Improving Geriatric Home Health Patient Care and Satisfaction

With many clients receiving home care over the age of 65, it is essential to understand how to care best for this population to be an outstanding agency. Though each client needs an individualized care plan, this article presents an overview of some commonly overlooked concerns affecting the geriatric client.

Complex Cases

Aging is not simple. The elderly often have complex health histories and comorbidities which can impact them 24/7. Of those over age 60, 80% have two or more chronic illnesses. Poor mobility, pain, sleeping and sensory disturbances or deficits, depression, anxiety, and dementia may layer on top of the most common chronic illnesses such as diabetes, heart and kidney disease. When your agency considers the interplay between a client’s complex medical history, medications, and their potential side effects in addition to the immediate focus area of care, health can be more readily restored. An improvement in mental health often follows an improvement in physical health. As a bonus, your agency could be given credit for going the extra mile. Is your home care agency considering what may be holding geriatric clients back?

Restorative Sleep

Healthy sleep equates to a healthier mind and body. The Journal of Clinical Sleep Medicine reports insomnia is very prevalent (over 50%) in older adults. It is well known that poor sleep negatively impacts several body systems, limits healing, and contributes to depression and anxiety. Sleep assessments are not routinely part of ongoing evaluation in the home, but the elderly population experiences poorer restorative sleep. Unfortunately, what is out of sight is often out of mind. Consider adding sleep assessments to client revisits. Your team should consider the following:

• Does the client have daytime sleepiness or report problems with getting to sleep or staying asleep?
• Is the client taking medications that can lead to sleep disturbances such as glucocorticoids, decongestants, antidepressants or diuretics taken too late in the day?
• Could the client have untreated sleep apnea, have had recent chemotherapy or radiation treatments, or anemia related to their chronic disease?

If a concern is noted with a client’s sleep, consider taking the following actions:

• Utilizing a variety of suggestions from the National Council on Aging for healthy sleep routines such as avoiding caffeine later in the day, getting outside during the day, and regular exercise
• Placing a note in the client’s chart that communications and visits should be later in the day when the client may be more alert if possible
• Contacting the client’s provider if the client may be experiencing a negative side effect of a medication to seek alternatives, or if the client may need an order for a sleep study to correct sleep apnea.

The Pain Truth

Pain is not an expectation with age, though sometimes American culture would disagree. The elderly have the highest rates of pain secondary to an underlying condition due to having more comorbidities. Advanced age also physiologically leads to a lesser pain threshold. Pain is poorly managed in older adults. Many elderly clients receiving home health services may also be experiencing acute pain from a recent surgery, infection, or fall which compounds the problem. Though pain is routinely addressed at the start of care or admission to home health, the assessment at subsequent visits may be lacking quality and action. Your team can better address the geriatric client’s pain by:

• Using simple language, identifying pain descriptors (aching, stabbing, shooting, dull, etc.) changes in pain quality, new onset or worsening pain, factors that make the pain worse or better, and the impact on their quality of life including daily activities and sleep
• Using a consistent, easy-to-use tool that is appropriate for the client (do they have dementia and staff need to utilize a more observational pain assessment tool?)
• Asking family if the client has had any changes that may indicate unmanaged pain (less active, depressed mood)
• Evaluating if the client is taking their pain medication(s) as prescribed, identifying if there is a possibility to increase their dosage or suggest to a provider an adjunct medication for better pain relief
• Suggesting the client utilize alternative pain modalities such as a heating pad prior to activity, a warm bath, or asking staff to call on their way to a visit to ensure the client takes their PRN pain medication.

Correcting a sleep problem and addressing unmanaged pain can improve a client’s mood, perception of, and participation in care. Ensure staff not only ask the questions and document but they are educated on who to contact when there is a concern. Ensure your agency has a home care software that can easily integrate assessment data and follow-up communication easily. Closed-loop communication will help clients feel better cared for while ensuring team members not present in the home are up to date on a client’s health status.

Caring Essentials

Not all caregivers have an innate ability to demonstrate care. According to Care.com, top complaints from recipients of care include poor communication, behavior that displays disrespect, and distractions during home visits. To improve satisfaction amongst geriatric clients within your agency, staff must be educated on topics of communicating well, how to avoid ageism, stereotyping and ensure the geriatric client does not feel they are a burden. Clients with underlying dementia require staff who especially have a calm demeanor and patience. Ensure your agency staff make elderly clients feel heard by utilizing suggestions for communication with the elderly from the Gerontological Society of America which include:

• Facing the client when talking at eye level
• Do not shout at those with hearing loss, speak slower and slightly louder
• Put away devices, try not to multitask while listening to the older adult, and avoid seeming rushed (even if you are behind!)
• Express genuine concern for fears related to aging, chronic illness and care needs.

Working in client homes allows an intimate view into a client’s life but clients also often feel vulnerable. Geriatric clients desire to age with respect and quality care, though the elderly may not always voice their concerns or symptoms. Your agency’s staff can advocate for geriatric clients by addressing commonly known health concerns and complaints. Ensure your home care agency does not lose sight of the basics of being well and well cared for.

Resources

1. Chronic disease cost and older adults
2. Most common chronic illnesses

Additional related blogs:

1. Caring for the baby boomer population
2. Increasing home health care patient engagement
3. Care plan oversight