Hospital-to-Shelter/Housing Interventions for Persons Experiencing Homelessness

Persons with lived and living experiences of homelessness (PWLEs) commonly use hospitals and emergency departments to access healthcare yet support for transitions from hospital to shelter/housing can be challenging to access. To improve the continuity of care and health outcomes for PWLEs who are being discharged from hospital, a more complete understanding of two hospital-to-shelter/housing programs in Metro Vancouver, Canada was sought. Using a community-based participatory research approach, we conducted in-depth interviews in-person or by phone. Participants included eight healthcare and shelter/housing decision-makers and providers and a convenience sample of ten program participants (two females and eight males who ranged in age from 31 to 74 years old; average = 50 years old). Data were analyzed in NVivo 12 to identify successes including: 1) achieving health stability and recovery following hospital discharge; 2) having privacy and freedom while in the program; 3) building relationships with providers; 4) having formal support to find housing; and 5) cross-sector relationships between providers. Challenges included: 1) limited availability of affordable and appropriate housing; 2) other guests’ ways of life; 3) complex needs versus limited after-care resources; and 4) inequities in program access. While hospital-to-shelter/housing programs can serve as intervention opportunities to connect PWLEs to permanent housing, discharge plans need to acknowledge the local limitations on housing availability and offer short-term options for patients who require sub-acute rest and convalescence.

Refining Care to Plan: Delivering Personalized Recommendations to Support Dementia Caregivers

Caregivers of persons living with Alzheimer’s disease and Alzheimer’s disease-related dementias (PLWD; AD/ADRD) benefit from unique interventions to address their different needs. While information on which interventions best meet specific needs exists, less is known about how to match caregivers with those interventions. To address this research gap, we tested Care to Plan (CtP) within a large healthcare system. After care navigators guided caregivers through twenty CtP tailoring questions to identify caregivers’ greatest needs, the online tool provided the intervention type best suited to meet their needs, along with region-specific information on available programs. This mixed methods analysis evaluated the utility of the CtP tool with 20 family caregivers of PLWD after a 1 month follow-up. Most caregivers agreed that the CtP tool was helpful (85%) and would recommend the tool to other caregivers (90%). Caregivers also said they valued being able to discuss the CtP recommendations with the care navigator (95%). However, only 65% said they found services that met their needs or planned on using services recommended by CtP. Interview data indicate time constraints and restricted availability of resources due to COVID-19 precautions reduced caregivers’ abilities to pursue some recommendations. In addition, the stage of dementia experienced by their care recipient may explain why others found CtP less useful. However, these caregivers noted the potential utility of the resources for their future care planning needs. A larger evaluation of the CtP tool within the healthcare system is ongoing.

Evaluation of Smart After-Care Program for Patients With Lung Cancer

Introduction: The efficacy of telemedicine in cancer survivors is uncertain. The Smart After-care Program (SAP), which is an interactive, smartphone-based remote health monitoring system, was developed to help individual patients manage their health after leaving the hospital. This study aims to evaluate the efficacy of our remote health care program for lung cancer patients. Methods We enrolled 50 lung cancer patients. Self-monitoring devices were supplied to all patients, who were instructed to enter their daily vital signs and subjective symptoms to the Smart After-care app. The app also provided information about rehabilitation exercises and a healthy diet for lung cancer patients. All patients received telephone health counseling once a week and visited an outpatient clinic on the 6th and 12th week to assess satisfaction with the SAP and changes in quality of life and physical performance. Results Overall satisfaction with the SAP was very high (very good, 61.9%; good, 26.2%). In the multivariate analysis for factors affecting satisfaction, the distance between the patient’s residence and the hospital was the only independent factor (p = 0.013). Quality of life was improved in all functional scales (p < 0.05). Muscle strength was significantly improved in the lower limbs (p = 0.012). Two-minute walk distance was also significantly improved (p = 0.028). Conclusion This study demonstrated that the SAP was acceptable among and supportive of patients with reduced pulmonary function after lung cancer treatment. The study proved that the SAP was more useful for patients living far away from a hospital.

515 Patient Satisfaction on Drainless Outpatient Parotidectomy

Background Parotidectomy is commonly performed as an inpatient procedure due to drain insertion. However recent evidence suggests that drainless outpatient parotidectomy is a safe option with comparable postoperative complication and hospital readmission rates to inpatient parotidectomies. Aim Patient satisfaction on outpatient parotidectomy is unclear and this study aims to report patients’ perspective and satisfaction on drainless outpatient parotidectomy. Method Anonymous ‘Core questionnaire for the assessment of Patient Satisfaction’ (COPS) for general Day care (COPS-D) questionnaire survey was completed by patients who underwent drainless same day parotidectomy at Ninewells Hospital, Dundee from June 2018 to October 2020. Patient satisfaction on different aspects of their outpatient parotidectomy journey (e.g., pre-admission, admission on ward, in-theatre experience, nursing care, pain control and overall satisfaction) were scored using a five-point Likert scale. Results A total of 31 drainless outpatient parotidectomies were performed and 28 patients completed the patient satisfaction survey. The majority of patients were highly satisfied (i.e., scored 5/5) with their preadmission visit (79.5%), admission on the ward (84.5%), operating room experience (96.4%), nursing care (83.9%), medical care (87.5%), information received (75.0%), autonomy (79.8%) and discharge and after care (61.9%). Despite preferring drainless parotidectomy, 16/28 (57.1%) patients either stayed for less than 23 hours or preferred to stay overnight stay in the hospital for non-surgical reasons. Conclusions Outpatient parotidectomy is well received by patients and the majority of patients preferred drainless parotidectomy over inpatient parotidectomy with drains.

How Do Observable Characteristics of Post-Mining Forests Affect Their Attractiveness for Recreation?

Afforestation is a popular practice of the recovery of landscape affected by open-cast coal mining. We investigated what impact the observable characteristics of restored forests have on their attractiveness for recreation framed as a one hour walk in a respective type of forest. In this study, we elaborate on some of the observable characteristics which have been previously found in the literature to affect the perceived attractiveness of outdoor environments. Environmental preference data were collected online using a quasi-representative sample of affected and control populations of the Czech Republic (N = 869). The questionnaire employed visual representations of typical reclaimed forest sites on spoil heaps in the Sokolov mining district. A mediation analysis revealed that forests growing in post-mining areas are perceived more negatively than the typical commercial spruce forest due to their lower permeability, lower level of stewardship, and perceived low safety. However, there are differences in observed characteristics also between different types of restored forests, even when controlling the effect of forest age. The results show for forestry practice that while some of the observed characteristics change by themselves with the increasing age of the forest (permeability, perceived safety, and naturalness of successional forests), improvement in others requires targeted after-care (perceived stewardship). In any case, our results are promising in that they imply that the recreational value of restored forests in post-mining areas may further increase in the future.

Connected After Care: Youth Characteristics, Policy, and Programs Associated With Postsecondary Education and Employment for Youth With Foster Care Histories

Recent federal laws and state policies reflect the government’s investment in improving education and employment outcomes for youth with foster care histories. However, little research has assessed the roles of these programs using national data. Drawing on data from the National Youth in Transitions Database (NYTD) ( n = 7797), this study examines the roles that state-level policies and programs, youth-level participation in programs and services, and youth characteristics play in youths’ connection to employment and education (“connectedness”) at age 21. Results from multilevel regression analyses find that foster youth in states with widely available tuition waiver programs increases the odds of connectedness to school. The amount of time youth spend in extended foster care, as well as receipt of postsecondary education aid and services, also increases connectedness. Study findings underscore the importance of material and relational supports in supporting foster youths’ connection to employment and education in early adulthood.