Northwestern University Feinberg School of Medicine

Institute for Public Health and Medicine

Advance Planning for Home Services for Seniors

May 15, 2013

Background: Remaining in their own home is one of the highest priorities of most seniors. Seniors often do not have an understanding of home care services. Likewise, seniors do not understand their health trajectory or plan accurately for future needs, which leads to them not remaining safely in their homes as long as they could. Seniors rarely believe that they will be hospitalized, although people aged 65 years account for 35% of hospitalizations annually. As a result of hospitalizations, seniors experience functional decline with placement in nursing homes. Seniors are often left out of critical decision making on their long-term care. Stressed family members choose nursing facilities while the senior is hospitalized and, in many cases, make decisions to move seniors out of their homes.

If seniors and their families understand home care services and plan for health events (e.g., hospitalizations, functional loss), then seniors could potentially remain safely in their homes longer. The goal of this proposal is to develop and test an advance planning tool to help seniors understand projected health needs and plan ways to remain in their own homes when these crises occur.

Objectives: Through partnerships with seniors, senior community groups, area agencies on aging, and homecare agencies, we plan to:

Aim 1: Develop, pilot test, and refine an Advanced Planning for Home Services (APHS) Tool to assist seniors in making informed choices about issues in their health trajectory that influence their ability to remain in their own home.
Aim 2: Conduct a randomized controlled trial of the APHS Tool intervention to determine subject
understanding of home care services and health trajectory and other patient-centered outcomes.
Aim 3: Disseminate the APHS Tool nationally through senior focused organizations (Home Care Association of America, Village to Village Network).


Methods: The APHS Tool will be developed by seniors and tested by seniors, for use by seniors with the partnership of university-based researchers. For Aim 1, focus groups with seniors and caregivers will be conducted with results informing the content/design of the APHS Tool. The tool will be tested in electronic and paper formats with 50 seniors each to inform further refinement of the tool.

In Aim 2, a randomized controlled study of the APHS Tool will be conducted with 600 community-living seniors with attention control as one arm and APHS Tool as the other arm. Patient-centered outcomes of understanding of health trajectory, understanding of home services, knowledge on access to home services, and communication with their families/health providers will be examined. In Aim 3, the APHS Tool will be actively disseminated among the senior-focused national organizations of the Village to  Village Network, Home Care Association of America.

This study will produce a viable advance planning for home services tool that will enable seniors to make informed decisions about safely living at home.

Visit PCORI for more information.

Center:Patient-Centered Outcomes

Funder: The Canadian Patient Safety Institute

Principal Investigator: