Center for Health Care Law

BackgroundChina’s healthcare system is confronting a rising burden of antimicrobial resistance, chronic complex diseases, and an aging population requiring long-term, post-acute care. As a value-based care model in the USA for over 50 years, home infusion therapy (HIT), combined with home health services (HHS), presents a sustainable alternative to prolonged hospitalization for intravenous medication administration. In this two-part narrative review, Part 1 provides a needs assessment describing the demographic, clinical, and public health factors driving the demand for HIT and HHS in China.MethodsWe conducted a literature search up to January 2026 using MEDLINE, EMBASE, PubMed, Web of Science, and China National Knowledge Infrastructure.ResultsIn Part 1, we present the impact of the aging population and chronic conditions requiring prolonged infusion therapy (including cancer, malnutrition and infections like osteomyelitis, endocarditis, and bacteremia) on the rising antimicrobial resistance, hospital burden and healthcare expenditures. Through the patient-centric solution of HIT and HHS, patients can receive intravenous medications and nutrition in the comfort of their homes, enabling the continuity of care beyond the hospital. Services include outpatient parenteral antibiotic therapy, hospice and palliative care in patients with cancer, and management of nutritional needs through total parenteral nutrition. Under this care model, reimbursement is tied to success in improved patient outcomes and reduced hospital readmissions. A detailed reimbursement and cost-effectiveness considerations are addressed in Part 2 of this review.ConclusionWith proper infrastructure development and reimbursement mechanisms that align payment with value, HIT and HHS could mitigate antimicrobial resistance, and transform and sustain affordable care delivery in China, especially for older adults and those with chronic conditions.Part 2 is available at https://doi.org/10.3389/fpubh.2026.1761870.

Health coaching has been shown to reduce heart failure (HF) caregiver stress and increase caregiver engagement in healthy lifestyle behaviors ("self-care"). The objective of this study was to examine potential downstream effects of improvements in self-care of the caregiver on HF patient hospitalization outcomes. Data were from a randomized controlled trial testing the efficacy of a health coaching intervention versus information-only control on HF caregiver self-care. Self-care of the caregiver was measured using the Self-Care Inventory. Care recipient hospitalizations and hospitalization days were abstracted from the medical record. Zero-inflated negative binomial models were used to assess the extent to which caregiver self-care improvement, of any degree and regardless of intervention condition, was predictive of patient hospitalization and hospitalization days, adjusting for common confounders. The sample included 125 HF patient-caregiver dyads from both groups, 61.6% of which were spousal/partnered. Nearly two-thirds (62.4%) of caregivers demonstrated self-care improvement. Approximately a quarter (25.6%) of patients experienced at least one hospitalization. Adjusting for confounders, patients with caregivers who improved in self-care experienced significantly fewer hospitalizations (IRR 0.332, 95% CI 0.131, 0.841, p=0.02). No significant effect was observed for hospital days (IRR 0.773, 95% CI 0.271, 2.206). Improvement in HF caregiver self-care was associated with a 67% decrease in patient hospitalizations. Our findings support additional investment in research, programs, and policies that support caregiver health. Our findings may also reassure caregivers, patients, and clinicians that investing time in supporting caregiver health is time well spent and may have potential benefits for patient outcomes. ClinicalTrials.gov, [NCT number blinded for review].

Abstract BackgroundAs interest shifts from a biomedical, task‐based approach to dementia care to a more person‐centered approach, understanding and adoption of behavioral, non‐pharmacological approaches to supporting people living with Alzheimer’s disease and other dementias (PwD) is increasing. Previous research has identified that the quality of the assessment and care plan is associated with the quality of care delivery and likelihood of a person‐centered approach. Home care agencies are an important but understudied source of nonmedical care for PwD. Having dementia‐specific tools to aid in the design and delivery of care can help support person‐centered care delivered by home care teams.MethodA brief web‐based memory care plan tool targeting care goals, care challenges, and techniques was piloted in two offices in the United States with a sample of people living with dementia (N = 34) receiving professional home care services. Nine individuals in care management‐type positions overseeing the nonmedical home care completed the memory care supplements for existing clients over two weeks. The care managers also completed a survey about their experience with the tool.ResultsThe tool was identified as acceptable and useful by the care managers. The three most common care goals identified were the following: providing cognitive engagement and stimulation, preventing challenging behavioral expressions, and reducing social isolation. The three most common challenges were the following: anosognosia, resistance to accepting care in the home or resistance toward the personal care approach, and communication challenges. An important functional aspect of the tool that was identified was the necessity of fillable free text options alongside structured responses to allow care managers to personalize goals, challenges, and techniques.ConclusionThese findings support the feasibility of a brief web‐based tool that can be completed in under 10 minutes developed to identify key care goals, challenges, and associated techniques for people living with dementia. Given the feasibility and acceptability of incorporating this tool into the broader home care assessment, a methodologically robust trial should be considered to further explore the effectiveness and value of the tool on outcomes relevant to the PwD and care partner.

Abstract BackgroundThere has been a growing commitment to incorporating the life stories of people with dementia as part of their person‐centered care. Although there has been some research exploring the role of life story work and reminiscence therapy on various dementia‐related outcomes, there has been relatively little scholarly work examining best practices for the incorporation of the life stories of people with dementia as part of a person‐centered assessment. The aim of this scoping review is to examine the themes and gaps associated with undertaking life history/life story assessment (LSA).MethodTwo databases (PubMed and PsychINFO) were searched from inception through October 1st, 2021 for English‐language articles and books using keywords relating to life story and dementia. The search returned 119 articles after removal of duplicates with 28 selected for inclusion into the review.ResultSix key themes emerged, including 1) the lack of a standardized approach or best practices in LSA, 2) differing goals in LSA (e.g., the creation of a life story book for reminiscence therapy versus the collection of data to help guide carer interactions), 3) the importance of flexibility in collecting information, 4) the role of close others as collateral sources of information, 5) the potential for one’s own biases and context to influence how and what information is collected, and 6) the role of technology in facilitating LSA.ConclusionIncorporating LSA is an important aspect of person‐centered care for people with dementia, yet there is little guidance on how to best approach the assessment. There are gaps in understanding the administration and mechanisms of LSA and the role of LSA in guiding daily care interactions and carer impacts (e.g., self‐efficacy in caring). There is a need for tools and guidance to enable individuals with varied professional backgrounds and disparate cultural contexts to collect life stories that are inclusive and encompass the many salient identities that a person with dementia might hold.

Unmet needs for family caregiver assistance threaten patient outcomes during Medicare home health care (HHC). Sepsis survivors represent a growing proportion of the HHC patient population, but little is known regarding their risk for unmet caregiving needs. We describe prevalence and underlying cause of unmet caregiving needs for sepsis survivors receiving HHC, using HHC patient assessment data for 85,851 older sepsis survivors receiving post-acute HHC in 2013-2014. Unmet caregiving needs were most common for assistance with Activities of Daily Living (ADLs) (28%) and medication administration (27%). Caregivers' need for training accounted for more than three-fourths of all unmet caregiving needs. Those who experienced decline/no improvement in cognitive function were more likely to experience unmet caregiving needs. Findings highlight the potential value of expanding family caregiver training to improve HHC outcomes for sepsis survivors and indicate that caregivers of sepsis survivors with poor cognitive function may benefit most.

Home health care is one of the fastest growing health care sectors in the United States. However, little is known of differences in trends in quality performance between rural and urban home health agencies over time. This study aimed to examine disparities in quality performance between rural and urban home health agencies between 2014 and 2018. This is a cohort study using 2014-2018 national Home Health Compare data and Providers of Service Profile data, including 7,908 home health agencies, of which 1,537 were rural agencies. Quality performance measures included timely initiation of care, hospitalization, and emergency department (ED) visits. Two-level hierarchical regression models were used to identify rural-urban differences in these quality indicators over time when controlling organizational characteristics. Rural agencies were less likely to be for-profit and accredited, and more likely to be hospital-based, serve both Medicare and Medicaid beneficiaries, and have hospice programs. Rural agencies consistently outperformed on timely initiation of care over time, and urban agencies consistently outperformed on hospitalization and ED visits over time. These gaps between rural and urban agencies were steady over time except the gap in hospitalization, which slightly narrowed over time (Coef. = 0.11, P = .001 for urban and year interaction term). Significant differences exist in quality of care between rural and urban home health agencies and such differences have not been significantly narrowed over time. To reduce rural-urban disparities, policy makers should take into account unique challenges faced by urban and rural agencies when making policy decisions.

Home-based primary care (HBPC) practices rapidly adapted to maintain care during the COVID-19 pandemic. This mixed-methods national online survey of HBPC practices probed responses to COVID-19 surges, COVID-19 testing, the use of telemedicine, practice challenges due to COVID-19, and adaptations to address these challenges. Seventy-nine practices across 29 states were included in the analyses. Eighty-five percent of practices continued to provide in-person care and nearly half cared for COVID-19 patients. Most practices also pivoted to concurrent use of video visits. The top five practice challenges were: patient familiarity with telemedicine, patient and clinician anxiety, technical difficulties reaching patients, and supply shortages. Practices also described creative strategies to physically support the needs of patients. These findings illustrate the need to balance in-person and virtual care for this population, and attend to the emotional needs of patients and staff.

Homeschooling is legal and growing in many countries but is virtually forbidden by law in Germany and a few others. The European Court of Human Rights (ECtHR) has reviewed and upheld this ban. Is home education a human right? How do these courts employ their jurisprudence of proportionality to find banning home education does not violate relevant constitutional or human rights norms? Why does Germany forbid home education? Why does the ECtHR uphold Germany’s position? What does this divergence imply about the right of home education and the jurisprudence of these courts? If the promise of human rights is individual liberty then a system that justifies or endorses state control of education for the purpose of cultural conformity can be said to be far too statist for a free and democratic society. In this article, I argue that both the German Constitutional Court (FCC) and the ECtHR have adopted an approach to education rights that is profoundly mistaken. I conclude that home education is a right of parents and children that must be protected by every state. Nations that respect and protect the right of parents and children to home educate demonstrate a commitment to respecting human rights; nations that do not, such as Germany and Sweden need to take steps to correct their failure to protect this important human right.

The states' participation in implementing the provisions of the Affordable Care Act will shape the form those provisions ultimately take.