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Home Healthcare, Hospice, and Information Technology Innovations Conference

Innovations in Home Healthcare, Hospice, and Information Technology

A forum towards achieving evidence-based diffusion and implementation of innovations

Fri, Nov 3, 2017
Friday, Nov 3, 2017, Washington - D.C.
H3IT: Home Healthcare, Hospice, and Information Technology Conference Chicago, IL, 2016
Understanding Information Exchange between
Home Care Clients and Aides: Opportunities for
Laura Kneale
(lkneale@uw.edu), Anne Ordway
(ordwaa@u.washington.edu), Kurt Johnson
George Demiris
n 2014 it was estimated that over 2 million individuals in the United States used formal personal care services
provided by paid, non-skilled care providers such as home care aides.
Although some individuals pay out of
pocket for these services, Medicaid in many states, including Washington State, provide home care aides for
older adults or disabled individuals who need support to stay in their homes. Home care aides in Washington
State support consumers with meal preparation, personal care activities, and light housekeeping.
Traditionally, due to their
scope of work, home care aides have not been required to complete comprehensive training; however, in 2011 Washington
State passed a law that required all home care aides to take standardized training courses and pass a certication test.
The purpose of this training is to ensure that all home care aides meet the basic qualications necessary to carry out their
Despite the routine nature of the services that they provide, home care aides are considered a signicant resource for
individuals that utilize their services.
Methods: We performed a secondary data analysis on transcripts from home care client and aide interviews that were
conducted between October 2014 and March 2015. The initial interviews gathered home care client and aide opinions on
the new Washington State home care aide training program. During the initial data collection, the interviews were audio
taped and transcribed. For the secondary data analysis, we identied excerpts from the interviews that discussed technology
use and/or information exchange between home care clients and aides. Each excerpt was coded along a number of salient
dimensions, such as topic, thematic content, and general sentiment.
Results: Twenty-seven participants (17 clients and 10 home care aides) were interviewed. The average age of the home care
aides was 45 years (range 26 to 64 years), and the average age of the home care clients was 53 years (range 31 to 71 years).
Independent and agency-aliated home care aides were equally represented. Both home care aides and clients considered
communication key to a successful client-aide relationship. Clients and aides regularly exchanged information about home
care schedules, the work of caregiving, and a range of interpersonal topics including family and hobbies. Most of the com-
munication was conducted face to face. Telephones and paper were used to communicate daily schedules, appointments, and
schedule changes. Other forms of technology were not used in information exchange between aides and clients even though
mobile telephones and computers were mentioned as potentially useful tools to support caregiving tasks. Participants also
discussed the challenges with communication and information exchange. Clients expressed frustration with several aspects
of care including having to continually train new home care aides on personal preferences and care needs, and the lack of
notication for last minute service disruptions that can be particularly challenging for clients that relied on aides to support
important activities such as fo od preparation and grocery shopping. In addition, home care aides also expressed frustration
with the clients’ lack of communication about their individual care needs, and often felt unprepared when arriving at a new
client’s home.
Discussion: Information exchange is critical for the success of the client-aide relationship in home care. Face to face
communication is most often used, however, our ndings show that there may be additional opportunities for technology
interventions to increase the eciency and reach of the information exchange. Informatics could help aides with communica-
tion, documentation, and with tasks related to care facilitating continuity of care and improving patient safety. For example,
technology could be used to help clients clearly express their individual needs and preferences, and communicate these needs
to aides prior to service. This may reduce the uncertainty from both the client’s and the aide’s perspective when starting a
new relationship. In addition, aides could use technology resources to supp ort caregiving tasks such as foot exams for clients
with diabetes.
Conclusion: Technology interventions in home and hospice care have often focused on skilled care providers such as home
health nurses, physicians, and therapists. Our ndings indicate that home care aides, due to the increasingly important role
that they play in care in the home, could potentially benet from informatics to ols to increase the eciency and eectiveness
of their services. More research is needed to better understand the current use of technology in home care encounters, to
specify the needs of home care aides and clients and to identify how technology can support care co ordination, continuity of
University of Washington, School of Medicine, Biomedical and Health Informatics
University of Washington, School of Medicine, Department of Rehabilitation Medicine
University of Washington, School of Nursing
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H3IT: Home Healthcare, Hospice, and Information Technology Conference Chicago, IL, 2016
care and increase home health aides’ condence. Furthermore, we need to explore how technology can be integrated into the
home health aide training program.
1. Forum on Aging, D et al. The Future of Home Health Care: Workshop Summary. National Academies Press (US), 2015.
2. Services that help an adult remain at home | Washington State Department of Social and Health Services. https:
//www.dshs.wa.gov/altsa/home- and- community- services/services- help- adult- remain- home. (Accessed on
3. Oce of Program Research Summary of Initiative 1163 Olympia, WA: State of Washington House of Representatives.
4. Choitz, V, Helmer, M, and Conway, M. Improving Jobs to Improve Care. Washington DC: The Aspen Institute. 2015.
Copyright © 2016 by Maryland Health Information Technology LLC Creative Commons License c bnd 43