What Senior Housing Can Learn from a Harvard Home Care Pilot

Senior living providers could benefit from a caregiver tool currently being studied by Harvard Medical School, despite its aim to improve outcomes for private duty home care recipients. 

While home care plays a crucial role in reducing avoidable hospitalizations, senior living operators have similar goals of keeping residents healthy and avoiding costlier care. The study, which was conducted over six months in early 2016, found that caregivers who utilize a short checklist about their patients’ conditions were able to report a number of changes that could result in more serious care interventions if left untreated. While the study looked at home care patients, residents living in senior living communities could similarly be tracked for changing conditions, the study’s authors say. 

“The study is about detecting changes in condition in real-time among recipients of private duty home care,” David Grabowksi, Ph.D., one of the authors of the study and a professor of health care policy in the Department of Health Care Policy at Harvard Medical School, told Senior Housing News. “We know lots of senior living residents receive home care. Either way, this kind of innovation has a lot of potential to help manage changes in condition.”


The study examined 22 offices with Right at Home (RAH), a home care company with more than 310 offices in 45 states. The company operates on a franchise model, and offers three levels of care, including companion, personal care, and skilled care. 

Caregivers were required to clock-in and clock-out of a web-based software platform by ClearCare that operates for visit scheduling, integrated telephony for point-of-care reporting, two-way caregiver messaging and other managerial functions. The check-in moments, which were designated at the beginning and end of a shift for payroll purposes also included a checklist about their patients.

Check-in, Check-out 


The checklist was administered when caregivers clocked out telephonically, which required them to answer a number of questions devised by the study authors, ClearCare and RAH in 2014. The checklist asked a number of questions, such as, ”Does the client seem different than usual? Has there been a change in mobility, eating or drinking, toileting, skin condition or increase in swelling?”

“The hypothesis is that by doing this tracking in real-time and managing those conditions, we will prevent hospitalizations,” Grabovski told SHN. 

If a caregiver notes any changes in condition, they receive additional questions before receiving a task on the system dashboard of the office’s care manager. The care manager can use that task, along with more information from the caregiver, to determine potential actions for the patient. 

“Most interviewees suggested that changes in condition would not have been reported without the in-home checklist,” the study reads. “They also reported relatively few ‘false positives’ in that they felt that most of the tasks warranted attention.”

While a home care agency tracks patients from its office, a senior living community could possibly take the tool one step further by having more staff available to manage changes in condition, right there on the floor with the resident, Grabowski said.

“There is real potential, given the amount of home care within assisted living settings, to manage changes in condition” Grabowski said. “The only touch we had with the care recipients was spread out, through the caregivers. Senior living has another group of individuals to help manage conditions. Here, we had a care manager. With assisted living, you’d have a whole set of potential personnel.”

During the course of the study, caregivers throughout the 22 RAH offices that participated reported condition changes after 2% of all shifts, representing an average 1.9 changes per care recipient. There were 402 hospitalizations over the study period, or 18 hospitalizations per office on average. 

Caregivers noted that the changes likely wouldn’t have been tracked if the checklist weren’t in place. However, care managers had varying views on the system.

“Certain care managers expressed concern that they already had systems in place to track changes in condition and hospitalizations and questioned the need for the In-Home intervention,” the study reads. “One care manager explained that, before the In-Home pilot, caregivers would call the office to report a change in an individual’s condition. Thus, she felt that the In-Home program was somewhat redundant.”

Other issues with the tracking were related to care recipients with chronic conditions that flared up occasionally. Right at Home staff reportedly said the checklist was not the right mechanism for chronic conditions, because many of these changes were caused by predictable flare-ups. 

Fortunately, caregivers reported that the checklist had a largely positive effect and felt “enthusiastic about the intervention,” according to the study. They even noted that the checklist did not add much time to the clock-out process overall, and enjoyed feeling they had a larger role in the overall care of the care recipient.

The next phase of the study will track hospitalizations and the care of a wider set of patients. More than 200 home care agencies across the country are currently being brought on to utilize the intervention tool. The full trial is expected to touch more than 100,000 unique individuals over the course of the study, or about 14,000 care recipients participating at any given time.

“It wasn’t what we did at this stage, but there’s real potential given the additional resources in senior living and add-on additional resources around this kind of program,” Grabowski said. “It could be done the way we have designed it here or bring in additional resources from senior living. There’s real relevance, a real business case.”

Written by Amy Baxter

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