Using Timed Automata Framework for Modeling Home Care Plans

Background: Older persons want to remain in their own homes as long as possible, making home care services essential for maintaining independence, completing daily activities and delaying entry into institutional care 1. While home care has the potential to improve health and well-being and reduce health care costs, provision of these services to the geriatric population is complicated by complex, multi-morbid health issues requiring care from a range of providers who work in isolation of each other. Improved integration from planning through delivery is a key priority for Canadian home care 2. Aims: This study aimed to develop an implementation framework for an integrated geriatric care planning approach in home care. Key objectives were to: a investigate current geriatric assessment practices; b collect ideas for improving person- and family-centred goal setting; and c co-design solutions for more integrated geriatric care planning with older adults, family caregivers and health care providers. Methods: This study applied a sequential transformative mixed methods design 3. Quantitative data were collected through a web-based survey that was developed with and delivered to frontline home health care nurses, occupational therapists and physiotherapists n=303. Qualitative data were collected in-person through solutions-focused key informant interviews with older adults and family caregivers n=24. Statistical and thematic analysis of the data was iterative and ongoing. Survey and interview data were brought together during the interpretation phase, where older adults, family caregivers, and health care providers n=19 were engaged in a workshop to co-design solutions for more integrated geriatric home care planning. Results: An implementation framework for integrated geriatric care planning in home care was developed. Components of the framework include: a common clinical and non-clinical information needed by everyone involved; b key touch points and actions for achieving the integrated care planning experience everyone involved wants; and c nine ideas for tools and technology to support integrated data collection, goal-setting and communication. Conclusions: Older adults, family caregivers and health care providers have both common and unique needs for sharing and receiving information to support planning care in the home. Home care planning should begin with a holistic baseline understanding of an individual person that prioritizes and applies information on personal background, goals, needs and preferences in seeking to understand individuals’ health challenges and plan for their care. Limitations: This study was conducted in a single region within Ontario, Canada. Suggestions for Future Research: Next steps for this research include additional co-design workshops in other regions, to develop prototypes of these new processes and tools for integrated geriatric care planning to be pilot tested in home care practice.

Post-surgery care involves ongoing collaboration between provider teams and patients, which starts from post-surgery hospitalization through home recovery after discharge. While prior HCI research has primarily examined patients' challenges at home, less is known about how provider teams coordinate discharge preparation and care handoffs, and how breakdowns in communication and care pathways may affect patient recovery. To investigate this gap, we conducted semi-structured interviews with 13 healthcare providers and 4 patients in the context of gastrointestinal (GI) surgery. We found coordination boundaries between in- and out-patient teams, coupled with complex organizational structures within teams, impeded the "invisible work" of preparing patients' home care plans and triaging patient information. For patients, these breakdowns resulted in inadequate preparation for home transition and fragmented self-collected data, both of which undermine timely clinical decision-making. Based on these findings, we outline design opportunities to formalize task ownership and handoffs, contextualize co-temporal signals, and align care plans with home resources.

Workforce planning in home social care services is becoming increasingly complex due to increasing demand, limited budgets, and the need for personalized and geographically distributed care. An emerging strategy involves the territorial organization of care delivery, where cities are partitioned into subareas managed by local caregiver teams. Although this model fosters continuity and familiarity between caregivers and users, it introduces operational challenges, particularly in managing fluctuating demand and ensuring efficient staff allocation. This paper addresses these challenges by proposing the Home Care Islands Optimization framework, which supports tactical decision-making in home care planning. The approach integrates two allocation mechanisms: (i) exclusive assignments of caregivers to specific subareas (referred to as islands) and (ii) a flexible floating team capable of operating across different islands. The model also allows for strategic merging of islands to improve resource utilization. This work is the first to integrate tactical workforce planning and territory merging under demand variability in home care. We develop a single-period Integer Linear Programming model that determines optimal hiring strategies, contract types (full-time vs. part-time), and team distribution and allocation while minimizing both non-served demand and cost. The methodology is applied to a real-world case study based on Barcelona’s public home care system, with data provided by the City Council. Through extensive computational experiments, we explore the impact of key parameters on the quality and structure of the solution. We show that non-served demand is eliminated when the tolerance parameter γ ≥ 30 , while the budget variability stabilizes only when γ ≥ 40 . Regarding the composition of the workforce, the share of part-time contracts decreases once α ≥ 10 , and the size of the floating team never exceeds 6–7 caregivers. Moreover, under higher demand variability, the minimum γ required for system stability rises, and the model tends to rely more heavily on part-time and floating caregivers; however, setting α = 11 effectively controls this effect and promotes employment stability. The framework offers a robust and flexible planning tool for public service managers, enabling data-driven decisions that improve service continuity, workforce stability, and system adaptability in the face of uncertain and variable demand. • Optimization model for tactical workforce planning in home social care services. • Integrates fixed local teams and a flexible floating team for better adaptability. • Supports territory merging to improve staff allocation and resource use. • Applied to real data from Barcelona’s public home care system. • Reduces unmet demand and costs through data-driven planning.

PurposePrevious research on the relationship between service environments and customer emotions and service outcomes has focused on the physical environment. Among studies exploring the social environment, the emphasis has been on service employees, ignoring the impact of other customers. Recent research has further called for the need to include displayed emotion within the social environment. Therefore, this study aims to develop and test a more comprehensive model that focuses on the relationship between the social environment (employee displayed emotion and customer climate) and the physical environment (ambient and design factors) and resulting customer emotion and service outcomes.Design/methodology/approachBased on past research, a theoretical framework was developed to propose the links between social/physical environments and customer emotion/perceptions. Extant research from various academic fields, including environmental psychology, was reviewed, deriving 11 hypotheses. Data collected from fashion apparel retailers, using both observation and customer survey methods, was examined through structural equation modeling (SEM).FindingsResults show that both social and physical environments have a positive influence on customer emotion and satisfaction, which in turn affect behavioral intentions. The physical environment exhibited more influence on customer emotion and satisfaction than social environment.Research limitations/implicationsThis research explains how both social and physical environments affect customer emotion and perceptions. Future research directions are discussed, with an emphasis on incorporating customer characteristics, industry attributes, and cultural variables to better understand the influence of service environments in different service settings.Practical implicationsSocial and physical environments influence customer emotional states within the service delivery context, which in turn affect customer service evaluations. Therefore, both social and physical service environments should be emphasized by service firms.Originality/valueThis research represents an early attempt to develop a more comprehensive model explaining how both social and physical environments affect customer emotion and perceptions. This study also represents the first empirical study of service environment research to include employee displayed emotion as part of the social environment.

A Multidisciplinary Team Approach to the Care of Patients With Advanced Interstitial Lung Disease (ILD) in the Outpatient Setting

We investigated the association between physical and social neighborhood environments and fifth-grade students' physical activity and obesity. We collected data on 650 children and their primary caregivers during phase 1 of Healthy Passages, a multisite, community-based, cross-sectional study of health risk behaviors and health outcomes in children. We conducted independent systematic neighborhood observations to measure neighborhood physical characteristics, and we analyzed survey data on social processes. We modeled children's physical activity and obesity status with structural equation models that included latent variables for the physical and social environments. After we controlled for children's sociodemographic factors, we found that a favorable social environment was positively associated with several measures of physical activity and that physical activity was negatively associated with obesity in these children. Physical environment was not significantly associated with physical activity. Our findings suggest that neighborhood social factors as well as the physical environment should be considered in the development of health policy and interventions to reduce childhood obesity.

Objective: to describe the facilitating and inhibiting determinants of transitional care at the discharge of older people and the interventions for a healthy transition. Method: qualitative and comprehensive study, carried out in a general hospital in Paraná, Brazil, with 11 health professionals, from December 2019 to May 2021, through semi-structured interviews. Content Analysis was used to analyze the data and the theoretical framework was the Transition Theory. Results: the following emerged as Facilitating Determinants: communication with the home care service; family involvement in hospitalization and multidisciplinary work. The Inhibitors were failures in communication with the primary health unit; little preparation and involvement of the family in care; lack of economic resources; scarce human resources in the health care network; physician-centered care transition. Interventions include discharge reports from the multidisciplinary team; home care plan; use of the senior citizen card; implementation of a computerized system integrating levels of care; multidisciplinary involvement and guidance to the caregiver during the older person hospitalization; network management of the older person's hospital-home care transition. Conclusion: the transition from hospital to home care for the older person is inefficient; interventions can reduce discontinuity of care and contribute to the implementation of strategies that favor comprehensive care, promoting safety for the older people. Transition Theory is a guide for healthcare professionals to understand transition as a dynamic and complex process that allows planning and implementation of interventions for a healthy care transition.

Children with medical complexity and pediatric palliative care: Data by a respiratory intermediate care unit.

For decades professional periodontal therapy has included scaling and polishing of patient’s teeth under anaesthesia. Periodontal therapy also includes clinical evaluation, supra and sub-gingival cleaning, sulcal lavage, periodontal probing, evaluation and charting, as well as radiographs and a home care plan. As part of a taught syllabus and through practice protocol, veterinary nurses have become proficient at this part of Schedule 3 procedures. Recent continuing professional development (CPD) has indicated a change in practice, suggesting that polishing is no longer recommended. An evidence-based question was formulated: ‘In companion animals undergoing professional periodontal therapy, does polishing have an effect on enamel?’ A literature search was performed which included veterinary nursing, veterinary and dental research, this was then critically analysed. The findings indicate that there is no evidence to suggest a change to clinical practice is currently needed.

BackgroundFrailty represents a public health priority and an increasingly prevalent condition in the ageing population. It is seen as reflecting an interaction among individual factors and a range of environmental elements. This study aims to examine the association between frailty and individual factors, physical and social environments among Chinese older people.MethodsThe data were from the Shanghai Healthy City Survey in 2017, which sampled 2559 older people aged ≥60 years from 67 neighbourhoods. The FRAIL scale was used to assess frailty, and social and physical environments were assessed using validated and psychometrically tested instruments. Individual factors included age, gender, education, employment, marital status, smoking, drinking, physical exercise, organization participation, self-rated health and psychological well-being. A multilevel analysis was conducted to examine whether physical and social environments were associated with frailty.ResultsThe prevalence of pre-frailty and frailty were 39.5 and 16.9%, respectively. The prevalence of frailty increased with age from 14.6% (60–64 years) to 26.5% (≥75 years). After adjusting for age and/or gender, older age, women, and those with low education, alcohol dependence, physical inactivity, poor self-rated health, or psychological disorders had a higher prevalence of frailty. The multilevel analysis indicated that after controlling for individual covariates, compared to the 1st quartile of aesthetic quality, the odds ratio (OR) of frailty for the 4th quartile was 0.65 (0.47–0.89); compared to the 1st quartile of walking environment, the OR of frailty for the 4th quartile was 0.43 (0.19–0.95); compared to the 1st quartile of social cohesion, the OR of frailty for the 4th quartile was 0.73 (0.54–0.99); compared to the 1st quartile of social participation, the ORs of frailty for the 2nd, 3rd and 4th quartiles were 0.76 (0.59–0.97), 0.59 (0.45–0.77) and 0.59 (0.45–0.77), respectively.ConclusionsFrailty is a highly prevalent health condition among the aged population in China. Healthcare should focus on frail elderly who are older age, women, those with low education, and those with mental health problems. It may decrease frailty among Chinese older people to encourage social participation and healthy behaviours and to build aesthetic, walkable and cohesive neighbourhoods.

Background We aimed to map evidenced-based policy actions proposed by public health institutes or organizations to promote physical activity and healthy diets by modifying the social and/or physical environment at the local level. Methods We conducted a scoping review to identify relevant evidence-based policy actions proposed by public health institutions. We used a two-step strategy to identify government-supported public health institutes or organizations that generate evidence-based recommendations for policy actions. We included policy actions if they 1) aimed at increasing physical activity or improving diet; 2) focused on modifying the physical or social environments; 3) were implemented at the local or community level; 4) were expressed as a concrete action rather than a general aim; and 5) were described explicitly as being based on evidence. Results Starting from 121 public health institutes, we identified 8 relevant organizations and reviewed 63 guidelines or reports that included actions to promote healthy diets and physical activity. Of the 540 proposed actions on diet and 358 on physical activity, 118 met the inclusion criteria. Given that many of the actions were recommended by multiple institutes, we synthesized the information in the infographics to provide recommendations on diet and physical activity in outdoor and indoor settings and schools. Conclusions Public health institutes have generated a wide range of evidence-based recommendations for the promotion of healthy diets and physical activity by modifying the physical and social environment that can be implemented in local settings. Future actions should address barriers to implementing these recommendations and analyze the determinants of local policy decisions.

Introduction: Worksite health promotion programs (HPPs) are effective in providing health benefits to participating employees. However, participation rates are traditionally low. Therefore, health promotion professionals implement a variety of strategies to encourage participation, which may include attending to the physical and social environment. However, little is known about how the physical and social environment influences participation in HPPs and physical activity. The purpose of this study was to examine if the physical and social environment of the workplace is associated with participation in HPPs and physical activity. Methods: The Environmental Assessment Tool (EAT) was administered at four university campuses, and university employees were sent an electronic survey that inquired about program and physical activity participation. Participation in a HPP was analyzed using a chi-square test for independence. To assess differences between groups for physical activity of higher, medium and lower levels of support, MANOVAs were performed. Results: Findings indicate that HPP participation was associated with level of physical and social support. The campus designated as the higher support campus had the highest participation rates in programming. The medium support campuses followed, and the lower support campus had the lowest overall participation rates. However, there was no significant difference in off-campus moderate or vigorous physical activity participation between campuses. Conclusion: The physical and social environment are important factors in HPP participation. Therefore, improving the physical and social environment of the workplace should be considered a best practice for HPPs.

The challenges of integrating a mobile robotic system into an application environment are many. Most problems inherent to installing the mobile robotic system fall into one of three categories: (1) the physical environment - location(s) where, and conditions under which, the mobile robotic system will work; (2) the technological environment - external equipment with which the mobile robotic system will interact; and (3) the human environment - personnel who will operate and interact with the mobile robotic system. The successful integration of a mobile robotic system into these three types of application environment requires more than a good pair of pliers. The tools for this job include: careful planning, accurate measurement data (as-built drawings), complete technical data of systems to be interfaced, sufficient time and attention of key personnel for training on how to operate and program the robot, on-site access during installation, and a thorough understanding and appreciation - by all concerned - of the mobile robotic system's role in the security mission at the site, as well as the machine's capabilities and limitations. Patience, luck, and a sense of humor are also useful tools to keep handy during a mobile robotic system installation. This paper will discuss some specific examples of problems in each of three categories, and explore approaches to solving these problems. The discussion will draw from the author's experience with on-site installations of mobile robotic systems in various applications. Most of the information discussed in this paper has come directly from knowledge learned during installations of Cybermotion's SR2 security robots. A large part of the discussion will apply to any vehicle with a drive system, collision avoidance, and navigation sensors, which is, of course, what makes a vehicle autonomous. And it is with these sensors and a drive system that the installer must become familiar in order to foresee potential trouble areas in the physical, technical, and human environment.

BackgroundThe concept of disability is now understood as a result of the interaction between the individual, features related to impairment, and the physical and social environment. It is important to understand these environmental influences and how they affect social participation. The purpose of this study is to describe the social participation of young adults with Down syndrome and examine its relationship with the physical and social environment.MethodsFamilies ascertained from the Down syndrome ‘Needs Opinion Wishes’ database completed questionnaires during 2011. The questionnaires contained two parts, young person characteristics and family characteristics. Young adults’ social participation was measured using the Assessment of Life Habits (LIFE-H) and the influences of environmental factors were measured by the Measure of the Quality of the Environment (MQE). The analysis involved descriptive statistics and linear and logistic regression.ResultsOverall, participation in daily activities was higher (mean 6.45) than in social roles (mean 5.17) (range 0 to 9). When the physical and/or social environment was reported as a facilitator, compared to being no influence or a barrier, participation in social roles was greater (coef 0.89, 95%CI 0.28, 1.52, coef 0.83, 95%CI 0.17, 1.49, respectively). The relationships between participation and both the physical (coef 0.60, 95% CI −0.40, 1.24) and social (coef 0.20, 95%CI −0.47, 0.87) environments were reduced when age, gender, behavior and functioning in ADL were taken into account.ConclusionWe found that young adults’ participation in social roles was influenced more by the physical environment than by the social environment, providing a potentially modifiable avenue for intervention.

Measurement of Quality in Assisted Living in the United States of America: A Scoping Review