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Older people account for a significant proportion of users of health and social care services (Wanless, 2006). Within current constraints on health and social care services, it is essential that interventions such as home visits for older people can be seen to be appropriately deployed resources for facilitating their safe and timely discharge home. This paper discusses the findings of an evaluation project undertaken in 2003/04 within two in‐patient intermediate care services. The service provided short‐term intervention for older people, with an emphasis on rehabilitation to enable a safe return to their own home environment. A government audit report in 2003 concerning effective discharge of older patients from NHS acute hospitals stated that delayed discharges are a significant problem, with 17% caused by delays in assessing patients, shortages of occupational therapists and lack of integrated therapy services (House of Commons, 2003).

Nurse home visiting programmes designed to reduce the likelihood of child maltreatment in families at risk have been widely implemented in Australia and overseas. The purpose of this paper is to examine the intensity and duration of maternal involvement in a nurse home visiting programme to prevent child maltreatment.

A retrospective, longitudinal design was employed. The clinical records of 40 mothers who had received nurse home visits following the birth of a new baby for at least six months, and had provided consent for their details to be accessed for research purposes, were selected for analysis. The influence of antenatal characteristics and well-being on maternal involvement in a nurse home visiting programme was examined using reliability of change indices.

Mothers with impaired family functioning reporting they experienced violence at home were more likely to leave the programme early and received fewer than the prescribed number of home visits compared to mothers who had been enroled into the programme for other complex psychosocial needs. At the same time, mothers enroled on the basis of impaired psychological functioning and who did not report violence in the home remained, and received more than the prescribed number of home visits over the course of their involvement.

Results showed that domestic violence increased the risk of poor engagement with a targeted nurse home visiting programme. At the same time, home visitors responded to complex individual and family needs by increasing the number of home visits accordingly. This theoretically based pilot research has helped to disentangle antecedents of maternal involvement and the subsequent impact on programme outcomes. Further investigation using a larger study sample is needed.

There is little published literature about the number of home visits provided to patients within forensic intellectual disability units, and there is no published data on variables that affect home visits. There is a need for a baseline audit that can formulate standards for future practice. The paper aims to discuss these issues.

This paper describes the home visit programme within a forensic intellectual disability service, and a baseline audit of the programme. The audit measured the number of home visits, any factors that adversely affect home visits, and the extent of family contact. The authors propose audit standards for evaluation of good practice in this area.

The audit involved 63 patients over a one-year period. In total, 81 per cent of patients had some form of family contact and 54 per cent of patients at least one home visit. However, 19 per cent of patients had no contact with their family due to a variety of reasons. There were no significant differences in the number of home visits between men and women, patients on civil vs criminal sections or those treated “within area” or “out of area”. Patients in rehabilitation wards had significantly more visits than those in low or medium secure.

Conventional wisdom is that reduced family contact is the direct result of patients being placed “out of area”. The results of this audit suggest that, at least in this group, the reasons may be much more nuanced and that the current definition of “out of area” has to be improved to incorporate the actual distance between the patient’s current family home and the service. Audit standards have been proposed to monitor family contact and home visits. Future work should focus on the relationship between family contact and treatment outcomes.

Home visiting is a strategy widely implemented to support families following the birth of a baby. There is a broad consensus that home visiting programmes are successful. But there is little understanding of factors moderating this success. The purpose of this paper is to examine the relationship between maternal involvement in a nurse home visiting programme, maternal depression, and adjustment to the parenting role.

A retrospective design was employed in which the medical records of 40 mothers who had been enroled in a nurse home visiting programme were examined. The number of nurse home visits from birth to six months, maternal depressive symptoms, Home Observation for Measurement of the Environment (HOME) and responsivity scores were examined. Mothers had been selected for the programme if they had a history of mental illness, were in a violent relationship, or reported drug or alcohol problems.

A significant, positive relationship was found between maternal involvement, positive HOME environment and maternal responsivity scores. Furthermore, the mothers with the highest scores for HOME environment and responsivity to their infant ' s cues at six months were mothers experiencing deteriorating symptoms of depression. These mothers had the highest levels of involvement with the programme. Despite their mothers’ deteriorating mental health, infants whose mothers received the greatest number of visits from a nurse received the greatest benefit ameliorating their risk for developing poor attachment and impaired behavioural, emotional and cognitive development.

This is the first study to examine the relationship between changes in maternal depression and programme outcomes in a home visiting programme. It is one of the first explorations of the relationship between maternal involvement and programme outcomes in a targeted nurse home visiting programme to prevent child maltreatment. The findings from this study are critical to future home visiting programme development and evaluation.

Discharge planning home visits (DPHVs) are a routine part of occupational therapy clinical practice. However, there is a dearth of evidence to support or refute their efficacy and limited policies or standards to guide clinical practice. This study aims to investigate current clinical practice during home visits and the value that occupational therapists’ attribute to home visits within an Irish context.

Data collection was carried out by using a survey questionnaire (postal and electronic options). The study population comprised occupational therapists across 52 sites including acute, rehabilitation and convalescence settings within the Republic of Ireland. In total, 122 occupational therapists that completed the survey questionnaire were recruited for the study.

Quantitative data identified time spent per visit, departmental size, hospital size, number of visits and report writing times. Information was gathered regarding clinical areas assessed during visits in a Likert scale format. Qualitative data identified benefits, risks, recommendations to improve home visit practice and clinical criteria for home visits. Findings conclude that DPHVs are routinely carried out by occupational therapists and that there is consistency in clinical practice within an Irish setting. Occupational therapists value home visits as clinical assessments and have identified risks during practice, benefits of visits and ways to improve practice.

This study has provided a reflection of clinical practice in the Republic of Ireland. It is the only study of its kind in an Irish setting, and it could be used as a knowledge base regarding current practice on DPHV and occupational therapists’ clinical reasoning regarding home visits. The information gathered in this study could influence policies regarding DPHV and could serve as a comparison to standardise practice and justify the need for DPHV.

Employing a participatory approach, the purpose of this paper is to identify possible areas for improvement in visiting nurses’ post-hospital medication management and to facilitate suggestions for changes in future practices.

Based on a previous study on visiting nurses’ post-hospital medication management, two workshops were conducted in a visiting nurse department in a Danish municipality.

The visiting nurses emphasised knowledge of patients’ basic needs and prioritised their performance of context-specific nursing assessments, with a preventive focus as a prerequisite for improved patient safety in post-hospital medication management.

The participatory approach can increase the acceptability and feasibility of changes regarding future practices and thereby reduce the gap between official documents and daily practice. Although the local development of suggestions for changes in practices does not provide general knowledge, a subsequent detailed description of the changes in practices can promote transferability to other healthcare settings after local adjustments are made.

Flexible home healthcare, with stable relationships enabling the continuous assessment of the patient’s needs and symptoms, along with subsequent adjustments being made in care and medical treatment, might enhance patient safety in post-hospital medication management.

This paper adds to the knowledge of the need for integrated care in medication management in patients’ homes. It argues for primary healthcare professionals as “experts in complexity” and suggests a reconsideration of the purchaser-provider division of care to patients with unstable health conditions and complex care needs during the first days following hospital discharge.

As part of a pilot studyassessing the feasibility of record-linking health and social care data, the purpose of this paper is to examine patterns of non-delivery of home care among older clients (>65 years) of a social home care provider in Glasgow, Scotland. The paper also assesses whether non-delivery is associated with subsequent emergency hospital admission.

After obtaining appropriate permissions, the electronic records of all home care clients were linked to a hospital inpatient database and anonymised. Data on home care plans were collated for 4,815 older non-hospitalised clients, and non-delivered visits were examined. Using case-control methodology, those who had an emergency hospital admission in the next calendar month were identified (n=586), along with age and sex-matched controls, to determine whether non-delivery was a risk factor for hospital admission.

There were 4,170 instances of “No Access” non-delivery among 1,411 people, and 960 instances of “Service Refusal” non-delivery among 427 people. The median number of undelivered visits was two among the one-third of clients who did not receive all their planned care. There were independent associations between being male and living alone, and non-delivery, while increasing age was associated with a decreased likelihood of non-delivery. Having any undelivered home care was associated with an increased risk of emergency hospital admission, but this could be due to uncontrolled confounding.

This study demonstrates untapped potential for innovative research into the quality of social care and effects on health outcomes.

Non-delivery of planned home care, for whatever reason, is associated with emergency hospital admission; this could be a useful indicator of vulnerable clients needing increased surveillance.

The aim of this study was to test whether the client homebound score (CHS), the case management intensity score (CMIS) and the client priority visit score (CPVS) could be used to predict in‐home time of professional caregivers in the Aspen community care program. A random sample of 34 community care clients from the different geographical areas of the Aspen Regional Health Authority was selected and the home visits for each client were tracked for three months. Information such as client demographics, the client diagnostic category, number and in‐home time of visits was collected. In addition, the CHS, the CMIS and the CPVS were measured for each client. Data were analyzed, using a robust variance estimator regression model. CMIS was found to be the best predictor of in‐home time (coefficient 9.521, p > 0.001), followed by the CHS and the CPVS.

The conventional wisdom suggests that the lack of prior host country-specific experience and a higher institutional distance deter multinational enterprises (MNEs) from entering a foreign country. However, past studies report that Chinese MNEs show an unconventional risk-taking behavior choosing foreign locations, where they have no prior experience or there is an increased institutional distance. Drawing on the institutional theory, the purpose of this paper is to argue that Chinese Government official visits to the host country may act as a risk-reduction device, thus providing an explanation for such an unconventional behavior.

The authors develop two hypotheses regarding how Chinese Government official visits moderate the impact of host country-specific experience and institutional distance on the location choice of Chinese MNEs. The authors test the hypotheses using a sample of investment location decisions by Chinese MNEs in Latin America.

The authors find that government official visits mitigate the lack of firm’s prior host country experience. However, only high-level government visits reduce institutional distance.

The authors contribute to the international business literature by analyzing how home country government diplomatic activities may pave the way of host country institutional environment for foreign MNEs from that home country. In addition, the authors provide an additional explanation for the unconventional risk-taking behavior of Chinese MNEs. Finally, the authors also contribute to a better understanding of the decision-making process of emerging-market MNEs entering other emerging economies.

This article describes one of the issues that arose from my research into the Longcare abuse scandal: how local authorities place learning‐disabled adults in out‐of‐area settings far from their original homes, and then fail to visit them regularly to check on their welfare. It describes the failings of three local and health authorities in the Longcare case, and then reveals that the problem was not confined to those authorities that placed adults at the Longcare homes. It also suggests that placing vulnerable adults in out‐of‐area homes puts them at a greater risk of abuse. The article concludes that, ten years on from the exposure of the Longcare regime, many local authorities are still placing vulnerable adults in out‐of‐area homes and failing to visit them. It calls for a national audit of out‐of‐area placements and for measures to be introduced to allow learning‐disabled adults to live in placements closer to their families and friends… and care managers.