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

Informatics

Laura Kneale

(lkneale@uw.edu), Anne Ordway

(ordwaa@u.washington.edu), Kurt Johnson

(kjohnson@uw.edu),

George Demiris

(gdemiris@uw.edu)

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 certiﬁcation test.

The purpose of this training is to ensure that all home care aides meet the basic qualiﬁcations necessary to carry out their

tasks.

Despite the routine nature of the services that they provide, home care aides are considered a signiﬁcant 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 identiﬁed 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-aﬃliated 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

notiﬁcation 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 ﬁndings show that there may be additional opportunities for technology

interventions to increase the eﬃciency 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 ﬁndings indicate that home care aides, due to the increasingly important role

that they play in care in the home, could potentially beneﬁt from informatics to ols to increase the eﬃciency and eﬀectiveness

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

H3IT: Home Healthcare, Hospice, and Information Technology Conference Chicago, IL, 2016

care and increase home health aides’ conﬁdence. Furthermore, we need to explore how technology can be integrated into the

home health aide training program.

References

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

03/13/2017).

3. Oﬃce of Program Research Summary of Initiative 1163 Olympia, WA: State of Washington House of Representatives.

2011.

4. Choitz, V, Helmer, M, and Conway, M. Improving Jobs to Improve Care. Washington DC: The Aspen Institute. 2015.