Background Home care workers ( HCW s) increasingly provide long‐term and posthospitalization care for community‐dwelling adults with heart failure ( HF ). They observe, assist, and advise these patients, yet few studies have examined their role in HF . As the foundation for future interventions, we sought to understand the perspectives of HCW s caring for adults with HF . Methods and Results We conducted 8 focus groups in partnership with the Home Care Industry Education Fund, a benefit fund of the 1199 Service Employees International Union United Healthcare Workers East, the largest healthcare union in the United States. English‐ and Spanish‐speaking HCW s with HF clients were eligible to participate. Data were analyzed thematically. Forty‐six HCW s employed by 21 unique home care agencies participated. General and HF ‐specific themes emerged. Generally, HCW s (1) feel overworked and undervalued; (2) find communication and care to be fragmented; (3) are dedicated to clients and families but are caught in the middle; and, despite this, (4) love their job. With respect to HF , HCW s (1) find it frightening and unpredictable; (2) are involved in HF self‐care without any HF training; and (3) find the care plan problematic. Conclusions Although frequently involved in HF self‐care, most HCW s have not received HF training. In addition, many felt poorly supported by other healthcare providers and the care plan, especially when their clients’ symptoms worsened. Interventions that provide HF ‐specific training and aim to improve communication between members of the home health care team may enhance HCW s’ ability to care for adults with HF and potentially lead to better patient outcomes.

BACKGROUND: Readmission rates are high among heart failure (HF) patients who require home health care (HHC) after hospitalization. Although HF patients who require HHC are often sicker than those who do not, HHC delivery itself may also be suboptimal. OBJECTIVE: We aimed to describe the workflow of HHC among adults discharged home after a HF hospitalization, including the roles of various stakeholders, and to determine where along these workflow challenges and opportunities for improvement exist. DESIGN AND PARTICIPANTS: In this qualitative study, we used purposeful sampling to approach and recruit a variety of key stakeholders including home health aides, nurses, HF patients, family caregivers, physicians, social workers, home care agency leaders, and policy experts. The study took place in New York, NY, from March to October 2018. APPROACH: Using a semi-structured topic guide, we elicited participants' experiences with HHC in HF through a combination of one-on-one interviews and focus groups. Data were recorded, transcribed, and analyzed thematically. We also asked selected participants to depict in a drawing their understanding of HHC workflow after hospitalization for HF patients. We synthesized the drawings into a final image. KEY RESULTS: Study participants (N = 80) described HHC for HF patients occurring in 6 steps, with home health aides playing a main role: (1) transitioning from hospital to home; (2) recognizing clinical changes; (3) making decisions; (4) managing symptoms; (5) asking for help; and (6) calling 911. Participants identified challenges and opportunities for improvement for each step. CONCLUSIONS: Our findings suggest that HHC for HF patients occurs in discrete steps, each with different challenges. Rather than a one-size-fits-all approach, various interventions may be required to optimize HHC delivery for HF patients in the post-discharge period.

Yanick rolled into my office for the first time 2 years ago. She was recovering from surgery and learning how to navigate life with a wheelchair. While poring over her medical records the prior evening, I saw she also had rheumatoid arthritis, gout, diabetes, and coronary artery disease. I knew we would need to cover a lot during our 30-minute visit, so I quickly rearranged the room to make space for her chair and began to ask about her pain.I only got a few words in before I heard a knock on the door. Yanick smiled and motioned for me to open it."Hi-sorry, Doc. I was just rounding up our stuff in the waiting room. I'm Marie, her home health aide."Marie slipped into the room, carrying with her both of their jackets, a bag of medications, hospital discharge papers, and a notepad. She hurriedly took out a pen and asked, "What did I miss?" I turned toward Yanick, hoping to receive a sign of reassurance that it was OK for Marie to join our visit. She nodded.Yanick then focused on her phone, tapping at the screen and saying, "I want to make sure my daughter, Christine, is here, too."After 2 rings, a new voice filled the room: "Hi, Mom. Hi, Marie. Hello, Doctor. Ready when you are!" Yanick smiled, placed the speaker phone on the table, and looked up at me.And so began our 4-person visit.After several months, and many more 4-person visits, I realized that each of us played an essential but distinct role in Yanick's care. While I always directed my questions toward her, Marie and Christine often chimed in with important observations or questions."Did you tell the doctor about your stomach pain?" Marie whispered at the end of a visit, during which Yanick spent the majority saying she felt fine."Doc, did the records arrive from the orthopedist?" Christine asked one afternoon. "They said something is wrong with mom's knee." Before she mentioned this, I didn't know that Yanick had been to another orthopedist for a second opinion.Over time, I came to understand that their assistance went beyond what I saw in the office. Marie helped with activities of daily living (ADLs), such as bathing and toileting, but also took Yanick's blood pressure, cooked meals, and brought her to medical appointments. Christine, who worked full time, managed the medications, including picking them up from the pharmacy and arranging them in a pillbox. In addition to providing functional support, both caregivers emotionally supported Yanick during periods of heightened pain and disability.Although Yanick and her caregivers appear to be a novel arrangement, they are far from unique. Nearly 40 million Americans receive help at home from an unpaid family caregiver, most often a spouse or adult child. 1 And

The aim of the study was to determine the main factors contributing to hospital readmissions and their potential preventability after a coronavirus disease 2019 (COVID-19) hospitalization at 2 New York City hospitals.Methods: This was a retrospective study at 2 affiliated New York City hospitals located in the Upper East Side and Lower Manhattan neighborhoods. We performed case reviews using the Hospital Medicine Reengineering Network framework to determine potentially preventable readmissions among patients hospitalized for COVID-19 between March 3, 2020 (date of first case) and April 27, 2020, and readmitted to either of the 2 hospitals within 30 days of discharge.Results: Among 53 readmissions after hospitalization for COVID-19, 44 (83%) were deemed not preventable and 9 (17%) were potentially preventable. Nonpreventable readmissions were mostly due to disease progression or complications of COVID-19 (37/44, 84%). Main factors contributing to potentially preventable readmissions were issues with initial disposition (5/ 9, 56%), premature discharge (3/9, 33%), and inappropriate readmission (1/9, 11%) for someone who likely did not require rehospitalization. Conclusions:Most readmissions after a COVID-19 hospitalization were not preventable and a consequence of the natural progression of the disease, specifically worsening dyspnea or hypoxemia. Some readmissions were potentially preventable, mostly because of issues with disposition that were directly related to challenges posed by the ongoing COVID-19 pandemic. Clinicians should be aware of challenges with disposition related to circumstances of the COVID-19 pandemic.

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