, supporting a total smoking ban in bars and the birth of a child. Generalised Estimating Equation models indicated that the change in total HSB in the intervention countries was greater than that in the control country. The findings suggest that smoke-free legislation does not lead to more smoking in smokers' homes. On the contrary, our findings demonstrate that smoke-free legislation may stimulate smokers to establish total smoking bans in

Home advantage in the Winter Olympics (1908-1998).

PubMed

Balmer, N J; Nevill, A M; Williams, A M

2001-02-01

We obtained indices of home advantage, based on the medals won by competing nations, for each event held at the Winter Olympics from 1908 to 1998. These indices were designed to assess home advantage while controlling for nation strength, changes in the number of medals on offer and the performance of 'non-hosting' nations. Some evidence of home advantage was found in figure skating, freestyle skiing, ski jumping, alpine skiing and short track speed skating. In contrast, little or no home advantage was observed in ice hockey, Nordic combined, Nordic skiing, bobsled, luge, biathlon or speed skating. When all events were combined, a significant home advantage was observed (P = 0.029), although no significant differences in the extent of home advantage were found between events (P > 0.05). When events were grouped according to whether they were subjectively assessed by judges, significantly greater home advantage was observed in the subjectively assessed events (P = 0.037). This was a reflection of better home performances, suggesting that judges were scoring home competitors disproportionately higher than away competitors. Familiarity with local conditions was shown to have some effect, particularly in alpine skiing, although the bobsled and luge showed little or no advantage over other events. Regression analysis showed that the number of time zones and direction of travel produced no discernible trends or differences in performance.

DOE Zero Energy Ready Home Case Study: Amaris Homes, Afton Model

DOE Office of Scientific and Technical Information (OSTI.GOV)

Pacific Northwest National Laboratory

Amaris Homes built this 3,734-ft2 home in Afton, Minnesota, to the performance criteria of the DOE Zero Energy Ready Home (ZERH) program. A high-efficiency gas boiler provides hot water for the zoned radiant floor system as well as for faucets and showers. A high-efficiency heat pump provides zoned cooling.

The contribution of at-home and away-from-home food to dietary intake among 2–13y Mexican children

PubMed Central

Taillie, Lindsey Smith; Afeiche, Myriam C.; Eldridge, Alison L.; Popkin, Barry M.

2016-01-01

Objectives Away-from-home foods have been shown to have lower nutritional quality and larger portion sizes as compared to many foods prepared at home. The objective of this study was to describe calorie and nutrient intakes among 2–13y old Mexican children by eating location (at-home and away-from-home), overall, by socio-economic status (SES), and by urbanicity. Design Dietary intake was collected via one 24-hr recall in the 2012 Mexican National Health and Nutrition Survey (ENSANUT). Location was reported for each food consumed. Results were adjusted for age, sex, weight status, socio-economic status and urbanicity. Setting Mexico (nationally representative) Subjects 2–5y (n=1905) and 6–13y (n=2868) children Results Children consumed the majority of daily energy at home (89% and 82%, respectively). The most common away-from-home eating location was the school (22% 2–5y; 43% 6–13y old), followed by street (14% 2–5y; 13% 6–13y old). The most common foods consumed away-from-home were wheat, rice, and corn mixed dishes, and sugar-sweetened beverages (SSBs), pastries/ candy/desserts, milk (2–5y only) and salty snacks (6–13y). Multivariate models showed that high SES 2–5 year-olds consumed 14% of daily energy away-from-home relative to 8% among low SES 2–5 year-olds, and high SES 6–13 year-olds consumed 21% of daily energy away-from-home compared to 14% among low SES 6–13 year-olds. There were no differences by urban residence. Conclusions Among Mexican children, most foods and beverages were consumed at home. However, the percent of foods consumed or purchased away-from-home increased with age and with SES. PMID:27608532

Prevalence and patterns of cooking dinner at home in the USA: National Health and Nutrition Examination Survey (NHANES) 2007-2008.

PubMed

Virudachalam, Senbagam; Long, Judith A; Harhay, Michael O; Polsky, Daniel E; Feudtner, Chris

2014-05-01

To measure the prevalence of cooking dinner at home in the USA and test whether home dinner preparation habits are associated with socio-economic status, race/ethnicity, country of birth and family structure. Cross-sectional analysis. The primary outcome, self-reported frequency of cooking dinner at home, was divided into three categories: 0-1 dinners cooked per week ('never'), 2-5 ('sometimes') and 6-7 ('always'). We used bivariable and multivariable regression analyses to test for associations between frequency of cooking dinner at home and factors of interest. The 2007-2008 National Health and Nutrition Examination Survey (NHANES). The sample consisted of 10 149 participants. Americans reported cooking an average of five dinners per week; 8 % never, 43 % sometimes and 49 % always cooked dinner at home. Lower household wealth and educational attainment were associated with a higher likelihood of either always or never cooking dinner at home, whereas wealthier, more educated households were more likely to sometimes cook dinner at home (P < 0·05). Black households cooked the fewest dinners at home (mean = 4·4, 95 % CI 4·2, 4·6). Households with foreign-born reference persons cooked more dinners at home (mean = 5·8, 95 % CI 5·7, 6·0) than households with US-born reference persons (mean = 4·9, 95 % CI 4·7, 5·1). Households with dependants cooked more dinners at home (mean = 5·2, 95 % CI 5·1, 5·4) than households without dependants (mean = 4·6, 95 % CI 4·3, 5·0). Home dinner preparation habits varied substantially with socio-economic status and race/ethnicity, associations that likely will have implications for designing and appropriately tailoring interventions to improve home food preparation practices and promote healthy eating.

Is There Evidence of Cream Skimming Among Nursing Homes Following the Publication of the Nursing Home Compare Report Card?

PubMed Central

Mukamel, Dana B.; Ladd, Heather; Weimer, David L.; Spector, William D.; Zinn, Jacqueline S.

2009-01-01

Purpose: A national quality report card for nursing homes, Nursing Home Compare, has been published since 2002. It has been shown to have some, albeit limited, positive impact on quality of care. The objective of this study was to test empirically the hypothesis that nursing homes have responded to the publication of the report by adopting cream skimming admission policies. Design and Methods: The study included all non-Medicare newly admitted patients to all Medicare- and Medicaid-certified nursing homes nationally during the 2001–2005 period. Using the Minimum Data Set data, we calculated for each quarter several admission cohort characteristics: average number of activity of daily living limitations and percent of residents admitted with pain, with pressure ulcers, with urinary incontinence, with diabetes, and with memory limitations. We tested whether residents admitted in the postpublication period were less frail and sick compared with residents admitted in the prepublication period by estimating fixed facility effects longitudinal regression models. Analyses were stratified by nursing home ownership, occupancy, reported quality ranking, chain affiliation, and region. Results: Evidence for cream skimming was found with respect to pain and, to a lesser degree, with respect to memory limitation but not with respect to the 4 other admission cohort characteristics. Implications: Despite the theoretical expectation, empirical evidence suggests only a limited degree of cream skimming. Further studies are required to investigate this phenomenon with respect to other admission cohort characteristics and with respect to post-acute patients. PMID:19491363

Utah obstetricians' opinions of planned home birth and conflicting NICE/ACOG guidelines: A qualitative study.

PubMed

Rainey, Emily; Simonsen, Sara; Stanford, Joseph; Shoaf, Kimberley; Baayd, Jami

2017-06-01

The United Kingdom's National Institute for Health and Care Excellence (NICE) recently published recommendations that support planned home birth for low-risk women. The American College of Obstetricians and Gynecologists (ACOG) remains wary of planned home birth, asserting that hospitals and birthing centers are the safest birth settings. Our objective was to examine opinions of obstetricians in Salt Lake City, Utah about home birth in the context of rising home birth rates and conflicting guidelines. Participants were recruited through online searches of Salt Lake City obstetricians and through snowball sampling. We conducted individual interviews exploring experiences with and attitudes toward planned home birth and the ACOG/NICE guidelines. Fifteen obstetricians who varied according to years of experience, location of medical training, sex, and subspecialty (resident, OB/GYN, maternal-fetal medicine specialist) were interviewed. Participants did not recommend home birth but supported a woman's right to choose her birth setting. Obstetrician opinions about planned home birth were shaped by misconceptions of home birth benefits, confusion surrounding the scope of care at home and among home birth providers, and negative transfer experiences. Participants were unfamiliar with the literature on planned home birth and/or viewed the evidence as unreliable. Support for ACOG guidelines was high, particularly in the context of the United States health care setting. Physician objectivity may be limited by biases against home birth, which stem from limited familiarity with published evidence, negative experiences with home-to-hospital transfers, and distrust of home birth providers in a health care system not designed to support home birth. © 2017 Wiley Periodicals, Inc.

Nutritional and health status among nursing home residents in Lebanon: comparison across gender in a national cross sectional study

PubMed Central

2014-01-01

Background This study described the differences between elderly men and women living in Lebanese long-term care nursing homes on socio-economic, health and nutritional status. Methods This study used a cross-sectional design. Field researchers obtained data from 221 residents; 148 (67%) women and 73 (33%) men, living in 36 nursing homes. Data on health conditions; nutritional, psychological, and functional status; socio-demographic characteristics, as well as social relations were collected. The analysis used both chi-square and t-test tests. Results The majority of elderly had low socio-economic and poor health status. In comparison to men, women were significantly less educated, had lower occupational status, had no partner, relied financially on their children and relatives, and enjoyed better social relations and health behaviours. Furthermore, the prevalence of both; malnutrition, and at risk of malnutrition, were at 3.2% and 27.6% respectively. There was no statistically significant difference between women and men on Mini Nutritional Assessment, Activities of Daily Living, Geriatric Depression Scale, Body Mass Index, and chronic diseases. While women reported “good” health status compared to men, they continued to have higher prevalence of diseases and chronic pain. Conclusions This study explored the socio-demographic, health, and nutritional status of elderly residing in Lebanese nursing homes and compared these characteristics across gender. The results indicated the need of health support and institutional interventions for elderly women residents. PMID:24950594

Differences in quality of life in home-dwelling persons and nursing home residents with dementia - a cross-sectional study.

PubMed

Olsen, Christine; Pedersen, Ingeborg; Bergland, Astrid; Enders-Slegers, Marie-José; Jøranson, Nina; Calogiuri, Giovanna; Ihlebæk, Camilla

2016-07-11

Dementia often eventually leads to dependency on others and finally to residential care. However, in Norway about half of the dementia population lives at home, due to individual and political wishes. There is scarce and inconclusive knowledge of how living in a nursing home differs from living at home for persons with dementia (PWDs) with regard to their quality of life (QoL). The first aim of the study was therefore to compare QoL, cognitive and physical functions, social contacts, sleep patterns, physical activity levels, exposure to light, and medication of PWDs in nursing homes and home-dwelling PWDs, and whether living in nursing homes was associated with a lower QoL than living at home for PWDs. A second aim was to examine if possible differences between residencies in QoL were consistent over time. The cross-sectional study was based on baseline data from two RCT studies of PWDs. A total of 15 nursing homes with adapted units for PWDs and 23 adapted day care centres for home-dwelling PWDs recruited 78 and 115 participants respectively. Trained nurses scored sociodemographic data, level of dementia (on the Clinical Dementia Rating scale), amount of medication, and QoL (QUALID). Sleep patterns, physical activity levels, and light exposure were measured by actigraphy. A multiple regression analysis was used to test the association between residency and QoL. The association between residency and change in QoL over time was investigated by linear regression analysis of a subsample with follow-up data. Home-dwelling PWDs showed significantly higher QoL than PWDs in nursing homes. This difference was maintained even after stratifying on the severity of dementia. Home-dwelling PWDs with moderate dementia showed significantly less use of walking aids, more social contact, higher levels of activity and exposure to daylight, and less use of psychotropic medications. The regression model explained 28 % of the variance in QoL in persons with moderate dementia. However

Weir Farm National Historic Site : alternative transportation feasibility study

DOT National Transportation Integrated Search

2012-07-31

This report provides an assessment of the feasibility of alternative transportation options to accommodate visitation at Weir Farm National Historic Site in Ridgefield, Connecticut. Weir Farm, the historic home of artist J. Alden Weir, faces numerous...

New quality regulations versus established nursing home practice: a qualitative study.

PubMed

Sandvoll, Anne Marie; Kristoffersen, Kjell; Hauge, Solveig

2012-06-07

Western governments have initiated reforms to improve the quality of care for nursing home residents. Most of these reforms encompass the use of regulations and national quality indicators. In the Norwegian context, these regulations comprise two pages of text that are easy to read and understand. They focus particularly on residents' rights to plan their day-to-day life in nursing homes. However, the research literature indicates that the implementation of the new regulations, particularly if they aim to change nursing practice, is extremely challenging. The aim of this study was to further explore and describe nursing practice to gain a deeper understanding of why it is so hard to implement the new regulations. For this qualitative study, an ethnographic design was chosen to explore and describe nursing practice. Fieldwork was conducted in two nursing homes. In total, 45 nurses and nursing aides were included in participant observation, and 10 were interviewed at the end of the field study. Findings indicate that the staff knew little about the new quality regulations, and that the quality of their work was guided by other factors rooted in their nursing practice. Further analyses revealed that the staff appeared to be committed to daily routines and also that they always seemed to know what to do. Having routines and always knowing what to do mutually strengthen and enhance each other, and together they form a powerful force that makes daily nursing care a taken-for-granted activity. New regulations are challenging to implement because nursing practices are so strongly embedded. Improving practice requires systematic and deeply rooted practical change in everyday action and thinking.

Creation of a National, At-home Model for Ashkenazi Jewish Carrier Screening.

PubMed

Grinzaid, Karen Arnovitz; Page, Patricia Zartman; Denton, Jessica Johnson; Ginsberg, Jessica

2015-06-01

Ethnicity-based carrier screening for the Ashkenazi Jewish population has been available and encouraged by advocacy and community groups since the early 1970's. Both the American College of Medical Genetics and the American Congress of Obstetricians and Gynecologists recommend carrier screening for this population (Obstetrics and Gynecology, 114(4), 950-953, 2009; Genetics in Medicine, 10(1), 55-56, 2008). While many physicians inquire about ethnic background and offer appropriate carrier screening, studies show that a gap remains in implementing recommendations (Genetic testing and molecular biomarkers, 2011). In addition, education and outreach efforts targeting Jewish communities have had limited success in reaching this at-risk population. Despite efforts by the medical and Jewish communities, many Jews of reproductive age are not aware of screening, and remain at risk for having children with preventable diseases. Reaching this population, preferably pre-conception, and facilitating access to screening is critically important. To address this need, genetic counselors at Emory University developed JScreen, a national Jewish genetic disease screening program. The program includes a national marketing and PR campaign, online education, at-home saliva-based screening, post-test genetic counseling via telephone or secure video conferencing, and referrals for face-to-face genetic counseling as needed. Our goals are to create a successful education and screening program for this population and to develop a model that could potentially be used for other at-risk populations.

There's a School in Your Mailbox: A Book on Home Study.

ERIC Educational Resources Information Center

Poteet, G. Howard

Divided into ten sequential chapters, this book provides a comprehensive consumer guide to home study (correspondence study). Chapters deal with educational alternatives (how to select the best training, pros and cons of home study), what can be learned through home study (yacht designing, gemology, stock market investment, military or job skills…

Nursing home work practices and nursing assistants' job satisfaction.

PubMed

Bishop, Christine E; Squillace, Marie R; Meagher, Jennifer; Anderson, Wayne L; Wiener, Joshua M

2009-10-01

To estimate the impact of nursing home work practices, specifically compensation and working conditions, on job satisfaction of nursing assistants employed in nursing homes. Data are from the 2004 National Nursing Assistant Survey, responses by the nursing assistants' employers to the 2004 National Nursing Home Survey, and county-level data from the Area Resource File. Multinomial logistic regression was used to estimate effects of compensation and working conditions on nursing assistants' overall job satisfaction, controlling for personal characteristics and local labor market characteristics. Wages, benefits, and job demands, measured by the ratio of nursing assistant hours per resident day, were associated with job satisfaction. Consistent with previous studies, job satisfaction was greater when nursing assistants felt respected and valued by their employers and had good relationships with supervisors. Nursing assistants were more satisfied when they had enough time to complete their work, when their work was challenging, when they were not subject to mandatory overtime, and where food was not delivered to residents on trays. This is the first investigation of nursing assistant job satisfaction using a nationally representative sample of nursing assistants matched to information about their employing nursing homes. The findings corroborate results of previous studies in showing that compensation and working conditions that provide respect, good relationships with supervisors, and better staffing levels are important to nursing assistant job satisfaction.

High Performance Builder Spotlight: Treasure Homes Inc.

DOE Office of Scientific and Technical Information (OSTI.GOV)

None

2011-01-01

Treasure Homes, Inc., achieved a HERS rating of 46 without PV on its prototype “Gem” home, located on the shores of Lake Michigan in northern Indiana, thanks in part to training received from a Building America partner, the National Association of Home Builders Research Center.

Interventions to delay institutionalization of frail older persons: design of a longitudinal study in the home care setting.

PubMed

De Almeida Mello, Johanna; Van Durme, Therese; Macq, Jean; Declercq, Anja

2012-08-06

Older people usually prefer staying at home rather than going into residential care. The Belgian National Institute for Health and Disability Insurance wishes to invest in home care by financing innovative projects that effectively help older people to stay at home longer. In this study protocol we describe the evaluation of 34 home care projects. These projects are clustered according to the type of their main intervention such as case management, night care, occupational therapy at home and psychological/psychosocial support. The main goal of this study is to identify which types of projects have the most effect in delaying institutionalization of frail older persons. This is a longitudinal intervention study based on a quasi-experimental design. Researchers use three comparison strategies to evaluate intervention--comparison among different types of projects, comparisons between older persons in the projects and older persons not benefiting from a project but who are still at home and between older persons in the projects and older persons who are already institutionalized. Projects are asked to include clients who are frail and at risk of institutionalization. In the study we use internationally validated instruments such as the interRAI Home Care instrument, the WHO-QOL-8 and the Zarit Burden Interview-12. These instruments are filled out at baseline, at exit from the project and 6 months after baseline. Additionally, caregivers have to do a follow-up every 6 months until exit from the project. Criteria to exit the cohort will be institutionalization longer than 3 months and death. The main analysis in the study consists of the calculation of incidence rates, cumulative incidence rates and hazard rates of definitive institutionalization through survival analyses for each type of project. This research will provide knowledge on the functional status of frail older persons who are still living at home. This is important information to identify determinants of

Roles and Educational Effects of Clinical Case Studies in Home Medical Care.

PubMed

Ohsawa, Tomoji; Shimazoe, Takao

2017-01-01

Due to the progression of aging in Japan, pharmacists need to participate in home medical care. To enable pharmacists with no previous experience to participate in home medical care of patients with various diseases in the home environment, it is necessary to adopt an approach of training them in advance. It is thought useful for such clinical training to include patient case studies, which may facilitate the training of pharmacists for home medical care through simulated experience. "The working group to create home clinical cases for education" was launched by a group of university faculty, who have educational knowledge, and trained pharmacists who work with the patients at home. The home care cases were compiled by the university faculty members and the home care practice pharmacists. Working pharmacists and students at pharmaceutical college studied the same case studies of home medical care, and their self-evaluations were compared. They showed that the students rated themselves higher than the pharmacists. One of the reasons was the systematic education of the case studies. The clinical case studies are a good educational tool to promote home care medicine in pharmacies and university pharmaceutical colleges.

Relocation Decisions and Constructing the Meaning of Home: A Phenomenological Study of the Transition into a Nursing Home

PubMed Central

Johnson, Rebecca A.; Bibbo, Jessica

2014-01-01

The transition from community dwelling to a nursing home is a common, though idiosyncratic, experience in the United States. This study employed an interpretive phenomenological approach to uncover how eight older adults in nursing homes in the Midwestern U.S. constructed the meaning of home shortly following the relocation and again approximately two months later. The degree to which the individual had been involved in the decision making process was also explored as it related to the meaning of home within the nursing home setting. The majority of individuals did not consider the facility to be “home,” but actively changed their attitudes toward the facility and themselves to better adjust to the setting. The findings demonstrate the importance of autonomy in older adults’ definitions of home. PMID:24984908

75 FR 41793 - Child and Adult Care Food Program: National Average Payment Rates, Day Care Home Food Service...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-07-19

... adjustments to the national average payment rates for meals and snacks served in child care centers, outside... payment rates for meals and snacks served in day care homes; and the administrative reimbursement rates...] Lunch and Centers Breakfast supper \\1\\ Snack Contingous States: Paid 0.26 0.26 0.06 Reduced Price 1.18 2...

A Systematic Review of Home-Based Childhood Obesity Prevention Studies

PubMed Central

Fawole, Oluwakemi; Segal, Jodi; Wilson, Renee F.; Cheskin, Lawrence J.; Bleich, Sara N.; Wu, Yang; Lau, Brandyn; Wang, Youfa

2013-01-01

BACKGROUND AND OBJECTIVES: Childhood obesity is a global epidemic. Despite emerging research about the role of the family and home on obesity risk behaviors, the evidence base for the effectiveness of home-based interventions on obesity prevention remains uncertain. The objective was to systematically review the effectiveness of home-based interventions on weight, intermediate (eg, diet and physical activity [PA]), and clinical outcomes. METHODS: We searched Medline, Embase, PsychInfo, CINAHL, clinicaltrials.gov, and the Cochrane Library from inception through August 11, 2012. We included experimental and natural experimental studies with ≥1-year follow-up reporting weight-related outcomes and targeting children at home. Two independent reviewers screened studies and extracted data. We graded the strength of the evidence supporting interventions targeting diet, PA, or both for obesity prevention. RESULTS: We identified 6 studies; 3 tested combined interventions (diet and PA), 1 used diet intervention, 1 combined intervention with primary care and consumer health informatics components, and 1 combined intervention with school and community components. Select combined interventions had beneficial effects on fruit/vegetable intake and sedentary behaviors. However, none of the 6 studies reported a significant effect on weight outcomes. Overall, the strength of evidence is low that combined home-based interventions effectively prevent obesity. The evidence is insufficient for conclusions about home-based diet interventions or interventions implemented at home in association with other settings. CONCLUSIONS: The strength of evidence is low to support the effectiveness of home-based child obesity prevention programs. Additional research is needed to test interventions in the home setting, particularly those incorporating parenting strategies and addressing environmental influences. PMID:23753095

Ownership status and home health care performance.

PubMed

Grabowski, David C; Huskamp, Haiden A; Stevenson, David G; Keating, Nancy L

2009-01-01

Few studies have analyzed for-profit and nonprofit differences in the home health care sector. Using data from the National Home and Hospice Care Survey, we found that patients in nonprofit agencies were more likely to be discharged within 30 days under Medicare cost-based payment compared to patients in for-profit agencies. However, this difference in length of enrollment did not translate into meaningful differences in discharge outcomes between nonprofit and for-profit patients, suggesting that-under a cost-based payment system-nonprofits may behave more efficiently relative to for-profits. These results highlight the importance of organizational and payment factors in the delivery of home health care services.

Weatherization and Indoor Air Quality: Measured Impacts in Single Family Homes Under the Weatherization Assistance Program

DOE Office of Scientific and Technical Information (OSTI.GOV)

Pigg, Scott; Cautley, Dan; Francisco, Paul

2014-09-01

This report summarizes findings from a national field study of indoor air quality parameters in homes treated under the Weatherization Assistance Program (WAP). The study involved testing and monitoring in 514 single-family homes (including mobile homes) located in 35 states and served by 88 local weatherization agencies.

Anticipatory prescribing at the end of life in Lothian care homes.

PubMed

Finucane, Anne M; Stevenson, Barbara; Gardner, Hilary; McArthur, Dorothy; Murray, Scott A

2014-11-01

Common symptoms at the end of life include pain, breathlessness, anxiety, respiratory secretions and nausea. National end-of-life care strategies advocate anticipatory prescribing for timely management of these symptoms to enhance patient care by preventing unnecessary distress. This study investigated the extent to which residents in eight Lothian care homes had anticipatory medications prescribed prior to death. Data were collected as part of a service development project to improve palliative care in nursing care homes in Edinburgh. Of the 77 residents who died in the care homes, 54% had anticipatory medicines prescribed. Only 15% had prescriptions for all four nationally recommended anticipatory medications. Many care home residents do not have the recommended anticipatory medications in place in the last days of life and thus may experience inadequate symptom control. Interventions that increase the availability of anticipatory medicines to manage common symptoms at the end of life for care home residents are required.

22 CFR 96.47 - Preparation of home studies in incoming cases.

Code of Federal Regulations, 2010 CFR

2010-04-01

... 22 Foreign Relations 1 2010-04-01 2010-04-01 false Preparation of home studies in incoming cases... Cases) § 96.47 Preparation of home studies in incoming cases. (a) The agency or person ensures that a home study on the prospective adoptive parent(s) (which for purposes of this section includes the...

22 CFR 96.47 - Preparation of home studies in incoming cases.

Code of Federal Regulations, 2012 CFR

2012-04-01

... 22 Foreign Relations 1 2012-04-01 2012-04-01 false Preparation of home studies in incoming cases... Cases) § 96.47 Preparation of home studies in incoming cases. (a) The agency or person ensures that a home study on the prospective adoptive parent(s) (which for purposes of this section includes the...

22 CFR 96.47 - Preparation of home studies in incoming cases.

Code of Federal Regulations, 2011 CFR

2011-04-01

... 22 Foreign Relations 1 2011-04-01 2011-04-01 false Preparation of home studies in incoming cases... Cases) § 96.47 Preparation of home studies in incoming cases. (a) The agency or person ensures that a home study on the prospective adoptive parent(s) (which for purposes of this section includes the...

22 CFR 96.47 - Preparation of home studies in incoming cases.

Code of Federal Regulations, 2013 CFR

2013-04-01

... 22 Foreign Relations 1 2013-04-01 2013-04-01 false Preparation of home studies in incoming cases... Cases) § 96.47 Preparation of home studies in incoming cases. (a) The agency or person ensures that a home study on the prospective adoptive parent(s) (which for purposes of this section includes the...

22 CFR 96.47 - Preparation of home studies in incoming cases.

Code of Federal Regulations, 2014 CFR

2014-04-01

... 22 Foreign Relations 1 2014-04-01 2014-04-01 false Preparation of home studies in incoming cases... Cases) § 96.47 Preparation of home studies in incoming cases. (a) The agency or person ensures that a home study on the prospective adoptive parent(s) (which for purposes of this section includes the...

Infants and Toddlers in Out-of-Home Care. A Series from the National Center for Early Development & Learning.

ERIC Educational Resources Information Center

Cryer, Debby, Ed.; Harms, Thelma, Ed.

One of the biggest changes in the lives of children in the United States is the increasing number of infants and toddlers who are cared for outside the home during work hours. This book provides a compilation of information and discussions from a meeting of the National Center for Early Development and Learning, held annually to convene experts…

32 CFR 728.76 - Naval Home residents.

Code of Federal Regulations, 2014 CFR

2014-07-01

... 32 National Defense 5 2014-07-01 2014-07-01 false Naval Home residents. 728.76 Section 728.76... FOR ELIGIBLE PERSONS AT NAVY MEDICAL DEPARTMENT FACILITIES Other Persons § 728.76 Naval Home residents. Provide necessary medical and dental care, both inpatient and outpatient, to residents of the Naval Home...

The National Tumor Association Foundation (ANT): A 30 year old model of home palliative care

PubMed Central

2010-01-01

Background Models of palliative care delivery develop within a social, cultural, and political context. This paper describes the 30-year history of the National Tumor Association (ANT), a palliative care organization founded in the Italian province of Bologna, focusing on this model of home care for palliative cancer patients and on its evaluation. Methods Data were collected from the 1986-2008 ANT archives and documents from the Emilia-Romagna Region Health Department, Italy. Outcomes of interest were changed in: number of patients served, performance status at admission (Karnofsky Performance Status score [KPS]), length of participation in the program (days of care provided), place of death (home vs. hospital/hospice), and satisfaction with care. Statistical methods included linear and quadratic regressions. A linear and a quadratic regressions were generated; the independent variable was the year, while the dependent one was the number of patients from 1986 to 2008. Two linear regressions were generated for patients died at home and in the hospital, respectively. For each regression, the R square, the unstandardized and standardized coefficients and related P-values were estimated. Results The number of patients served by ANT has increased continuously from 131 (1986) to a cumulative total of 69,336 patients (2008), at a steady rate of approximately 121 additional patients per year and with no significant gender difference. The annual number of home visits increased from 6,357 (1985) to 904,782 (2008). More ANT patients died at home than in hospice or hospital; this proportion increased from 60% (1987) to 80% (2007). The rate of growth in the number of patients dying in hospital/hospice was approximately 40 patients/year (p < 0.01), vs. approximately 177 patients/year for patients who died at home. The percentage of patients with KPS < 40 at admission decreased from 70% (2003) to 30% (2008); the percentage of patients with KPS > 40 increased. Mean days of care

The Healthy Home Offerings via the Mealtime Environment (HOME) Plus study: design and methods.

PubMed

Fulkerson, Jayne A; Neumark-Sztainer, Dianne; Story, Mary; Gurvich, Olga; Kubik, Martha Y; Garwick, Ann; Dudovitz, Bonnie

2014-05-01

Informed and engaged parents and healthful home environments are essential for the health of youth. Although research has shown health benefits associated with family meals, to date, no randomized controlled trial (RCT) has been developed to examine the impact of a family meals intervention on behavioral and health outcomes. The Healthy Home Offerings via the Mealtime Environment (HOME) Plus study is a two-arm (intervention versus attention-only control) RCT being conducted in Minneapolis/St. Paul. Built on previous pilot research, HOME Plus aims to increase the frequency and healthfulness of family meals and snacks and reduce children's sedentary behavior, particularly screen time, to promote healthier eating and activity behaviors and prevent obesity. HOME Plus is delivered to families in community settings. The program includes 10 monthly sessions focused on nutrition and activity education, meal planning and preparation skill development. In addition, five motivational goal-setting phone calls are conducted with parents. The primary outcome measure is age- and gender-adjusted child BMI-z score at post-intervention by treatment group. Secondary household-level outcomes include family meal frequency, home availability of healthful foods (fruits/vegetables) and unhealthful foods (high-fat/sugary snacks) and beverages (sugar-sweetened beverages), and the quality of foods served at meals and snacks. Secondary child outcomes include dietary intake of corresponding foods and beverages and screen time. The HOME Plus RCT actively engages whole families of 8-12 year old children to promote healthier eating and activity behaviors and prevent obesity through promotion of family meals and snacks and limited media use. Copyright © 2014 Elsevier Inc. All rights reserved.

Map of Water Infrastructure and Homes Without Access to Safe Drinking Water and Basic Sanitation on the Navajo Nation - October 2010

EPA Pesticide Factsheets

This document presents the results of completed work using existing geographic information system (GIS) data to map existing water and sewer infrastructure and homes without access to safe drinking water and basic sanitation on the Navajo Nation.

The National Potential of Home Equity Conversion.

ERIC Educational Resources Information Center

Jacobs, Bruce

1986-01-01

Examined the potential effects of converting home equity into spendable income using "reverse mortgages." Analysis revealed that reverse mortgage loans could have a substantial impact on the budgets of many elderly homeowners, with impressive percentage increases in income and decreases in poverty rates. (Author/ABB)

Patients' expectations of coming home with Very Early Supported Discharge and home rehabilitation after stroke - an interview study.

PubMed

Nordin, Åsa; Sunnerhagen, Katharina S; Axelsson, Åsa B

2015-11-16

An Early Supported Discharge (ESD) and rehabilitation from a coordinated team in the home environment is recommended in several high-income countries for patients with mild to moderate symptoms after stroke. Returning home from the hospital takes place very early in Sweden today (12 days post stroke), thus the term Very Early Supported Discharge (VESD) is used in the current study. The aim of this study was to describe patients' expectations of coming home very early after stroke with support and rehabilitations at home. This is an interview study nested within a randomized controlled trial; Gothenburg Very Early Supported Discharge (GOTVED), comparing VESD containing a home rehabilitation intervention from a coordinated team to conventional care after stroke. Ten participants (median age 69) with mild to moderate stroke symptoms (NHISS 0 to 8 points) were recruited from the intervention group in GOTVED. Interviews were conducted 0-5 days before discharge and the material was analyzed with qualitative content analysis. Four main categories containing 11 subcategories were found. The VESD team was expected to provide "Support towards independency", by helping the participants to manage and feel safe at home as well as to regain earlier abilities. The very early discharge gave rise to expectations of coming home to "A new and unknown situation", causing worries not to manage at home and to leave the safe environment at the ward. A fear to suffer a recurrent stroke when being out of reach of immediate professional help was also pronounced. In contrast to these feelings of insecurity and fear, "Returning to one's own setting" described the participants longing home, where they would become autonomous and capable people again. They expected this to facilitate recovery and rehabilitation. "A new everyday life" waited for the participants at home and this was expected to be challenging. Different strategies to deal with these challenges were described. The participants

Nursing home evacuation plans.

PubMed

Castle, Nicholas G

2008-07-01

I examined evacuation plans from 2134 nursing homes and analyzed national data to determine the types of nursing homes cited for deficiencies in their evacuation plans. Evacuation plans were assessed according to criteria developed by an expert panel funded by the Office of the Inspector General. Deficiency citations came from the Online Survey, Certification, and Recording database, collected from 1997 to 2005. Four specific citations, for written emergency plans, staff training, written evacuation plans, and fire drills, were examined with multivariate logistic regression. Most plans had water supply provisions (96%). Only 31% specified an evacuation route. The rate of citations was relatively stable throughout the study period: each year approximately 0.6% of facilities were found to be deficient in written emergency plans, 2.1% in staff training, 1.2% in written evacuation plans, and 7.9% in fire drills. Some nursing homes need more specific evacuation plans. Water supply was the most and evacuation routes were the least well-addressed areas.

Argonne Chemical Sciences & Engineering - Awards Home

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Argonne National Laboratory Chemical Sciences & Engineering DOE Logo CSE Home About CSE Argonne Home > Chemical Sciences & Engineering > Fundamental Interactions Catalysis & Energy Computational Postdoctoral Fellowships Contact Us CSE Intranet Awards Argonne's Chemical Sciences and

Barriers to successful implementation of care in home haemodialysis (BASIC-HHD):1. Study design, methods and rationale

PubMed Central

2013-01-01

Background Ten years on from the National Institute of Health and Clinical Excellence’ technology appraisal guideline on haemodialysis in 2002; the clinical community is yet to rise to the challenge of providing home haemodialysis (HHD) to 10-15% of the dialysis cohort. The renal registry report, suggests underutilization of a treatment type that has had a lot of research interest and several publications worldwide on its apparent benefit for both physical and mental health of patients. An understanding of the drivers to introducing and sustaining the modality, from organizational, economic, clinical and patient perspectives is fundamental to realizing the full benefits of the therapy with the potential to provide evidence base for effective care models. Through the BASIC-HHD study, we seek to understand the clinical, patient and carer related psychosocial, economic and organisational determinants of successful uptake and maintenance of home haemodialysis and thereby, engage all major stakeholders in the process. Design and methods We have adopted an integrated mixed methodology (convergent, parallel design) for this study. The study arms include a. patient; b. organization; c. carer and d. economic evaluation. The three patient study cohorts (n = 500) include pre-dialysis patients (200), hospital haemodialysis (200) and home haemodialysis patients (100) from geographically distinct NHS sites, across the country and with variable prevalence of home haemodialysis. The pre-dialysis patients will also be prospectively followed up for a period of 12 months from study entry to understand their journey to renal replacement therapy and subsequently, before and after studies will be carried out for a select few who do commence dialysis in the study period. The process will entail quantitative methods and ethnographic interviews of all groups in the study. Data collection will involve clinical and biomarkers, psychosocial quantitative assessments and neuropsychometric

DOE Zero Energy Ready Home Case Study: Green Extreme Homes & Carl Franklin Homes — First DOE Zero Energy Ready Home Retrofit, Garland, TX

DOE Office of Scientific and Technical Information (OSTI.GOV)

none,

This builder was honored with an Affordable Builder award in the 2014 Housing Innovation Awards, for the first retrofit home certified to the DOE Zero Energy Ready home requirements.The 60-year-old, three-bedroom ranch home is expected to save its homeowner more than $1,000 a year in utility bills compared to a home built to the current 2009 International Energy Conservation Code.

Unvented kerosene-heater emissions in mobile homes: Studies on indoor air particles, semivolatile organics, carbon monoxide, and mutagenicity

DOE Office of Scientific and Technical Information (OSTI.GOV)

Mumford, J.L.; Lewtas, J.; Burton, R.M.

1990-01-01

The study was conducted to assess human exposure to air pollutants resulting from the use of kerosene heaters in mobile homes. It has been estimated that 15-17 million unvented kerosene heaters have been sold in the United States, and 33% of these heaters have been sold to mobile home residents. The emissions from kerosene heaters can result in high pollutants levels in mobile homes that have a small air volume and low ventilation rate. Indoor air exchange rate, temperature, and humidity were measured. Chemical analyses, including polycyclic aromatic hydrocarbon (PAH) and nitro PAH, also were performed on the indoor airmore » samples from a selected home with the kerosene heater on and off. Increases in CO and organic concentrations resulting from the use of kerosene heaters were found in most homes monitored. Chemical analysis data also suggested the presence of evaporated, unburned kerosene fuel present in semivolatile organics collected in the XAD samples. When kerosene heaters were on, 56% of the sampling days (in all homes) showed dose-response mutagenic activity and 19% showed mutagenic activity on the heater-off days. In comparison with the U.S. national ambient air standards, four out of the eight heaters investigated in this study emitted pollutants that exceeded the ambient air standards some days. These data suggested that emissions from unvented kerosene heaters can significantly impact indoor air quality in mobile homes and that these emissions contain carcinogenic compounds and can be potentially carcinogenic in humans.« less

A field study setup of four homes having non-ventilated and semi-conditioned sealed attics

DOE Office of Scientific and Technical Information (OSTI.GOV)

Miller, William A.; Boudreaux, Philip R.; Pallin, Simon B.

During the 2015-2016 fiscal year and with financial support from the Florida Building Commission (FBC) and the Florida Roofing and Sheet Metal Contractors Association (FRSA ), the University of Florida (UF) and the Oak Ridge National Laboratory (ORNL) completed Phase I of a study that setup four residential home demonstrations in Florida climate zones CZ-1A and CZ-2A. UF and ORNL are evaluating the hygrothermal (heat and moisture flow) performance and durability of sealed attic construction where expanded foam insulation is applied directly to the underside of the roof deck. The four homes are instrumented for measuring temperature and relative humiditymore » of the indoor living space, the outdoor air and the attic air. In addition, the temperature, relative humidity and moisture content of the roof sheathing are being monitored and recorded by remotely-accessible data acquisition equipment. Here, air leakage tests on the whole house, on the sealed attic and in the HVAC ducts were conducted on all four homes.« less

A field study setup of four homes having non-ventilated and semi-conditioned sealed attics

DOE PAGES

Miller, William A.; Boudreaux, Philip R.; Pallin, Simon B.; ...

2016-06-01

During the 2015-2016 fiscal year and with financial support from the Florida Building Commission (FBC) and the Florida Roofing and Sheet Metal Contractors Association (FRSA ), the University of Florida (UF) and the Oak Ridge National Laboratory (ORNL) completed Phase I of a study that setup four residential home demonstrations in Florida climate zones CZ-1A and CZ-2A. UF and ORNL are evaluating the hygrothermal (heat and moisture flow) performance and durability of sealed attic construction where expanded foam insulation is applied directly to the underside of the roof deck. The four homes are instrumented for measuring temperature and relative humiditymore » of the indoor living space, the outdoor air and the attic air. In addition, the temperature, relative humidity and moisture content of the roof sheathing are being monitored and recorded by remotely-accessible data acquisition equipment. Here, air leakage tests on the whole house, on the sealed attic and in the HVAC ducts were conducted on all four homes.« less

ABR - Home

Science.gov Websites

Argonne National Laboratory Applied Battery Research for Transportation Program DOE Logo Home ; ABR > About ABR Projects News cell fabrication faciity posttest facility MERF Cell Fabrication Facility Post-Test Facility Materials Engineering Research Facility Battery News Recent Reports Funding

Barriers to successful implementation of care in home haemodialysis (BASIC-HHD):1. Study design, methods and rationale.

PubMed

Jayanti, Anuradha; Wearden, Alison J; Morris, Julie; Brenchley, Paul; Abma, Inger; Bayer, Steffen; Barlow, James; Mitra, Sandip

2013-09-17

Ten years on from the National Institute of Health and Clinical Excellence' technology appraisal guideline on haemodialysis in 2002; the clinical community is yet to rise to the challenge of providing home haemodialysis (HHD) to 10-15% of the dialysis cohort. The renal registry report, suggests underutilization of a treatment type that has had a lot of research interest and several publications worldwide on its apparent benefit for both physical and mental health of patients. An understanding of the drivers to introducing and sustaining the modality, from organizational, economic, clinical and patient perspectives is fundamental to realizing the full benefits of the therapy with the potential to provide evidence base for effective care models. Through the BASIC-HHD study, we seek to understand the clinical, patient and carer related psychosocial, economic and organisational determinants of successful uptake and maintenance of home haemodialysis and thereby, engage all major stakeholders in the process. We have adopted an integrated mixed methodology (convergent, parallel design) for this study. The study arms include a. patient; b. organization; c. carer and d. economic evaluation. The three patient study cohorts (n = 500) include pre-dialysis patients (200), hospital haemodialysis (200) and home haemodialysis patients (100) from geographically distinct NHS sites, across the country and with variable prevalence of home haemodialysis. The pre-dialysis patients will also be prospectively followed up for a period of 12 months from study entry to understand their journey to renal replacement therapy and subsequently, before and after studies will be carried out for a select few who do commence dialysis in the study period. The process will entail quantitative methods and ethnographic interviews of all groups in the study. Data collection will involve clinical and biomarkers, psychosocial quantitative assessments and neuropsychometric tests in patients. Organizational

DOE Zero Energy Ready Home Case Study: Healthy Efficient Homes - Spirit Lake, Iowa

DOE Office of Scientific and Technical Information (OSTI.GOV)

none,

2014-11-01

This case study describes a DOE Zero Energy Ready Home in Spirit Lake, Iowa, that scored HERS 41 without PV and HERS 28 with PV. This 3,048 ft2 custom home has advanced framed walls filled with 1.5 inches closed-cell spray foam, a vented attic with spray foam-sealed top plates and blown fiberglass over the ceiling deck. R-23 basement walls are ICF plus two 2-inch layers of EPS. The house also has a mini-split heat pump, fresh air fan intake, and a solar hot water heater.

Home Page: Division of Birds: Department of Vertebrate Zoology: National

Science.gov Websites

} Advanced Search Plan Your Visit Exhibitions Education Research & Collections About Us Get Involved © Smithsonian Institution Home Research Collections Visitor Information Loans Destructive Sampling Genetic Resources Database VZ Libraries Related Links Staff VZ All Birds Contact Us NMNH Home › Research &

An estimation of the cost per visit of nursing home care services.

PubMed

Ryu, Ho-Sihn

2009-01-01

Procedures used for analyzing the cost of providing home care nursing services through hospital-based home care agencies (HCAs) was the focus of this study. A cross-sectional descriptive study design was used to analyze the workload and caseload of 36 home care nurses from ten HCAs. In addition, information obtained from a national health insurance database, including 54,639 home care claim cases from a total of 185 HCAs during a 6-month period, were analyzed. The findings provide a foundation for improving the alternative home care billing and reimbursement system by using the actual amount of time invested in providing home care when calculating the cost of providing home care nursing services. Further, this study provides a procedure for calculating nursing service costs by analyzing actual data. The results have great potential for use in nursing service cost analysis methodology, which is an essential step in developing a policy for providing home care.

DOE Zero Energy Ready Home Case Study: Sterling Brook Custom Homes — Village Park Eco Home, Double Park, TX

DOE Office of Scientific and Technical Information (OSTI.GOV)

none,

This builder won a Custom Builder honor in the 2014 Housing Innovation Awards for this showcase home that serves as an energy-efficient model home for the custom home builder: 1,300 visitors toured the home, thousands more learned about the home’s advanced construction via the webpage, YouTube, Twitter, Facebook, Instagram, and Pinterest.

[Implementation of the influenza vaccination recommendation in nursing homes in Germany : results of a survey as part of the national influenza immunization campaign].

PubMed

Bödeker, B; Wichmann, O; Mertens, B; Seefeld, L; Pott, E

2014-11-01

Residents and staff of nursing homes are important target groups for influenza vaccination in Germany. The aim of this study was to gain the first insights into whether nursing homes organize activities with respect to vaccination against influenza and whether there is a demand for further information. In the context of the national influenza immunization campaign-which is jointly carried out by the Robert Koch Institute (RKI) and the Federal Centre for Health Education (BZgA) on an annual basis-influenza information kits were sent to the management of 10,700 nursing homes in September 2013. Along with the information material, the institutions also received a questionnaire to which they were able to respond via mail, fax, or online. Data from 988 homes were included in the analysis. The majority of institutions informed both residents (88.9 %) and nursing staff (81.2 %) about influenza vaccination. However, only 64.7 % of nursing homes carried out specific immunization activities for their residents and only half (49.3 %) offered a flu shot to their staff. When asked why the institutions do not provide influenza-specific information and vaccination to their staff, the majority had the opinion that this is the responsibility of each individual's general practitioner. Overall, only 4.9 % of nursing homes assessed influenza vaccination coverage among their staff annually. A third of all surveyed institutions (33.6 %) expressed a demand for additional influenza vaccine-related information. In conclusion, improved health education is needed to raise awareness about the importance of influenza vaccination among residents and employees of nursing homes in Germany so as to prevent influenza-associated morbidity and mortality in this risk group.

Lunches Selected and Consumed from the National School Lunch Program in Schools Designated As HealthierUS School Challenge Schools Are More Nutritious than Lunches Brought from Home

ERIC Educational Resources Information Center

Bergman, Ethan A.; Saade, Catherine; Shaw, Emily; Englund, Tim; Cashman, Linda; Taylor, Katie Weigt; Watkins, Tracee; Rushing, Keith

2014-01-01

Purpose/Objective: The purpose of this study was to compare the nutrient content of National School Lunch Program (NSLP) lunches and lunches brought from home (LBFH) lunches in elementary schools participating in the HealthierUS School Challenge (HUSSC). Methods: Participants included students in grades 2-5 in four Washington state HUSSC…

Structure, environment and strategic outcome: a study of Pennsylvania nursing homes.

PubMed

Aaronson, W E; Zinn, J S; Rosko, M D

1995-02-01

This study applies Porter's model of competitive advantage to the nursing home industry. Discriminant analysis is used to identify organizational and environmental characteristics associated with nursing homes which have demonstrated valued strategic outcomes, and to distinguish the more successful nursing homes from their rivals. The results of the discriminant analysis suggest that nursing homes with superior payer mix outcomes are distinguishable from their less successful rivals in areas associated with a focused generic strategy. The study suggests that nursing homes which are better staffed, of smaller size and lower price are more likely to achieve high levels of self-pay utilization. Independent living units, continuing care retirement communities in particular, are likely to act synergistically with nursing home organizational characteristics to enhance competitive advantage by linking the value chain of the nursing home to that of retirement housing. Nursing homes with higher proportions of Medicare were found to provide a unique product when compared to their rivals. Profit status does not discriminate better self-pay strategic utilization, but for-profit facilities are more likely to pursue a Medicare strategy. Concern was raised that, as nursing homes become more strategically oriented, Medicaid access may become more problematic.

The Future of Home Health Care: A Strategic Framework for Optimizing Value.

PubMed

Landers, Steven; Madigan, Elizabeth; Leff, Bruce; Rosati, Robert J; McCann, Barbara A; Hornbake, Rodney; MacMillan, Richard; Jones, Kate; Bowles, Kathryn; Dowding, Dawn; Lee, Teresa; Moorhead, Tracey; Rodriguez, Sally; Breese, Erica

2016-11-01

The Future of Home Health project sought to support transformation of home health and home-based care to meet the needs of patients in the evolving U.S. health care system. Interviews with key thought leaders and stakeholders resulted in key themes about the future of home health care. By synthesizing this qualitative research, a literature review, case studies, and the themes from a 2014 Institute of Medicine and National Research Council workshop on "The Future of Home Health Care," the authors articulate a vision for home-based care and recommend a bold framework for the Medicare-certified home health agency of the future. The authors also identify challenges and recommendations for achievement of this framework.

Health status of UK care home residents: a cohort study

PubMed Central

Gordon, Adam Lee; Franklin, Matthew; Bradshaw, Lucy; Logan, Pip; Elliott, Rachel; Gladman, John R.F.

2014-01-01

Background: UK care home residents are often poorly served by existing healthcare arrangements. Published descriptions of residents’ health status have been limited by lack of detail and use of data derived from surveys drawn from social, rather than health, care records. Aim: to describe in detail the health status and healthcare resource use of UK care home residents Design and setting: a 180-day longitudinal cohort study of 227 residents across 11 UK care homes, 5 nursing and 6 residential, selected to be representative for nursing/residential status and dementia registration. Method: Barthel index (BI), Mini-mental state examination (MMSE), Neuropsychiatric index (NPI), Mini-nutritional index (MNA), EuroQoL-5D (EQ-5D), 12-item General Health Questionnaire (GHQ-12), diagnoses and medications were recorded at baseline and BI, NPI, GHQ-12 and EQ-5D at follow-up after 180 days. National Health Service (NHS) resource use data were collected from databases of local healthcare providers. Results: out of a total of 323, 227 residents were recruited. The median BI was 9 (IQR: 2.5–15.5), MMSE 13 (4–22) and number of medications 8 (5.5–10.5). The mean number of diagnoses per resident was 6.2 (SD: 4). Thirty per cent were malnourished, 66% had evidence of behavioural disturbance. Residents had contact with the NHS on average once per month. Conclusion: residents from both residential and nursing settings are dependent, cognitively impaired, have mild frequent behavioural symptoms, multimorbidity, polypharmacy and frequently use NHS resources. Effective care for such a cohort requires broad expertise from multiple disciplines delivered in a co-ordinated and managed way. PMID:23864424

Energy-Efficient Homes (Done Right)

DOE Office of Scientific and Technical Information (OSTI.GOV)

None

2017-07-31

Home energy upgrade measures allow individuals to enjoy a safe, comfortable, and energy-efficient home. But how do you know if the work is done right? Learn how the U.S Department of Energy and its National Renewable Energy Laboratory are working to ensure that energy efficient measures are being installed correctly across the United States.

Impact of national smoke-free legislation on home smoking bans – Findings from the International Tobacco Control (ITC) Policy Evaluation Project Europe Surveys

PubMed Central

Mons, Ute; Nagelhout, Gera E.; Allwright, Shane; Guignard, Romain; van den Putte, Bas; Willemsen, Marc C.; Fong, Geoffrey T.; Brenner, Hermann; Pötschke-Langer, Martina; Breitling, Lutz P.

2014-01-01

Objectives To measure changes in prevalence and predictors of home smoking bans (HSB) among smokers in four European countries after the implementation of national smoke-free legislation. Design Two waves of the International Tobacco Control (ITC) Policy Evaluation Project Europe Surveys, which is a prospective panel study. Pre- and post-legislation data was used from Ireland, France, Germany, and the Netherlands. Two pre-legislation waves from UK were used as control. Participants 4,634 respondents from the intervention countries and 1,080 from the control country completed both baseline and follow-up, and were included in the present analyses. Methods Multiple logistic regression models to identify predictors of having or of adopting a total HSB, and Generalised Estimating Equation (GEE) models to compare patterns of change after implementation of smoke-free legislation to a control country without such legislation. Results Most smokers had at least partial smoking restrictions in their home, but the proportions varied significantly between countries. After implementation of national smoke-free legislation, the proportion of smokers with a total HSB increased significantly in all four countries. Among continuing smokers the number of cigarettes smoked per day either remained stable or decreased significantly. Multiple logistic regression models indicated that having a young child in the household and supporting smoking bans in bars were important correlates of having a pre-legislation HSB. Prospective predictors of imposing a HSB between survey waves were planning to quit smoking, supporting a total smoking ban in bars, and the birth of a child. GEE models indicated that the change in total HSB in the intervention countries was greater than in the control country. Conclusions The findings suggest that smoke-free legislation does not lead to more smoking in smokers’ homes. On the contrary, our findings demonstrate that smoke-free legislation may stimulate

Registered nurse retention strategies in nursing homes: a two-factor perspective.

PubMed

Hunt, Selina R; Probst, Janice C; Haddock, Kathlyn S; Moran, Robert; Baker, Samuel L; Anderson, Ruth A; Corazzini, Kirsten

2012-01-01

As the American population ages and the proportion of individuals over the age of 65 expands, the demand for high-quality nursing home care will increase. However, nursing workforce instability threatens care quality and sustainability in this sector. Despite increasing attention to nursing home staff turnover, far less is known about registered nurse (RN) retention. In this study, the relationships between retention strategies, employee benefits, features of the practice environment, and RN retention were explored. Further, the utility of Herzberg's two-factor theory of motivation as a framework for nursing home retention studies was evaluated. This study was a secondary analysis of the nationally representative 2004 National Nursing Home Survey. The final sample of 1,174 participating nursing homes were either certified by Medicare or Medicaid or licensed by state agencies. We used a weighted multinomial logistic regression using an incremental approach to model the relationships. Although most nursing homes offered some combination of retention programs, the majority of strategies did not have a significant association with the level of RN retention reported by facilities. Director of nursing tenure and other extrinsic factors had the strongest association with RN retention in adjusted analyses. To improve RN retention, organizations may benefit greatly from stabilizing nursing home leadership, especially the director of nursing position. Second, managers of facilities with poor retention may consider adding career ladders for advancement, awarding attendance, and improving employee benefits. As a behavioral outcome of motivation and satisfaction, retention was not explained as expected using Herzberg's two-factor theory.

Prevention of NSAID gastropathy in elderly patients. An observational study in general practice and nursing homes.

PubMed

van Leen, M W F; van der Eijk, I; Schols, J M G A

2007-07-01

The objectives of this study were to (i) survey the risk factors for NSAID gastropathy in outpatients (elderly patients in the community), compared to those living in old people's homes or nursing homes, (ii) study the prescription of medication prophylaxis during use of NSAIDs conform the current national guidelines and (iii) survey the influence on gastrointestinal symptoms and safety of pantoprazole 20 mg as prophylaxis for NSAID gastropathy. Patients over 65 years of age, using an NSAID without prophylaxis or newly starting NSAID treatment were included in the study. Pantoprazole 20 mg was prescribed as prophylaxis. Patients using an NSAID with prophylaxis being a proton pump inhibitor at the first visit were registered for epidemiological reasons. Demographic data, risk factors, gastrointestinal complaints, and adverse events were collected at t = 0, t = 2 weeks, t = 3 months and t = 6 months. Differences between groups were analysed with Chi-square tests and Mann-Whitney U tests; changes in time in GI symptoms were tested using Wilcoxon signed ranks tests and McNemar tests. One hundred eighty one general practitioners (treating outpatients and patients in old people's homes)and five nursing home physicians participated in the study and a total of 615 patients were included (522 patients treated by general practitioners (GP) and 93 patients in nursing homes). Four hundred thirty two patients were using NSAIDs without prophylaxis or started using an NSAID at the first visit; 269 (62.1%) and 163 (37.9%) patients respectively. 65.3% of the outpatients (224 out of 343) did not receive indicated prophylaxis, versus 76.2% (16 out of 21) in old people's homes and 42.6% in nursing homes (29 out of 69) (P < 0.001). Patients in nursing homes had more risk factors for gastrointestinal complications (2.94 +/- 1.3 versus 1.77 +/- 0.9) than outpatients. More patients using an NSAID prior to the study complained of gastrointestinal symptoms compared to new users (P < 0

Predictors of Numeracy Performance in National Testing Programs: Insights from the Longitudinal Study of Australian Children

ERIC Educational Resources Information Center

Carmichael, Colin; MacDonald, Amy; McFarland-Piazza, Laura

2014-01-01

This article is based on an exploratory study that examines factors which predict children's performance on the numeracy component of the Australian National Assessment Program--Literacy and Numeracy (NAPLAN). Utilizing an ecological theoretical model, this study examines child, home and school variables which may enable or constrain NAPLAN…

Enhancing Resident Safety by Preventing Healthcare-Associated Infection: A National Initiative to Reduce Catheter-Associated Urinary Tract Infections in Nursing Homes

PubMed Central

Mody, Lona; Meddings, Jennifer; Edson, Barbara S.; McNamara, Sara E.; Trautner, Barbara W.; Stone, Nimalie D.; Krein, Sarah L.; Saint, Sanjay

2015-01-01

Preventing healthcare-associated infection (HAI) is a key contributor to enhancing resident safety in nursing homes. In 2013, the U.S. Department of Health and Human Services approved a plan to enhance resident safety by reducing HAIs in nursing homes, with particular emphasis on reducing indwelling catheter use and catheter-associated urinary tract infection (CAUTI). Lessons learned from a recent multimodal Targeted Infection Prevention program in a group of nursing homes as well as a national initiative to prevent CAUTI in over 950 acute care hospitals called “On the CUSP: STOP CAUTI” will now be implemented in nearly 500 nursing homes in all 50 states through a project funded by the Agency for Healthcare Research and Quality (AHRQ). This “AHRQ Safety Program in Long-Term Care: HAIs/CAUTI” will emphasize professional development in catheter utilization, catheter care and maintenance, and antimicrobial stewardship as well as promoting patient safety culture, team building, and leadership engagement. We anticipate that an approach integrating technical and socio-adaptive principles will serve as a model for future initiatives to reduce other infections, multidrug resistant organisms, and noninfectious adverse events among nursing home residents. PMID:25814630

Consumer-reported handling of raw poultry products at home: results from a national survey.

PubMed

Kosa, Katherine M; Cates, Sheryl C; Bradley, Samantha; Chambers, Edgar; Godwin, Sandria

2015-01-01

Salmonella and Campylobacter cause an estimated combined total of 1.8 million foodborne infections each year in the United States. Most cases of salmonellosis and campylobacteriosis are associated with eating raw or undercooked poultry or with cross-contamination. Between 1998 and 2008, 20% of Salmonella and 16% of Campylobacter foodborne disease outbreaks were associated with food prepared inside the home. A nationally representative Web survey of U.S. adult grocery shoppers (n = 1,504) was conducted to estimate the percentage of consumers who follow recommended food safety practices when handling raw poultry at home. The survey results identified areas of low adherence to current recommended food safety practices: not washing raw poultry before cooking, proper refrigerator storage of raw poultry, use of a food thermometer to determine doneness, and proper thawing of raw poultry in cold water. Nearly 70% of consumers reported washing or rinsing raw poultry before cooking it, a potentially unsafe practice because "splashing" of contaminated water may lead to the transfer of pathogens to other foods and other kitchen surfaces. Only 17.5% of consumers reported correctly storing raw poultry in the refrigerator. Sixty-two percent of consumers own a food thermometer, and of these, 26% or fewer reported using one to check the internal temperature of smaller cuts of poultry and ground poultry. Only 11% of consumers who thaw raw poultry in cold water reported doing so correctly. The study results, coupled with other research findings, will inform the development of science-based consumer education materials that can help reduce foodborne illness from Salmonella and Campylobacter.

Medicare and Medicaid programs; Home Health Prospective Payment System rate update for CY 2014, home health quality reporting requirements, and cost allocation of home health survey expenses. Final rule.

PubMed

2013-12-02

This final rule will update the Home Health Prospective Payment System (HH PPS) rates, including the national, standardized 60-day episode payment rates, the national per-visit rates, the low-utilization payment adjustment (LUPA) add-on, and the non-routine medical supply (NRS) conversion factor under the Medicare prospective payment system for home health agencies (HHAs), effective January 1, 2014. As required by the Affordable Care Act, this rule establishes rebasing adjustments, with a 4-year phase-in, to the national, standardized 60-day episode payment rates; the national per-visit rates; and the NRS conversion factor. In addition, this final rule will remove 170 diagnosis codes from assignment to diagnosis groups within the HH PPS Grouper, effective January 1, 2014. Finally, this rule will establish home health quality reporting requirements for CY 2014 payment and subsequent years and will clarify that a state Medicaid program must provide that, in certifying HHAs, the state's designated survey agency carry out certain other responsibilities that already apply to surveys of nursing facilities and Intermediate Care Facilities for Individuals with Intellectual Disabilities (ICF-IID), including sharing in the cost of HHA surveys. For that portion of costs attributable to Medicare and Medicaid, we will assign 50 percent to Medicare and 50 percent to Medicaid, the standard method that CMS and states use in the allocation of expenses related to surveys of nursing homes.

Heart failure in nursing home residents; a cross-sectional study to determine the prevalence and clinical characteristics.

PubMed

Daamen, Mariëlle A M J; Hamers, Jan P H; Gorgels, Anton P M; Brunner-La Rocca, Hans-Peter; Tan, Frans E S; van Dieijen-Visser, Marja P; Schols, Jos M G A

2015-12-16

Heart failure (HF) is expected to be highly prevalent in nursing home residents, but precise figures are scarce. The aim of this study was to determine the prevalence of HF in nursing home residents and to get insight in the clinical characteristics of residents with HF. The study followed a multi-centre cross-sectional design. Nursing home residents (n = 501) in the southern part of the Netherlands aged over 65 years and receiving long-term somatic or psychogeriatric care were included in the study. The diagnosis of HF and related characteristics were based on data collected from actual clinical examinations (including history, physical examination, ECG, cardiac markers and echocardiography), patient records and questionnaires. A panel of two cardiologists and a geriatrician ultimately judged the data to diagnose HF. The overall prevalence of HF in nursing home residents was 33 %, of which 52 % had HF with preserved ejection fraction. The symptoms dyspnoea and oedema and a cardiac history were more common in residents with HF. Diabetes mellitus, chronic obstructive pulmonary disease (COPD) were also more prevalent in those with HF. Residents with HF had a higher score on the Mini Mental State Examination. 54 % of those with HF where not known before, and in 31 % with a history of HF, this diagnosis was not confirmed by the expert panel. This study shows that HF is highly prevalent in nursing home residents with many unknown or falsely diagnosed with HF. Equal number of HF patients had reduced and preserved left-ventricular ejection fraction. The Netherlands National Trial Register NTR2663 (27-12-2010).

The Healthy Home Offerings via the Mealtime Environment (HOME) Plus study: Design and methods1

PubMed Central

Fulkerson, Jayne A.; Neumark-Sztainer, Dianne; Story, Mary; Gurvich, Olga; Kubik, Martha Y.; Garwick, Ann; Dudovitz, Bonnie

2014-01-01

Background Informed and engaged parents and healthful home environments are essential for the health of youth. Although research has shown health benefits associated with family meals, to date, no randomized controlled trial (RCT) has been developed to examine the impact of a family meals intervention on behavioral and health outcomes. Methods/Design The Healthy Home Offerings via the Mealtime Environment (HOME) Plus study is a two-arm (intervention versus attention-only control) RCT being conducted in Minneapolis/St. Paul. Built on previous pilot research, HOME Plus aims to increase the frequency and healthfulness of family meals and snacks and reduce children’s sedentary behavior, particularly screen time, to promote healthier eating and activity behaviors and prevent obesity. HOME Plus is delivered to families in community settings. The program includes 10 monthly sessions focused on nutrition and activity education, meal planning and preparation skill development. In addition, five motivational goal-setting phone calls are conducted with parents. The primary outcome measure is age- and gender-adjusted child BMI-z score at post-intervention by treatment group. Secondary household-level outcomes include family meal frequency, home availability of healthful foods (fruits/vegetables) and unhealthful foods (high-fat/sugary snacks) and beverages (sugar-sweetened beverages), and the quality of foods served at meals and snacks. Secondary child outcomes include dietary intake of corresponding foods and beverages and screen time. Conclusions The HOME Plus RCT actively engages whole families of 8–12 year old children to promote healthier eating and activity behaviors and prevent obesity through promotion of family meals and snacks and limited media use. PMID:24480729

Use of the computer and Internet among Italian families: first national study.

PubMed

Bricolo, Francesco; Gentile, Douglas A; Smelser, Rachel L; Serpelloni, Giovanni

2007-12-01

Although home Internet access has continued to increase, little is known about actual usage patterns in homes. This nationally representative study of over 4,700 Italian households with children measured computer and Internet use of each family member across 3 months. Data on actual computer and Internet usage were collected by Nielsen//NetRatings service and provide national baseline information on several variables for several age groups separately, including children, adolescents, and adult men and women. National averages are shown for the average amount of time spent using computers and on the Web, the percentage of each age group online, and the types of Web sites viewed. Overall, about one-third of children ages 2 to 11, three-fourths of adolescents and adult women, and over four-fifths of adult men access the Internet each month. Children spend an average of 22 hours/month on the computer, with a jump to 87 hours/month for adolescents. Adult women spend less time (about 60 hours/month), and adult men spend more (over 100). The types of Web sites visited are reported, including the top five for each age group. In general, search engines and Web portals are the top sites visited, regardless of age group. These data provide a baseline for comparisons across time and cultures.

The Brightest in Solar Homes to Shine in Public Tour

Science.gov Websites

open to the public Oct. 19 as part of the National Solar Home Tour sponsored by the American Solar are taking part in this year's national tour. Locally the homes will be open to the public from 10 a.m

The home health workforce: a distinction between worker categories.

PubMed

Stone, Robyn; Sutton, Janet P; Bryant, Natasha; Adams, Annelise; Squillace, Marie

2013-01-01

The demand for home health aides is expected to rise, despite concerns about the sustainability of this workforce. Home health workers receive low wages and little training and have high turnover. It is difficult to recruit and retain workers to improve clinical outcomes. This study presents national estimates to examine how home health workers and the subgroup of workers differ in terms of sociodemographic characteristics, compensation, benefits, satisfaction, and retention. Hospice aides fare better than other categories of workers and are less likely to leave their job. Policymakers should consider strategies to increase the quality and stability of this workforce.

DOE Zero Energy Ready Home Case Study: Amaris Custom Homes, St. Paul, Minnesota

DOE Office of Scientific and Technical Information (OSTI.GOV)

None

For this project, Amaris worked with U.S. Department of Energy (DOE) team, NorthernSTAR Building America Partnership, to develop the first Zero Energy Ready Home (ZERH) in Minnesota's cold climate using reasonable, cost-effective, and replicable construction materials and practices. The result is a passive solar, super-efficient 3542-ft2 walkout ranch-style home with all the creature comforts. Along with meeting ZERH standards, Amaris also achieved certifications for Leadership in Energy & Environmental Design for Homes v4, MN Green Path Emerald, and a Builders Association of the Twin Cities Reggie Award of Excellence. The home achieves a HERS score of 41 without photovoltaics; withmore » PV, the home achieves a HERS score of 5.« less

Family environment and the malleability of cognitive ability: A Swedish national home-reared and adopted-away cosibling control study

PubMed Central

Kendler, Kenneth S.; Turkheimer, Eric; Ohlsson, Henrik; Sundquist, Jan; Sundquist, Kristina

2015-01-01

Cognitive ability strongly aggregates in families, and prior twin and adoption studies have suggested that this is the result of both genetic and environmental factors. In this study, we used a powerful design—home-reared and adopted-away cosibling controls—to investigate the role of the rearing environment in cognitive ability. We identified, from a complete national Swedish sample of male–male siblings, 436 full-sibships in which at least one member was reared by one or more biological parents and the other by adoptive parents. IQ was measured at age 18–20 as part of the Swedish military service conscription examination. Parental educational level was rated on a 5-point scale. Controlling for clustering of offspring within biological families, the adopted siblings had an IQ 4.41 (SE = 0.75) points higher than their nonadopted siblings. Each additional unit of rearing parental education was associated with 1.71 (SE = 0.44) units of IQ. We replicated these results in 2,341 male–male half-sibships, in which, controlling for clustering within families, adoption was associated with a gain of IQ of 3.18 (SE = 0.34) points. Each additional unit of rearing parental education was associated with 1.94 (SE = 0.18) IQ units. Using full- and half-sibling sets matched for genetic background, we found replicated evidence that (i) rearing environment affects IQ measured in late adolescence, and (ii) a portion of the IQ of adopted siblings could be explained by the educational level of their adoptive parents. PMID:25831538

Interprofessional collaboration in nursing homes (interprof): a grounded theory study of general practitioner experiences and strategies to perform nursing home visits.

PubMed

Fleischmann, Nina; Tetzlaff, Britta; Werle, Jochen; Geister, Christina; Scherer, Martin; Weyerer, Siegfried; Hummers-Pradier, Eva; Mueller, Christiane A

2016-08-30

Interprofessionalism, considered as collaboration between medical professionals, has gained prominence over recent decades and evidence for its impact has grown. The steadily increasing number of residents in nursing homes will challenge medical care and the interaction across professions, especially nurses and general practitioners (GPs). The nursing home visit, a key element of medical care, has been underrepresented in research. This study explores GP perspectives on interprofessional collaboration with a focus on their visits to nursing homes in order to understand their experiences and expectations. This research represents an aspect of the interprof study, which explores medical care needs as well as the perceived collaboration and communication by nursing home residents, their families, GPs and nurses. This paper focusses on GPs' views, investigating in particular their visits to nursing homes in order to understand their experiences. Open guideline-interviews covering interprofessional collaboration and the visit process were conducted with 30 GPs in three study centers and analyzed with grounded theory methodology. GPs were recruited via postal request and existing networks of the research partners. Four different types of nursing home visits were found: visits on demand, periodical visits, nursing home rounds and ad-hoc-decision based visits. We identified the core category "productive performance" of home visits in nursing homes which stands for the balance of GPs´ individual efforts and rewards. GPs used different strategies to perform a productive home visit: preparing strategies, on-site strategies and investing strategies. We compiled a theory of GPs home visits in nursing homes in Germany. The findings will be useful for research, and scientific and management purposes to generate a deeper understanding of GP perspectives and thereby improve interprofessional collaboration to ensure a high quality of care.

Alternative perspectives of safety in home delivered health care: a sequential exploratory mixed method study.

PubMed

Jones, Sarahjane

2016-10-01

The aim of this study was to discover and describe how patients, carers and case management nurses define safety and compare it to the traditional risk reduction and harm avoidance definition of safety. Care services are increasingly being delivered in the home for patients with complex long-term conditions. However, the concept of safety remains largely unexplored. A sequential, exploratory mixed method design. A qualitative case study of the UK National Health Service case management programme in the English UK National Health Service was deployed during 2012. Thirteen interviews were conducted with patients (n = 9) and carers (n = 6) and three focus groups with nurses (n = 17) from three community care providers. The qualitative element explored the definition of safety. Data were subjected to framework analysis and themes were identified by participant group. Sequentially, a cross-sectional survey was conducted during 2013 in a fourth community care provider (patient n = 35, carer n = 19, nurse n = 26) as a form of triangulation. Patients and carers describe safety differently to case management nurses, choosing to focus on meeting needs. They use more positive language and recognize the role they have in safety in home-delivered health care. In comparison, case management nurses described safety similarly to the definitions found in the literature. However, when offered the patient and carer definition of safety, they preferentially selected this definition to their own or the literature definition. Patients and carers offer an alternative perspective on patient safety in home-delivered health care that identifies their role in ensuring safety and is more closely aligned with the empowerment philosophy of case management. © 2016 John Wiley & Sons Ltd.

Work-Related Stressors Among Maternal, Infant, and Early Childhood Home Visiting (MIECHV) Home Visitors: A Qualitative Study.

PubMed

Alitz, Paige J; Geary, Shana; Birriel, Pamela C; Sayi, Takudzwa; Ramakrishnan, Rema; Balogun, Omotola; Salloum, Alison; Marshall, Jennifer T

2018-05-31

Background The Florida Maternal, Infant, and Early Childhood Home Visiting (MIECHV) program delivers evidence-based home visiting services to over 1400 families each year. Home visitors are integral in providing resources for families to promote healthy pregnancy, child development, family wellness, and self-sufficiency. Due to the nature of this work, home visitors experience work-related pressures and stressors that can impact staff well-being and retention. Objectives The purpose of this study was to understand primary sources of work-related stress experienced by home visitors, subsequent effects on their engagement with program participants, and to learn of coping mechanisms used to manage stress. Methods In 2015, Florida MIECHV program evaluators conducted ten focus groups with 49 home visitors during which they ranked and discussed their top sources of work-related stress. Qualitative analysis was conducted to identify emergent themes in work-related stressors and coping/supports. Results Across all sites, the burden of paperwork and data entry were the highest ranked work-related stressors perceived as interfering with home visitors' engagement with participants. The second-highest ranked stressors included caseload management, followed by a lack of resources for families, and dangerous environments. Home visitors reported gratification in their helping relationships families, and relied on coworkers or supervisors as primary sources of workplace support along with self-care (e.g. mini-vacations, recreation, and counseling). Conclusions for practice Florida MIECHV home visitors across all ten focus groups shared similar work-related stressors that they felt diminished engagement with program participants and could impact participant and staff retention. In response, Florida MIECHV increased resources to support home visitor compensation and reduce caseloads, and obtained a competitive award from HRSA to implement a mindfulness-based stress reduction

Understanding sharps injuries in home healthcare: The Safe Home Care qualitative methods study to identify pathways for injury prevention.

PubMed

Markkanen, Pia; Galligan, Catherine; Laramie, Angela; Fisher, June; Sama, Susan; Quinn, Margaret

2015-04-11

Home healthcare is one of the fastest growing sectors in the United States. Percutaneous injuries from sharp medical devices (sharps) are a source of bloodborne pathogen infections among home healthcare workers and community members. Sharps use and disposal practices in the home are highly variable and there is no comprehensive analysis of the system of sharps procurement, use and disposal in home healthcare. This gap is a barrier to effective public health interventions. The objectives of this study were to i) identify the full range of pathways by which sharps enter and exit the home, stakeholders involved, and barriers for using sharps with injury prevention features; and ii) assess the leverage points for preventive interventions. This study employed qualitative research methods to develop two systems maps of the use of sharps and prevention of sharps injuries in home healthcare. Twenty-six in-depth interview sessions were conducted including home healthcare agency clinicians, public health practitioners, sharps device manufacturers, injury prevention advocates, pharmacists and others. Interview transcripts were audio-recorded and analyzed thematically using NVIVO qualitative research analysis software. Analysis of supporting archival material also was conducted. All findings guided development of the two maps. Sharps enter the home via multiple complex pathways involving home healthcare providers and home users. The providers reported using sharps with injury prevention features. However, home users' sharps seldom had injury prevention features and sharps were commonly re-used for convenience and cost-savings. Improperly discarded sharps present hazards to caregivers, waste handlers, and community members. The most effective intervention potential exists at the beginning of the sharps systems maps where interventions can eliminate or minimize sharps injuries, in particular with needleless treatment methods and sharps with injury prevention features

Home - Tohono O'odham Nation

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about our history, culture, governance and other aspects of the Nation that otherwise may not be readily history, culture and governance components while educating the public on its broad spectrum of services †’ Address Tohono O'odham Nation P.O. Box 837 | Sells, AZ 85634 contactus@tonation-nsn.gov Login Governance

Edison Home Community Study Unit.

ERIC Educational Resources Information Center

Lee County School District, Ft. Myers, FL. Dept. of Environmental Education and Instructional Development Services.

History is not merely events that occurred in the past. The past has influenced the present, as the present will influence the future. The purpose of this community study unit is to provide fourth grade students with an opportunity to investigate some of the history of Lee County, Florida. The unit's focus is on Thomas Edison, who built a home in…

Case mix reimbursement for nursing homes.

PubMed

Schlenker, R E

1986-01-01

Nursing home care is growing in importance as the population ages and as Medicare's prospective payment system encourages earlier discharges from acute care settings to nursing homes. Nursing home reimbursement policy is primarily a Medicaid issue, since Medicaid pays for about half the nation's nursing home care. The research reviewed in this article suggests a strong association between case mix and cost, and a weaker but still positive association between quality and cost. The research also implies that traditional nursing home reimbursement methodologies may impede access and may lower quality for Medicaid (and Medicare) recipients. To offset these problems, several states have recently begun to incorporate case mix directly into the reimbursement process. These systems deserve careful policy consideration.

[Influence of income on food expenditures away from home among Brazilian families, 2002-2003].

PubMed

Claro, Rafael Moreira; Levy, Renata Bertazzi; Bandoni, Daniel Henrique

2009-11-01

This study describes and evaluates the influence of income on the percentage of food expenditures away from home for Brazilian families. Food acquisition data from the National Household Budget Survey conducted from 2002 to 2003 (POF 2002/2003) by the Brazilian Institute of Geography and Statistics (IBGE) or National Census Bureau was used in the analysis. Information on food-and-drink expenditures away from home was analyzed. The influence of income on the share of food purchased away from home in the household budget, adjusted for socio-demographic variables, was analyzed through elasticity coefficients estimated in multiple linear regression. Food purchased away from home accounted for 21% of total food expenditures by Brazilian households. A 10% increase in income increased the share of food purchased away from home by 3%. Income elasticity was high, especially for the lowest income families. The results demonstrate an important influence of income on food expenditures away from home, and higher income is associated with a greater share of food purchased away from home.

Factors associated with home hazards: Findings from the Malaysian Elders Longitudinal Research study.

PubMed

Romli, Muhammad H; Tan, Maw P; Mackenzie, Lynette; Lovarini, Meryl; Kamaruzzaman, Shahrul B; Clemson, Lindy

2018-03-01

Previous studies have investigated home hazards as a risk factor for falls without considering factors associated with the presence of home hazards. The present study aimed to determine patterns of home hazards among urban community-dwelling older Malaysians, and to identify factors contributing to home hazards. Cross-sectional data from the initial wave of the Malaysian Elders Longitudinal Research study were used. Basic demographics were obtained from the Global Questionnaire. Basic and instrumental activities of daily living were measured using the Katz and Lawton-Brody scales, and home hazards were identified using the Home Falls and Accidents Screening Tool. Participants were also asked if they had fallen in the previous 12 months. Data were analyzed from 1489 participants. Hazards were frequently identified (>30%) in the toilet and bathroom areas (no grab rail, no non-slip mat, distant toilet), slippery floors, no bedside light access and inappropriate footwear. Lower educational attainment, traditional housing, Chinese ethnicity, greater number of home occupants, lower monthly expenditure, poor vision and younger age were the factors independently associated with home hazards. This study provides evidence that home hazards are a product of the interaction of the individual's function within their home environment. Hazards are also influenced by local sociocultural and environmental factors. The relationship between home hazards and falls appears complex and deserves further evaluation. Geriatr Gerontol Int 2018; 18: 387-395. © 2017 Japan Geriatrics Society.

Business Solutions Case Study: Marketing Zero Energy Homes: Tommy Williams Homes, Gainesville, Florida

DOE Office of Scientific and Technical Information (OSTI.GOV)

None

Building America research has shown that high-performance homes can potentially give builders an edge in the marketplace and can boost sales, but it doesn't happen automatically. It requires a tailored, easy-to-understand marketing campaign, and sometimes a little flair. This case study highlights the successful marketing approach of Tommy Williams Homes, which devotes resources to advertising, targeted social media outlets and blogs, realtor education seminars, and groundbreaking and open house celebrations. As a result, in one community, 2013 property sales records show that TWH outsells the only other builder in the development at a higher price, with fewer days on themore » market.« less

Medicare and Medicaid Programs; CY 2018 Home Health Prospective Payment System Rate Update and CY 2019 Case-Mix Adjustment Methodology Refinements; Home Health Value-Based Purchasing Model; and Home Health Quality Reporting Requirements. Final rule.

PubMed

2017-11-07

This final rule updates the home health prospective payment system (HH PPS) payment rates, including the national, standardized 60-day episode payment rates, the national per-visit rates, and the non-routine medical supply (NRS) conversion factor, effective for home health episodes of care ending on or after January 1, 2018. This rule also: Updates the HH PPS case-mix weights using the most current, complete data available at the time of rulemaking; implements the third year of a 3-year phase-in of a reduction to the national, standardized 60-day episode payment to account for estimated case-mix growth unrelated to increases in patient acuity (that is, nominal case-mix growth) between calendar year (CY) 2012 and CY 2014; and discusses our efforts to monitor the potential impacts of the rebasing adjustments that were implemented in CY 2014 through CY 2017. In addition, this rule finalizes changes to the Home Health Value-Based Purchasing (HHVBP) Model and to the Home Health Quality Reporting Program (HH QRP). We are not finalizing the implementation of the Home Health Groupings Model (HHGM) in this final rule.

Efficient Solutions for Existing Homes Case Study: Demonstration House of Cold-Climate Solutions for Affordable Housing

DOE Office of Scientific and Technical Information (OSTI.GOV)

T. Schirber, C. Ojczyk, and R. Jacobson

2016-05-01

Single family homes in urban areas that are available for renovation by nonprofit developers are often in rough shape (1MM to 2MM nationally). Budgeting has historically focused on improving homes to meet basic housing standards. A rising interest in the long-term impact of homeownership has introduced the need to balance basic needs with home performance. This demonstration project aims to help nonprofit affordable housing developers become familiar with three Building America performance measures, the installation processes, and impacts and benefits of each. A story and a half home in North Minneapolis, MN was presented by Urban Homeworks our local nonprofitmore » partner. The team helped them install three researched upgrade measures: exterior roof insulation or 'overcoat,' exterior foundation insulation, or 'excavationless', and a combined space and water heating HVAC system or 'combi.'« less

Energy and nutrient intake according to away-from-home food consumption in the Northeast Region: an analysis of the 2008-2009 National Dietary Survey.

PubMed

Cavalcante, Jessica Brito; Moreira, Tyciane Maria Vieira; Mota, Caroline da Costa; Pontes, Carolinne Reinaldo; Bezerra, Ilana Nogueira

2017-01-01

Away-from-home food consumption has increased in Brazil and is associated with fewer nutritious food choices. To describe energy and specific nutrient intake among consumers and non-consumer of away-from-home food in the Northeast Region. A sample of 11,674 individuals from the National Dietary Survey data, which is part of the 2008-2009 Household Budget Survey, from the Northeast Region, was analyzed. Individuals provided two dietary records in nonconsecutive days, informing the place where foods were consumed (at-home or away-from-home). Away-from-home food was defined as foods acquired and consumed away from home. Linear regression models were developed to assess the relationship between away-from-home food consumption in one of the two-day food record and the energy and nutrient intake, adjusted for age, gender, and per capita income. Away-from-home food consumption, in at least one of the two-day food record, was reported by 42% of individuals in the Northeast Region. Individuals who consumed food away from home in the Northeast Region presented poor nutrient intake compared to those who did not report consumption away from home, with higher intake of energy, free sugar, saturated fat, and trans fat and lower intake of protein, iron, and dietary fiber, regardless of age, gender, and income (p < 0.05). Away-from-home food consumption in the Northeast Region contributed to higher energy and poorer nutrient intake. Therefore, the development of public policies and strategies that favor health food choices when individuals eat away from home is necessary.

Palliative care in the home: a scoping review of study quality, primary outcomes, and thematic component analysis.

PubMed

Hofmeister, Mark; Memedovich, Ally; Dowsett, Laura E; Sevick, Laura; McCarron, Tamara; Spackman, Eldon; Stafinski, Tania; Menon, Devidas; Noseworthy, Tom; Clement, Fiona

2018-03-07

The aim of palliative care is to improve the quality of life of patients and families through the prevention and relief of suffering. Frequently, patients may choose to receive palliative care in the home. The objective of this paper is to summarize the quality and primary outcomes measured within the palliative care in the home literature. This will synthesize the current state of the literature and inform future work. A scoping review was completed using PRISMA guidelines. PubMed, Embase, CINAHL, Web of Science, Cochrane Library, EconLit, PsycINFO, Centre for Reviews and Dissemination, Database of Abstracts of Reviews of Effects, and National Health Service Economic Evaluation Database were searched from inception to August 2016. Inclusion criteria included: 1) care was provided in the "home of the patient" as defined by the study, 2) outcomes were reported, and 3) reported original data. Thematic component analysis was completed to categorize interventions. Fifty-three studies formed the final data set. The literature varied extensively. Five themes were identified: accessibility of healthcare, caregiver support, individualized patient centered care, multidisciplinary care provision, and quality improvement. Primary outcomes were resource use, symptom burden, quality of life, satisfaction, caregiver distress, place of death, cost analysis, or described experiences. The majority of studies were of moderate or unclear quality. There is robust literature of varying quality, assessing different components of palliative care in the home interventions, and measuring different outcomes. To be meaningful to patients, these interventions need to be consistently evaluated with outcomes that matter to patients. Future research could focus on reaching a consensus for outcomes to evaluate palliative care in the home interventions.

The first multicenter, randomized, controlled trial of home telemonitoring for Japanese patients with heart failure: home telemonitoring study for patients with heart failure (HOMES-HF).

PubMed

Kotooka, Norihiko; Kitakaze, Masafumi; Nagashima, Kengo; Asaka, Machiko; Kinugasa, Yoshiharu; Nochioka, Kotaro; Mizuno, Atsushi; Nagatomo, Daisuke; Mine, Daigo; Yamada, Yoko; Kuratomi, Akiko; Okada, Norihiro; Fujimatsu, Daisuke; Kuwahata, So; Toyoda, Shigeru; Hirotani, Shin-Ichi; Komori, Takahiro; Eguchi, Kazuo; Kario, Kazuomi; Inomata, Takayuki; Sugi, Kaoru; Yamamoto, Kazuhiro; Tsutsui, Hiroyuki; Masuyama, Tohru; Shimokawa, Hiroaki; Momomura, Shin-Ichi; Seino, Yoshihiko; Sato, Yasunori; Inoue, Teruo; Node, Koichi

2018-02-15

Home telemonitoring is becoming more important to home medical care for patients with heart failure. Since there are no data on home telemonitoring for Japanese patients with heart failure, we investigated its effect on cardiovascular outcomes. The HOMES-HF study was the first multicenter, open-label, randomized, controlled trial (RCT) to elucidate the effectiveness of home telemonitoring of physiological data, such as body weight, blood pressure, and pulse rate, for Japanese patients with heart failure (UMIN Clinical Trials Registry 000006839). The primary end-point was a composite of all-cause death or rehospitalization due to worsening heart failure. We analyzed 181 recently hospitalized patients with heart failure who were randomly assigned to a telemonitoring group (n = 90) or a usual care group (n = 91). The mean follow-up period was 15 (range 0-31) months. There was no statistically significant difference in the primary end-point between groups [hazard ratio (HR), 0.95; 95% confidence interval (CI), 0.548-1.648; p = 0.572]. Home telemonitoring for Japanese patients with heart failure was feasible; however, beneficial effects in addition to those of usual care were not demonstrated. Further investigation of more patients with severe heart failure, participation of home medical care providers, and use of a more integrated home telemonitoring system emphasizing communication as well as monitoring of symptoms and physiological data are required.

Improving the Quality of Home Visitation: An Exploratory Study of Difficult Situations

ERIC Educational Resources Information Center

LeCroy, Craig Winston; Whitaker, Kate

2005-01-01

Objective: The primary purpose of this study was to use an ecological assessment model to obtain a better understanding of difficult situations that home visitors confront when implementing home visitation services. Method: A mixed method study was used which included conducting focus groups to identify specific situations faced by home visitors…

Los Alamos National Lab: National Security Science

Science.gov Websites

SKIP TO PAGE CONTENT Los Alamos National Laboratory Delivering science and technology to protect Permit for Storm Water Public Reading Room Environment Home News Los Alamos National Lab: National deposition operations for the Center for Integrated Nanotechnologies at Los Alamos. Innovation drives his

Medical Home Transformation in Pediatric Primary Care—What Drives Change?

PubMed Central

McAllister, Jeanne W.; Cooley, W. Carl; Van Cleave, Jeanne; Boudreau, Alexy Arauz; Kuhlthau, Karen

2013-01-01

PURPOSE The aim of this study was to characterize essential factors to the medical home transformation of high-performing pediatric primary care practices 6 to 7 years after their participation in a national medical home learning collaborative. METHODS We evaluated the 12 primary care practice teams having the highest Medical Home Index (MHI) scores after participation in a national medical home learning collaborative with current MHI scores, a clinician staff questionnaire (assessing adaptive reserve), and semistructured interviews. We reviewed factors that emerged from interviews and analyzed domains and subdomains for their agreement with MHI and adaptive reserve domains and subthemes using a process of triangulation. RESULTS At 6 to 7 years after learning collaborative participation, 4 essential medical home attributes emerged as drivers of transformation: (1) a culture of quality improvement, (2) family-centered care with parents as improvement partners, (3) team-based care, and (4) care coordination. These high-performing practices developed comprehensive, family-centered, planned care processes including flexible access options, population approaches, and shared care plans. Eleven practices evolved to employ care coordinators. Family satisfaction appeared to stem from better access, care, and safety, and having a strong relationship with their health care team. Physician and staff satisfaction was high even while leadership activities strained personal time. CONCLUSIONS Participation in a medical home learning collaborative stimulated, but did not complete, medical home changes in 12 pediatric practices. Medical home transformation required continuous development, ongoing quality improvement, family partnership skills, an attitude of teamwork, and strong care coordination functions. PMID:23690392

Pilot study to investigate the feasibility of the Home Falls and Accidents Screening Tool (HOME FAST) to identify older Malaysian people at risk of falls

PubMed Central

Romli, Muhammad Hibatullah; Mackenzie, Lynette; Lovarini, Meryl; Tan, Maw Pin

2016-01-01

Objective The relationship between home hazards and falls in older Malaysian people is not yet fully understood. No tools to evaluate the Malaysian home environment currently exist. Therefore, this study aimed to pilot the Home Falls and Accidents Screening Tool (HOME FAST) to identify hazards in Malaysian homes, to evaluate the feasibility of using the HOME FAST in the Malaysian Elders Longitudinal Research (MELoR) study and to gather preliminary data about the experience of falls among a small sample of Malaysian older people. Design A cross-sectional pilot study was conducted. Setting An urban setting in Kuala Lumpur. Participants 26 older people aged 60 and over were recruited from the control group of a related research project in Malaysia, in addition to older people known to the researchers. Primary outcome measure The HOME FAST was applied with the baseline survey for the MELoR study via a face-to-face interview and observation of the home by research staff. Results The majority of the participants were female, of Malay or Chinese ethnicity and living with others in a double-storeyed house. Falls were reported in the previous year by 19% and 80% of falls occurred at home. Gender and fear of falling had the strongest associations with home hazards. Most hazards were detected in the bathroom area. A small number of errors were detected in the HOME FAST ratings by researchers. Conclusions The HOME FAST is feasible as a research and clinical tool for the Malaysian context and is appropriate for use in the MELoR study. Home hazards were prevalent in the homes of older people and further research with the larger MELoR sample is needed to confirm the validity of using the HOME FAST in Malaysia. Training in the use of the HOME FAST is needed to ensure accurate use by researchers. PMID:27531736

Comprehensive home-based care coordination for vulnerable elders with dementia: Maximizing Independence at Home-Plus-Study protocol.

PubMed

Samus, Quincy M; Davis, Karen; Willink, Amber; Black, Betty S; Reuland, Melissa; Leoutsakos, Jeannie; Roth, David L; Wolff, Jennifer; Gitlin, Laura N; Lyketsos, Constantine G; Johnston, Deirdre

2017-12-01

Despite availability of effective care strategies for dementia, most health care systems are not yet organized or equipped to provide comprehensive family-centered dementia care management. Maximizing Independence at Home-Plus is a promising new model of dementia care coordination being tested in the U.S. through a Health Care Innovation Award funded by the Centers for Medicare and Medicaid Services that may serve as a model to address these delivery gaps, improve outcomes, and lower costs. This report provides an overview of the Health Care Innovation Award aims, study design, and methodology. This is a prospective, quasi-experimental intervention study of 342 community-living Medicare-Medicaid dual eligibles and Medicare-only beneficiaries with dementia in Maryland. Primary analyses will assess the impact of Maximizing Independence at Home-Plus on risk of nursing home long-term care placement, hospitalization, and health care expenditures (Medicare, Medicaid) at 12, 18 (primary end point), and 24 months, compared to a propensity-matched comparison group. The goals of the Maximizing Independence at Home-Plus model are to improve care coordination, ability to remain at home, and life quality for participants and caregivers, while reducing total costs of care for this vulnerable population. This Health Care Innovation Award project will provide timely information on the impact of Maximizing Independence at Home-Plus care coordination model on a variety of outcomes including effects on Medicaid and Medicare expenditures and service utilization. Participant characteristic data, cost savings, and program delivery costs will be analyzed to develop a risk-adjusted payment model to encourage sustainability and facilitate spread.

Physicians' attitudes toward home healthcare services in Turkey: A qualitative study.

PubMed

Aksoy, Hilal; Kahveci, Rabia; Döner, Pınar; Aksoy, İhsan; Ayhan, Duygu; Koç, E Meltem; Şencan, İrfan; Kasım, İsmail; Özkara, Adem

2015-01-01

Because of the growth of the older population and the prevalence of chronic diseases, home care services (HCS) have become an important aspect of healthcare worldwide. However, various difficulties and deficiencies are present in the provision of these recently implemented services in Turkey. Modifications to home healthcare services are in progress. Physicians have an active role in home healthcare services. The present study was performed to examine physicians' attitudes toward this service in detail. Twenty-six physicians who provide home healthcare services in the city of Ankara were included in the study. We conducted in-depth, semi-structured, face-to-face interviews. The interviews were audio-recorded, transcribed, and qualitatively analysed. Most physicians thought that home care could be provided to patients who are bedridden, are very old, have a chronic disease, have problems leaving the house, or do not have family support. They also expressed displeasure about the abuse of services and discordance of organization between hospitals and primary care centres. They noted that real circumstances in practice were not compatible with regulations and that cooperation and coordination between departments are necessary and important. The current study underlines physicians' interest in and support of the home care system, which has various drawbacks and limitations. Legislation needs to be further changed to improve the quality of service and eliminate deficiencies in home healthcare.

Forgotten resources of older home care clients: focus group study in Finland.

PubMed

Turjamaa, Riitta; Hartikainen, Sirpa; Pietilä, Anna-Maija

2013-09-01

In this qualitative focus group study, the resources available to older home-dwelling people, particularly incoming and existing home care clients, are described from the viewpoint of home care professionals (n = 32). The data were analyzed using inductive content analysis. There were three categories of older people requiring resources from the viewpoint of interviewers: home-dwelling people, incoming home care clients, and existing home care clients. Based on the analysis, the resources of older home-dwelling people were categorized in terms of support, meaningful life, everyday activities, and environment. Incoming home care client resources were support, out-of-home activities, in-home activities, and environment. Existing client resources were described in terms of support, everyday activities, and environment. Home care professionals described the resources of the older home-dwelling people in diverse ways, but those of the perspective of existing clients were reduced. The biggest difference was in everyday activities. Psychological and social resources, including meaningful life and social relationships, seemed to be forgotten. All available resources must be taken into account, especially in the everyday home care services for existing home care clients. © 2013 Wiley Publishing Asia Pty Ltd.

What Makes Learners Learn? Motivational Learning Theory in Home Study.

ERIC Educational Resources Information Center

Feingold, S. Norman

1979-01-01

Motivation is vital to all learning with the possible exception of incidental learning. Home study may adapt motivational learning theory to its goals by considering basic concepts with related examples. First, the more advance reasons an individual has to believe in the value of home study, the more likely will be the success of educational…

Untangling home care's Gordion knot. The Home Care Information Management and Technology Forum.

PubMed

Wilhelm, Lawrence

2003-03-01

As home care and hospice technological tools have evolved over the past six years, there have been no efforts to standardize the collection, storage, and reporting of data among different systems. The rapid pace of technological change, increased use of wireless and remote technology, a greater reliance on tools for collaboration and networking, and the ever-increasing regulatory burden on home care and hospice providers have resulted in the need for polices and procedures for the standardization of data across the industry. Agency administrators, already strapped for cash and time, need to know what technology investments they need to make now in order to remain competitive in the future. The National Association for Home Care & Hospice has created a forum to address these concerns and to develop a blueprint for the future development of home care and hospice technology.

Indoor air pollutants from unvented kerosene-heater emissions in mobile homes: Studies on particles, semivolatile organics, carbon monoxide, and mutagenicity

DOE Office of Scientific and Technical Information (OSTI.GOV)

Mumford, J.L.; Williams, R.W.; Walsh, D.B.

1991-01-01

The study was conducted to assess human exposure to air pollutants resulting from the use of kerosene heaters in mobile homes. It has been estimated that 15-17 million unvented kerosene heaters have been sold in the United States, and 33% of these heaters have been sold to mobile home residents. The emissions from kerosene heaters can result in high pollutants levels in mobile homes that have a small air volume and low ventilation rate. Eight totally electric mobile homes with no smokers living in the homes were monitored for indoor air particles < 10 micrometer (PM10), semivolatile organics, carbon monoxidemore » (CO), and mutagenicity of semivolatile and particle-phase organics in Salmonella typhimurium TA98 without S9 using a microsuspension reverse-mutation assay. Each home was monitored for an average of 6.5 h/day, 3 days/week, for 4 weeks (2 weeks with the heater on and 2 weeks with the heater off) during the heating season of 1989. Indoor air exchange rate, temperature, and humidity were measured. Chemical analyses, including polycyclic aromatic hydrocarbon (PAH) and nitro PAH, also were performed on the indoor air samples from a selected home with the kerosene heater on and off. Increases in CO and organic concentrations resulting from the use of kerosene heaters were found in most homes monitored. Chemical analysis data also suggested the presence of evaporated, unburned kerosene fuel present in semivolatile organics collected in the XAD samples. In comparison with the U.S. national ambient air standards, four out of the eight heaters investigated in the study emitted pollutants that exceeded the ambient air standards some days. These data suggested that emissions from unvented kerosene heaters can significantly impact indoor air quality in mobile homes and that these emissions contain carcinogenic compounds and can be potentially carcinogenic in humans.« less

Safety in home care: A research protocol for studying medication management

PubMed Central

2010-01-01

Background Patient safety is an ongoing global priority, with medication safety considered a prevalent, high-risk area of concern. Yet, we have little understanding of the supports and barriers to safe medication management in the Canadian home care environment. There is a clear need to engage the providers and recipients of care in studying and improving medication safety with collaborative approaches to exploring the nature and safety of medication management in home care. Methods A socio-ecological perspective on health and health systems drives our iterative qualitative study on medication safety with elderly home care clients, family members and other informal caregivers, and home care providers. As we purposively sample across four Canadian provinces: Alberta (AB), Ontario (ON), Quebec (QC) and Nova Scotia (NS), we will collect textual and visual data through home-based interviews, participant-led photo walkabouts of the home, and photo elicitation sessions at clients' kitchen tables. Using successive rounds of interpretive description and human factors engineering analyses, we will generate robust descriptions of managing medication at home within each provincial sample and across the four-province group. We will validate our initial interpretations through photo elicitation focus groups with home care providers in each province to develop a refined description of the phenomenon that can inform future decision-making, quality improvement efforts, and research. Discussion The application of interpretive and human factors lenses to the visual and textual data is expected to yield findings that advance our understanding of the issues, challenges, and risk-mitigating strategies related to medication safety in home care. The images are powerful knowledge translation tools for sharing what we learn with participants, decision makers, other healthcare audiences, and the public. In addition, participants engage in knowledge exchange throughout the study with the use

Exploring the Barriers of Home Care Services in Iran: A Qualitative Study

PubMed Central

Heydari, Heshmatolah; Shahsavari, Hooman; Hazini, Abdolrahim; Nasrabadi, Alireza Nikbakht

2016-01-01

With increasing chronic diseases, the use of home care is rising in the world. Home care in Iran has many challenges and to improve that, we should identify the challenges and barriers of home care. The aim of this study was to identify and explore the barriers of home care in Iran. This is a qualitative study with content analysis approach that was conducted in Iran in 2015. Fourteen key informants comprising health policymakers, faculty members, nurses, and physicians as well as patients and families engaged in home care purposefully participated in this study. Data was obtained using face-to-face semistructured interviews. A focus group discussion was also used to complete the findings. Graneheim and Lundman's approach was used for analysis of data and Lincoln and Guba's criteria were used to confirm the trustworthiness of study's findings. The data were divided into three main categories and eight subcategories. Main categories included treatment-based approach in the healthcare system, cultural dimensions, and the lack of adequate infrastructure. A position for home care in the healthcare system, considering cultural dimensions in Iranian society and providing an appropriate infrastructure, can be beneficial to improve the situation of home care services in Iran. PMID:27127677

Determinants of hospital-to-nursing home placement delays: a pilot study.

PubMed Central

Weissert, W G; Cready, C M

1988-01-01

Estimates of hospital-to-nursing home placement delays have always been varied, and given Medicare's new Prospective Payment System (PPS) based on diagnosis-related groups (DRGs), they are likely to have changed again. Theory and previous research suggest that four patient characteristics are the main causes of delays: Medicaid as the patient's nursing home payer source; need for heavy care due to major physical or mental problems; admission to the hospital from a nursing home; and lack of social support. A pilot study of all 1,016 elderly awaiting nursing home placement in two admission cohorts (pre- and post-PPS) from the three largest hospitals in the county surrounding Charlotte, North Carolina--where nursing home beds are in short supply--indicates that other factors are more important. While most placements were delayed, delays were short. Multiple regression results show that Medicaid patients' delays were only about a day longer than those of private-pay patients. Of the many heavy-care conditions studied, only three were associated with delay. Patients without social support and patients admitted from a nursing home, discharged to a hospital-affiliated facility, or placed after PPS had shorter delays. Long delays were found among patients who had applied for Medicaid coverage but had not yet been certified as financially eligible. Nonwhites and males were also delayed. These findings, if replicated in other areas with perceived nursing home bed shortages, appear to have important implications not only for the usefulness of nursing home case-mix reimbursement and subacute levels of nursing home care, but for nursing home bed-need estimates, too, as well as for Medicaid eligibility determination practices and civil rights law enforcement. PMID:3060449

The effect of Medicaid reimbursement on quality of care in nursing homes.

PubMed

Cohen, J W; Spector, W D

1996-02-01

This study uses a nationally representative sample of nursing homes and nursing home residents to examine the effect of Medicaid reimbursement on quality of care. The analysis shows that both reimbursement approach and level affect nursing home quality, as measured by case-mix adjusted staff to resident ratios. The analysis also shows that staffing ratios have a significant impact on resident outcomes, and these impacts vary by professional category of staff. Reimbursement does not have a significant impact on outcomes, however.

Integrating care coordination home telehealth and home based primary care in rural Oklahoma: a pilot study.

PubMed

Sorocco, Kristen H; Bratkovich, Kristi L; Wingo, Rita; Qureshi, Saleem M; Mason, Patrick J

2013-08-01

The purpose of this program was to evaluate the benefits of integrating VA Care Coordination Home Telehealth and Telemental health within HBPC. A case study design was used to determine quality assurance and quality improvement of incorporating additional home telehealth equipment within Home Based Primary Care (HBPC). Veterans with complex medical conditions and their caregivers living in rural Oklahoma were enrolled. Veterans received the same care other HBPC patients received with the addition of home telehealth equipment. Members from the interdisciplinary treatment team were certified to use the telehealth equipment. Veterans and their caregivers were trained on use of the equipment in their homes. Standard HBPC program measures were used to assess the program success. Assessments from all disciplines on the HBPC team were at baseline, 3, and 6 months, and participants provided satisfaction and interview data to assess the benefits of integrating technology into standard care delivery within an HBPC program. Six veterans were enrolled (mean age = 72 yrs) with a range of physical health conditions including: chronic obstructive pulmonary disease, cerebrovascular accident, spinal cord injury, diabetes, hypertension, and syncope. Primary mental health conditions included depression, dementia, anxiety, and PTSD. Scores on the Mini-Mental State Examination ranged from 18 to 30. Over a 6-month period, case studies indicated improvements in strength, social functioning, decreased caregiver burden, and compliance with treatment plan. This integration of CCHT and HBPC served previously underserved rural veterans having complex medical conditions and appears both feasible and clinically beneficial to veterans and their caregivers. PsycINFO Database Record (c) 2013 APA, all rights reserved.

The National Asthma Survey--New York State: association of the home environment with current asthma status.

PubMed

Nguyen, Trang; Lurie, Melissa; Gomez, Marta; Reddy, Amanda; Pandya, Kruti; Medvesky, Michael

2010-01-01

The National Asthma Survey--New York State (NYS), a telephone survey of NYS residents, was conducted in 2002-2003 to further understand the burden of asthma among adults and children and to identify health, socioeconomic, behavioral, and environmental factors associated with asthma. A total of 1,412 households with at least one member with current asthma and 2,290 control households answered questions about their home environment (e.g., presence of asthma triggers and practices that promote or reduce common asthma triggers). RESULTS; For children younger than 18 years of age, we found statistically significant positive associations between current asthma and the presence of mold (adjusted odds ratio [AOR] = 2.1, 95% confidence interval [CI] 1.3, 3.3), air cleaners (AOR = 1.5, 95% CI 1.1, 2.1), dehumidifiers (AOR = 2.0, 95% CI 1.4, 2.7), and humidifiers (AOR = 1.6, 95% CI 1.1, 2.3). For adults, there were statistically significant positive associations with the presence of mold (AOR = 2.5, 95% CI 1.8, 3.4), air cleaners (AOR = 2.2, 95% CI 1.7, 2.8), and humidifiers (AOR = 1.4, 95% CI 1.1, 1.8). There were no statistically significant associations with the presence of cockroaches, pets, or tobacco smoke, while use of a wood-burning stove or fireplace was significantly more prevalent in control homes. Asthma guidelines emphasize the importance of reducing triggers in the home as part of a multifaceted approach to asthma control. Despite these guidelines, many asthma triggers (specifically, mold) were as prevalent or more so in the homes of New Yorkers with asthma as compared with control households. Public health interventions in NYS should focus on educating households about potential asthma triggers and their sources and teach methods to prevent, reduce, or eliminate them.

Deaths from Resident-to-Resident Aggression in Australian Nursing Homes.

PubMed

Murphy, Briony; Bugeja, Lyndal; Pilgrim, Jennifer; Ibrahim, Joseph E

2017-12-01

To describe the frequency and nature of deaths from resident-to-resident aggression (RRA) in nursing homes in Australia. National population-based retrospective cohort study. Accredited nursing homes in Australia. Residents whose deaths resulted from RRA and were reported to the coroner between July 1, 2000, and December 31, 2013. Cases were identified using the National Coronial Information System, and data on individual, interpersonal, organizational, and societal factors were collected through review of the paper-based coroners' files. This research identified 28 deaths from RRA over a 14-year study period (0.004 per 100,000 bed days). Most exhibitors of aggression were male (n = 24, 85.7%), and risk of death from RRA was twice as high for male as for female nursing home residents (relative risk (RR) = 2.13, 95% confidence interval (CI) = 0.93-4.80, P = .05). Almost 90% of residents involved in RRA had a diagnosis of dementia, and three-quarters had a history of behavioral problems, including wandering and aggression. Dyad analysis showed that exhibitors of aggression were often younger and more recently admitted to the nursing home than targets. RRA incidents commonly occurred in communal areas and during the afternoon and involved a "push and fall." Seven (25%) RRA deaths had a coronial inquest; criminal charges were rarely filed. This is the first national study in Australia, and the largest internationally, to examine RRA deaths using medicolegal data. This generates hypotheses for future research on the effect of environmental and organizational factors on the frequency and preventability of RRA. © 2017, Copyright the Authors Journal compilation © 2017, The American Geriatrics Society.

Tai Chi-based exercise program provided via telerehabilitation compared to home visits in a post-stroke population who have returned home without intensive rehabilitation: study protocol for a randomized, non-inferiority clinical trial

PubMed Central

2014-01-01

Background The incidence of strokes in industrialized nations is on the rise, particularly in the older population. In Canada, a minority of individuals who have had a stroke actually receive intensive rehabilitation because most stroke patients do not have access to services or because their motor recovery was judged adequate to return home. Thus, there is a considerable need to organize home-based rehabilitation services for everyone who has had a stroke. To meet this demand, telerehabilitation, particularly from a service center to the patient’s home, is a promising alternative approach that can help improve access to rehabilitation services once patients are discharged home. Methods/Design This non-inferiority study will include patients who have returned home post-stroke without requiring intensive rehabilitation. To be included in the study, participants will: 1) not be referred to an Intensive Functional Rehabilitation Unit, 2) have a Rankin score of 2 or 3, and 3) have a balance problem (Berg Balance Scale score between 46 and 54). Participants will be randomly assigned to either the teletreatment group or the home visits group. Except for the delivery mode, the intervention will be the same for both groups, that is, a personalized Tai Chi-based exercise program conducted by a trained physiotherapist (45-minute session twice a week for eight consecutive weeks). The main objective of this research is to test the non-inferiority of a Tai Chi-based exercise program provided via telerehabilitation compared to the same program provided in person at home in terms of effectiveness for retraining balance in individuals who have had a stroke but do not require intensive functional rehabilitation. The main outcome of this study is balance and mobility measured with the Community Balance and Mobility Scale. Secondary outcomes include physical and psychological capacities related to balance and mobility, participants’ quality of life, satisfaction with services

Rationale and design for the Asia BP@Home study on home blood pressure control status in 12 Asian countries and regions.

PubMed

Kario, Kazuomi; Tomitani, Naoko; Buranakitjaroen, Peera; Chen, Chen-Huan; Chia, Yook-Chin; Divinagracia, Romeo; Park, Sungha; Shin, Jinho; Siddique, Saulat; Sison, Jorge; Soenarta, Arieska Ann; Sogunuru, Guru Prasad; Tay, Jam Chin; Turana, Yuda; Wang, Ji-Guang; Wong, Lawrence; Zhang, Yuqing; Wanthong, Sirisawat; Hoshide, Satoshi; Kanegae, Hiroshi

2018-01-01

Home blood pressure (BP) monitoring is endorsed in multiple guidelines as a valuable adjunct to office BP measurements for the diagnosis and management of hypertension. In many countries throughout Asia, physicians are yet to appreciate the significant contribution of BP variability to cardiovascular events. Furthermore, data from Japanese cohort studies have shown that there is a strong association between morning BP surge and cardiovascular events, suggesting that Asians in general may benefit from more effective control of morning BP. We designed the Asia BP@Home study to investigate the distribution of hypertension subtypes, including white-coat hypertension, masked morning hypertension, and well-controlled and uncontrolled hypertension. The study will also investigate the determinants of home BP control status evaluated by the same validated home BP monitoring device and the same standardized method of home BP measurement among 1600 or more medicated patients with hypertension from 12 countries/regions across Asia. ©2017 Wiley Periodicals, Inc.

Emergency Department Visits by Nursing Home Residents in the United States

PubMed Central

Wang, Henry E.; Shah, Manish N.; Allman, Richard M.; Kilgore, Meredith

2012-01-01

BACKGROUND/OBJECTIVES The Emergency Department (ED) is an important source of health care for nursing home residents. The objective of this study was to characterize ED use by nursing home residents in the United States (US). DESIGN Analysis of the National Hospital Ambulatory Medical Care Survey SETTING US Emergency Departments, 2005-2008 PARTICIPANTS Individuals visiting US EDs, stratified by nursing home and non-nursing home residents. INTERVENTIONS None MEASUREMENTS We identified all ED visits by nursing home residents. We contrasted the demographic and clinical characteristics between nursing home residents and non-nursing home residents. We also compared ED resource utilization, length of stay and outcomes. RESULTS During 2005-2008, nursing home residents accounted for 9,104,735 of 475,077,828 US ED visits (1.9%; 95% CI: 1.8-2.1%). The annualized number of ED visits by nursing home residents was 2,276,184. Most nursing home residents were elderly (mean 76.7 years, 95% CI: 75.8-77.5), female (63.3%), and non-Hispanic White (74.8%). Compared with non-nursing home residents, nursing home residents were more likely have been discharged from the hospital in the prior seven days (adjusted OR 1.4, 95% CI: 1.1-1.9). Nursing home residents were more likely to present with fever (adjusted OR 1.9; 95% CI: 1.5-2.4) or hypotension (systolic blood pressure ≤90 mm Hg, OR 1.8; 95% CI: 1.5-2.2). Nursing home patients were more likely to receive diagnostic test, imaging and procedures in the ED. Almost half of nursing home residents visiting the ED were admitted to the hospital. Compared with non-nursing home residents, nursing home residents were more likely to be admitted to the hospital (adjusted OR 1.8; 95% CI 1.6-2.1) and to die (adjusted OR 2.3; 95% CI 1.6-3.3). CONCLUSIONS Nursing home residents account for over 2.2 million ED visits annually in the US. Compared with other ED patients, nursing home residents have higher medical acuity and complexity. These

Pilot study to investigate the feasibility of the Home Falls and Accidents Screening Tool (HOME FAST) to identify older Malaysian people at risk of falls.

PubMed

Romli, Muhammad Hibatullah; Mackenzie, Lynette; Lovarini, Meryl; Tan, Maw Pin

2016-08-16

The relationship between home hazards and falls in older Malaysian people is not yet fully understood. No tools to evaluate the Malaysian home environment currently exist. Therefore, this study aimed to pilot the Home Falls and Accidents Screening Tool (HOME FAST) to identify hazards in Malaysian homes, to evaluate the feasibility of using the HOME FAST in the Malaysian Elders Longitudinal Research (MELoR) study and to gather preliminary data about the experience of falls among a small sample of Malaysian older people. A cross-sectional pilot study was conducted. An urban setting in Kuala Lumpur. 26 older people aged 60 and over were recruited from the control group of a related research project in Malaysia, in addition to older people known to the researchers. The HOME FAST was applied with the baseline survey for the MELoR study via a face-to-face interview and observation of the home by research staff. The majority of the participants were female, of Malay or Chinese ethnicity and living with others in a double-storeyed house. Falls were reported in the previous year by 19% and 80% of falls occurred at home. Gender and fear of falling had the strongest associations with home hazards. Most hazards were detected in the bathroom area. A small number of errors were detected in the HOME FAST ratings by researchers. The HOME FAST is feasible as a research and clinical tool for the Malaysian context and is appropriate for use in the MELoR study. Home hazards were prevalent in the homes of older people and further research with the larger MELoR sample is needed to confirm the validity of using the HOME FAST in Malaysia. Training in the use of the HOME FAST is needed to ensure accurate use by researchers. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

Going national with HERS and EEMs: Issues and impacts. The collected papers of the national collaborative

DOE Office of Scientific and Technical Information (OSTI.GOV)

None

This collection of papers is a companion volume to A National Program for Energy-Efficient Mortgages and Home Energy Rating Systems: A Blueprint for Action (NREL/TP-261-4677). The Blueprint reports the findings and recommendations of the National Collaborative on Home Energy Rating Systems and Mortgage Incentives for Energy Efficiency about a voluntary national program linking energy-efficient mortgages and home energy rating systems. This volume provides technical documentation for A Blueprint for Action. It consists of 55 technical issue papers and 13 special papers prepared by the technical advisory committees and some members of the Collaborative Consensus Committee of the National Collaborative. Itmore » also contains the bibliography and the glossary written by the members and staff of the National Collaborative.« less

Scoring the home falls and accidents screening tool for health professionals (HOME FAST-HP): Evidence from one epidemiological study.

PubMed

Mackenzie, Lynette; Byles, Julie

2018-03-30

Falls in older people are a major public health concern. To target falls prevention interventions, screening tools need to be able to identify older people at greater risk of falling. This study aimed to investigate the screening capacity of the Home Falls and Accidents Screening Tool for health professionals (HOME FAST-HP), and to identify the best cut-off score to identify older people at higher risk of falls using the HOME FAST-HP. The study used cross-sectional data from a random sample of 650 women from the 1921 to 1926 cohort of the Australian Longitudinal Study of Women's Health (ALSWH). Selected women were sent a postal survey including the HOME FAST-HP, falls history, and other health factors. Scores on the home fast were calculated and the cut-point for optimal sensitivity and specificity of the HOME FAST-HP in relation to falls was assessed using a Receiver Operating Characteristic curve. A total of 567 older women participated (response rate 87%). The mean age of participants was 77.5 yrs (95% CI 77.31-77.70). A total of 153 participants (27%) reported a fall in the previous six months. The mean number of hazards using the HOME FAST-HP was 9.74 (95% CI 9.48-10.01), range 2-22. Non-fallers had a mean of 9.6 hazards (95% CI 9.32-9.91) and fallers had a mean of 10.63 hazards (95% CI 10.08-11.19) which was a significant difference (t = 3.41, P = 0.001). The area under the receiver operator curve (AUC) was 0.58 (95% CI 0.53-0.64). A HOME FAST-HP cut-off score of 9 was associated with the optimal sensitivity for falls (73.9%), with specificity (37.9%), and positive predictive value was 30.6% and negative predictive value was 79.7%. The HOME FAST-HP can be used as a screening tool to identify fallers with a cut-off score of nine indicating a higher risk of falling. © 2018 Occupational Therapy Australia.

Chaotic homes and school achievement: a twin study

PubMed Central

Hanscombe, Ken B; Haworth, Claire MA; Davis, Oliver SP; Jaffee, Sara R; Plomin, Robert

2011-01-01

Background Chaotic homes predict poor school performance. Given that it is known that genes affect both children's experience of household chaos and their school achievement, to what extent is the relationship between high levels of noise and environmental confusion in the home, and children's school performance, mediated by heritable child effects? This is the first study to explore the genetic and environmental pathways between household chaos and academic performance. Method Children's perceptions of family chaos at ages 9 and 12 and their school performance at age 12 were assessed in more than 2,300 twin pairs. The use of child-specific measures in a multivariate genetic analysis made it possible to investigate the genetic and environmental origins of the covariation between children's experience of chaos in the home and their school achievement. Results Children's experience of family chaos and their school achievement were significantly correlated in the expected negative direction (r = −.26). As expected, shared environmental factors explained a large proportion (63%) of the association. However, genetic factors accounted for a significant proportion (37%) of the association between children's experience of household chaos and their school performance. Conclusions The association between chaotic homes and poor performance in school, previously assumed to be entirely environmental in origin, is in fact partly genetic. How children's home environment affects their academic achievement is not simply in the direction environment → child → outcome. Instead, genetic factors that influence children's experience of the disordered home environment also affect how well they do at school. The relationship between the child, their environment and their performance at school is complex: both genetic and environmental factors play a role. PMID:21675992

The nature, characteristics and associations of care home staff stress and wellbeing: a national survey.

PubMed

Islam, Muhammad Saiful; Baker, Christine; Huxley, Peter; Russell, Ian T; Dennis, Michael S

2017-01-01

The majority of residents in care homes in the United Kingdom are living with dementia or significant memory problems. Caring in this setting can be difficult and stressful for care staff who work long hours, have little opportunity for training, are poorly paid and yet subject to high expectation. This may affect their mental and physical wellbeing, cause high rates of staff turnover and absenteeism, and affect the quality of care they provide. The main objective of this survey was to explore the nature, characteristics and associations of stress in care home staff. Staff working in a stratified random sample of care homes within Wales completed measures covering: general health and wellbeing (SF-12); stress (Work Stress Inventory); job content (Karasek Job Content); approach to, and experience of, working with people living with dementia (Approaches to Dementia Questionnaire; and Experience of Working with Dementia Patients); and Productivity and Health Status (SPS-6). Multiple linear regressions explored the effects of home and staff characteristics on carers. 212 staff from 72 care homes completed questionnaires. Staff from nursing homes experienced more work stress than those from residential homes (difference 0.30; 95% confidence interval (CI) from 0.10 to 0.51; P  < 0.01), and were more likely to report that their health reduced their ability to work (difference -4.77; CI -7.80 to -1.73; P  < 0.01). Psychological demands on nurses were higher than on other staff (difference = 1.57; CI 0.03 to 3.10; P  < 0.05). A positive approach to dementia was more evident in those trained in dementia care (difference 8.54; CI 2.31 to 14.76; P  < 0.01), and in staff working in local authority homes than in the private sector (difference 7.75; CI 2.56 to 12.94; P  < 0.01). Our study highlights the importance of dementia training in care homes, with a particular need in the private sector. An effective intervention to reduce stress in health and

The relationship of education level to the job tenure of nursing home administrators and directors of nursing.

PubMed

Decker, Frederic H; Castle, Nicholas G

2009-01-01

Research indicates that the length of time a nursing home administrator (NHA) or director of nursing (DON) has worked in a nursing home may have a positive relationship to quality of care. Few studies, however, have focused on factors associated with the job tenure of NHAs and DONs. One important factor may be education level. This study used a nationally representative sample of nursing homes to examine the influence of education level on the current job tenure of NHAs and DONs. The data sources were the 2004 National Nursing Home Survey and the Area Resource File. Control variables for facility characteristics (e.g., ownership type), market characteristics (e.g., unemployment rate), and career experience were included. Data on NHAs, DONs, and nursing facility characteristics came from the National Nursing Home Survey. Market characteristics came from the Area Resource File. The analysis on NHA tenure included 1,082 cases with usable data from the 1,174 sampled facilities in the National Nursing Home Survey. The analysis on DON tenure included 1,048 cases. Job tenure was measured in number of months. Regression models on NHA and DON tenure were analyzed. Among NHAs, and to a lesser extent among DONs, higher education was significantly associated with shorter tenure rather than longer tenure. Ownership status was a notable predictor. For owners of nursing homes, our findings may raise a hiring dilemma. Hiring the best educated NHA and DON may be advantageous, but the retention for these same top managers may be the shortest. Initiatives to hire NHAs and DONs with better educational training may need to be coupled with initiatives designed to promote greater retention.

Do Safety Culture Scores in Nursing Homes Depend on Job Role and Ownership? Results from a National Survey.

PubMed

Banaszak-Holl, Jane; Reichert, Heidi; Todd Greene, M; Mody, Lona; Wald, Heidi L; Crnich, Christopher; McNamara, Sara E; Meddings, Jennifer

2017-10-01

To identify facility- and individual-level predictors of nursing home safety culture. Cross-sectional survey of individuals within facilities. Nursing homes participating in the national Agency for Healthcare Research and Quality Safety Program for Long-Term Care: Healthcare-Associated Infections/Catheter-Associated Urinary Tract Infections Project. Responding nursing home staff (N = 14,177) from 170 (81%) of 210 participating facilities. Staff responses to the Nursing Home Survey on Patient Safety Culture (NHSOPS), focused on five domains (teamwork, training and skills, communication openness, supervisor expectations, organizational learning) and individual respondent characteristics (occupation, tenure, hours worked), were merged with data on facility characteristics (from the Certification and Survey Provider Enhanced Reporting): ownership, chain membership, percentage residents on Medicare, bed size. Data were analyzed using multivariate hierarchical models. Nursing assistants rated all domains worse than administrators did (P < .001), with the largest differences for communication openness (24.3 points), teamwork (17.4 points), and supervisor expectations (16.1 points). Clinical staff rated all domains worse than administrators. Nonprofit ownership was associated with worse training and skills (by 6.0 points, P =.04) and communication openness (7.3 points, P =.004), and nonprofit and chain ownership were associated with worse supervisor expectations (5.2 points, P =.001 and 3.2 points, P =.03, respectively) and organizational learning (5.6 points, P =.009 and 4.2 points, P = .03). The percentage of variation in safety culture attributable to facility characteristics was less than 22%, with ownership having the strongest effect. Perceptions of safety culture vary widely among nursing home staff, with administrators consistently perceiving better safety culture than clinical staff who spend more time with residents. Reporting safety culture scores according to

Exiting and Returning to the Parental Home for Boomerang Kids

PubMed Central

Sandberg-Thoma, Sara E.; Snyder, Anastasia R.; Jang, Bohyun Joy

2015-01-01

Young adults commonly exit from and return to the parental home, yet few studies have examined the motivation behind these exits and returns using a life course framework. Using data from the National Longitudinal Survey of Youth 1997, the authors examined associations between mental health problems and economic characteristics and exits from (n = 8,162), and returns to (n = 6,530), the parental home during the transition to adulthood. The average age of the respondents was 24 years. The authors found evidence that mental health and economic characteristics were related to home leaving and returning. Emotional distress was associated with earlier exits from, and returns to, the parental home; alcohol problems were associated with earlier returns to the parental home. The findings regarding economic resources were unexpectedly mixed. Greater economic resources were linked to delayed exits from, and earlier returns to, the parental home. The implications of these findings for young adults are discussed. PMID:26023244

Exiting and Returning to the Parental Home for Boomerang Kids.

PubMed

Sandberg-Thoma, Sara E; Snyder, Anastasia R; Jang, Bohyun Joy

2015-06-01

Young adults commonly exit from and return to the parental home, yet few studies have examined the motivation behind these exits and returns using a life course framework. Using data from the National Longitudinal Survey of Youth 1997, the authors examined associations between mental health problems and economic characteristics and exits from (n = 8,162), and returns to (n = 6,530), the parental home during the transition to adulthood. The average age of the respondents was 24 years. The authors found evidence that mental health and economic characteristics were related to home leaving and returning. Emotional distress was associated with earlier exits from, and returns to, the parental home; alcohol problems were associated with earlier returns to the parental home. The findings regarding economic resources were unexpectedly mixed. Greater economic resources were linked to delayed exits from, and earlier returns to, the parental home. The implications of these findings for young adults are discussed.

DOE Zero Energy Ready Home Case Study, Weiss Building & Development, LLC., System Home, River Forest, Illinois

DOE Office of Scientific and Technical Information (OSTI.GOV)

none,

The Passive House Challenge Home located in River Forest, Illinois, is a 5-bedroom, 4.5-bath, 3,600 ft2 two-story home (plus basement) that costs about $237 less per month to operate than a similar sized home built to the 2009 IECC. For a home with no solar photovoltaic panels installed, it scored an amazingly low 27 on the Home Energy Rating System (HERS) score.An ENERGY STAR-rated dishwasher, clothes washer, and refrigerator; an induction cooktop, condensing clothes dryer, and LED lighting are among the energy-saving devices inside the home. All plumbing fixtures comply with EPA WaterSense criteria. The home was awarded a 2013more » Housing Innovation Award in the "systems builder" category.« less

Attitudes toward Foreign Language Study and Requirements in American Schools and Colleges: Results of a National Survey.

ERIC Educational Resources Information Center

Eddy, Peter A.

1979-01-01

Reports the results of a national survey conducted in the US to determine: (1) languages used in the home, (2) second languages learned, (3) current use of second language, (4) attitudes toward the worth of second language study, and (5) opinions about the opportunity and requirement to study languages at various educational levels. (AM)

Home Economics/Social Studies Cross-Credit Curriculum.

ERIC Educational Resources Information Center

Bellino, Claire; And Others

This curriculum guide outlines two one-semester home economics courses that students can take to fulfill requirements in social studies or vocational education. The courses, Money and Your Future and Consumer Skills, contain the academic competencies from the Connecticut Common Core of Learning required for credit in social studies. The curriculum…

Home Visiting: Looking Back and Moving Forward

ERIC Educational Resources Information Center

Boller, Kimberly; Strong, Debra A.; Daro, Deborah

2010-01-01

Recent large federal investments in services for pregnant women and young children will fuel the expansion of home visiting services across the U.S. The authors summarize the history of home visiting and describe trends toward evidence-based and national program models. Moving to an integrated system requires supports for implementation with…

Investigating energy consumption of coastal vacation rental homes

NASA Astrophysics Data System (ADS)

Myers, Sam

In 2007, vacation rental properties in the United States accounted for more than 22% of the domestic lodging market. These properties are a unique segment of the lodging industry due to their residential design and commercial use. Coastal vacation rental properties represent the largest supply, demand and value of the nation's vacation rental supply. In the case of North Carolina's Outer Banks, tourism is the area's largest source of income, with vacation real estate agencies being the largest accommodation provider. This study uses a multiple regression analysis to investigate the energy consumption of 30 vacation rental homes on Hatteras Island. Hatteras Island's abundant supply of vacation rental homes provided a diverse sample to study energy consumption with a wide range of houses regarding size, age, and location. Since very little research has been conducted on the energy consumption of vacation rental homes, this study aims to contribute detailed information regarding the energy consumption of unique accommodation sector.

Maternal factors and the probability of a planned home birth.

PubMed

Anthony, S; Buitendijk, S E; Offerhaus, P M; Dommelen, P; Pal-de Bruin, K M

2005-06-01

In the Netherlands, approximately one-third of births are planned home births, mostly supervised by a midwife. The relationship between maternal demographic factors and home births supervised by midwives was examined. Cross-sectional study. Setting Dutch national perinatal registries of the year 2000. All women starting their pregnancy care under the supervision of a midwife, because these women have the possibility of having a planned home birth. The possible groups of birth were as follows: planned home birth or short stay hospital birth, both under the supervision of a midwife, or hospital birth under the supervision of an obstetrician after referral from the midwife during pregnancy or birth. The studied demographic factors were maternal age, parity, ethnicity and degree of urbanisation. Probabilities of having a planned home birth were calculated for women with different demographic profiles. Place of birth. In all age groups, the planned home birth percentage in primiparous women was lower than in multiparous women (23.5%vs 42.8%). A low home birth percentage was observed in women younger than 25 years. Dutch and non-Dutch women showed almost similar percentages of obstetrician-supervised hospital births but large differences in percentage of planned home births (36.5%vs 17.3%). Fewer home births were observed in large cities (30.5%) compared with small cities (35.7%) and rural areas (35.8%). This study demonstrates a clear relationship between maternal demographic factors and the place of birth and type of caregiver and therefore the probability of a planned home birth.

Do patients in Dutch nursing homes have more pressure ulcers than patients in German nursing homes? A prospective multicenter cohort study.

PubMed

Meesterberends, Esther; Halfens, Ruud J G; Spreeuwenberg, Marieke D; Ambergen, Ton A W; Lohrmann, Christa; Neyens, Jacques C L; Schols, Jos M G A

2013-08-01

To investigate whether the incidence of pressure ulcers in nursing homes in the Netherlands and Germany differs and, if so, to identify resident-related risk factors, nursing-related interventions, and structural factors associated with pressure ulcer development in nursing home residents. A prospective multicenter cohort study. Ten nursing homes in the Netherlands and 11 nursing homes in Germany (around Berlin and Brandenburg). A total of 547 newly admitted nursing home residents, of which 240 were Dutch and 307 were German. Residents had an expected length of stay of 12 weeks or longer. Data were collected for each resident over a 12-week period and included resident characteristics (eg, demographics, medical history, Braden scale scores, nutritional factors), pressure ulcer prevention and treatment characteristics, staffing ratios and other structural nursing home characteristics, and outcome (pressure ulcer development during the study). Data were obtained by trained research assistants. A significantly higher pressure ulcer incidence rate was found for the Dutch nursing homes (33.3%) compared with the German nursing homes (14.3%). Six factors that explain the difference in pressure ulcer incidence rates were identified: dementia, analgesics use, the use of transfer aids, repositioning the residents, the availability of a tissue viability nurse on the ward, and regular internal quality controls in the nursing home. The pressure ulcer incidence was significantly higher in Dutch nursing homes than in German nursing homes. Factors related to residents, nursing care and structure explain this difference in incidence rates. Continuous attention to pressure ulcer care is important for all health care settings and countries, but Dutch nursing homes especially should pay more attention to repositioning residents, the necessity and correct use of transfer aids, the necessity of analgesics use, the tasks of the tissue viability nurse, and the performance of regular

The contribution of at-home and away-from-home food to dietary intake among 2-13-year-old Mexican children.

PubMed

Taillie, Lindsey Smith; Afeiche, Myriam C; Eldridge, Alison L; Popkin, Barry M

2017-10-01

Away-from-home foods have been shown to have lower nutritional quality and larger portion sizes than many foods prepared at home. We aimed to describe energy and nutrient intakes among 2-13-year-old Mexican children by eating location (at home and away from home), overall, by socio-economic status (SES) and by urbanicity. Dietary intake was collected via one 24 h recall in the 2012 Mexican National Health and Nutrition Survey (ENSANUT). Location was reported for each food consumed. Results were adjusted for sex, day of recall, region, weight status, SES and urbanicity. Mexico (nationally representative). Children aged 2-5 years (n 1905) and 6-13 years (n 2868). Children consumed the majority of daily energy at home (89% of 2-5-year-olds; 82 % of 6-13-year-olds). The most common away-from-home eating location was school (22 % of 2-5-year-olds; 43 % of 6-13-year-olds), followed by the street (14 % of 2-5-year-olds; 13 % of 6-13-year-olds). The most common foods consumed away from home were wheat/rice and corn mixed dishes, sugar-sweetened beverages, pastries/candy/desserts, milk (2-5-year-olds only) and salty snacks (6-13-year-olds). Multivariate models showed that high-SES 2-5-year-olds consumed 14 % of daily energy away from home v. 8 % among low-SES 2-5-year-olds, and high-SES 6-13-year-olds consumed 21 % of daily energy away from home v. 14 % among low-SES 6-13 year-olds. There were no differences by urban residence. Among Mexican children, most foods and beverages were consumed at home. However, the percentage of foods consumed or purchased away from home increased with age and with SES.

[A Cross-sectional Study of School dropout in adolescents: National Mental Health Survey Colombia 2015].

PubMed

Gómez-Restrepo, Carlos; Padilla Muñoz, Andrea; Rincón, Carlos Javier

2016-12-01

School dropout in adolescents can have negative consequences, not only for the individual and the family, but also for the society. To identify the characteristics associated with the occurrence of this event might contribute to the planning of a prevention strategy. To evaluate the relationship between the individual and home characteristics and school dropout in adolescents from 12 to 17 years old in Colombia. A cross sectional study was conducted from information taken from the results obtained in the 2015 National Mental Health Survey. A study was made of the relationship between the individual and home characteristics and school dropout in adolescents from 12 to 17 years old RESULTS: A higher percentage of school dropouts was found in the older adolescents, females, and those who have children. Among the home characteristics, it was observed that those homes with more than two people, located in rural area, or that are classified as poor, have an increased percentage of school dropout adolescents. Strategies for which the main goal is to prevent school dropout should consider populations with higher prevalence of out-of-school adolescents (female, homes in rural area, or household poverty). Preventive actions of adolescent pregnancy might contribute to reduce the school dropout rate. Copyright © 2016 Asociación Colombiana de Psiquiatría. Publicado por Elsevier España. All rights reserved.

Readiness of Primary Care Practices for Medical Home Certification

PubMed Central

Clark, Sarah J.; Sakshaug, Joseph W.; Chen, Lena M.; Hollingsworth, John M.

2013-01-01

OBJECTIVES: To assess the prevalence of medical home infrastructure among primary care practices for children and identify practice characteristics associated with medical home infrastructure. METHODS: Cross-sectional analysis of restricted data files from 2007 and 2008 of the National Ambulatory Medical Care Survey. We mapped survey items to the 2011 National Committee on Quality Assurance’s Patient-Centered Medical home standards. Points were awarded for each “passed” element based on National Committee for Quality Assurance scoring, and we then calculated the percentage of the total possible points met for each practice. We used multivariate linear regression to assess associations between practice characteristics and the percentage of medical home infrastructure points attained. RESULTS: On average, pediatric practices attained 38% (95% confidence interval 34%–41%) of medical home infrastructure points, and family/general practices attained 36% (95% confidence interval 33%–38%). Practices scored higher on medical home elements related to direct patient care (eg, providing comprehensive health assessments) and lower in areas highly dependent on health information technology (eg, computerized prescriptions, test ordering, laboratory result viewing, or quality of care measurement and reporting). In multivariate analyses, smaller practice size was significantly associated with lower infrastructure scores. Practice ownership, urban versus rural location, and proportion of visits covered by public insurers were not consistently associated with a practice’s infrastructure score. CONCLUSIONS: Medical home programs need effective approaches to support practice transformation in the small practices that provide the vast majority of the primary care for children in the United States. PMID:23382438

Food Service Managerial. Student Guide to Home Study. Camp Administration Series.

ERIC Educational Resources Information Center

Henderson, Karla

The food service managerial home study student guide begins with a brief overview of the conduct of the course, the desired outcomes of camp director education, instructions on phases I and II of home study, a student needs assessment form, a reading checklist, a student vita form, an individualized plan of study, and a list of suggested learning…

Nursing home staff's views on residents' dignity: a qualitative interview study.

PubMed

Oosterveld-Vlug, Mariska G; Pasman, H Roeline W; van Gennip, Isis E; Willems, Dick L; Onwuteaka-Philipsen, Bregje D

2013-09-16

Maintaining dignity is an important element of end-of-life care and also of the care given in nursing homes. Factors influencing personal dignity have been studied from both nursing home residents' and staff's perspective. Little is however known about the way nursing home staff perceive and promote the personal dignity of individual residents in daily practice, or about staff's experiences with preserving dignity within the nursing home. The aim of this study is to gain more insight in this. A qualitative descriptive interview study was designed, in which in-depth interviews were performed with 13 physicians and 15 nurses. They expressed their views on the personal dignity of 30 recently admitted nursing home residents on the general medical wards of four nursing homes in The Netherlands. Interviews were transcribed and analyzed following the principles of thematic analysis. According to both physicians and nurses, physical impairment and being dependent on others threatened the residents' dignity. Whether or not this led to a violation of an individual resident's dignity, depended--in staff's opinion--on the resident's ability to show resilience and to keep his/her individuality. Staff mentioned treating residents with respect and taking care of their privacy as most important elements of dignity-conserving care and strived to treat the residents as they would like to be treated themselves. They could often mention aspects that were important for a particular resident's dignity. But, when asked what they could contribute to a particular resident's dignity, they often mentioned general aspects of dignity-conserving care, which could apply to most nursing home residents. By attempting to give dignity-conserving care, physicians and nurses often experienced conflicting values in daily care and barriers caused by the lack of resources. Tailoring dignity-conserving care to an individual nursing home resident appears hard to bring about in daily practice. Both

Privacy, boundaries and smart homes for health: An ethnographic study.

PubMed

Burrows, Alison; Coyle, David; Gooberman-Hill, Rachael

2018-03-01

This article explores how people negotiate borders and boundaries within the home, in the context of health and the introduction of new technologies. We draw on an ethnographic study involving a socially diverse group of people, which included people with experience of telecare or smart home energy systems. Participants engaged in various strategies to regulate the borders of their home, even though new technologies have begun to change the nature of these borders. Participants managed health conditions but also their use of technology through boundary work that permitted devices to be more or less visible and integrated within the home. Findings highlight that if smart healthcare technologies are to be accepted in the home then there is a need for mechanisms that allow people to control the interpretation of data and flow of information generated about them and their households. Copyright © 2018 The Authors. Published by Elsevier Ltd.. All rights reserved.

Home Mechanical Ventilation: A 12-Year Population-Based Retrospective Cohort Study.

PubMed

Povitz, Marcus; Rose, Louise; Shariff, Salimah Z; Leonard, Sean; Welk, Blayne; Jenkyn, Krista Bray; Leasa, David J; Gershon, Andrea S

2018-04-01

Increasing numbers of individuals are being initiated on home mechanical ventilation, including noninvasive (bi-level) and invasive mechanical ventilation delivered via tracheostomy due to chronic respiratory failure to enable symptom management and promote quality of life. Given the high care needs of these individuals, a better understanding of the indications for home mechanical ventilation, and health-care utilization is needed. We performed a retrospective cohort study using provincial health administrative data from Ontario, Canada (population ∼13,000,000). Home mechanical ventilation users were characterized using health administrative data to determine the indications for home mechanical ventilation, the need for acute care at the time of ventilation approval, and their health service use and mortality rates following approval. The annual incidence of home mechanical ventilation approval rose from 1.8/100,000 in 2000 to 5.0/100,000 in 2012, or an annual increase of approximately 0.3/100,000 persons/y. The leading indications were neuromuscular disease, thoracic restriction, and COPD. The indication for the remainder could not be determined due to limitations of the administrative databases. Of the 4,670 individuals, 23.0% commenced home mechanical ventilation following an acute care hospitalization. Among individuals who survived at least 1 y, fewer required hospitalization in the year that followed home mechanical ventilation approval (29.9% vs 39.8%) as compared with the year prior. Utilization of home mechanical ventilation is increasing in Ontario, Canada, and further study is needed to clarify the factors contributing to this and to further optimize utilization of health-care resources. Copyright © 2018 by Daedalus Enterprises.

Marital Status, Gender, and Home-to-Job Conflict Among Employed Parents

PubMed Central

Nomaguchi, Kei M.

2012-01-01

Although researchers argue that single parents perceive more work-family conflict than married parents, little research has examined nuances in such differences. Using data from the 2002 National Study of Changing Workforce (N = 1,430), this study examines differences in home-to-job conflict by marital status and gender among employed parents. Findings indicate that single mothers feel more home-to-job conflict than single fathers, married mothers, and married fathers. Some predictors of home-to-job conflict vary by marital status and gender. Job pressure is related to home-to-job conflict more for single parents than for married parents. Age of children is related to conflict for single fathers only. Whereas an unsupportive workplace culture is related to conflict, especially for married fathers, the lack of spouses’ share of domestic responsibilities is related to conflict, especially for married mothers. These findings indicate that marital status and gender create distinct contexts that shape employed parents’ perceived home-to-job conflict. PMID:23155301

Marital Status, Gender, and Home-to-Job Conflict Among Employed Parents.

PubMed

Nomaguchi, Kei M

2012-03-01

Although researchers argue that single parents perceive more work-family conflict than married parents, little research has examined nuances in such differences. Using data from the 2002 National Study of Changing Workforce (N = 1,430), this study examines differences in home-to-job conflict by marital status and gender among employed parents. Findings indicate that single mothers feel more home-to-job conflict than single fathers, married mothers, and married fathers. Some predictors of home-to-job conflict vary by marital status and gender. Job pressure is related to home-to-job conflict more for single parents than for married parents. Age of children is related to conflict for single fathers only. Whereas an unsupportive workplace culture is related to conflict, especially for married fathers, the lack of spouses' share of domestic responsibilities is related to conflict, especially for married mothers. These findings indicate that marital status and gender create distinct contexts that shape employed parents' perceived home-to-job conflict.

Tai Chi-based exercise program provided via telerehabilitation compared to home visits in a post-stroke population who have returned home without intensive rehabilitation: study protocol for a randomized, non-inferiority clinical trial.

PubMed

Tousignant, Michel; Corriveau, Hélène; Kairy, Dahlia; Berg, Katherine; Dubois, Marie-France; Gosselin, Sylvie; Swartz, Richard H; Boulanger, Jean-Martin; Danells, Cynthia

2014-01-30

The incidence of strokes in industrialized nations is on the rise, particularly in the older population. In Canada, a minority of individuals who have had a stroke actually receive intensive rehabilitation because most stroke patients do not have access to services or because their motor recovery was judged adequate to return home. Thus, there is a considerable need to organize home-based rehabilitation services for everyone who has had a stroke. To meet this demand, telerehabilitation, particularly from a service center to the patient's home, is a promising alternative approach that can help improve access to rehabilitation services once patients are discharged home. This non-inferiority study will include patients who have returned home post-stroke without requiring intensive rehabilitation. To be included in the study, participants will: 1) not be referred to an Intensive Functional Rehabilitation Unit, 2) have a Rankin score of 2 or 3, and 3) have a balance problem (Berg Balance Scale score between 46 and 54). Participants will be randomly assigned to either the teletreatment group or the home visits group. Except for the delivery mode, the intervention will be the same for both groups, that is, a personalized Tai Chi-based exercise program conducted by a trained physiotherapist (45-minute session twice a week for eight consecutive weeks). The main objective of this research is to test the non-inferiority of a Tai Chi-based exercise program provided via telerehabilitation compared to the same program provided in person at home in terms of effectiveness for retraining balance in individuals who have had a stroke but do not require intensive functional rehabilitation. The main outcome of this study is balance and mobility measured with the Community Balance and Mobility Scale. Secondary outcomes include physical and psychological capacities related to balance and mobility, participants' quality of life, satisfaction with services received, and cost

Contact us | National Oceanic and Atmospheric Administration

Science.gov Websites

MENU CLOSE NOAA Home National Oceanic and Atmospheric AdministrationU.S. Department of Commerce Find mailing address National Oceanic and Atmospheric Administration 1401 Constitution Avenue NW, Room 5128 Great Barrier Reef, March 2016. NOAA Home National Oceanic and Atmospheric AdministrationU.S. Department

Home Media and Children's Achievement and Behavior

ERIC Educational Resources Information Center

Hofferth, Sandra L.

2010-01-01

This study provides a national picture of the time American 6- to 12-year-olds spent playing video games, using the computer, and watching TV at home in 1997 and 2003, and the association of early use with their achievement and behavior as adolescents. Girls benefited from computer use more than boys, and Black children benefited more than White…

Travel and the home advantage.

PubMed

Pace, A; Carron, A V

1992-03-01

The purpose of the present study was to examine the relative contributions of various travel related variables to visiting team success in the National Hockey League. A multiple regression design was used with game outcome as the dependent variable. The independent variables of interest included, as main effects and interactions, number of time zones crossed, direction of travel, distance traveled, preparation/adjustment time, time of season, game number on the road trip, and the home stand. Visiting team success was negatively associated with the interaction of number of time zones crossed and increased preparation time between games, and was positively associated with game number on the road. It was concluded that only a small portion of the variance in the home advantage/visitor disadvantage can be explained by travel related factors.

Care relationships at stake? Home healthcare professionals' experiences with digital medicine dispensers - a qualitative study.

PubMed

Nakrem, Sigrid; Solbjør, Marit; Pettersen, Ida Nilstad; Kleiven, Hanne Hestvik

2018-01-15

Although digital technologies can mitigate the burdens of home healthcare services caused by an ageing population that lives at home longer with complex health problems, research on the impacts and consequences of digitalised remote communication between patients and caregivers is lacking. The present study explores how home healthcare professionals had experienced the introduction of digital medicine dispensers and their influence on patient-caregiver relationships. The multi-case study comprised semi-structured interviews with 21 healthcare professionals whose home healthcare service involved using the digital medicine dispensers. The constant comparative method was used for data analyses. Altogether, interviewed healthcare professionals reported three main technology-related impacts upon their patient-caregiver relationships. First, national and local pressure to increase efficiency had troubled their relationships with patients who suspected that municipalities have sought to lower costs by reducing and digitalising services. Participants reported having to consider such worries when introducing technologies into their services. Second, participants reported a shift towards empowering patients. Digital technology can empower patients who value their independence, whereas safety is more important for other patients. Healthcare professionals needed to ensure that replacing care tasks with technology implies safe and improved care. Third, the safety and quality of digital healthcare services continues to depend upon surveillance and control mechanisms that compensate for less face-to-face monitoring. Participants did not consider the possibility that surveillance exposes information about patients' everyday lives to be problematic, but to constitute opportunities for adjusting services to meet patients' needs. Technologies such as digital medicine dispensers can improve the efficiency of healthcare services and enhance patients' independence when introduced in a

Living and dying: responsibility for end-of-life care in care homes without on-site nursing provision - a prospective study.

PubMed

Handley, Melanie; Goodman, Claire; Froggatt, Katherine; Mathie, Elspeth; Gage, Heather; Manthorpe, Jill; Barclay, Stephen; Crang, Clare; Iliffe, Steve

2014-01-01

The aim of the study was to describe the expectations and experiences of end-of-life care of older people resident in care homes, and how care home staff and the healthcare practitioners who visited the care home interpreted their role. A mixed-method design was used. The everyday experience of 121 residents from six care homes in the East of England were tracked; 63 residents, 30 care home staff with assorted roles and 19 National Health Service staff from different disciplines were interviewed. The review of care home notes demonstrated that residents had a wide range of healthcare problems. Length of time in the care homes, functional ability or episodes of ill-health were not necessarily meaningful indicators to staff that a resident was about to die. General Practitioner and district nursing services provided a frequent but episodic service to individual residents. There were two recurring themes that affected how staff engaged with the process of advance care planning with residents; 'talking about dying' and 'integrating living and dying'. All participants stated that they were committed to providing end-of-life care and supporting residents to die in the care home, if wanted. However, the process was complicated by an ongoing lack of clarity about roles and responsibilities in providing end-of-life care, doubts from care home and primary healthcare staff about their capacity to work together when residents' trajectories to death were unclear. The findings suggest that to support this population, there is a need for a pattern of working between health and care staff that can encourage review and discussion between multiple participants over sustained periods of time. © 2013 John Wiley & Sons Ltd.

Home Start Followup Study: A Study of Long-Term Impact of Home Start on Program Participants. Executive Summary.

ERIC Educational Resources Information Center

Bache, William; Nauta, Marrit J.

This paper provides a summary of a Home Start Followup Study (HSFS) which was initiated in 1976. An attempt was made to examine the durability of gains made as the result of families' (parents and their 3- to 5-year-old children) participation in the program. In addition, the study was designed to determine whether program duration (one versus two…

Genetic Mediation of the Home Environment during Infancy: A Sibling Adoption Study of the HOME.

ERIC Educational Resources Information Center

Braungart, Julia M.; And Others

1992-01-01

The home environment of nonadoptive and adoptive sibling pairs was assessed using the Home Observation for Measurement of the Environment when each sibling was one and two years of age. Correlations between home environment scores for nonadoptive siblings were greater than those for adoptive siblings. (BC)

Research Exploring Physical Activity in Care Homes (REACH): study protocol for a randomised controlled trial.

PubMed

Forster, Anne; Airlie, Jennifer; Birch, Karen; Cicero, Robert; Cundill, Bonnie; Ellwood, Alison; Godfrey, Mary; Graham, Liz; Green, John; Hulme, Claire; Lawton, Rebecca; McLellan, Vicki; McMaster, Nicola; Farrin, Amanda

2017-04-19

As life expectancy increases and the number of older people, particularly those aged 85 years and over, expands there is an increase in demand for long-term care. A large proportion of people in a care home setting spend most of their time sedentary, and this is one of the leading preventable causes of death. Encouraging residents to engage in more physical activity could deliver benefits in terms of physical and psychological health, and quality of life. This study is the final stage of a programme of research to develop and preliminarily test an evidence-based intervention designed to enhance opportunities for movement amongst care home residents, thereby increasing levels of physical activity. This is a cluster randomised feasibility trial, aiming to recruit at least 8-12 residents at each of 12 residential care homes across Yorkshire, UK. Care homes will be randomly allocated on a 1:1 basis to receive either the intervention alongside usual care, or to continue to provide usual care alone. Assessment will be undertaken with participating residents at baseline (prior to care home randomisation) and at 3, 6, and 9 months post-randomisation. Data relating to changes in physical activity, physical function, level of cognitive impairment, mood, perceived health and wellbeing, and quality of life will be collected. Data at the level of the home will also be collected and will include staff experience of care, and changes in the numbers and types of adverse events residents experience (for example, hospital admissions, falls). Details of National Health Service (NHS) usage will be collected to inform the economic analysis. An embedded process evaluation will obtain information to test out the theory of change underpinning the intervention and its acceptability to staff and residents. This feasibility trial with embedded process evaluation and collection of health economic data will allow us to undertake detailed feasibility work to inform a future large-scale trial

Bridging the Gap between Home and School--Perceptions of Classroom Teachers and Principals: Case Studies of Two Jamaican Inner-City Schools

ERIC Educational Resources Information Center

Kinkead-Clark, Zoyah

2017-01-01

Within the past 5 years, the island of Jamaica has aimed to address social issues through the development of a National Parenting Program. Schools too have taken on this task and have sought to bridge the gap between home and school by working with parents in meaningful and sustainable ways. This small-scale study highlights how two inner-city…

Predictors of Home Care Expenditures and Death at Home for Cancer Patients in an Integrated Comprehensive Palliative Home Care Pilot Program

PubMed Central

Howell, Doris M.; Abernathy, Tom; Cockerill, Rhonda; Brazil, Kevin; Wagner, Frank; Librach, Larry

2011-01-01

Purpose: Empirical understanding of predictors for home care service use and death at home is important for healthcare planning. Few studies have examined these predictors in the context of the publicly funded Canadian home care system. This study examined predictors for home care use and home death in the context of a “gold standard” comprehensive palliative home care program pilot in Ontario where patients had equal access to home care services. Methods: Secondary clinical and administrative data sources were linked using a unique identifier to examine multivariate factors (predisposing, enabling, need) on total home care expenditures and home death for a cohort of cancer patients enrolled in the HPCNet pilot. Results: Subjects with gastrointestinal symptoms (OR: 1.64; p=0.03) and those with higher income had increased odds of dying at home (OR: 1.14; p<0.001), whereas age, number of GP visits, gastrointestinal symptoms (i.e., nausea, vomiting, bowel obstruction) and eating problems (i.e., anorexia/cachexia) predicted home care expenditures. Conclusions: Predictors of home death found in earlier studies appeared less important in this comprehensive palliative home care pilot. An income effect for home death observed in this study requires examination in future controlled studies. Relevance: Access to palliative home care that is adequately resourced and organized to address the multiple domains of issues that patients/families experience at the end of life has the potential to enable home death and shift care appropriately from limited acute care resources. PMID:22294993

Parental longevity and offspring's home blood pressure: the Ohasama study.

PubMed

Watanabe, Yumiko; Metoki, Hirohito; Ohkubo, Takayoshi; Hirose, Takuo; Kikuya, Masahiro; Asayama, Kei; Inoue, Ryusuke; Hara, Azusa; Obara, Taku; Hoshi, Haruhisa; Totsune, Kazuhito; Imai, Yutaka

2010-02-01

Longevity is clustered in particular families. Some studies using conventional blood pressure (BP) reported an association between parental longevity and offspring's BP. No study has used self-measurement of BP at home (home BP). We examined the association between parental longevity and home BP values of adult Japanese offspring. Home and conventional BPs were measured in 1961 residents aged 40 years and over in the general population of Ohasama, Japan. Information about the ages of offspring's parents (age at death or current age) was obtained from a standardized questionnaire. The mean +/- SD values of systolic/diastolic home BP in offspring whose mothers died at less than 69 years of age, at 69-84 years of age, and in offspring whose mothers were alive at age 84 years were 127.4 +/- 13.2/76.2 +/- 9.1, 124.8 +/- 15.0/74.4 +/- 10.0, and 123.4 +/- 15.2/74.4 +/- 10.3 mmHg (P = 0.0002/0.009), respectively. Corresponding values in offspring whose fathers died at less than 66 years of age, at 66-80 years of age, and in offspring whose fathers were alive at age 80 years were 125.7 +/- 15.2/75.6 +/- 10.6, 124.7 +/- 14.1/75.0 +/- 9.2 and 122.4 +/- 14.6/73.6 +/- 9.5 mmHg (P = 0.001/0.003), respectively. Multivariate analysis demonstrated associations that were only weakly observed for conventional BP values (conventional BP: P = 0.3/0.4 for maternal and P = 0.3/0.3 for paternal longevity; home BP: P = 0.05/0.2 for maternal and P = 0.0004/0.007 for paternal longevity). Parental premature death was significantly associated with higher home BP levels in adult offspring, suggesting that parental longevity might be a useful additional marker for screening adult offspring at higher risk of hypertension.

Home-based intermediate care program vs hospitalization: Cost comparison study.

PubMed

Armstrong, Catherine Deri; Hogg, William E; Lemelin, Jacques; Dahrouge, Simone; Martin, Carmel; Viner, Gary S; Saginur, Raphael

2008-01-01

To explore whether a home-based intermediate care program in a large Canadian city lowers the cost of care and to look at whether such home-based programs could be a solution to the increasing demands on Canadian hospitals. Single-arm study with historical controls. Department of Family Medicine at the Ottawa Hospital (Civic campus) in Ontario. Patients requiring hospitalization for acute care. Participants were matched with historical controls based on case-mix, most responsible diagnosis, and level of complexity. Placement in the home-based intermediate care program. Daily home visits from the nurse practitioner and 24-hour access to care by telephone. Multivariate regression models were used to estimate the effect of the program on 5 outcomes: length of stay in hospital, cost of care substituted for hospitalization (Canadian dollars), readmission for a related diagnosis, readmission for any diagnosis, and costs incurred by community home-care services for patients following discharge from hospital. The outcomes of 43 hospital admissions were matched with those of 363 controls. Patients enrolled in the program stayed longer in hospital (coefficient 3.3 days, P < .001), used more community care services following discharge (coefficient $729, P = .007), and were more likely to be readmitted to hospital within 3 months of discharge (coefficient 17%, P = .012) than patients treated in hospital. Total substituted costs of home-based care were not significantly different from the costs of hospitalization (coefficient -$501, P = .11). While estimated cost savings were not statistically significant, the limitations of our study suggest that we underestimated these savings. In particular, the economic inefficiencies of a small immature program and the inability to control for certain factors when selecting historical controls affected our results. Further research is needed to determine the economic effect of mature home-based programs.

Remote home management for chronic kidney disease: A systematic review.

PubMed

He, Ting; Liu, Xing; Li, Ying; Wu, Qiaoyu; Liu, Meilin; Yuan, Hong

2017-01-01

Background Remote home management is a new healthcare model that uses information technology to enhance patients' self-management of disease in a home setting. This study is designed to identify the effects of remote home management on patients with chronic kidney disease (CKD). Methods A comprehensive search of PubMed, MEDLINE, Embase, and the Cochrane Central Register of Controlled Trials was performed in January 2015. The reference listings of the included articles in this review were also manually examined. Randomized controlled trials (RCTs) designed to evaluate the effects of remote home management on patients with CKD were included. Results Eight trials were identified. The results of this study suggest that the quality of life (QOL) enabled by remote home management was higher than typical care in certain dimensions. However, the effects of remote home management on blood pressure (BP) remain inconclusive. The studies that assessed health service utilization demonstrated a significant decrease in hospital readmission, emergency room visits, and number of days in the hospital. Another favorable result of this study is that regardless of their gender, age or nationality, patients tend to comply with remote home management programs and the use of related technologies. Conclusions The available data indicate that remote home management may be a novel and effective disease management strategy for improving CKD patients' QOL and influencing their attitudes and behaviors. And, relatively little is known about BP and cost-effectiveness, so future research should focus on these two aspects for the entire population of patients with CKD.

An assessment of home remedy use by African Americans.

PubMed

Boyd, E L; Taylor, S D; Shimp, L A; Semler, C R

2000-07-01

This analysis represents the first national look at family and individual use of home remedies by African Americans. The purpose is to examine home remedy usage by African-American individuals and their families and assess the relationship between sociodemographic characteristics and home remedy usage for African-American families and African-American individuals. Using logistic regression, a secondary analysis of the National Survey on Black Americans (NSBA) data (N = 2107) was conducted to examine factors associated with home remedy use. Multivariate analysis indicated that parent's education, importance of religion, living with a grandparent, and living in a rural area were associated with families' use of home remedies. Age, gender, living with a grandparent, education, and geographic region were associated with individual home remedy use. The results of this research may provide insight to health care practitioners in their challenge of appropriately integrating self-care practices (i.e., home remedy use) and the use of the formal health care system among the patients that utilize both "scientific" and "folk" medical systems. When possible, treatment plans should be adapted to consider patients' demographics, health beliefs, and self-care practices. Health care providers should encourage patient and family involvement and dialogue regarding therapeutic approaches. As more information becomes available, health care practitioners will be better able to ascertain the possible health consequences of concurrent usage of home remedies and prescription drug therapies.

Profile of Families Who Home School in Maine.

ERIC Educational Resources Information Center

Kilgore, Peter

In Maine and across the nation, increasing numbers of parents are choosing to educate their children at home, often illegally. The anarchistic home schooling movement springs from various motivations: religious views, pursuit of independent lifestyles, desire to spend more time with one's children, and others. Whatever their reasons, home…

Hospital Inpatient versus HOme-based rehabilitation after knee arthroplasty (The HIHO study): study protocol for a randomized controlled trial.

PubMed

Buhagiar, Mark A; Naylor, Justine M; Harris, Ian A; Xuan, Wei; Kohler, Friedbert; Wright, Rachael J; Fortunato, Renee

2013-12-17

Formal rehabilitation programs are often assumed to be required after total knee arthroplasty to optimize patient recovery. Inpatient rehabilitation is a costly rehabilitation option after total knee arthroplasty and, in Australia, is utilized most frequently for privately insured patients. With the exception of comparisons with domiciliary services, no randomized trial has compared inpatient rehabilitation to any outpatient based program. The Hospital Inpatient versus HOme (HIHO) study primarily aims to determine whether 10 days of post-acute inpatient rehabilitation followed by a hybrid home program provides superior recovery of functional mobility on the 6-minute walk test (6MWT) compared to a hybrid home program alone following total knee arthroplasty. Secondarily, the trial aims to determine whether inpatient rehabilitation yields superior recovery in patient-reported function. This is a two-arm parallel randomized controlled trial (RCT), with a third, non-randomized, observational group. One hundred and forty eligible, consenting participants who have undergone a primary total knee arthroplasty at a high-volume joint replacement center will be randomly allocated when cleared for discharge from acute care to either 10 days of inpatient rehabilitation followed by usual care (a 6-week hybrid home program) or to usual care. Seventy participants in each group (140 in total) will provide 80% power at a significance level of 5% to detect an increase in walking capacity from 400 m to 460 m between the Home and Inpatient groups, respectively, in the 6MWT at 6 months post-surgery, assuming a SD of 120 m and a drop-out rate of <10%.The outcome assessor will assess participants at 10, 26 and 52 weeks post-operatively, and will remain blind to group allocation for the duration of the study, as will the statistician. Participant preference for rehabilitation mode stated prior to randomization will be accounted for in the analysis together with any baseline differences in

Hospital Inpatient versus HOme-based rehabilitation after knee arthroplasty (The HIHO study): study protocol for a randomized controlled trial

PubMed Central

2013-01-01

Background Formal rehabilitation programs are often assumed to be required after total knee arthroplasty to optimize patient recovery. Inpatient rehabilitation is a costly rehabilitation option after total knee arthroplasty and, in Australia, is utilized most frequently for privately insured patients. With the exception of comparisons with domiciliary services, no randomized trial has compared inpatient rehabilitation to any outpatient based program. The Hospital Inpatient versus HOme (HIHO) study primarily aims to determine whether 10 days of post-acute inpatient rehabilitation followed by a hybrid home program provides superior recovery of functional mobility on the 6-minute walk test (6MWT) compared to a hybrid home program alone following total knee arthroplasty. Secondarily, the trial aims to determine whether inpatient rehabilitation yields superior recovery in patient-reported function. Methods/Design This is a two-arm parallel randomized controlled trial (RCT), with a third, non-randomized, observational group. One hundred and forty eligible, consenting participants who have undergone a primary total knee arthroplasty at a high-volume joint replacement center will be randomly allocated when cleared for discharge from acute care to either 10 days of inpatient rehabilitation followed by usual care (a 6-week hybrid home program) or to usual care. Seventy participants in each group (140 in total) will provide 80% power at a significance level of 5% to detect an increase in walking capacity from 400 m to 460 m between the Home and Inpatient groups, respectively, in the 6MWT at 6 months post-surgery, assuming a SD of 120 m and a drop-out rate of <10%. The outcome assessor will assess participants at 10, 26 and 52 weeks post-operatively, and will remain blind to group allocation for the duration of the study, as will the statistician. Participant preference for rehabilitation mode stated prior to randomization will be accounted for in the analysis together

Home intravenous therapy: Part I--Issues.

PubMed

McAbee, R R; Grupp, K; Horn, B

1991-01-01

Concerns related to providing home intravenous therapy were among the top ten clinical problems identified by Northwest Medicare-certified home care agencies in a 1986 survey. This paper addresses issues related to home intravenous therapy and provides lists of resources for the development of home intravenous therapy programs. Part I of the paper covers concerns related to intravenous therapy as expressed by home care agencies in the Northwest and synthesized the literature about home intravenous therapies. Survey results are presented, followed by a discussion of client and caregiver concerns. These include: discharge planning, client admission criteria and client and caregiver education. Standards, staffing, and staff education issues are discussed followed by sections on economics, marketing regulations and legal and ethical concerns. Finally, there is a discussion of issues related to specific types of intravenous therapies: parenteral nutrition, antibiotic therapy; chemotherapy; blood and blood component therapy and other less frequently used types of intravenous therapies. Each therapy is discussed with regard to complications, client and caregiver instruction and financial considerations. Part II of the paper is a resource guide which lists resources that agencies may use to develop a home intravenous therapy program. In the first section, national organizations and journals and books concerned with intravenous therapy are listed as well as journal articles, guidelines and guidebooks and client and provider educational materials. National and regional product and service representatives of intravenous therapy related companies are also listed. In the second section, addresses for the State Boards of Nursing are given for Alaska, Idaho, Montana, Oregon and Washington. Each state section includes a list of those agencies who indicated in the 1988 survey that they would be willing to share materials. In addition, product and service vendors of intravenous

Implementing home care in Canada: four critical elements.

PubMed

Richardson, B

2000-01-01

While MacAdam proposes a "national approach to home care#8221; the obstacles to this are well known and substantial. They are the likely cost and the limitations of the federal government s role in healthcare. Building on MacAdam's assessment, this paper outlines four problems embedded in the various home-care service delivery models in Canada: the lack of factual client outcome information to support decision-making, the limited client choice of provider, the perverse incentive of fee for service and the bias against the for-profit provider. The paper proposes that the assessment, classification and measurement of outcomes for every recipient of home-care services be standardized using a proven assessment instrument, such as OASIS-B or MDS-HC, by healthcare professionals certified in its use. The resulting information would be captured in a regional database and available for analysis and research. CIHI would be contracted to manage a national database and to fund the training and certification of assessors. The paper proposes a new service delivery and funding model, utilizing standard client outcome information, different roles for regional health authorities and service providers, and a prospective payment mechanism replacing fee for service. A national home care program may be an elusive dream, but that shouldn't stop experimentation, evaluation and improvement.

Medication management at home: enhancing nurse's skills and improving patient satisfaction--a longitudinal study.

PubMed

Mager, Diana R; Morrissey Ross, Mary

2013-01-01

The purpose of this longitudinal study was to improve nurse medication management skills during home care (HC) visits, and thus improve care quality and the related patient ratings of nurse performance. Nurses completed presurveys asking how often they asked to see, taught about, and explained side effects of patient medications. Two focus groups were held with HC nurses to determine barriers to provision of such medication interventions, followed by presentation of a series of 5 medication-related educational sessions. HC nurse's surveys 6 months later reveal an increased frequency of medication skill performance, and patient ratings in these same areas improved statistically significantly, nearing or surpassing national benchmarks.

Bronchitis and Its Associated Risk Factors in First Nations Children

PubMed Central

Karunanayake, Chandima P.; Rennie, Donna C.; Ramsden, Vivian R.; Fenton, Mark; Kirychuk, Shelley; Lawson, Joshua A.; Henderson, Raina; Jimmy, Laurie; Seeseequasis, Jeremy; Abonyi, Sylvia; Dosman, James A.; Pahwa, Punam

2017-01-01

Respiratory diseases, such as bronchitis and pneumonia, are common in First Nations children in Canada. The objectives are to determine prevalence and associated risk factors of bronchitis in children 6–17 years old residing in two reserve communities. The cross-sectional study was conducted in 2013 and children from two First Nations reserve communities participated. The outcome was ever presence/absence of bronchitis. Logistic regression analysis was conducted to examine the relationship between bronchitis and the individual and environmental factors. A total of 351 First Nations children participated in the study. The prevalence of bronchitis was 17.9%. While 86.6% had at least one parent who smoked, smoking inside home was 43.9%. Signs of mold and mildew in homes were high. Prevalence of houses with any damage caused by dampness was 42.2%, with 44.2% of homes showing signs of mold or mildew. Significant predictors of increased risk of bronchitis were: being obese; having respiratory allergies; exposed to parental cigarette smoking; and signs of mold and mildew in the home. There are several modifiable risk factors that should be considered when examining preventive interventions for bronchitis including obesity, smoking exposure, and home mold or dampness. PMID:29186802

Best Practices Case Study: Urbane Homes - Crestwood, KY, Various Locations, Greater Louisville, KY

DOE Office of Scientific and Technical Information (OSTI.GOV)

None

Case study of Urbane Homes, who worked with Building America to build market rate homes with HERS scores of 57 to 62. Despite a down market they’ve sold every home within 3 weeks of listing, without any advertising.

Markers of Impaired Decision Making in Nursing Home Residents: Assessment by Nursing Home Staff in a Population-Based Study.

PubMed

Fain, Kevin M; Rosenberg, Paul B; Pirard, Sandrine; Bogunovic, Olivera; Spira, Adam P

2015-07-01

Many nursing home residents have cognitive impairment that affects their decision making. In order to identify potential markers of impaired decision making, we investigated the association between a range of nursing home resident characteristics and impaired decision making in a population-based sample. Participants were 13,013 residents in the 2004 National Nursing Home Survey. We used logistic regression to determine the association between resident characteristics (ie, gender, age, race, mood, recent pain, falls, fractures, or hospitalizations, length of stay, number of activities of daily living (ADL) requiring help, and diagnoses of dementia, anxiety disorders, and depression) and impaired (vs independent) decision making. After controlling for depression and anxiety diagnoses, as well as gender, age, race, and recent hospitalization or pain, characteristics associated with impaired decision making included depressed, sad, or anxious mood ["mild" odds ratio (OR) = 1.39, 95% confidence interval (CI) = 1.23-1.58; "severe" OR = 2.69, 95% CI = 2.27-3.20); diagnosed dementia or living on a dementia hall (OR = 5.07, 95% CI = 4.52-5.67); number of ADL requiring assistance (with 5 ADL, OR = 10.69, 95% CI = 6.82-16.75); length of nursing home stay [101-365 days (OR = 1.60, 95% CI = 1.36-1.89); 366 days-2 years (OR = 1.60, 95% CI = 1.34-1.90); >2 years (OR = 2.25, 95% CI = 1.92-2.63)]; and history of falls or fractures in the last 6 months (OR = 1.19, 95% CI = 1.07-1.32)]. Residents reporting pain in the last week were less likely to have impaired decision making (OR = 0.58, 95% CI = 0.52-0.66). We found several independent markers of impaired decision making in nursing home residents, including depressed, sad, or anxious mood (independent of depression or anxiety diagnosis); dementia; and greater need for ADL assistance. Some of these factors, in particular mood, are modifiable and addressing them may help improve decision making. These markers should be explored

Development of eHOME, a Mobile Instrument for Reporting, Monitoring, and Consulting Drug-Related Problems in Home Care: Human-Centered Design Study

PubMed Central

Sino, Carolina Geertruida Maria; Heerdink, Eibert Rob; Schuurmans, Marieke Joanna

2018-01-01

Background Home care patients often use many medications and are prone to drug-related problems (DRPs). For the management of problems related to drug use, home care could add to the multidisciplinary expertise of general practitioners (GPs) and pharmacists. The home care observation of medication-related problems by home care employees (HOME)-instrument is paper-based and assists home care workers in reporting potential DRPs. To facilitate the multiprofessional consultation, a digital report of DRPs from the HOME-instrument and digital monitoring and consulting of DRPs between home care and general practices and pharmacies is desired. Objective The objective of this study was to develop an electronic HOME system (eHOME), a mobile version of the HOME-instrument that includes a monitoring and a consulting system for primary care. Methods The development phase of the Medical Research Council (MRC) framework was followed in which an iterative human-centered design (HCD) approach was applied. The approach involved a Delphi round for the context of use and user requirements analysis of the digital HOME-instrument and the monitoring and consulting system followed by 2 series of pilots for testing the usability and redesign. Results By using an iterative design approach and by involving home care workers, GPs, and pharmacists throughout the process as informants, design partners, and testers, important aspects that were crucial for system realization and user acceptance were revealed. Through the report webpage interface, which includes the adjusted content of the HOME-instrument and added home care practice–based problems, home care workers can digitally report observed DRPs. Furthermore, it was found that the monitoring and consulting webpage interfaces enable digital consultation between home care and general practices and pharmacies. The webpages were considered convenient, clear, easy, and usable. Conclusions By employing an HCD approach, the eHOME-instrument was

'Smart' homes and telecare for independent living.

PubMed

Tang, P; Venables, T

2000-01-01

Telecare services and 'smart' homes share a common technological base in information technology and telecommunications. There is growing interest in both telecare services and smart homes, although they have been studied in isolation. Telecare has been driven largely by perceived cost savings and improved service delivery to the home, leading to improved quality of life and independent living. Smart homes are also expected to provide better and safer living conditions. The integration of the two should produce more secure and autonomous living. There are different forms of telecare services, as there are different types of smart homes, each ranging from basic systems involving the use of alarms and the ordinary telephone to intelligent monitoring with sensors and interactive communication. The introduction of these systems has policy implications, such as the need for coordination between health, social services and housing policy makers, which will reduce duplication and inefficient allocation of resources. Successful delivery of telecare to the home is as much dependent on the construction and condition of the housing stock as it is on the ability of the care provider to meet users' needs. If the UK National Health Service (NHS) could replace a significant proportion of domiciliary nursing visits by telephone calls, then savings of up of 200 million Pounds per annum would be possible.

Home Away from Home?: A Case Study of Student Transitions to an International Branch Campus

ERIC Educational Resources Information Center

Cicchetti, Kaitlin Oyler

2017-01-01

This study explored the transition experience of home-campus students attending an international branch campus. The studied was informed by a diverse range of literature, including the internationalization of higher education and student affairs, development of international branch campuses, students in transition, the development of student…

Organizational home care models across Europe: A cross sectional study.

PubMed

Van Eenoo, Liza; van der Roest, Henriëtte; Onder, Graziano; Finne-Soveri, Harriet; Garms-Homolova, Vjenka; Jonsson, Palmi V; Draisma, Stasja; van Hout, Hein; Declercq, Anja

2018-01-01

Decision makers are searching for models to redesign home care and to organize health care in a more sustainable way. The aim of this study is to identify and characterize home care models within and across European countries by means of structural characteristics and care processes at the policy and the organization level. At the policy level, variables that reflected variation in health care policy were included based on a literature review on the home care policy for older persons in six European countries: Belgium, Finland, Germany, Iceland, Italy, and the Netherlands. At the organizational level, data on the structural characteristics and the care processes were collected from 36 home care organizations by means of a survey. Data were collected between 2013 and 2015 during the IBenC project. An observational, cross sectional, quantitative design was used. The analyses consisted of a principal component analysis followed by a hierarchical cluster analysis. Fifteen variables at the organizational level, spread across three components, explained 75.4% of the total variance. The three components made it possible to distribute home care organizations into six care models that differ on the level of patient-centered care delivery, the availability of specialized care professionals, and the level of monitoring care performance. Policy level variables did not contribute to distinguishing between home care models. Six home care models were identified and characterized. These models can be used to describe best practices. Copyright © 2017 Elsevier Ltd. All rights reserved.

Incidence of venous thromboembolism in care homes: a prospective cohort study.

PubMed

Apenteng, Patricia N; Hobbs, Fd Richard; Roalfe, Andrea; Muhammad, Usman; Heneghan, Carl; Fitzmaurice, David

2017-02-01

Care home residents have venous thromboembolism (VTE) risk profiles similar to medical inpatients; however, the epidemiology of VTE in care homes is unclear. To determine the incidence of VTE in care homes. Observational cohort study of 45 care homes in Birmingham and Oxford, UK. A consecutive sample of care home residents was enrolled and followed up for 12 months. Data were collected via case note reviews of care home and GP records; mortality information was supplemented with Health and Social Care Information Centre (now called NHS Digital) cause of death data. All potential VTE events were adjudicated by an independent committee according to three measures of diagnostic certainty: definite VTE (radiological evidence), probable VTE (high clinical indication but no radiological evidence), or possible VTE (VTE cannot be ruled out). (Study registration number: ISTCTN80889792.) RESULTS: There were 1011 participants enrolled, and the mean follow-up period was 312 days (standard deviation 98 days). The incidence rate was 0.71 per 100 person years of observation (95% confidence interval [CI] = 0.26 to 1.54) for definite VTE, 0.83 per 100 person years (95% CI = 0.33 to 1.70) for definite and probable VTE, and 2.48 per 100 person years (95% CI = 1.53 to 3.79) for definite, probable, and possible VTE. The incidence of VTE in care homes in this study (0.71-2.48 per 100 person years) is substantial compared with that in the community (0.117 per 100 person years) and in people aged ≥70 years (0.44 per 100 person years). Further research regarding risk stratification and VTE prophylaxis in this population is needed. © British Journal of General Practice 2017.

Food safety and foodborne disease in 21st century homes.

PubMed

Scott, Elizabeth

2003-09-01

Over the past decade there has been a growing recognition of the involvement of the home in several public health and hygiene issues. Perhaps the best understood of these issues is the role of the home in the transmission and acquisition of foodborne disease. The incidence of foodborne disease is increasing globally. Although foodborne disease data collection systems often miss the mass of home-based outbreaks of sporadic infection, it is now accepted that many cases of foodborne illness occur as a result of improper food handling and preparation by consumers in their own kitchens. Some of the most compelling evidence has come from the international data on Salmonella species and Campylobacter species infections.By its very nature, the home is a multifunctional setting and this directly impacts upon the need for better food safety in the home. In particular, the growing population of elderly and other immnocompromised individuals living at home who are likely to be more vulnerable to the impact of foodborne disease is an important aspect to consider. In addition, some developed nations are currently undergoing a dramatic shift in healthcare delivery, resulting in millions of patients nursed at home. Other aspects of the home that are unique in terms of food safety are the use of the home as a daycare centre for preschool age children, the presence of domestic animals in the home and the use of the domestic kitchen for small-scale commercial catering operations. At the global level, domestic food safety issues for the 21st century include the continued globalization of the food supply, the impact of international travel and tourism, and the impact of foodborne disease on developing nations.A number of countries have launched national campaigns to reduce the burden of foodborne disease, including alerting consumers to the need to practice food safety at home. Home hygiene practice and consumer hygiene products are being refined and targeted to areas of risk

Smoke-free rules and secondhand smoke exposure in homes and vehicles among US adults, 2009-2010.

PubMed

King, Brian A; Dube, Shanta R; Homa, David M

2013-05-16

An increasing number of US states and localities have implemented comprehensive policies prohibiting tobacco smoking in all indoor areas of public places and worksites. However, private settings such as homes and vehicles remain a major source of exposure to secondhand smoke (SHS) for many people. This study assessed the prevalence and correlates of voluntary smoke-free rules and SHS exposure in homes and vehicles among US adults. We obtained data from the 2009-2010 National Adult Tobacco Survey, a landline and cellular-telephone survey of adults aged 18 years or older residing in the 50 US states or the District of Columbia. We calculated national and state estimates of smoke-free rules and past-7-day SHS exposure in homes and vehicles and examined national estimates by sex, age, race/ethnicity, and education. The national prevalence of voluntary smoke-free home rules was 81.1% (state range, 67.9%-92.9%), and the prevalence of household smoke-free vehicle rules was 73.6% (state range, 58.6%-85.8%). Among nonsmokers, the prevalence of SHS exposure was 6.0% in homes (state range, 2.4%-13.0%) and 9.2% in vehicles (state range, 4.8%-13.7%). SHS exposure among nonsmokers was greatest among men, younger adults, non-Hispanic blacks, and those with a lower level of education. Most US adults report having voluntary smoke-free home and vehicle rules; however, millions of people remain exposed to SHS in these environments. Disparities in exposure also exist among certain states and subpopulations. Efforts are needed to warn about the dangers of SHS and to promote voluntary smoke-free home and vehicle rules.

1977 Nationwide Personal Transportation Study : home-to-work trips and travel

DOT National Transportation Integrated Search

1980-12-01

This report is part of a series that presents findings from the 1977 Nationwide Personal Transportation Study (NPTS). This report describes home-to-work trips and trave l in 1977. The home-to-work trip purpose is explored relative to location, househ...

Determining Home Range and Preferred Habitat of Feral Horses on the Nevada National Security Site Using Geographic Information Systems

DOE Office of Scientific and Technical Information (OSTI.GOV)

Burns, Ashley V.

2014-05-30

Feral horses (Equus caballus) are free-roaming descendants of domesticated horses and legally protected by the Wild and Free-Roaming Horses and Burros Act of 1971, which mandates how feral horses and burros should be managed and protected on federal lands. Using a geographic information system to determine the home range and suitable habitat of feral horses on the federally managed Nevada National Security Site can enable wildlife biologists in making best management practice recommendations. Home range was estimated at 88.1 square kilometers. Site suitability was calculated for elevation, forage, slope, water presence and horse observations. These variables were combined in successivemore » iterations into one polygon. Suitability rankings established that 85 square kilometers are most suitable habitat, with 2,052 square kilometers of good habitat 1,252 square kilometers of fair habitat and 122 square kilometers of least suitable habitat.« less

[The childhood home accidents: risk perception and behavior].

PubMed

Langiano, E; Ferrara, M; Lanni, L; De Vito, E

2016-01-01

The aim of the study was to assess the frequency and the kind of home injuries among the children and to have information on the sources of risk and hazardous behaviors in the home setting. An anonymous questionnaire was administered to parents. In order to evaluate the risk perception in relation to the home environment, drawings to color were administered to children in kindergarten and to those of the first cycle of elementary school. A questionnaire was administered to older pupils. Statistical analyses were performed using the statistical program EPIINFO. The most risky behaviors showed by about half of parents were to cook lunch and doing other works in the house, cook with children in the kitchen. 28.0% said that sometimes left unattended appliances. Discordant opinions were found on the possibility of having injuries at home, in fact, 39.7% of parents affirmed that their son was victim of a home injury, compared with 64.0% of children. The number of children victims of home injuries was significantly higher among those aged between 6 and 10 years. Our search was in according with the national trend of the types and outcomes of home injuries, and confirms the existence of relationship between low educational level and higher frequency of injuries in childhood. Although prevention was considered an invaluable tool by parents to ensure the child's safety from the earliest years of life in this way, this study highlights the urgent need to take preventive action to develop an adequate safety culture.

Exploring Multilevel Factors for Family Engagement in Home Visiting Across Two National Models.

PubMed

Latimore, Amanda D; Burrell, Lori; Crowne, Sarah; Ojo, Kristen; Cluxton-Keller, Fallon; Gustin, Sunday; Kruse, Lakota; Hellman, Daniela; Scott, Lenore; Riordan, Annette; Duggan, Anne

2017-07-01

The associations of family, home visitor and site characteristics with family engagement within the first 6 months were examined. The variation in family engagement was also explored. Home visiting program participants were drawn from 21 Healthy Families America sites (1707 families) and 9 Nurse-Family Partnership sites (650 families) in New Jersey. Three-level nested generalized linear mixed models assessed the associations of family, home visitor and site characteristics with family receipt of a high dose of services in the first 6 months of enrollment. A family was considered to have received a high dose of service in the first 6 months of enrollment if they were active at 6 months and had received at least 50% of their expected visits in the first 6 months. In general, both home visiting programs engaged, at a relatively high level (Healthy Families America (HFA) 59%, Nurse-Family Partnership (NFP) 64%), with families demonstrating high-risk characteristics such as lower maternal education, maternal smoking, and maternal mental health need. Home visitor characteristics explained more of the variation (87%) in the receipt of services for HFA, while family characteristics explained more of the variation (75%) in the receipt of services for NFP. At the family level, NFP may improve the consistency with which they engage families by increasing retention efforts among mothers with lower education and smoking mothers. HFA sites seeking to improve engagement consistency should consider increasing the flexible in home visitor job responsibilities and examining the current expected-visit policies followed by home visitors on difficult-to-engage families.

Healthy ageing and home: the perspectives of very old people in five European countries.

PubMed

Sixsmith, J; Sixsmith, A; Fänge, A Malmgren; Naumann, D; Kucsera, C; Tomsone, S; Haak, M; Dahlin-Ivanoff, S; Woolrych, R

2014-04-01

This paper reports on in-depth research, using a grounded theory approach, to examine the ways in which very old people perceive healthy ageing in the context of living alone at home within urban settings in five European countries. This qualitative study was part of a cross-national project entitled ENABLE-AGE which examined the relationship between home and healthy ageing. Interviews explored the notion of healthy ageing, the meaning and importance of home, conceptualisations of independence and autonomy and links between healthy ageing and home. Data analysis identified five ways in which older people constructed healthy ageing: home and keeping active; managing lifestyles, health and illness; balancing social life; and balancing material and financial circumstances. Older people reflected on their everyday lives at home in terms of being engaged in purposeful, meaningful action and evaluated healthy ageing in relation to the symbolic and practical affordances of the home, contextualised within constructions of their national context. The research suggests that older people perceive healthy ageing as an active achievement, created through individual, personal effort and supported through social ties despite the health, financial and social decline associated with growing older. The physicality and spatiality of home provided the context for establishing and evaluating the notion of healthy ageing, whilst the experienced relationship between home, life history and identity created a meaningful space within which healthy ageing was negotiated. Copyright © 2014 Elsevier Ltd. All rights reserved.

Consumption of foods away from home in Brazil.

PubMed

Bezerra, Ilana Nogueira; Souza, Amanda de Moura; Pereira, Rosangela Alves; Sichieri, Rosely

2013-02-01

To describe foods consumed away from home and associated factors in Brazil. The study was based on the National Dietary Survey which was conducted among residents aged over 10 years old in 24% of households participating in the Household Budget Survey in 2008-2009 (n = 34,003). The consumption of food and beverages was collected through records of foods consumed, type of preparation, quantity, time and food source (inside or outside home). The frequency with which individuals consumed food away from home was calculated according to age, gender, income, household area location, family size, presence of children at home and age of head of household in Brazil and in each Brazilian region. Specific sampling weight and effect of the sampling design were considered in the analyses. Consumption of food away from home in Brazil was reported by 40% of respondents, varying from 13% among the elderly in the Midwest Region to 51% among adolescents in the Southeast. This percentage decreased with age and increased with income in all regions of Brazil and was higher among men and in urban areas. Foods with the highest percentage of consumption outside home were alcoholic beverages, baked and fried snacks, pizza, soft drinks and sandwiches. Foods consumed away from home showed a predominance of high energy content and poor nutritional content, indicating that the consumption of foods away from home should be considered in public health campaigns aimed at improving Brazilians' diet.

Best Practices Case Study: Imagine Homes - Stillwater Ranch, San Antonio, TX

DOE Office of Scientific and Technical Information (OSTI.GOV)

none,

2011-04-01

This case study describes Imagine Homes, who met Builders Challenge criteria on more than 200 homes in San Antonio with rigid foam exterior sheathing, ducts and air handler in conditioned space in a spray-foam insulated attic, and high-efficiency HVAC, windows, and appliances.

Effectiveness of a transitional home care program in reducing acute hospital utilization: a quasi-experimental study.

PubMed

Low, Lian Leng; Vasanwala, Farhad Fakhrudin; Ng, Lee Beng; Chen, Cynthia; Lee, Kheng Hock; Tan, Shu Yun

2015-03-14

Improving healthcare utilization is essential as health systems around the world grapple with the escalating demands for acute hospital resources. Evidence suggests that transitional care programs are effective to improve utilization of healthcare. However, the evidence for transitional care programs that enhance the home medical care model and provide multi-disciplinary patient-centered care is not well established. We evaluated if a transitional home care program operated by the Singapore General Hospital was effective in reducing acute hospital utilization. We performed a quasi-experimental study using a pre-post design to evaluate the effectiveness of a transitional home care program in reducing hospital admissions and emergency department attendances of medically complex patients enrolled into the program in a tertiary hospital in Singapore. Patients received a comprehensive needs assessment performed by the physician and a nurse case manager in the home setting, followed by an individualized care plan that included medical and nursing care, patient education and coordination of care with hospital specialists and community services. Primary study outcomes were emergency department attendances and hospital admissions to all hospitals. These were extracted from hospital administrative data and national health records. Wilcoxon Signed Ranks Test was used for assess differences in pre and post continuous data. Overall, 262 patients were enrolled into the program and 259 were analyzed. Patients had a 51.6% and 52.8% reduction in hospital admissions in the three-month and six-month post enrollment, respectively. Similarly, a 47.1% and 48.2% reduction was observed for emergency department attendances in the three and six months post enrollment, respectively. The average difference in per patient hospital bed days in the pre- and post-enrollment periods were 12.05 days and 20.03 days at the 3-month and 6-month periods, respectively. Patients enrolled in the

Context for Understanding the National Demonstration Project and the Patient-Centered Medical Home

PubMed Central

Stange, Kurt C.; Miller, William L.; Nutting, Paul A.; Crabtree, Benjamin F.; Stewart, Elizabeth E.; Jaén, Carlos Roberto

2010-01-01

This article introduces a journal supplement evaluating the country’s first national demonstration of the patient-centered medical home (PCMH) concept. The PCMH is touted by some as a linchpin for renewing the foundering US health care system and its primary care foundation. The National Demonstration Project (NDP) tested a new model of care and compared facilitated and self-directed implementation approaches in a group-randomized clinical trial. The NDP asked what a national sample of 36 highly motivated family practices could accomplish in moving toward the PCMH ideal during 2 years within the current US health care payment and organizational system. Our independent evaluation used a multimethod approach that integrated qualitative methods to tell the NDP story from multiple perspectives and quantitative methods to assess and compare aspects that could be measured. The 7 scientific reports presented in this supplement explain the process, outcomes, lessons, and implications of the NDP. This introductory article provides context for making sense of the NDP. Important context includes the evolution of the PCMH concept and movement, the roots of the NDP and how it developed, and both what is valuable and what is problematic about family medicine and primary care. Together, the articles in this supplement show how primary care practices and the concept of the PCMH can continue to evolve. The evaluation depicts some of the early effects of this evolution on patients and practices, and shows how the process of practice development can be understood and how lessons from the NDP can inform ongoing and future efforts to transform primary care and health care systems. PMID:20530391

Cost analysis of nursing home registered nurse staffing times.

PubMed

Dorr, David A; Horn, Susan D; Smout, Randall J

2005-05-01

To examine potential cost savings from decreased adverse resident outcomes versus additional wages of nurses when nursing homes have adequate staffing. A retrospective cost study using differences in adverse outcome rates of pressure ulcers (PUs), urinary tract infections (UTIs), and hospitalizations per resident per day from low staffing and adequate staffing nursing homes. Cost savings from reductions in these events are calculated in dollars and compared with costs of increasing nurse staffing. Eighty-two nursing homes throughout the United States. One thousand three hundred seventy-six frail elderly long-term care residents at risk of PU development. Event rates are from the National Pressure Ulcer Long-Term Care Study. Hospital costs are estimated from Medicare statistics and from charges in the Healthcare Cost and Utilization Project. UTI costs and PU costs are from cost-identification studies. Time horizon is 1 year; perspectives are societal and institutional. Analyses showed an annual net societal benefit of 3,191 dollars per resident per year in a high-risk, long-stay nursing home unit that employs sufficient nurses to achieve 30 to 40 minutes of registered nurse direct care time per resident per day versus nursing homes that have nursing time of less than 10 minutes. Sensitivity analyses revealed a robust set of estimates, with no single or paired elements reaching the cost/benefit equality threshold. Increasing nurse staffing in nursing homes may create significant societal cost savings from reduction in adverse outcomes. Challenges in increasing nurse staffing are discussed.

Randomized trial of a home monitoring system for early detection of choroidal neovascularization home monitoring of the Eye (HOME) study.

PubMed

Chew, Emily Y; Clemons, Traci E; Bressler, Susan B; Elman, Michael J; Danis, Ronald P; Domalpally, Amitha; Heier, Jeffrey S; Kim, Judy E; Garfinkel, Richard

2014-02-01

To determine whether home monitoring with the ForeseeHome device (Notal Vision Ltd, Tel Aviv, Israel), using macular visual field testing with hyperacuity techniques and telemonitoring, results in earlier detection of age-related macular degeneration-associated choroidal neovascularization (CNV), reflected in better visual acuity, when compared with standard care. The main predictor of treatment outcome from anti-vascular endothelial growth factor (VEGF) agents is the visual acuity at the time of CNV treatment. Unmasked, controlled, randomized clinical trial. One thousand nine hundred and seventy participants 53 to 90 years of age at high risk of CNV developing were screened. Of these, 1520 participants with a mean age of 72.5 years were enrolled in the Home Monitoring of the Eye study at 44 Age-Related Eye Disease Study 2 clinical centers. In the standard care and device arms arm, investigator-specific instructions were provided for self-monitoring vision at home followed by report of new symptoms to the clinic. In the device arm, the device was provided with recommendations for daily testing. The device monitoring center received test results and reported changes to the clinical centers, which contacted participants for examination. The main outcome measure was the difference in best-corrected visual acuity scores between baseline and detection of CNV. The event was determined by investigators based on clinical examination, color fundus photography, fluorescein angiography, and optical coherence tomography findings. Masked graders at a central reading center evaluated the images using standardized protocols. Seven hundred sixty-three participants were randomized to device monitoring and 757 participants were randomized to standard care and were followed up for a mean of 1.4 years between July 2010 and April 2013. At the prespecified interim analysis, 82 participants progressed to CNV, 51 in the device arm and 31 in the standard care arm. The primary analysis

Time to and predictors of dual incontinence in older nursing home admissions.

PubMed

Bliss, Donna Z; Gurvich, Olga V; Eberly, Lynn E; Harms, Susan

2018-01-01

There are few studies of nursing home residents that have investigated the development of dual incontinence, perhaps the most severe type of incontinence as both urinary and fecal incontinence occur. To determine the time to and predictors of dual incontinence in older nursing home residents. Using a cohort design, records of older nursing home admissions who were continent or had only urinary or only fecal incontinence (n = 39,181) were followed forward for report of dual incontinence. Four national US datasets containing potential predictors at multiple levels describing characteristics of nursing home residents, nursing homes (n = 445), and socioeconomic and sociodemographic status of the community surrounding nursing homes were analyzed. A Cox proportional hazard regression with nursing home-specific random effect was used. At 6 months after admission, 28% of nursing home residents developed dual incontinence, at 1 year 42% did so, and at 2 years, 61% had dual incontinence. Significant predictors for time to developing dual incontinence were having urinary incontinence, greater functional or cognitive deficits, more comorbidities, older age, and lesser quality of nursing home care. The development of dual incontinence is a major problem among nursing home residents. Predictors in this study offer guidance in developing interventions to prevent and reduce the time to developing this problem which may improve the quality of life of nursing residents. © 2017 Wiley Periodicals, Inc.

Nursing home resident smoking policies.

PubMed

Stefanacci, Richard G; Lester, Paula E; Kohen, Izchak

2008-01-01

To identify nursing home standards related to resident smoking through a nation wide survey of directors of nursing. A national survey was distributed online and was completed by 248 directors of nursing. The directors of nurses answered questions concerning resident smoking including the criteria utilized to determine an unsafe resident smoker. For those residents identified as unsafe, the questions asked were specifically related to monitoring, staff involvement, safety precautions and policy. The results of the survey demonstrated a consistent policy practiced among facilities across the United States. The monitoring of nursing home residents is based on a resident's mental acuity, physical restrictions and equipment requirements. Once a resident was identified as a smoker at risk of harm to self or others, staff involvement ranged from distributing cigarettes to direct supervision. In addition, the majority of facilities required residents to wear fire resistant aprons and provided a fire extinguisher in smoking areas. Monitoring policies of nursing home residents who smoke starts with identifying those residents at risk based on an assessment of mental acuity, physical restrictions and equipment requirements. Those that are identified as being at risk smokers have their cigarettes controlled and distributed by nursing staff and are supervised by facility staff when smoking. This policy is implemented through written policy as well as staff education. Despite some discrepancies in the actual implementation of policies to supervise residents who smoke, the policies for assessment for at-risk smokers requiring monitoring is consistent on a national basis.

Development of eHOME, a Mobile Instrument for Reporting, Monitoring, and Consulting Drug-Related Problems in Home Care: Human-Centered Design Study.

PubMed

Dijkstra, Nienke Elske; Sino, Carolina Geertruida Maria; Heerdink, Eibert Rob; Schuurmans, Marieke Joanna

2018-03-07

Home care patients often use many medications and are prone to drug-related problems (DRPs). For the management of problems related to drug use, home care could add to the multidisciplinary expertise of general practitioners (GPs) and pharmacists. The home care observation of medication-related problems by home care employees (HOME)-instrument is paper-based and assists home care workers in reporting potential DRPs. To facilitate the multiprofessional consultation, a digital report of DRPs from the HOME-instrument and digital monitoring and consulting of DRPs between home care and general practices and pharmacies is desired. The objective of this study was to develop an electronic HOME system (eHOME), a mobile version of the HOME-instrument that includes a monitoring and a consulting system for primary care. The development phase of the Medical Research Council (MRC) framework was followed in which an iterative human-centered design (HCD) approach was applied. The approach involved a Delphi round for the context of use and user requirements analysis of the digital HOME-instrument and the monitoring and consulting system followed by 2 series of pilots for testing the usability and redesign. By using an iterative design approach and by involving home care workers, GPs, and pharmacists throughout the process as informants, design partners, and testers, important aspects that were crucial for system realization and user acceptance were revealed. Through the report webpage interface, which includes the adjusted content of the HOME-instrument and added home care practice-based problems, home care workers can digitally report observed DRPs. Furthermore, it was found that the monitoring and consulting webpage interfaces enable digital consultation between home care and general practices and pharmacies. The webpages were considered convenient, clear, easy, and usable. By employing an HCD approach, the eHOME-instrument was found to be an easy-to-use system. The systematic

"Making Do" Decisions: How Home Healthcare Personnel Manage Their Exposure to Home Hazards.

PubMed

Wills, Celia E; Polivka, Barbara J; Darragh, Amy; Lavender, Steven; Sommerich, Carolyn; Stredney, Donald

2016-04-01

This study describes the decision-making processes home healthcare personnel (HHP) use to manage their personal health and safety when managing hazards in client homes. A professionally diverse national sample of 68 HHP participated in individual semi-structured interviews and focus group discussions, and described their decision making and strategies for hazard management in their work environments. HHP described 353 hazard management dilemmas within 394 specifically identified hazards, which were clustered within three broader categories: electrical/fire, slip/trip/lift, and environmental exposures. HHP described multiple types of "making do" decisions for hazard management solutions in which perceived and actual resource limitations constrained response options. A majority of hazard management decisions in the broader hazards categories (72.5%, 68.5%, and 63.5%, respectively) were classifiable as less than optimal. These findings stress the need for more support of HHPs, including comprehensive training, to improve HHP decision making and hazard management strategies, especially in context of resource constraints. © The Author(s) 2015.

Pediatric Home Sleep Studies: A Prospective Study

DTIC Science & Technology

2016-04-19

not always available, and is inconvenient for patients. Therefore, 90% of children undergo adenotonsillectomy without confirmatory diagnostic testing. Home sleep testing for OSA may alleviate these issues.

Underweight and malnutrition in home care: A multicenter study.

PubMed

Lahmann, Nils A; Tannen, Antje; Suhr, Ralf

2016-10-01

This study aimed to provide representative figures about the prevalence of underweight and malnutrition among home care clients, and to determine the associated risk factors and the provided nutritional nursing interventions. In 2012, a multicenter point prevalence study was conducted among 878 randomly selected clients from 100 randomly selected home care services across Germany. Following a standardized study protocol, demographics, nutritional assessments (Body Mass Index, Malnutrition Universal Screening Tool (MUST), Mini nutritional Assessment - short form (MNA-sf), nurses' clinical judgment on nutritional status) and interventions were assessed. Common nutritional risk factors for underweight and malnutrition were analyzed in a logistic regression model. Malnutrition figures varied between 4.8% (MNA-sf) and 6.8% (MUST), underweight between 8.7% (BMI < 20 kg/m(2)) and 10.2% (clinical judgment). Missing values were high in both malnutrition assessments (MNA-sf 48.8%, MUST 39.1%) due to a lack of information on many clients' loss of weight within the past 3-6 months. Regular weighing was performed in 33.6-57.3% of all clients, depending on weight and nutritional status. Mental overload (OR 8.1/4.4), needs help with feeding (OR 5.0/2.8) and loss of appetite (OR 3.6/3.9) were highly associated with malnutrition/underweight. Malnutrition and underweight are important issues in home care clients. Regular weighing should be performed in all home care clients so that a potential weight loss can be detected in time. Copyright © 2015 Elsevier Ltd and European Society for Clinical Nutrition and Metabolism. All rights reserved.

Belt restraint reduction in nursing homes: design of a quasi-experimental study.

PubMed

Gulpers, Math J M; Bleijlevens, Michel H C; van Rossum, Erik; Capezuti, Elizabeth; Hamers, Jan P H

2010-02-25

The use of physical restraints still is common practice in the nursing home care. Since physical restraints have been shown to be an ineffective and sometimes even hazardous measure, interventions are needed to reduce their usage. Several attempts have been made to reduce the use of physical restraints. Most studies used educational approaches and introduced a nurse specialist as a consultant. However, the success rate of these interventions has been inconsistent. We developed a new multi-component intervention (EXBELT) comprising an educational intervention for nursing home staff in combination with a policy change (belt use is prohibited by the nursing home management), availability of a nurse specialist and nursing home manager as consultants, and availability of alternative interventions. The first aim of this study is to further develop and test the effectiveness of EXBELT on belt restraint reduction in Dutch psychogeriatric nursing homes. However, the reduction of belts should not result in an increase of other restrictive restraints (such as a chair with locked tray table) or psychoactive drug use. The overall aim is an effective and feasible intervention that can be employed on a large scale in Dutch nursing homes. Effects of EXBELT will be studied in a quasi-experimental longitudinal study design. Alongside the effect evaluation, a process evaluation will be carried out in order to further develop EXBELT. Data regarding age, gender, use of physical restraints, the number of falls and fall related injuries, psychoactive drug use, and the use of alternative interventions will be collected at baseline and after four and eight months of follow-up. Data regarding the process evaluation will be gathered in a period of eight months between baseline and the last measurement. Furthermore, changing attitudes will become an important addition to the educational part of EXBELT. A quasi-experimental study is presented to investigate the effects of EXBELT on the use of

Pain management in home hospice patients: A retrospective descriptive study.

PubMed

Campbell, Cathy L; Kelly, Meghan; Rovnyak, Virginia

2017-09-01

The development and evaluation of evidence-based, safe, and effective home-based pain management models for caregivers implementation is receiving greater attention in the literature because of international initiatives intended to increase the number of people who receive end-of-life care in home-based settings. The purpose of this "retrospective descriptive design" study was to describe pharmacological pain management and outcomes for 40 cancer and non-cancer patients receiving hospice care at home. While the median pain score was higher at admission in the cancer group than in the hospice care at home group, the difference was not significant at or within 48 hour of admission. Overall, there was a significant decrease in pain from the first measurement to the second. Within the last seven days of life, the majority of participants were not able to provide a pain severity score when asked to evaluate the effectiveness of pain management, thus their caregiver provided a proxy evaluation. Pain management was effective in the home setting. More research is needed on the best methods to teach lay caregivers to assess pain and evaluate the effectiveness of pharmacological modalities to manage pain. © 2017 John Wiley & Sons Australia, Ltd.

Nursing Homes Appeals of Deficiency Citations: The Informal Dispute Resolution Process

PubMed Central

Mukamel, Dana B.; Weimer, David L.; Li, Yue; Bailey, Lauren; Spector, William D.; Harrington, Charlene

2012-01-01

Objective Nursing homes found to be not meeting quality standards are cited for deficiencies. Before 1995, their only recourse was a formal appeal process, which is lengthy and costly. In 1995, the Centers for Medicare & Medicaid Services (CMS) instituted the Informal Dispute Resolution (IDR) process. This study presents for the first time national statistics about the IDR process and an analysis of the factors that influence nursing homes’ decisions to request an IDR. Design Retrospective study including descriptive statistics and multivariate logistic hierarchical models. Setting U.S. nursing homes in 2005 to 2008. Participant 15,916 Medicaid and Medicare certified nursing homes nationally, with 94,188 surveys and 9,388 IDRs. Measures The unit of observation was an annual survey or a complaint survey that generated at least one deficiency. The dependent variable was dichotomous and indicated whether the annual or a complaint survey triggered an IDR request. Independent variables included characteristics of the nursing home, the deficiency, the market, and the state regulatory environment. Results Ten percent of all annual surveys and complaint surveys resulted in IDRs. There was substantial variation across states, which persisted over time. Multivariate results suggest that nursing homes’ decisions to request an IDR depend on their assessment of the probability of success and assessment of the benefits of the submission. Conclusions Nursing homes avail themselves of the IDR process. Their propensity to do so depends on a number of factors, including the state regulatory system and the market environment in which they operate. PMID:22402171

Determinants of nursing home costs in Florida: policy implications and support in national research findings.

PubMed Central

Traxler, H G

1982-01-01

Descriptive and econometric analysis of the major nonquality determinants of nursing home costs for Florida shows that mean costs, size, and occupancy rate increased between 1971 and 1976, that per diem costs and occupancy rate were inversely related, and that the per diem cost was lower in rural than in urban areas. Regression of the data shows that--next to inflation, as expressed by the Consumer Price Index--the occupancy rate accounts for most of the variation in per diem costs, followed by size, urban-rural location, and by type of control. The hypothetical "optimal," defined as lowest cost-size range, was calculated to be more than 350 beds. Recent research substantiates most of these findings. Medicaid Cost Reports from Florida's nursing homes were the source of the information analyzed; by 1976, the sixth year of the study, the data base covered nearly 9 of 10 licensed beds in the State. Some policy implications can be drawn from the analysis. Reductions in per diem costs could be achieved by higher occupancy rates, especially in the larger nursing homes, and a reduction in the rate of inflation would reduce the rate of increase in nursing home costs. PMID:6815706

Exporting a Student-Centered Curriculum: A Home Institution's Perspective.

PubMed

Waterval, Dominique; Tinnemans-Adriaanse, Marjolijn; Meziani, Mohammed; Driessen, Erik; Scherpbier, Albert; Mazrou, Abdulrahman; Frambach, Janneke

2017-07-01

Numerous, mainly Anglo-Saxon, higher education institutions have agreements with foreign providers to deliver their curricula abroad. This trend is gradually making inroads into the medical domain, where foreign institutions undertake to offer their students learning experiences similar to those of the home institution. Not an easy feat, as the national health care contexts differ greatly between institutions. In a bid to export the curriculum, institutions risk compromising their financial resilience and reputation. This article presents an instrumental case study of a home institution's perspective on the establishment of a cross-border student-centered curriculum partnership. It provides the reader with a practical discourse on dimensions that need to be bridged between home and host contexts, and on new working processes that need to be integrated within the home institution's existing organizational structure. We describe the advantages and disadvantages based on our experiences with a centralized organizational approach, and advocate for a gradual move toward decentral interfaculty communities of practice.

Does a referral from home to hospital affect satisfaction with childbirth? A cross-national comparison.

PubMed

Christiaens, Wendy; Gouwy, Anneleen; Bracke, Piet

2007-07-12

The Belgian and Dutch societies present many similarities but differ with regard to the organisation of maternity care. The Dutch way of giving birth is well known for its high percentage of home births and its low medical intervention rate. In contrast, home births in Belgium are uncommon and the medical model is taken for granted. Dutch and Belgian maternity care systems are compared with regard to the influence of being referred to specialist care during pregnancy or intrapartum while planning for a home birth. We expect that a referral will result in lower satisfaction with childbirth, especially in Belgium. Two questionnaires were filled out by 605 women, one at 30 weeks of pregnancy and one within the first two weeks after childbirth, either at home or in a hospital. Of these, 563 questionnaires were usable for analysis. Women were invited to participate in the study by independent midwives and obstetricians during antenatal visits in 2004-2005. Satisfaction with childbirth was measured by the Mackey Satisfaction with Childbirth Rating Scale, which takes into account the multidimensional nature of the concept. Belgian women are more satisfied than Dutch women and home births are more satisfying than hospital births. Women who are referred to the hospital while planning for a home birth are less satisfied than women who planned to give birth in hospital and did. A referral has a greater negative impact on satisfaction for Dutch women. There is no reason to believe Dutch women receive hospital care of lesser quality than Belgian women in case of a referral. Belgian and Dutch attach different meaning to being referred, resulting in a different evaluation of childbirth. In the Dutch maternity care system home births lead to higher satisfaction, but once a referral to the hospital is necessary satisfaction drops and ends up lower than satisfaction with hospital births that were planned in advance. We need to understand more about referral processes and how women

Nursing home staff’s views on residents’ dignity: a qualitative interview study

PubMed Central

2013-01-01

Background Maintaining dignity is an important element of end-of-life care and also of the care given in nursing homes. Factors influencing personal dignity have been studied from both nursing home residents’ and staff’s perspective. Little is however known about the way nursing home staff perceive and promote the personal dignity of individual residents in daily practice, or about staff’s experiences with preserving dignity within the nursing home. The aim of this study is to gain more insight in this. Methods A qualitative descriptive interview study was designed, in which in-depth interviews were performed with 13 physicians and 15 nurses. They expressed their views on the personal dignity of 30 recently admitted nursing home residents on the general medical wards of four nursing homes in The Netherlands. Interviews were transcribed and analyzed following the principles of thematic analysis. Results According to both physicians and nurses, physical impairment and being dependent on others threatened the residents’ dignity. Whether or not this led to a violation of an individual resident’s dignity, depended - in staff’s opinion - on the resident’s ability to show resilience and to keep his/her individuality. Staff mentioned treating residents with respect and taking care of their privacy as most important elements of dignity-conserving care and strived to treat the residents as they would like to be treated themselves. They could often mention aspects that were important for a particular resident’s dignity. But, when asked what they could contribute to a particular resident’s dignity, they often mentioned general aspects of dignity-conserving care, which could apply to most nursing home residents. By attempting to give dignity-conserving care, physicians and nurses often experienced conflicting values in daily care and barriers caused by the lack of resources. Conclusions Tailoring dignity-conserving care to an individual nursing home resident

Examining the relationship between therapeutic self-care and adverse events for home care clients in Ontario, Canada: a retrospective cohort study.

PubMed

Sun, Winnie; Doran, Diane M; Wodchis, Walter P; Peter, Elizabeth

2017-03-14

In an era of a rapidly aging population who requires home care services, clients must possess or develop therapeutic self-care ability in order to manage their health conditions safely in their homes. Therapeutic self-care is the ability to take medications as prescribed and to recognize and manage symptoms that may be experienced, such as pain. The purpose of this research study was to investigate whether therapeutic self-care ability explained variation in the frequency and types of adverse events experienced by home care clients. A retrospective cohort design was used, utilizing secondary databases available for Ontario home care clients from the years 2010 to 2012. The data were derived from (1) Health Outcomes for Better Information and Care; (2) Resident Assessment Instrument-Home Care; (3) National Ambulatory Care Reporting System; and (4) Discharge Abstract Database. Descriptive analysis was used to identify the types and prevalence of adverse events experienced by home care clients. Logistic regression analysis was used to examine the association between therapeutic self-care ability and the occurrence of adverse events in home care. The results indicated that low therapeutic self-care ability was associated with an increase in adverse events. In particular, logistic regression results indicated that low therapeutic self-care ability was associated with an increase in clients experiencing: (1) unplanned hospital visits; (2) a decline in activities of daily living; (3) falls; (4) unintended weight loss, and (5) non-compliance with medication. This study advances the understanding about the role of therapeutic self-care ability in supporting the safety of home care clients. High levels of therapeutic self-care ability can be a protective factor against the occurrence of adverse events among home care clients. A clear understanding of the nature of the relationship between therapeutic self-care ability and adverse events helps to pinpoint the areas of home